Evaluating the performance of the quick CSF method in detecting contrast sensitivity function changes

Assessing Contrast Sensitivity Function in CRB1-Retinopathies: Exploring Child-Friendly Measures of Visual Function

Purpose

Mutations affecting the CRB1 gene can result in a range of retinal phenotypes, including early onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA), retinitis pigmentosa, cone-rod dystrophy (CORD), and macular dystrophy (MD). As research into treatment strategies advances towards clinical translation, there is a need to establish reliable outcome metrics. This study explores the contrast sensitivity function (CSF) across different spatial frequencies in individuals with CRB1-retinopathies using the child-friendly PopCSF test, an iPad-based "gamified" assessment.

Methods

Prospective cross-sectional study of 20 patients with molecularly confirmed biallelic CRB1 pathogenic variants from Moorfields Eye Hospital, London, UK, was conducted. Best-corrected visual acuity (BCVA), contrast sensitivity using the Pelli-Robson chart, and the PopCSF test were performed.

Results

Of the 20 CRB1 patients, seven had EOSRD/LCA, three had CORD, and 10 had MD. There was no statistically significant difference between the mean BCVA between phenotypes (P = 0.066). However, a significant difference was found between groups in the mean letter log contrast sensitivity (logCS) and area under the contrast sensitivity function (AUCSF) with P = 0.047 and P < 0.001, respectively. A moderate positive correlation was observed between Pelli-Robson and PopCSF (r = 0.53, P = 0.020). The CRB1 cohort had significantly lower CSF at both low and high spatial frequencies compared to controls. Among the CRB1 phenotypes, patients with EOSRD/LCA, exhibited the lowest CSF.

Conclusions

This study is the first to examine CSF across spatial frequencies in patients with CRB1-retinopathies using the novel PopCSF test.

Translational Relevance

The CSF holds promise as a potential functional vision trial endpoint.

Using Hierarchical Bayesian Modeling to Enhance Statistical Inference on Contrast Sensitivity

Purpose

The purpose of this study is to introduce a nonparametric hierarchical Bayesian model (HBM) that enables advanced statistical inference on contrast sensitivity (CS) both at individual spatial frequencies (SFs) and across multiple SFs in clinical trials, where CS measurements are crucial for assessing safety and efficacy.

Methods

The HBM computes the joint posterior distribution of CS at six Food and Drug Administration-designated SFs across the population, individual, and test levels. It incorporates covariances at both population and individual levels to capture the relationship between CSs across SFs. A Bayesian inference procedure (BIP) is also used to estimate the posterior distribution of CS at each SF independently. Both methods are applied to a quantitative CSF (qCSF) dataset of 112 subjects and compared in terms of precision, test-retest reliability of CS estimates, sensitivity, accuracy, and statistical power in detecting CS changes.

Results

The HBM reveals correlations between CSs in pairs of SFs and provides significantly more precise estimates and higher test-retest reliability compared to the BIP. Additionally, it improves the average sensitivity and accuracy in detecting CS changes for individual subjects, as well as statistical power for detecting group-level CS changes at individual and combinations of multiple SFs between luminance conditions.

Conclusions

The HBM establishes a comprehensive framework to enhance sensitivity, accuracy, and statistical power for detecting CS changes in hierarchical experimental designs.

Translational Relevance

The HBM presents a valuable tool for advancing CS assessments in the clinic and clinical trials, potentially improving the evaluation of treatment efficacy and patient outcomes.

Comparison of the quantitative contrast sensitivity function between early keratoconus and normal eyes

PURPOSE

To compare the characteristics of the quantitative contrast sensitivity function (qCSF) in eyes with early keratoconus (Early-KC) and normal control (NC) eyes and investigate the associated factors.

DESIGN

A cross-sectional study.

METHODS

This study included 43 eyes of 43 patients with Early-KC (including subclinical keratoconus [SKC] and forme fruste keratoconus [FFKC]) and 77 NC eyes of 77 participants with corrected distance visual acuity (CDVA) all ≥ 20/20. Contrast sensitivity (CS) was assessed using the qCSF tests. Subgroup analysis was performed according to keratoconus type(SKC and FFKC) and astigmatism(cylindrical refraction >-1.0D or ≤-1.0D).

RESULTS

Sex ratio, spherical refraction, and spherical equivalent (SE) varied significantly between the two groups (all P < 0.01). The area under log CSF (AULCSF), CSF Acuity, and CS at low (1.0 and 1.5 cycles per degree [cpd]) and high (12.0 and 18.0 cpd) spatial frequencies decreased significantly in the Early-KC group than that in the NC group (all P < 0.05). The subgroup analysis revealed a similar decrease in the SKC group (all P < 0.05). AULCSF, CSF Acuity, and CS at high spatial frequencies of patients with cylindrical refraction ≤-1.0D in the Early-KC group decreased significantly (all P < 0.05) than those in the NC group. The index of vertical asymmetry and index of height decentration correlated negatively with CS at 1.5 cpd (r= -0.321 and -0.306; both P < 0.05).

