Qualitative assessment of visual impairment in patients with age-related macular degeneration using standardized, image-based questionnaires

The purpose of the study is to test a simple approach for characterizing subjective perception in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). This multi-center study was performed in four private ophthalmology practices including 20 patients with CNV. Subjects were presented the original image on the affected eye and afterwards modified candidate images to the contralateral eye. Then they chose one image that most closely matched the perception on the affected eye. This was repeated with three different images representing three everyday life scenes manipulated to mimic visual perception with reduced color perception (image 1), central scotomas (image 2), and blurring with four varying sizes (image 3). The frequency of response to the forced choice questionnaire experiment for each image was recorded. Our results show that images manipulated using a Gaussian blur filter, a brightness filter, and a sinusoidal distortion filter were selected by 9, 10, and 1 patients, respectively. Size of modification was not associated with visual acuity in image 1 or image 3. In image 2, however, the size of the modification was dependent on visual acuity (p = .01). In conclusion, subjective perception in patients with AMD may significantly differ between individual patients. A better understanding of the visual disturbance will facilitate communication and involvement of patients in treatment decisions.