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Bianchi E, Reddingius PF, Rathore M, Lindfield D, Crabb DP, Jones PR. Pushing the envelope: the feasibility of using a mailed contrast sensitivity test to prioritise cataract waiting lists. Eye (Lond) 2024; 38:2568-2574. [PMID: 38802486 PMCID: PMC11385213 DOI: 10.1038/s41433-024-03081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Cataract waiting lists are growing globally. Pragmatic, cost-effective methods are required to prioritise the most urgent cases. Here we investigate the feasibility of using a third-party pen-and-paper contrast sensitivity, CS, test (SpotChecksTM), delivered by mail, and performed by patients at home unsupervised, to flag eyes requiring surgery. METHODS Pen-and-paper CS tests were mailed to 233 people waiting for a cataract assessment, along with a prepaid return envelope (cross-sectional study). Response rates were tabulated (stratified by age, sex and socioeconomic status), and test scores analysed to see how well the home tests predicted which eyes were listed subsequently for surgery. A subset of patients (N = 39) also underwent in-person follow-up testing, to confirm the accuracy of the home data. RESULTS Forty-six percent of patients responded (216 eyes). No gross differences were observed between respondents and non-respondents, either in terms of age, sex, socioeconomic status, or geographic location (all P > 0.05). The home-test CS scores predicted which eyes were subsequently listed for surgery, with an AUROC {±CI95%} of 0.69 {0.61-0.76}. Predictive performance was further-improved when machine learning was used to combine CS scores with letter acuity, extracted from patients' medical records (AUROC {±CI95%} = 0.77 {0.70-0.83}). Among 39 patients who underwent follow-up testing, home CS scores were correlated with various measures made in clinic: biometry signal-to-noise (P = 0.032), LogMAR acuity, Pelli-Robson CS and SpotChecks CS (all P < 0.001). CONCLUSIONS Mailing patients pen-and-paper CS tests may be a feasible, 'low-tech' way of prioritising patients on cataract waiting lists.
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Affiliation(s)
- Eleonora Bianchi
- Glaucoma Services, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Peter F Reddingius
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England
| | - Mehal Rathore
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England
| | - Dan Lindfield
- Glaucoma Services, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England
| | - Pete R Jones
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, England.
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Jayaraman D, Bagga DK, Ag A, Raghuram A, Shirodker SSS, Idhayavannan IP, Christy B. Contrast Sensitivity and Low Contrast Visual Acuity in Children With Normal Visual Acuity. Am J Ophthalmol 2024; 268:54-65. [PMID: 39059601 DOI: 10.1016/j.ajo.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE To measure and report the distribution of distance and near contrast sensitivity (CS) and low contrast visual acuity (LCVA) at 5% and 2.5% contrast in children aged 5-15 years with normal visual acuity (VA). DESIGN Prospective, cross-sectional study. SETTING Schools in Southern India. STUDY POPULATION One thousand fifty-two children aged 5 to 15 years (mean age 10.61 ± 2.85 years) with a presenting visual acuity of 0.00 logMAR or better in both eyes and a stereo acuity of 40 seconds of arc or better were recruited from nine schools. Repeatability of contrast sensitivity and low contrast visual acuities were tested in 246 children. Pelli-Robson charts were used to measure the distance and near contrast sensitivity at 1 m and 40 cm, respectively. The low contrast visual acuity was recorded at 5% and 2.5% contrast using LEA Symbols at 3 m. RESULTS Overall, the mean ± SD, (95% CI) monocular distance and near CS were 1.75 ± 0.11 (1.76-1.75) logCS and 1.72 ± 0.10 (1.73-1.71) logCS, respectively. The mean LCVA at 5% and 2.5% contrasts were 0.20 ± 0.10 (0.21-0.20) logMAR and 0.39 ± 0.11 (0.40-0.39) logMAR, respectively. Distance and near CS gradually improved till the ages of 11 and 13, respectively, and then plateaued. Similarly, LCVA at 5% and 2.5% contrasts gradually improved till age ten before plateauing. The Coefficient of Repeatability (CoR) for CS was ±0.02 logCS for distance, ±0.05 logCS for near, and ±0.01 logMAR for both LCVA contrasts. CONCLUSIONS The study provides age-specific normative values for distance and near CS, and LCVA in a cohort of children aged 5-15 years. These results are important to understand the impact of ocular conditions on CS in children and have utility in clinical evaluations.
