Low contrast charts effectively differentiate between types of blur

Understanding the Impact of Individual Perceived Image Quality Features on Visual Performance

Purpose

This study aimed to quantify the impact of blur, contrast, and ghosting on perceived overall image quality (IQ) as well as resultant predicted visual acuity, utilizing simulated acuity charts from objective refraction among eyes of individuals with Down syndrome (DS).

Methods

Acuity charts were produced, simulating the retinal image when applying 16 different metric-derived sphero-cylindrical refractions for each eye of 30 adult patients with DS. Fourteen dilated adult observers (normal vision) viewed subsets of logMAR acuity charts displayed on an LCD monitor monocularly through a unit magnification 3-mm aperture telescope. Observers rated features blur, ghosting, and contrast on 10-point scales (10 = poorest) and overall IQ on a 0- to 100-point scale (100 = best) and read each chart until five total letters were missed (logMAR technique). Mixed modeling was used to estimate feature influence on overall perceived IQ and relative acuity (compared with an unaberrated chart), separately.

Results

Perceived IQ spanned the entire scale (mean = 59 ± 22) and average reduction in relative acuity was two lines (0.2 ± 0.14 logMAR). Perceived blur, ghosting, and contrast were individually correlated with overall IQ and relative acuity. Blur, contrast, and ghosting exert unique effects on overall perceived IQ (P < 0.05). Blur (b = -.009, P < 0.001) and ghosting (b = -.003, P < 0.001) influence relative acuity over and beyond their effects on overall IQ (b = .001, P < 0.0001) and contrast.

Conclusions

Objectively identified refractions would ideally provide high contrast, low blur, and low ghosting. These data suggest that blur and ghosting may be given priority over contrast when improving acuity is the goal.

Translational Relevance

Findings may guide objective refraction in clinical care.

Effects of Light Scatter and Blur on Low-Contrast Vision and Disk Halo Size

PURPOSE

To investigate the individual effects of forward light scatter (FLS) and refractive blur on low-contrast vision and the size of the disk halo produced in response to an external glare source.

METHODS

Monocular disk halo radius, high- and low-contrast distance visual acuity (HCVA, LCVA), and contrast sensitivity (CS) were determined in 25 eyes of 25 healthy subjects under normal, FLS, and blur conditions. FLS was induced using the filter Black ProMist 2 to simulate an early cataract. Blur was induced using a +1.00 diopter lens to simulate an uncorrected refractive error.

RESULTS

Similar significant mean increases in halo radius were observed for the FLS (0.32 ± 0.10 log arc min; P < .0001) and refractive blur (0.40 ± 0.18 log arc min; P < .0001). Under induced blur, 3 lines of HCVA (0.32 ± 0.15 logMAR; P < .0001) and 4 lines of LCVA (0.39 ± 0.16 logMAR; P < .0001) were lost. FLS had a minimal (but significant) effect on HCVA, but worsened mean LCVA by more than 1 line (0.13 ± 0.10 logMAR; P < .0001). Similar significant mean CS reductions of 0.17 ± 0.12 (P < .0001) and 0.14 ± 0.12 log units (P < .0001) were produced in response to FLS and refractive blur, respectively (approximately 1 triplet).

CONCLUSIONS

Forward light scatter and refractive blur contributed to an increased size of the disk halo produced by a glare source in similar proportion. Although defocus blur has a substantial effect on LCVA, a loss of more than 1 line of LCVA after best refractive correction would be indicative of FLS.