CONCLUSIONS

CS decreased significantly at low and high spatial frequencies in Early-KC, though with normal CDVA. The qCSF test can sensitively reflect visual performance in early keratoconus.

Predicting contrast sensitivity functions with digital twins

We developed and validated digital twins (DTs) for contrast sensitivity function (CSF) across 12 prediction tasks using a data-driven, generative model approach based on a hierarchical Bayesian model (HBM). For each prediction task, we utilized the HBM to compute the joint distribution of CSF hyperparameters and parameters at the population, subject, and test levels. This computation was based on a combination of historical data (N = 56), any new data from additional subjects (N = 56), and "missing data" from unmeasured conditions. The posterior distributions of the parameters in the unmeasured conditions were used as input for the CSF generative model to generate predicted CSFs. In addition to their accuracy and precision, these predictions were evaluated for their potential as informative priors that enable generation of synthetic quantitative contrast sensitivity function (qCSF) data or rescore existing qCSF data. The DTs demonstrated high accuracy in group level predictions across all tasks and maintained accuracy at the individual subject level when new data were available, with accuracy comparable to and precision lower than the observed data. DT predictions could reduce the data collection burden by more than 50% in qCSF testing when using 25 trials. Although further research is necessary, this study demonstrates the potential of DTs in vision assessment. Predictions from DTs could improve the accuracy, precision, and efficiency of vision assessment and enable personalized medicine, offering more efficient and effective patient care solutions.

Knowing what to know: Implications of the choice of prior distribution on the behavior of adaptive design optimization

Adaptive design optimization (ADO) is a state-of-the-art technique for experimental design (Cavagnaro et al., 2010). ADO dynamically identifies stimuli that, in expectation, yield the most information about a hypothetical construct of interest (e.g., parameters of a cognitive model). To calculate this expectation, ADO leverages the modeler's existing knowledge, specified in the form of a prior distribution. Informative priors align with the distribution of the focal construct in the participant population. This alignment is assumed by ADO's internal assessment of expected information gain. If the prior is instead misinformative, i.e., does not align with the participant population, ADO's estimates of expected information gain could be inaccurate. In many cases, the true distribution that characterizes the participant population is unknown, and experimenters rely on heuristics in their choice of prior and without an understanding of how this choice affects ADO's behavior. Our work introduces a mathematical framework that facilitates investigation of the consequences of the choice of prior distribution on the efficiency of experiments designed using ADO. Through theoretical and empirical results, we show that, in the context of prior misinformation, measures of expected information gain are distinct from the correctness of the corresponding inference. Through a series of simulation experiments, we show that, in the case of parameter estimation, ADO nevertheless outperforms other design methods. Conversely, in the case of model selection, misinformative priors can lead inference to favor the wrong model, and rather than mitigating this pitfall, ADO exacerbates it.

Quantifying the Functional Relationship Between Visual Acuity and Contrast Sensitivity Function

Purpose

Studies have reported that individuals with certain ocular disorders may have significant decreases in contrast sensitivity function (CSF) despite having normal or near normal visual acuity (VA). This study seeks to elucidate this phenomenon by investigating the relationship between VA and CSF.

Methods

We analyzed data from 14 eyes tested with Electronic Early Treatment Diabetic Retinopathy and quantitative CSF under four Bangerter foil conditions (n = 56). From the CSF data, we estimated peak gain, peak frequency, and contrast sensitivity acuity (CSA). We explored the correlations between VA and various CSF parameters and evaluated five predictive models of VA using CSA alone and in combination with additional CSF parameters through ridge regression.

Results

We found that similar VA scores can correspond with markedly different CSFs and observed significant correlations among all CSF parameters and between VA and each CSF parameter (all P < 0.001). The most effective predictive model, incorporating CSA and peak gain, explained 90.97% of the variance with a root mean squared error of 0.0676 logMAR, which is comparable with the average standard deviation of the VA scores (0.0627 logMAR) and accounted for 38.6% of the residual variance not explained by the CSA-alone model.

Conclusions

This study offers the first empirical inference of the quantitative relationship between VA and CSF, suggesting that various CSF parameter combinations can yield identical VA. This might help to explain why some clinical populations with normal or near-normal VA exhibit significant CSF deficits and calls for further research in different clinical settings.

