Cone- and rod-mediated dark adaptation impairment in age-related maculopathy

Objective: To examine impairment in cone- versus rod-mediated dark adaptation in the parafovea of persons with age-related maculopathy (ARM). Design: Cross-sectional. Participants: Older adults with ARM at various severity levels from early to advanced (n = 83) and in good retinal health (n = 43), as determined by stereo fundus photographs evaluated with the Age-Related Eye Disease Study severity scale. Methods: Dark adaptation, both cone- and rod-mediated components, was measured with a modified Humphrey Field Analyzer using a target located 120 in the inferior visual field on the vertical meridian, after exposure to a 98% bleach. Information was collected on self-reported problems for activities at night or under dim illumination (Low Luminance Questionnaire [LLQ]) and for activities during daytime conditions (modified National Eye Institute Visual Function Questionnaire [NEI VFQ]. Main Outcome Measures: Cone- and rod-mediated parameters of dark adaptation. Results: Compared with older adults in normal retinal health, ARM patients had significant impairments in rod-mediated parameters of dark adaptation (rod-cone break, rod slope, rod sensitivity) (P < 0.0001), which were increasingly abnormal as disease severity increased. Cone-mediated parameters (cone time constant and cone sensitivity) were not impaired. Low Luminance Questionnaire scores and NEI VFQ scores decreased with increased ARM severity (P = 0.0004 and P = 0.0005, respectively); the percent decrease in LLQ scores as a function of disease severity was larger in magnitude than the percent decrease in NEI VFQ scores. Conclusions: Disturbances in rod-mediated but not cone-mediated dark adaptation in the parafovea at 12 degrees in the inferior field on the vertical meridian are characteristic of ARM even in its early phases. Ophthalmology 2007,114:1728-1735 (c) 2007 by the American Academy of Ophthalmology.