The effect of dioptric blur on reading performance

Little is known about the systematic impact of blur on reading performance. The purpose of this study was to quantify the effect of dioptric blur on reading performance in a group of normally sighted young adults. We measured monocular reading performance and visual acuity for 19 observers with normal vision, for five levels of optical blur (no-blur, 0.5, 1, 2, and 3D). Dioptric blur was induced using convex trial lenses placed in front of the testing eye, with the pupil dilated and in the presence of a 3mm artificial pupil. Reading performance was assessed using eight versions of the MNREAD Acuity Chart. For each level of dioptric blur, observers read aloud sentences on one of these charts, from large to small print. Reading time for each sentence and the number of errors made were recorded and converted to reading speed in words per minute. Visual acuity was measured using 4-orientation Landolt C stimuli. For all levels of dioptric blur, reading speed increased with print size up to a certain print size and then remained constant at the maximum reading speed. By fitting nonlinear mixed-effects models, we found that the maximum reading speed was minimally affected by blur up to 2D, but was approximately 23% slower for 3D of blur. When the amount of blur increased from 0 (no-blur) to 3D, the threshold print size (print size corresponded to 80% of the maximum reading speed) increased from 0.01 to 0.88 logMAR, reading acuity worsened from -0.16 to 0.58 logMAR, and visual acuity worsened from -0.19 to 0.64 logMAR. The similar rates of change with blur for threshold print size, reading acuity and visual acuity implicates that visual acuity is a good predictor of threshold print size and reading acuity. Like visual acuity, reading performance is susceptible to the degrading effect of optical blur. For increasing amount of blur, larger print sizes are required to attain the maximum reading speed.

Influence of Stiles-Crawford apodization on visual acuity

The Stiles-Crawford effect (SCE) of the first kind has often been considered to be important to spatial visual performance in that it ameliorates the influence of defocus and aberrations. We investigated the influence of SCE apodization on visual acuity as a function of defocus (out to +/-2 D) in four subjects. We used optical filters, conjugate with the eye's entrance pupil, that neutralized or doubled the existing SCE. With an illiterate-E task, the influence of the SCE was more noticeable for myopic defocus than for hypermetropic defocus, was generally more noticeable for high-contrast than for low-contrast letters, and increased with increase in pupil size. The greatest influence on visual acuity of neutralizing the SCE, across the subjects and range of conditions, was deterioration of 0.06 (4-mm pupil), 0.16 (6-mm pupil), and 0.29 log unit (7.6-mm pupil).

Visual acuity in contact lens wearers

PURPOSE

The difference between high- and low-contrast visual acuity provides a sensitive indicator of vision loss in ocular disease; however, the effect of refractive error correction on this difference is still debated.

METHODS

High- and low-contrast visual acuity was measured in 116 rigid gas permeable contact lens wearers, 51 spectacle wearers, and 50 soft contact lens wearers with habitual and best correction. Twenty-nine of the soft contact lens wearers reported that they wore disposable contact lenses (discarded on a monthly or more frequent basis), whereas the other 21 soft contact lens wearers wore traditional soft contact lenses.

RESULTS

Rigid gas permeable contact lens wearers had statistically worse high-contrast habitual visual acuity than spectacle wearers (Tukey-Kramer, p = 0.0075). Traditional soft contact lens wearers had significantly worse low-contrast visual acuity compared with all other groups (Tukey-Kramer, p < 0.02 for each comparison). Traditional soft contact lens wearers had a significantly larger difference between high- and low-contrast visual acuity with best correction compared with rigid gas permeable wearers (Tukey-Kramer, p = 0.0099).

CONCLUSIONS

Rigid gas permeable contact lens wearers had statistically worse habitual high-contrast visual acuity compared with spectacle wearers, but no difference was present under best-corrected conditions. We hypothesize that rigid gas permeable contact lens wearers were not wearing their optimal correction habitually. Traditional soft contact lens wearers had significantly worse low-contrast visual acuity. They also had a larger difference between their best-corrected high- and low-contrast visual acuity scores compared with rigid gas permeable contact lens wearers.

The influence of level and polarity of figure-ground contrast on vision

PURPOSE

To document the effect upon human foveal vision of changes in the level and polarity of figure-ground contrast under photopic controlled test conditions, with particular emphasis on performance at low contrast levels.

METHODS

Using a forced-choice psychophysical paradigm, threshold acuity estimates were derived at 9 discrete levels over a near-3 octave contrast range for Landolt ring-type stimuli of either positive or negative polarity. Data were obtained under binocular conditions from 10 young adults, each wearing their optimum low myopic spectacle correction.

