Contrast Adaptation in Pseudophakic Patients with Macular Disorders

Purpose: To learn whether contrast adaptation, induced by positive spherical defocus, is compromised by macular disorders such as age-related macular degeneration (AMD) or epiretinal membranes (ERM) and to gain further insight in the functionality of the pathological macula and the level of "functional reserve" often postulated for the indication of presbyopia correcting IOLs.Methods: In a pilot study, patients with macular disorders, AMD and ERM, (n = 10) and healthy volunteers (n = 10) were tested to quantify contrast adaption after +4 D defocus for 10 min, by performing an interocular contrast matching task. Subjects manually adjusted the perceived contrast of the test patch as seen by the test eye to match to the contrast of a target patch with a fixed Michelson contrast of 0.2 as seen by the contralateral untreated eye.Results: Patients with macular disorders subjectively matched the 0.2 target contrast with a contrast of 0.24 +/- 0.06 (mean +/- SD) before adaptation and with a contrast of 0.19 +/- 0.04 after adaptation (p < 0.05). Accordingly, patients with macular disorders showed an induced contrast gain by adaptation of 0.05 (27%), which was not different from the control group, which showed an induced contrast gain by adaptation of 0.06 (35%).Conclusion: Patients with mild and moderate macular disorders, such as AMD and ERM, show an induced contrast adaptation, i.e. a gain in contrast sensitivity, at 3.2 cpd, which is not different in level from the induced contrast adaptation in healthy subjects. Macular disorders do not prevent adaptation of the patient's visual system to low contrast or blurred retinal images. Therefore, the implantation of presbyopia correcting IOLs is not a strict exclusion criterion for these patients, but the progressive nature of the macular disorder must be taken into account.