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Affiliation(s)
- Deiva Jayaraman
- From the Institute for Vision Rehabilitation, L V Prasad Eye Institute (D.J., D.K.B., A.A., S.S.S.S., I.P.I., B.C.), Hyderabad, India.
| | - Deepak Kumar Bagga
- From the Institute for Vision Rehabilitation, L V Prasad Eye Institute (D.J., D.K.B., A.A., S.S.S.S., I.P.I., B.C.), Hyderabad, India
| | - Ananthapadmanabhan Ag
- From the Institute for Vision Rehabilitation, L V Prasad Eye Institute (D.J., D.K.B., A.A., S.S.S.S., I.P.I., B.C.), Hyderabad, India
| | - Aparna Raghuram
- Harvard Medical School (A.R.), Boston, United States; Vision-Aid (A.R.), Massachusetts, United States
| | - Suchana S Shet Shirodker
- From the Institute for Vision Rehabilitation, L V Prasad Eye Institute (D.J., D.K.B., A.A., S.S.S.S., I.P.I., B.C.), Hyderabad, India
| | - Idhaya Priya Idhayavannan
- From the Institute for Vision Rehabilitation, L V Prasad Eye Institute (D.J., D.K.B., A.A., S.S.S.S., I.P.I., B.C.), Hyderabad, India
| | - Beula Christy
- From the Institute for Vision Rehabilitation, L V Prasad Eye Institute (D.J., D.K.B., A.A., S.S.S.S., I.P.I., B.C.), Hyderabad, India
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Vu LT, Tran KM, Niu Y, Cheng H. Evaluation of the SpotChecks contrast sensitivity test in healthy adults. Ophthalmic Physiol Opt 2024. [PMID: 39031645 DOI: 10.1111/opo.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE SpotChecks is a new contrast sensitivity (CS) test designed for self-monitoring of vision. This study assessed the test-retest repeatability of take-home SpotChecks, in-office SpotChecks and near Pelli-Robson charts in healthy adults. METHODS One eye of 61 healthy adults with near visual acuity (VA) of 6/9 or better (age range 22-84, mean 49 [18] years) was tested during two office visits (mean 10 [8] days apart). Each visit included high-contrast VA, then 12 randomly ordered CS tests (6 different SpotChecks and 6 different Pelli-Robson) under the same lighting (luminance 110 cd/m2), all at near in the same eye with habitual correction. The same eye was self-tested with take-home SpotChecks once a day on 6 days between the office visits. SpotChecks was scored by the logCS at the highest line with ≥2 errors. Pelli-Robson was scored by [0.05 × number of letters read correctly - 0.15]. Repeatability of logCS was defined as 1.962 $$ \sqrt{2} $$ Sw, Sw representing within-subject standard deviation. Comparison for repeatability was performed with Bootstrap hypothesis test. RESULTS SpotChecks and Pelli-Robson showed similar intra-session or inter-visit repeatability (p = 0.14-0.81). Inter-day repeatability for take-home SpotChecks was 0.18 logCS, the same as that from the first measurements of two office visits with SpotChecks or Pelli-Robson. Inter-visit repeatability improved to 0.15 by using the average of two repeated measurements for SpotChecks (p = 0.02) or three repeated measurements for Pelli-Robson (p = 0.04). Age showed a small effect on logCS (-0.015/decade, p = 0.02) for both SpotChecks and Pelli-Robson. Mean logCS was 0.05 lower in those ≥50 years (SpotChecks 1.84 [0.10] and Pelli-Robson 1.77 [0.10]) compared with those <50 years of age (SpotChecks 1.89 [0.07] and Pelli-Robson 1.83 [0.07]). CONCLUSIONS SpotChecks showed good repeatability with take-home and in-office testing in healthy adults, making it a promising tool for monitoring disease progression at home.