RESULTS

Visual acuity declined linearly with reducing stimulus contrast, the deterioration increasing substantially at <10% figure-ground contrast regardless of stimulus polarity. Performance was slightly (but not statistically significantly) better for positive contrast stimuli.

CONCLUSION

Irrespective of contrast polarity, a reduction in stimulus figure-ground contrast <10% produces an accelerated decrement in photopic foveal vision compared to the performance at levels >10%. Some clinical and practical implications of this outcome are considered with regard to the examination of patients with normal and compromised visual function.

Vernier and letter acuities for low-pass filtered moving stimuli

Vernier and letter acuities are both susceptible to degradation by image motion. In a previous study, we showed that the worsening of Vernier acuity for stimuli moving up to 4 degrees/s is accounted for primarily by a shift of visual sensitivity to mechanisms of lower spatial frequency. The purposes of this study were to extend the previous results for Vernier acuity to higher stimulus contrast and velocities, and to determine if a shift in spatial scale can similarly explain the degradation of letter acuity for moving stimuli. We measured Vernier discrimination for a pair of vertical abutting thin lines and letter resolution for a four-orientation letter 'T' as a function of stimulus velocity ranging from 0 to 12 degrees/s. Stimuli were presented at 20 times the detection threshold, determined for each velocity. To determine the spatial-frequency mechanism that mediates each task at each velocity, we measured Vernier and letter acuities with low-pass filtered stimuli (cut-off spatial-frequency: 17.1-1.67 c/deg) and analyzed the data using an equivalent blur analysis. Our results show that the empirically determined, equivalent intrinsic blur associated with both tasks increases as a function of stimulus velocity, suggesting corresponding increases in the size of optimally responding mechanisms. This progressive increase in mechanism size can account for the worsening of Vernier and letter acuities with velocity. Vernier discrimination is found to be more susceptible to degradation by various stimulus parameters than letter resolution, suggesting that different mechanisms are involved in the two tasks. We conclude that the elevations in Vernier and letter acuities for moving stimuli are the consequence of a shift of visual sensitivity toward mechanisms of lower spatial frequencies.

Assessment of contrast sensitivity of patients with macular disease using reduced contrast near visual acuity charts

A set of near Bailey-Lovie logMAR letter charts that varied in contrast from 0.40 dB (C = 0.95) to 58.0 dB (C = 0.001) were used to measure the middle and high spatial frequency range of the contrast sensitivity function (CSF) of 15 subjects with age-related maculopathy (ARM) and 15 age-matched normal subjects. The letter charts were shown to have good test-retest reliability. Compared with measures made using CRT generated square wave gratings of variable contrast and spatial frequency they were also shown to provide a valid measure of CSF in the mid to high spatial frequency range. The 20.0 dB letter chart alone was shown to be a good screening device for macular disease. The letter charts do not provide a measure of the peak of the CSF and a supplementary test of contrast sensitivity is needed to quantify contrast sensitivity at a low spatial frequency. Three measures are proposed as necessary to document foveal visual capability of patients with macular disease: distance logMAR visual acuity to measure high spatial frequency resolution, visual acuity with letter charts of 20 dB contrast to assess mid spatial frequency resolution; and contrast sensitivity for the detection of an edge to estimate contrast sensitivity for larger objects.

Effect of target contrast and luminance on soft contact lens and spectacle visual performance

The visual performance of four soft contact lenses was investigated using visual acuity charts at six contrast levels (from 90 to 8%) under normal (250cd/m2) and reduced 92.5cd/m2) luminances. This investigation reveals significant differences not detected by conventional visual acuity measurements; in general, reducing luminance or contrast increases the magnitude of any recorded difference. Furthermore, the study pointed to a significantly poorer visual performance with spectacles compared to standard thickness soft contact lenses under low luminance and contrast conditions. Finally, a recommended examination routine is described.