Impaired Visual Function in Posterior Vitreous Detachment Assessed With the Active-Learning Quantitative Contrast Sensitivity Function Test

Introduction: To investigate whether there is visual function impairment in patients with posterior vitreous detachment (PVD) using the active-learning quantitative contrast sensitivity function test. Methods: In this cross-sectional study, contrast sensitivity was measured in eyes with PVD and eyes without PVD using the quantitative contrast sensitivity function algorithm on the Adaptive Sensory Technology platform. Outcomes included the area under the log contrast sensitivity function curve, contrast acuity, and contrast sensitivity thresholds at 1 to 18 cycles per degree (cpd). Snellen visual acuity (VA) was also measured. Mixed-effects multiple linear regression analyses were performed to evaluate the association between the presence of PVD and visual function, controlling for age and lens status. Results: The cohort comprised 232 healthy eyes of 205 participants; of these, 80 eyes of 69 patients had PVD. There was no significant association between VA and PVD presence. However, PVD was significantly associated with decreased contrast sensitivity thresholds at 1.5 cpd (β, -0.058; P = .003) and 3 cpd (β, -0.067; P = .004). Contrast sensitivity thresholds at lower (1 cpd) or higher (6, 12, 18 cpd) spatial frequencies did not significantly correlate with PVD presence. Even in the subgroup of symptomatic PVD eyes, VA was not significantly decreased, while quantitative contrast sensitivity function outcomes showed visual function deficits at low spatial frequencies (1.5 cpd and 3 cpd). Conclusions: Contrast sensitivity measured with the quantitative contrast sensitivity function test showed visual function deficits in eyes with PVD that would have been missed with VA testing alone. Incorporating this test in the retina clinic might offer a more comprehensive functional assessment of eyes with PVD, serving as an adjunct outcome metric in clinical decision-making.

The effect of femtosecond laser-assisted in situ keratomileusis on contrast sensitivity

The benefits of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correcting vision, particularly in terms of spherical equivalent (SE) and visual acuity (VA), have gained broad recognition. Nevertheless, it has remained uncertain whether FS-LASIK has a positive impact on contrast sensitivity (CS). In this study, we measured CS on seven participants by the quick contrast sensitivity function (qCSF) and compared CS before and after the surgery at two time points (1 day and 7 days after) by the repeated measures analysis of variance (ANOVA). Then, we clarified the underlying mechanisms using the perceptual template model (PTM). Furthermore, we investigated the relationship among SE, VA, and CS employing the Pearson correlation test. We found that (1) CS exhibited significant improvements on postoperative day 1, with further enhancements observed up to postoperative day 7, (2) CS improvements were dependent on spatial frequency (SF) and external noise, (3) CS improvements were attributed to the reduction of internal noise and the enhancement of the perceptual template, (4) VA and SE demonstrated significant improvement post-surgery, and (5) no significant correlations were observed among SE, VA, and CS, possibly due to limitations in sample size and lighting conditions. These findings contribute to our comprehension of FS-LASIK and provide a great indicator for assessing the outcomes of visual surgery.

Enabling identification of component processes in perceptual learning with nonparametric hierarchical Bayesian modeling

Perceptual learning is a multifaceted process, encompassing general learning, between-session forgetting or consolidation, and within-session fast relearning and deterioration. The learning curve constructed from threshold estimates in blocks or sessions, based on tens or hundreds of trials, may obscure component processes; high temporal resolution is necessary. We developed two nonparametric inference procedures: a Bayesian inference procedure (BIP) to estimate the posterior distribution of contrast threshold in each learning block for each learner independently and a hierarchical Bayesian model (HBM) that computes the joint posterior distribution of contrast threshold across all learning blocks at the population, subject, and test levels via the covariance of contrast thresholds across blocks. We applied the procedures to the data from two studies that investigated the interaction between feedback and training accuracy in Gabor orientation identification over 1920 trials across six sessions and estimated learning curve with block sizes L = 10, 20, 40, 80, 160, and 320 trials. The HBM generated significantly better fits to the data, smaller standard deviations, and more precise estimates, compared to the BIP across all block sizes. In addition, the HBM generated unbiased estimates, whereas the BIP only generated unbiased estimates with large block sizes but exhibited increased bias with small block sizes. With L = 10, 20, and 40, we were able to consistently identify general learning, between-session forgetting, and rapid relearning and adaptation within sessions. The nonparametric HBM provides a general framework for fine-grained assessment of the learning curve and enables identification of component processes in perceptual learning.

Can children measure their own vision? A comparison of three new contrast sensitivity tests

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.

Caffeinated Soda Intake in Children Is Associated with Neurobehavioral Risk Factors for Substance Misuse

BACKGROUND AND OBJECTIVES

Use of psychotropic substances in childhood has been associated with both impulsivity and other manifestations of poor executive function as well as escalation over time to use of progressively stronger substances. However, how this relationship may start in earlier childhood has not been well explored. Here, we investigated the neurobehavioral correlates of daily caffeinated soda consumption in preadolescent children and examined whether caffeinated soda intake is associated with a higher risk of subsequent alcohol initiation.

