Establishment of a normative database and evaluation of the test-retest repeatability of the Spaeth/Richman contrast sensitivity test

Visual function tests for glaucoma practice - What is relevant?

Glaucoma represents one of the most important ocular diseases causing irreversible ganglion cell death. It is one of the most common causes of visual impairment and morbidity in the elderly population. There are various tests for measuring visual function in glaucoma. While visual field remains the undisputed method for screening, diagnosis, and monitoring disease progression, other tests have been studied for their utility in glaucoma practice. This review discusses some of the commonly used tests of visual function that can be routinely used in clinics for glaucoma management. Among the various modalities of testing visual function in glaucoma, this review highlights the tests that are most clinically relevant.

Spaeth/Richman Contrast Sensitivity in Staging Glaucoma

Purpose

To investigate contrast sensitivity measures in glaucoma eyes with moderate to severe glaucoma.

Methods

The study included 50 eyes of 47 pseudophakic patients with moderate or severe glaucoma who were seen at a tertiary center from 2017 to 2020. Assessment of contrast sensitivity using the Spaeth/Richman contrast sensitivity (SPARCS) test and the Pelli-Robson (PR) chart was compared in eyes with mean deviation (MD) < -12 decibels (dB) and > -20 dB (group 1), MD < -20 dB and > -30 dB (group 2), or MD < -30 dB (group 3). Multivariate regression analysis was used to analyze the association of visual field MD with SPARCS/PR scores and various clinical variables, including age, diagnosis, and logMar visual acuity.

Results

SPARCS total scores and quadrant-wise scores were significantly different in all of the quadrants, whereas central scores and PR contrast sensitivity were similar across groups. The total SPARCS scores predicted the change in MD (β = 0.5, P < 0.001, R ² = 61.8%) with minimal association of other quadrantic or PR scores. Total SPARCS scores of <45 and <38 predicted severe glaucoma with MD crossing -20 dB (sensitivity, 70.5%; specificity, 80.9%) and -30 dB (sensitivity, 79.3%; specificity, 77.7%), respectively. The logMar visual acuity did not correlate with any contrast sensitivity measure or clinical variables in this study.

Conclusions

The total SPARCS score may be used in staging glaucoma severity and to assess visual function in eyes with severe glaucoma.

Translational Relevance

The SPARCS test is a useful tool for assessing visual function in advanced glaucoma beyond MD worse than -20 dB or -30 dB.

Contrast Sensitivity and Glaucoma

Spatial contrast sensitivity decline occurs in different types and stages of glaucoma. In this short review we discuss methods of assessing contrast sensitivity, the role of contrast sensitivity in the pathogenesis of glaucoma and its practical application in clinical practice.