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Purpose: To assess whether age-related macular degeneration (AMD) patients are aware of binocular central visual field defects., Methods: One hundred fifty-three consecutive AMD patients in their initial low-vision rehabilitation evaluation were immediately asked at the beginning of their visit (1) whether they were able to see any blind spots or defects in their field of vision and (2) whether they had any evidence or experiences that led them to believe that they had defects in their field of vision. They then had their vision assessed by binocular central visual field testing using the California Central Visual Field Test, binocular reading performance evaluated using the Smith-Kettlewell Reading Test (SK Read) and MN Read charts, and visual acuity measured using the ETDRS chart at 1 meter. Mean diameters of the scotomas with borders near fixation were noted., Results: Visual acuity median was 20/253 (range 20/40 to hand movements). Binocular scotomas were present in 88% of patients (66% had dense scotoma). Of patients with binocular scotomas, 56% were totally unaware of their presence, even with dense scotomas measuring up to 30° in diameter; 1.5% could fleetingly see a defect in their visual field on waking; and 44% related experiences of things "disappearing" on them. The median and range of scotoma diameters for those unaware vs. those with some awareness of their scotomas were comparable. There was no significant relationship of awareness of the scotoma with age, acuity, scotoma size, density, or duration of onset. Awareness of scotoma was associated with fewer errors on the SK Read (p < 0.01)., Conclusions: Low vision clinicians cannot depend on patients to report the presence of significant scotomas; thus, appropriate testing must be performed. Presence of scotomas decreased reading accuracy, but some awareness of the scotomas had a tendency to improve accuracy. The value of rehabilitation programs aimed at increasing patient awareness of their scotomas may be supported by this evidence.

Purpose: The ability to recognize faces is fundamental to social interactions but has not been studied extensively in visual disorders such as age-related macular degeneration (AMD). We report here the development of a face discrimination test, in which both response times (RTs) and accuracies are measured. Results are compared for young and older control subjects and older adults with AMD to determine the factors underlying performance on this test., Methods: Subjects were 14 older controls, 11 young adult controls, and 34 individuals with binocular AMD. In the face discrimination test, colored reference photographs of eight people were presented continuously (male faces in the first half of the test, female faces in the second). On each trial, subjects reported which reference face matched the test face (shown with different poses and/or expressions). In addition, the older controls then identified the expression on the test face., Results: The older controls showed generally small numbers of errors (0 to 9%) on the face identifications but more errors on expression identifications (up to 22%). They tended to show shorter RTs (but no changes in accuracy) with repeated presentations of the same face. The young controls responded more quickly, and they made almost no mistakes. Although performance varied, as a group, those with AMD were slower and showed more errors in identification than the older controls did. Across all subjects, both visual acuity and contrast sensitivity contributed significantly to the variances in RTs and accuracy., Conclusions: The group of older controls had poorer and more variable RTs and accuracies than the young controls. Difficulties in face matching, in terms of both accuracy and RT, were observed for subjects with AMD. Performance accuracy and RTs for this new test depended on both visual acuity and contrast sensitivity.

Purpose: A detailed understanding of overall quality of vision may help primary care physicians, optometrists, and general ophthalmologists to improve the care of patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD)., Methods: Published literature was reviewed using Medline searches and the authors' knowledge of the field., Results: Both visual acuity and contrast sensitivity are strongly associated with the ability to perform vision-related activities of daily living. CNV resulting from AMD often leads to scotoma, which is also strongly associated with the ability to perform everyday activities such as reading and driving. Contrast sensitivity and visual field extent may be better predictors of many abilities than visual acuity. Laser photocoagulation, verteporfin therapy, and pegaptanib sodium have been proven to reduce the risk of visual acuity loss in patients with CNV resulting from AMD. Laser photocoagulation frequently causes scotoma, but data on its effects on other aspects of overall quality of vision are scarce. Verteporfin therapy has been shown to also reduce the risk of contrast sensitivity loss and has been associated with stabilization or reduction of scotoma size. Treatment effects beyond visual acuity have not been investigated for pegaptanib. Detailed assessment of overall quality of vision also aids the design of vision rehabilitation programs tailored to the needs of individual patients., Conclusions: Understanding the impact of vision loss on patients with CNV resulting from AMD and assessing treatment benefits requires assessment of overall quality of vision. Primary care physicians and optometrists have an important role in ensuring that patients receive the best possible care, which can be aided by prompt referral to an ophthalmologist or retina specialist and collaboration with low-vision specialists and optometrists who together can make detailed assessments of overall quality of vision, implement appropriate treatment, and design effective rehabilitation strategies.

Purpose: Submacular surgery for choroidal neovascularization (CNV) is under investigation in the treatment of age-related macular degeneration (AMD) and the presumed ocular histoplasmosis syndrome. Four case studies are presented to demonstrate scanning laser ophthalmoscope (SLO) testing in the pre- and postsurgical evaluation of visual function in patients with subfoveal CNV secondary to AMD, presumed ocular histoplasmosis syndrome, and submacular hemorrhage secondary to AMD., Methods: Patients underwent a visual assessment pre- and 6 months postoperatively, consisting of low vision visual acuity measurement, SLO macular perimetry of dense and relative scotomas, and analysis of the preferred retinal locus for fixation (PRL) location and ability., Results: Visual acuity, dense and relative scotoma size and location, and PRL location were compared; and relationships between anatomic and functional changes were observed. Decreases in scotoma size and improvement in PRL location and ability usually corresponded with improved visual acuity. Preoperative scotoma and PRL location guided retinotomy site selection., Conclusion: Scanning laser ophthalmoscope macular perimetry and PRL testing may be useful adjuncts in the visual assessment of submacular surgery and may advance under-standing of the effects of submacular surgery on visual function. In addition, this testing may be used to plan location of surgical interventions for macular diseases.