METHODS

Using Adolescent Brain Cognitive Development study data (N = 2,092), we first investigated cross-sectional relationships between frequent caffeinated soda intake and well-known risk factors of substance misuse: impaired working memory, high impulsivity, and aberrant reward processing. We then examined whether caffeinated soda intake at baseline predicts more alcohol sipping at 12 months follow-up using a machine learning algorithm.

RESULTS

Daily consumption of caffeinated soda was cross-sectionally associated with neurobehavioral risk factors for substance misuse such as higher impulsivity scores and lower working memory performance. Furthermore, caffeinated soda intake predicted a 2.04 times greater likelihood of alcohol sipping after 12 months, even after controlling for rates of baseline alcohol sipping rates.

CONCLUSIONS

These findings suggest that previous linkages between caffeine and substance use in adolescence also extend to younger initiation, and may stem from core neurocognitive features thought conducive to substance initiation.

Endpoints for clinical trials in ophthalmology

With the identification of novel targets, the number of interventional clinical trials in ophthalmology has increased. Visual acuity has for a long time been considered the gold standard endpoint for clinical trials, but in the recent years it became evident that other endpoints are required for many indications including geographic atrophy and inherited retinal disease. In glaucoma the currently available drugs were approved based on their IOP lowering capacity. Some recent findings do, however, indicate that at the same level of IOP reduction, not all drugs have the same effect on visual field progression. For neuroprotection trials in glaucoma, novel surrogate endpoints are required, which may either include functional or structural parameters or a combination of both. A number of potential surrogate endpoints for ophthalmology clinical trials have been identified, but their validation is complicated and requires solid scientific evidence. In this article we summarize candidates for clinical endpoints in ophthalmology with a focus on retinal disease and glaucoma. Functional and structural biomarkers, as well as quality of life measures are discussed, and their potential to serve as endpoints in pivotal trials is critically evaluated.

Evaluating Contrast Sensitivity in Early and Intermediate Age-Related Macular Degeneration With the Quick Contrast Sensitivity Function

Purpose

The purpose of this study was to describe, validate, and compare the contrast sensitivity functions (CSFs) acquired with the novel quick CSF (qCSF) method from patients with early and intermediate age-related macular degeneration (eAMD and iAMD) and healthy controls.

Methods

This is a cross-sectional analysis of contrast sensitivity (CS) and visual acuity (VA) baseline data from the prospective Multimodal Functional and Structural Visual System Characterization (MUMOVI) study. The qCSF testing was conducted with the manifold contrast vision meter (Adaptive Sensory Technology, San Diego, CA, USA). CS levels at spatial frequencies from 1 cycle per degree (CPD) to 18 CPD, the area underneath the logarithmic contrast sensitivity function (AULCSF), and contrast acuity (CA) were analyzed. The association of functional metrics with variables of interest was tested with linear models.

Results

Ninety-four study eyes from 94 study patients were included in the analysis (13 patients with eAMD, 33 patients with iAMD, and 48 healthy controls). Significant differences between the eAMD and the iAMD model estimates were only found for CS at 1 CPD (t value = -2.9, P value = 0.006) and CS at 1.5 CPD (-2.7, 0.01). A specific association between smoking years and CS at 1 CPD (P = 0.02) and CS at 1.5 CPD (P = 0.03) could be described in patients with AMD.

Conclusions

The qCSF testing allows the fast measurement of the whole CSF, enabling the integration into clinical routine. We showed that novel qCSF-derived metrics detect slight functional differences between AMD stages, which testing by Pelli-Robson charts or VA testing would miss. This study, therefore, yields novel qCSF-derived candidate metrics for therapeutic trials in AMD.

Quantification of expected information gain in visual acuity and contrast sensitivity tests

We make use of expected information gain to quantify the amount of knowledge obtained from measurements in a population. In the first application, we compared the expected information gain in the Snellen, ETDRS, and qVA visual acuity (VA) tests, as well as in the Pelli-Robson, CSV-1000, and qCSF contrast sensitivity (CS) tests. For the VA tests, ETDRS generated more expected information gain than Snellen. Additionally, the qVA test with 15 rows (or 45 optotypes) generated more expected information gain than ETDRS, whether scored with VA threshold alone or with both VA threshold and VA range. Regarding the CS tests, CSV-1000 generated more expected information gain than Pelli-Robson, and the qCSF test with 25 trials generated more expected information gain than CSV-1000, whether scored with AULCSF or with CSF at six spatial frequencies. The active learning-based qVA and qCSF tests have the potential to generate more expected information gain than traditional paper chart tests. Although we have specifically applied it to compare VA and CS tests, expected information gain is a general concept that can be used to compare measurements in any domain.