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Affiliation(s)
- Lien T Vu
- College of Optometry, University of Houston, Houston, Texas, USA
| | - Kelly M Tran
- College of Optometry, University of Houston, Houston, Texas, USA
| | - Yabo Niu
- Department of Mathematics, University of Houston, Houston, Texas, USA
| | - Han Cheng
- College of Optometry, University of Houston, Houston, Texas, USA
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Karampatakis V, P. Papadopoulou E, Almpanidou S, Karamitopoulos L, Almaliotis D. Evaluation of contrast sensitivity in visually impaired individuals using K-CS test. A novel smartphone-based contrast sensitivity test-Design and validation. PLoS One 2024; 19:e0288512. [PMID: 38330096 PMCID: PMC10852338 DOI: 10.1371/journal.pone.0288512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/29/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND To describe the development and investigate the accuracy of a novel smartphone-based Contrast Sensitivity (CS) application, the K-CS test. METHODS A total of 67 visually impaired and 50 normal participants were examined monocularly using the novel digital K-CS test and the Pelli-Robson (PR) chart. The K-CS test examines letter contrast sensitivity in logarithmic units, using eight levels of contrast from logCS = ~0,1 to logCS = ~2,1 at two spatial frequencies of 1.5 and 3 cycles per degree (cpd). The K-CS test was compared to the gold standard, PR test and intra-session test repeatability was also examined. RESULTS The K-CS test in normally sighted was found to agree well with the PR, providing comparable mean scores in logCS (±SD) (K-CS = 1.908 ± 0.06 versus PR = 1.93 ± 0.05) at 1.5 cpd and mean (± SD) logCS at 3 cpd (K-CS = 1.83 ± 0.13 versus PR = 1.86 ± 0.07). The mean best corrected visual acuity of visually impaired participants was 0.67 LogMAR (SD = 0.21) and the K-CS was also found to agree well with the Pelli-Robson in this group, with an equivalent mean (±SD) logCS at 1.5 cpd: (K-CS = 1.19 ± 0.27, PR = 1.15 ± 0.31), 3 cpd: K-CS = 1.01 ± 0.33, PR = 0.94 ± 0.34. Regarding the intra-session test repeatability, both the K-CS test and the PR test showed good repeatability in terms of the 95% limits of agreement (LoA): K-CS = ±0.112 at 1.5 cpd and ±0.133 at 3 cpd, PR = ±0.143 at 1.5 cpd and ±0.183 in 3 cpd in visually impaired individuals. CONCLUSION The K-CS test provides a quick assessment of the CS both in normally sighted and visually impaired individuals. The K-CS could serve as an alternative tool to assess contrast sensitivity function using a smartphone and provides results that agree well with the commonly used PR test.
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Affiliation(s)
- Vasileios Karampatakis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni P. Papadopoulou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Almpanidou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leonidas Karamitopoulos
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diamantis Almaliotis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Crossland MD, Dekker TM, Dahlmann-Noor A, Jones PR. Can children measure their own vision? A comparison of three new contrast sensitivity tests. Ophthalmic Physiol Opt 2024; 44:5-16. [PMID: 37728235 DOI: 10.1111/opo.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the feasibility of children measuring their own contrast sensitivity using a range of tablet- and paper-based tests. METHODS Forty children aged 5-15 years with amblyopia (N = 10), bilateral vision impairment (N = 10) or good vision (N = 20) measured their own vision on a screen-based optotype test (Manifold), a gamified vision test (PopCSF) and a paper-based test (Spotchecks) in a laboratory with minimal supervision. Completion rate, test-retest repeatability, test duration and participants' preferences were recorded for each test. RESULTS Most participants (36/40) were able to perform all three tests. All tests were correlated with clinically measured visual acuity and contrast sensitivity (p < 0.001). The 95% coefficient of repeatability was 0.30 dB for Manifold, 0.29 dB for PopCSF and 0.13 dB for Spotchecks. All tests differentiated between children with reduced contrast sensitivity and control participants. PopCSF and Spotchecks were also able to differentiate between children with amblyopia and those with good vision. Median test time was 152, 130 and 202 s for Manifold, PopCSF and Spotchecks, respectively. Twenty-two participants preferred the PopCSF test, 10 preferred Spotchecks and 6 preferred Manifold. Thirty-nine out of the 40 children (98%) said they would measure their own vision at home using at least one of these tests every month. CONCLUSIONS Children and young people can test their own contrast sensitivity with repeatable results. Of these three tests, the most repeatable was Spotchecks, the quickest was PopCSF and participants' favourite was PopCSF. Nearly all of the participants said they would be willing to use at least one of the three tests at home.
