Journal
OPHTHALMOLOGY
Volume 123, Issue 2, Pages 344-351Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ophtha.2015.09.041
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Funding
- National Institute on Aging [R01AG04212]
- National Eye Institute [R01EY06109]
- National Institutes of Health (Bethesda, MD)
- EyeSight Foundation of Alabama (Birmingham, AL)
- International Retinal Research Foundation (Birmingham, AL)
- Ludwig von Sallmann Prize (New York, NY)
- Research to Prevent Blindness Inc (New York, NY)
- Alfreda J. Schueler Trust (Chicago, IL)
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Purpose: To examine whether slowed rod-mediated dark adaptation (DA) in adults with normal macular health at baseline is associated with the incidence of age-related macular degeneration (AMD) 3 years later. Design: Prospective cohort. Participants: Adults aged >= 60 years were recruited from primary care ophthalmology clinics. Both eyes were required to be step 1 (normal) on the Age-Related Eye Disease Study 9-step AMD classification system based on color fundus photographs graded by experienced and masked evaluators. Methods: Rod-mediated DA was assessed at baseline in 1 eye after a photobleach using a computerized dark adaptometer with targets centered at 5 degrees on the inferior vertical meridian. Speed of DA was characterized by the rod-intercept value, with abnormal DA defined as rod-intercept >= 12.3 minutes. Demographic characteristics, best-corrected visual acuity, and smoking status were also assessed. Log-binomial regression was used to calculate unadjusted and adjusted risk ratios (RRs) and associated 95% confidence intervals (CIs) for the association between baseline DA and incident AMD. Main Outcome Measures: Presence of AMD at the 3-year follow-up visit for the eye tested for DA at baseline. Results: Both baseline and follow-up visits were completed by 325 persons (mean age, 67.8 years). At baseline, 263 participants had normal DA with mean rod-intercept of 9.1 (standard deviation [SD], 1.5), and 62 participants had abnormal DA with mean rod-intercept of 15.1 (SD, 4.0). After adjustment for age and smoking, those with abnormal DA in the tested eye at baseline were approximately 2 times more likely to have AMD in that eye (RR, 1.92; 95% CI, 1.03-3.62) by the time of the follow-up visit, compared with those who had normal DA at baseline. Conclusions: Delayed rod-mediated DA in older adults with normal macular health is associated with incident early AMD 3 years later, and thus is a functional biomarker for early disease. The biological relevance of this test is high, because it assesses translocation of vitamin A derivatives across the retinal pigment epithelium and Bruch's membrane, 2 tissues with prominent age-and AMD-related pathology. (C) 2016 by the American Academy of Ophthalmology.
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