The spatial contrast sensitivity function and its neurophysiological bases

Contrast processing is a fundamental function of the visual system, and contrast sensitivity as a function of spatial frequency (CSF) provides critical information about the integrity of the system. Here, we used a novel iPad-based instrument to collect CSFs and fitted the data with a difference of Gaussians model to investigate the neurophysiological bases of the spatial CSF. The reliability of repeat testing within and across sessions was evaluated in a sample of 22 adults for five spatial frequencies (0.41-13 cycles/degree) and two temporal durations (33 and 500 ms). Results demonstrate that the shape of the CSF, lowpass versus bandpass, depends on the temporal stimulus condition. Comparisons with previous psychophysical studies and with single-cell data from macaques and humans indicate that the major portion of the CSF, spatial frequencies >1.5 cycles/degree regardless of temporal condition, is determined by a 'sustained' mechanism (presumably parvocellular input to primary visual cortex [V1]). Contrast sensitivity to the lowest spatial frequency tested appears to be generated by a 'transient' mechanism (presumably magnocellular input to V1). The model fits support the hypothesis that the high spatial frequency limb of the CSF reflects the receptive field profile of the center mechanism of the smallest cells in the parvocellular pathway. These findings enhance the value of contrast sensitivity testing in general and increase the accessibility of this technique for use by clinicians through implementation on a commercially-available device.

Adaptive Design Optimization as a Promising Tool for Reliable and Efficient Computational Fingerprinting

A key challenge in understanding mental (dys)functions is their etiological and functional heterogeneity, and several multidimensional assessments have been proposed for their comprehensive characterization. However, such assessments require lengthy testing, which may hinder reliable and efficient characterization of individual differences due to increased fatigue and distraction, especially in clinical populations. Computational modeling may address this challenge as it often provides more reliable measures of latent neurocognitive processes underlying observed behaviors and captures individual differences better than traditional assessments. However, even with a state-of-the-art hierarchical modeling approach, reliable estimation of model parameters still requires a large number of trials. Recent work suggests that Bayesian adaptive design optimization (ADO) is a promising way to address these challenges. With ADO, experimental design is optimized adaptively from trial to trial to extract the maximum amount of information about an individual's characteristics. In this review, we first describe the ADO methodology and then summarize recent work demonstrating that ADO increases the reliability and efficiency of latent neurocognitive measures. We conclude by discussing the challenges and future directions of ADO and proposing development of ADO-based computational fingerprints to reliably and efficiently characterize the heterogeneous profiles of psychiatric disorders.

Quantification of Expected Information Gain in Visual Acuity and Contrast Sensitivity Tests

We introduce expected information gain to quantify measurements and apply it to compare visual acuity (VA) and contrast sensitivity (CS) tests. We simulated observers with parameters covered by the visual acuity and contrast sensitivity tests and observers based on distributions of normal observers tested in three luminance and four Bangerter foil conditions. We first generated the probability distributions of test scores for each individual in each population in the Snellen, ETDRS and qVA visual acuity tests and the Pelli-Robson, CSV-1000 and qCSF contrast sensitivity tests and constructed the probability distributions of all possible test scores of the entire population. We then computed expected information gain by subtracting expected residual entropy from the total entropy of the population. For acuity tests, ETDRS generated more expected information gain than Snellen; scored with VA threshold only or with both VA threshold and VA range, qVA with 15 rows (or 45 optotypes) generated more expected information gain than ETDRS. For contrast sensitivity tests, CSV-1000 generated more expected information gain than Pelli-Robson; scored with AULCSF or with CS at six spatial frequencies, qCSF with 25 trials generated more expected information gain than CSV-1000. The active learning based qVA and qCSF tests can generate more expected information than the traditional paper chart tests. Although we only applied it to compare visual acuity and contrast sensitivity tests, information gain is a general concept that can be used to compare measurements and data analytics in any domain.

Collective endpoint of visual acuity and contrast sensitivity function from hierarchical Bayesian joint modeling

Clinical trials typically analyze multiple endpoints for signals of efficacy. To improve signal detection for treatment effects using the high-dimensional data collected in trials, we developed a hierarchical Bayesian joint model (HBJM) to compute a five-dimensional collective endpoint (CE5D) of contrast sensitivity function (CSF) and visual acuity (VA). The HBJM analyzes row-by-row CSF and VA data across multiple conditions, and describes visual functions across a hierarchy of population, individuals, and tests. It generates joint posterior distributions of CE5D that combines CSF (peak gain, peak frequency, and bandwidth) and VA (threshold and range) parameters. The HBJM was applied to an existing dataset of 14 eyes, each tested with the quantitative VA and quantitative CSF procedures in four Bangerter foil conditions. The HBJM recovered strong correlations among CE5D components at all levels. With 15 qVA and 25 qCSF rows, it reduced the variance of the estimated components by 72% on average. Combining signals from VA and CSF and reducing noises, CE5D exhibited significantly higher sensitivity and accuracy in discriminating performance differences between foil conditions at both the group and test levels than the original tests. The HBJM extracts valuable information about covariance of CSF and VA parameters, improves precision of the estimated parameters, and increases the statistical power in detecting vision changes. By combining signals and reducing noise from multiple tests for detecting vision changes, the HBJM framework exhibits potential to increase statistical power for combining multi-modality data in ophthalmic trials.