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Affiliation(s)
- Michael D Crossland
- NIHR Moorfields Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Tessa M Dekker
- NIHR Moorfields Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Annegret Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Pete R Jones
- UCL Institute of Ophthalmology, London, UK
- Department of Optometry and Visual sciences, City, University of London, London, UK
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Abraham CH, Morny E, Aboagye-MacCarthy A, Ocansey S, Ntodie M, Sakyi-Badu G, Dadzie AK, Addo NA, Holdbrook S, Abu EK. The effect of filters and varying illumination on contrast sensitivity in eyes with moderate to severe visual impairment. Int Ophthalmol 2023:10.1007/s10792-023-02738-7. [PMID: 37193933 DOI: 10.1007/s10792-023-02738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To investigate the effect of filters and illumination on contrast sensitivity in persons with cataract, pseudophakia, maculopathy and glaucoma to provide a guide for eye care providers in low vision rehabilitation. MATERIALS AND METHODS A within-subjects experimental design with a counter-balanced presentation technique was employed in this study. The contrast sensitivity of eyes with cataract, pseudophakia, maculopathy and glaucoma was measured with filters (no filter, yellow, pink and orange) combined with increasing illumination levels (100 lx, 300 lx, 700 lx and 1000 lx) using the SpotChecks™ contrast sensitivity chart. The data were analyzed using descriptive statistics and two-way repeated measures ANOVA. RESULTS The yellow filter at 100 lx significantly improved contrast sensitivity in the maculopathy group. There were no significant improvements with either intervention in the rest of the groups. There was, however, a significant interaction between filters and illumination in the cataract group. CONCLUSION There were small improvements in contrast sensitivity at low illumination levels with the yellow filter in the maculopathy group, and this could be considered in clinical practice and low vision rehabilitation. Overall, filters at most illumination levels did not benefit most groups.
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Affiliation(s)
- Carl Halladay Abraham
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Enyam Morny
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | | | - Stephen Ocansey
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Michael Ntodie
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Godfred Sakyi-Badu
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Albert Kofi Dadzie
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Naa Adjeley Addo
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Selina Holdbrook
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Kwasi Abu
- Department of Optometry and Vision Science, University of Cape Coast, Cape Coast, Ghana
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Anderson HA, Mathew AR, Cheng H. Evaluation of the SpotChecks contrast sensitivity test in children. Ophthalmic Physiol Opt 2023; 43:64-72. [PMID: 36164764 PMCID: PMC10087722 DOI: 10.1111/opo.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to determine intrasession repeatability of a worksheet style contrast sensitivity test (SpotChecks) in children and agreement with an established contrast sensitivity test (Pelli-Robson). METHODS Forty-three children aged 4 to 12 years participated in this single visit study that included two administrations of the SpotChecks binocularly, a single administration of the Pelli-Robson test and other measures of visual performance such as high-contrast visual acuity. Test order was randomised, and participants wore their habitual correction (39 unaided, 4 wearing glasses) for testing. Bland-Altman plots were used to assess the test-retest repeatability of SpotChecks and its agreement with the Pelli-Robson test. Multiple linear regressions were performed to evaluate whether contrast sensitivity was related to participant characteristics such as age, sex and near binocular visual acuity. RESULTS The mean difference in log contrast sensitivity (logCS) between two administrations of the SpotChecks was 0.01, with a coefficient of repeatability (1.96*SD of differences) of 0.14 logCS. The mean difference between SpotChecks and Pelli-Robson was 0.00 logCS with 95% limits of agreement of -0.19 to +0.20. For both tests, a statistically significant increase in logCS was associated with age (slopes were 0.02 logCS/year, p < 0.001 and 0.01 logCS/year, p = 0.02 for the SpotChecks and Pelli-Robson tests, respectively). CONCLUSIONS The SpotChecks test shows good intrasession repeatability and excellent agreement with the Pelli-Robson test in children. Contrast sensitivity showed an increase in logCS with age in children for both tests.
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Affiliation(s)
| | | | - Han Cheng
- College of Optometry, University of Houston, Houston, Texas, USA
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