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Relative foveal dark adaptation: a potential method for assessing macular health

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Abstract

Background/Objective

Dark adaptation measures photoreceptor recovery following intense light stimulation. Time to recovery reflects retinal function. We describe a novel method of relative foveal dark adaptation using an iPhone. Data from a small number of healthy subjects were studied to assess reproducibility, effects of age, and consider potential clinical utility.

Methods

Relative foveal dark adaption was studied in 6 normal subjects across ages from 20 to 81 years and across differing testing conditions. Foveal bleaching is produced by fixating a bright white circle on an iPhone for variable times. After foveal bleaching an annular surround appears to complete a bullseye stimulus with surround initially brighter than centre. As the fovea recovers the centre regains brightness. Relative foveal dark adaptation, the time for the visual anchor to shift from surround to centre, was studied across a range of bleaching times, ages, and testing conditions.

Results

Dispersion of dark adaptation times grows with increasing age. Foveal bleaching for 30 s was as effective as longer times. Testing times with a 30 s bleach were less than 1 min. Foveal dark adaptation was reproducible within each subject and was unaffected by ambient room lighting, pupil size, and light attenuation. Repeat, immediately sequential testing was similarly reproducible except after long bleaching.

Conclusions

This method of dark adaptation is intuitive, repeatable, and relatively unaffected by testing condition. Testing times are brief, requiring only an iPhone screen positioned at reading distance. Relative foveal dark adaptation may be a useful tool to assess macular health.

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Fig. 1: Bullseye endpoint, centre and peripheral annulus.
Fig. 2: Dark adaptation versus bleaching time.

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Data availability

Raw data from this study can be requested by contacting Dr. Kane. Code for the MacDx® adaptometer is the property of AMA Optics, Inc. AMA Optics can be contacted if more information about the app is desired.

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Acknowledgements

The authors thank Dr. Phyllis Faust for reading the manuscript and for helpful suggestions.

Funding

The MacDx® adaptometer app was generously provided by AMA Optics, Inc., Miami Beach, FL, USA.

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Authors and Affiliations

  1. Boston University School of Public Health, Boston, MA, USA

    Julia S. Kane

  2. University of New Haven, West Haven, CT, USA

    Mark Gaspich

  3. Albert Einstein College of Medicine, Bronx, NY, USA

    Avery Gold

  4. City College, Department of Biology, New York, NY, USA

    Hillary Pichardo

  5. The Edward S. Harkness Eye Institute, Columbia University, New York, NY, 10032, USA

    Steven A. Kane

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  1. Julia S. Kane
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Contributions

All authors whose names appear on this submission made substantial contributions to the acquisition, analysis, and interpretation of data, discussed the results, commented on the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JK took the lead in writing the manuscript. She drafted the work and revised it critically for important intellectual content. MG verified the analytical methods and participated in study design and data acquisition. AG participated in study design and data acquisition and was particularly helpful for the analysis of bleaching time durations. HP supervised the study and IRB requirements and provided critical feedback. SK participated in study design, arranged for IRB supervision, and supervised data collection, subject consents, data storage, and data interpretation.

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Correspondence to Steven A. Kane.

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Kane, J.S., Gaspich, M., Gold, A. et al. Relative foveal dark adaptation: a potential method for assessing macular health. Eye (2024). https://doi.org/10.1038/s41433-024-03201-2

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