Characteristics and Related Parameters of Quick Contrast Sensitivity Function in Chinese Ametropia Children

PURPOSE

To investigate the characteristics of quick contrast sensitivity function (qCSF) and its related parameters in Chinese ametropia children.

METHODS

This case series study enrolled 106 eyes of 53 children (male/female=29/24, age: 9.04±2.06 years). Examinations included manifest refraction, axial length, corneal curvature, and monocular and binocular qCSF readings without refractive correction (area under log CSF [AULCSF], CSF acuity, and contrast sensitivity [CS] at 1.0 to 18.0 cpd). The subjects were divided into groups according to age and refractive parameters for analysis.

RESULTS

The mean spherical equivalent (SE), AULCSF, and CSF acuity of the test eyes were -0.94±1.53 D, 0.44±0.33, and 8.50±5.97 cpd, respectively. In the monocular qCSF comparison, the refraction sphere (RS) was the major factor correlated with qCSF readings (B=0.186, P =0.009 for AULCSF; B=0.543, P =0.019 for CSF acuity; generalized linear model). The three groups stratified by RS/SE (<-1.00D, -1.00D to 0D, and >0D) showed significant differences in CS at medium spatial frequencies (3.0 and 6.0 cpd; all P <0.05). In the low RS/SE group (within -1 to 0 D), the CS at 12.0 cpd was significantly lower than that in the hyperopia group (all P <0.05). Binocular qCSF readings were significantly correlated with those of the eyes with lower RS (all P <0.05).

CONCLUSION

RS and SE are the major contributing factors of qCSF without refractive correction in children. The CS at medium spatial frequencies decrease significantly as the RS/SE increase. In low myopia children, the CS at medium and high spatial frequencies are significantly decreased, providing practical value in visual function screening in children.

Association Between Contrast Sensitivity and Central Subfield Thickness in Center-Involving Diabetic Macular Edema

Purpose: To evaluate the association between contrast sensitivity (CS) and central subfield thickness (CST) in diabetic macular edema (DME). Methods: This prospectively recruited, cross-sectional study included eyes with DME evaluated from November 2018 to March 2021. CST was measured using spectral-domain optical coherence tomography on the same day as CS testing. Only eyes with center-involving DME (CST >305 µm for women; >320 µm for men) were included. CS was evaluated using the quantitative CS function (qCSF) test. Outcomes included visual acuity (VA) and the following qCSF metrics: area under the log CS function, contrast acuity (CA), and CS thresholds at 1 to 18 cycles per degree (cpd). Pearson correlation and mixed-effects regression analyses were performed. Results: The cohort included 52 eyes of 43 patients. Pearson correlation analysis showed a stronger association between CST and CS thresholds at 6 cpd (r = -0.422, P = 0.002) than CST and VA (r = 0.293, P = 0.035). Mixed-effects univariate and multivariate regression analyses showed significant associations between CST and CA (β = -0.001, P = .030), CS at 6 cpd (β = -0.002, P = .008), and CS at 12 cpd (β = -0.001, P = .049) but no significant associations between CST and VA. Among the visual function metrics, the effect size of CST was largest on CS at 6 cpd (βStandardized = -0.37, P = .008). Conclusions: In patients with DME, CS may be more strongly associated with CST than VA. Including CS as an adjunct visual function outcome measure in eyes with DME may prove clinically valuable.

Structure-function association between contrast sensitivity and retinal thickness (total, regional, and individual retinal layer) in patients with idiopathic epiretinal membrane

PURPOSE

To investigate structure-function associations between retinal thickness, visual acuity (VA), and contrast sensitivity (CS), using the quantitative contrast sensitivity function (qCSF) method in patients with idiopathic epiretinal membrane (ERM).

METHODS

Retrospective, cross-sectional observational study. Patients with a diagnosis of idiopathic ERM were included. Patients underwent complete ophthalmic examination, spectral-domain optical coherence tomography imaging (SD-OCT) (SPECTRALIS® Heidelberg), and CS testing using the qCSF method. Outcomes included area under the log CSF (AULCSF), contrast acuity (CA), and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd).

