Age-related macular degeneration (AMD) is the leading cause of visual impairment in the developed world. The prevalence of this disease will continue to increase over the coming decades as the average age of the global population rises. There is consequently an urgent need to develop tests that are sensitive to early visual dysfunction, in order to identify individuals that have a high risk of developing AMD, to identify patients that would benefit from treatment, to assess the outcomes of that treatment and to evaluate emerging treatment strategies. An emerging body of evidence suggests that dark adaptation is a sensitive biomarker for early AMD. Cone dark adaptation is of particular interest to clinicians, as it can identify patients with early AMD in a relatively short recording period. Consequently, this thesis aimed to optimise psychophysical and electrophysiological techniques for the assessment of cone dark adaptation in early AMD, in order to maximise its diagnostic potential. A range of psychophysical methods were shown to be capable of monitoring the rapid changes in threshold that occur during cone dark adaptation. An optimal psychophysical protocol for the assessment of cone dark adaptation in early AMD was developed based on the results of a systematic evaluation of the effect of stimulus parameters and pre-adapting light intensity on the diagnostic potential of cone dark adaptation in early AMD. When compared to the focal cone ERG photostress test, both techniques were shown to be similarly diagnostic for early AMD. In addition, the time constant of cone recovery was shown to be significantly correlated with age, hence the sensitivity and specificity of cone dark adaptation as a biomarker for early macular disease may be further improved by considering these age-related changes. In conclusion, this thesis has confirmed that cone dark adaptation is a sensitive functional biomarker for early AMD. However, as cross-sectional studies are unable to determine the true diagnostic potential of a biomarker, longitudinal investigations are needed to explore the long-term potential of cone dark adaptation and other visual functions as biomarkers for early AMD.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:567427 |
| Date | January 2012 |
| Creators | Gaffney, Allannah J. |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/41072/ |
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