RESULTS

A total of 102 eyes of 79 patients were included. Comparing standardized regression coefficients, retinal thickness in most ETDRS sectors was associated with larger reductions in AULCSF, CA, and CS thresholds at 3 and 6 cpd than those in logMAR VA. These differences in effect on VA and CS metrics were more pronounced in the central subfield and inner ETDRS sectors. Among the retinal layers, increased INL thickness had the most detrimental effect on visual function, being significantly associated with reductions in logMAR VA, AULCSF, CA, and CS thresholds at 3 and 6 cpd (all p < .01), as well as at 1.5 and 12 cpd (p < .05).

CONCLUSION

Retinal thickness seems to be associated with larger reductions in contrast sensitivity than VA in patients with ERM. Measured with the qCSF method, contrast sensitivity may serve as a valuable adjunct visual function metric for patients with ERM.

Cross-Sectional Study of Cone Function in Age-Related Macular Degeneration Subjects With Non-foveal Nascent Geographic Atrophy

PURPOSE

To determine photoreceptor function in subjects with drusen only and non-foveal nascent geographic atrophy (nGA) intermediate age-related macular degeneration.

METHODS

In this cross-sectional study, 60 eyes from 33 subjects, 30 with drusen only and 30 with non-foveal nGA determined by spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) underwent testing for best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), and qCSF algorithm (area under log contrast sensitivity function [AULCSF]) under both standard photopic and low-luminance (LL AULCSF) conditions. Areas of nGA-associated hypo-autofluorescence (hypo-AF) were graded.

RESULTS

In the drusen group, visual acuity (VA) = 81 letters ± 3 (mean ± SD), LLVA = 65 letters ± 4, AULCSF = 0.99 ± 0.0.5, and LL AULCSF = 0.38 ± 0.04, whereas in the nGA group, VA = 77 ± 4 letters, LLVA = 61± 4, AULCSF = 0.87 ± 0.09, and LL AULCSF = 0.28 ± 0.06. Multivariate analysis of variance among the LLVA, AULCSF, and LL AULCSF did not demonstrate a statistical difference (P = .167), whereas LL AULCSF analyzed by analysis of variance demonstrated a significant difference between the 2 groups (P = .037). Linear regressions demonstrated significant relationships between BCVA and AULCSF in both the drusen and nGA groups (r = 0.83, P < 10^-9 and r = 0.61, P = .0004) but did not correlate with AULCSF under low-luminance conditions (r = 2.9, P = .13) in the nGA group. The total area of hypo-AF was negatively associated with poorer visual functions.

CONCLUSIONS

The use of LL AULCSF and certain features of FAF should be considered in clinical trials of intermediate age-related macular degeneration. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Reduced contrast sensitivity function correlated with superficial retinal capillary plexus impairment in early stage of dysthyroid optic neuropathy

BACKGROUND

To assess the accuracy of contrast sensitivity function (CSF) in detecting dysthyroid optic neuropathy (DON) at an early stage in thyroid-associated ophthalmopathy (TAO) patients and to examine potential factors that may be linked to early visual impairments in these individuals.

METHODS

A total of 81 TAO patients (50 non-DON and 31 DON), and 24 control subjects participated in the study. CSF was measured with the quick CSF (qCSF) method. Optical coherence tomography angiography (OCTA) images of the ganglion cell complex layer (GCCL), superficial and deep retinal capillary plexuses (SRCP and DRCP) in a 3 mm diameter area around the macula were evaluated.

RESULTS

Compared with the controls, the area under the log contrast sensitivity function (AULCSF) and SRCP density were significantly reduced in non-DON and DON patients (all P < 0.05). The GCCL thickness of the DON patients was thinner than that of the controls and non-DON patients (all P < 0.05). The AULCSF was significantly correlated with spherical equivalent refractive error, muscle index, SRCP density and GCCL thickness in TAO patients, respectively (all P < 0.05). However, stepwise multi-regression analysis showed that the AULCSF was only significantly correlated with SRCP density (P < 0.001). Receiver operating characteristic curve analysis showed that the AULCSF produced the most accurate discrimination between non-DON and DON patients from the controls (AUC = 0.831, 0.987, respectively; all P < 0.001).

CONCLUSIONS

CSF change in the early stage of DON is related to SRCP density. It can be an early indicator of visual impairments associated with DON in TAO patients.

The Characteristics of Quick Contrast Sensitivity Function in Keratoconus and Its Correlation with Corneal Topography

INTRODUCTION

To characterize quick contrast sensitivity function (qCSF) in keratoconus and its correlation with corneal topographic parameters.

METHODS

Patients with keratoconus (n = 120) who visited the Fudan Eye and ENT Hospital between April and June 2021 were enrolled in our study. A total of 215 eyes were subdivided into three groups according to maximum keratometry (K_max): Group 1 (K_max ≤ 48 D, 74 eyes), Group 2 (48 D < K_max ≤ 55 D, 64 eyes), and Group 3 (K_max > 55 D, 77 eyes). Manifest refraction, best corrected distance visual acuity (BCVA), corneal topography, and the qCSF test were examined. Intergroup comparisons and correlations among various corneal topographic parameters and qCSF were analyzed.

RESULTS

Significant differences in the area under the log CSF (AULCSF) and CSF Acuity among the three groups were found, which decreased with an increase in K_max. Contrast sensitivity (CS) between spatial frequencies of 3.0 to 18.0 cpd was significantly different (all P < 0.05) between Groups 1 and 2. The CS at all spatial frequencies was significantly different (all P < 0.05) between Group 3 and other two groups. At 3.0-18.0 cpd, CS decreased significantly (all P < 0.05) in Groups 1-3. Manifest refraction and topographic indices correlated significantly with qCSF parameters (all P < 0.05). Multivariable linear regression analysis showed that cylindrical refraction, logMAR BCVA, and index of surface variance had good predictive values for AULCSF and CSF Acuity.

CONCLUSIONS

The use of qCSF test can serve as a feasible tool to evaluate visual quality and severity of keratoconus, since changes in CS significantly correlated with keratoconus severity.

The effect of small incision lenticule extraction on contrast sensitivity

The improvements due to small incision lenticule extraction (SMILE) in vision, e.g., in spherical equivalent (SE) and visual acuity (VA), has been widely recognized. However, the contrast sensitivity (CS) change after SMILE was not certain. Here, we investigated the effect of SMILE on CS before, 1 day after and 7 days after surgery and then clarified the corresponding mechanism by using a perceptual template model (PTM). In addition, the relationship among SE, VA, and CS was discussed. The quick contrast sensitivity function (qCSF) was applied to measure CS with high precision and accuracy. We found that (1) CS was significantly improved 1 day after SMILE and was also increased 7 days after the surgery, (2) CS improvements were dependent on spatial frequency and external noise, (3) the increase in CS was due to the decreased internal additive noise and an enhanced perceptual template, and (4) Greater SE improvements predicted better VA improvements 1 day after SMILE, and a positive correlation between SE improvements and AULCSF improvements 7 days after SMILE was observed. These findings help us better understand the effect of SMILE and provide effective indicators for future visual research.

Assessing the contrast sensitivity function in myopic parafovea: A quick contrast sensitivity functions study

Purpose

Compare peripheral contrast sensitivity functions (CSF) between myopes and emmetropes to reveal potential myogenic risks during emmetropization.

Materials and methods

This observational, cross-sectional, non-consecutive case study included data from 19 myopes (23.42 ± 4.03 years old) and 12 emmetropes (22.93 ± 2.91 years old) who underwent central and peripheral quick CSF (qCSF) measurements. Summary CSF metrics including the cut-off spatial frequency (cut-off SF), area under log CSF (AULCSF), low-, intermediate-, and high-spatial-frequency AULCSFs (l-, i-, and h-SF AULCSFs), and log CS at 19 SFs in the fovea and 15 peripheral locations (superior, inferior, temporal, and nasal quadrants at 6, 12, 18, and 24° eccentricities, excluding the physiological scotoma at 18°) were analyzed with 3-way and 4-way between-subjects analysis of variance (ANOVA) (α = 0.05).

Results

Three-way ANOVA showed that myopes had significantly increased AULCSF at 6° (mean difference, 0.08; 95% CI, 0.02–0.13; P = 0.007) and 12° (mean difference, 0.09; 95% CI, 0.03–0.14; P = 0.003). Log CS at all 19 SFs were higher in the myopia group compared to the normal group (mean differencesuperior, 0.02; 95% CI, 0.01–0.20; P = 0.02 and mean differenceinferior, 0.11; 95% CI, 0.02–0.21; P = 0.01) at 12°. The h-SF AULCSF at 6° (mean differenceinferior, 1.27; 95% CI, 0.32–2.22; P = 0.009) and i-SF AULCSF at 12° (mean differencesuperior, 5.31; 95% CI, 4.35–6.27; P < 0.001; mean differenceinferior, 1.14; 95% CI, 0.19–2.10; P = 0.02) were higher in myopia vs. normal group.

Conclusion

We found myopia increased contrast sensitivity in superior and inferior visual field locations at 6° parafoveal and 12° perifoveal regions of the retina. The observation of increased contrast sensitivities within the macula visual field in myopia might provide important insights for myopia control during emmetropization.

Active Learning to Characterize the Full Contrast Sensitivity Function in Cataracts

Background

To characterize contrast sensitivity function (CSF) in cataractous and pseudophakic eyes compared to healthy control eyes using a novel quantitative CSF test with active learning algorithms.

Methods

This is a prospective observational study at an academic medical center. CSF was measured in eyes with visually significant cataract, at least 2+ nuclear sclerosis (NS) and visual acuity (VA) ≥ 20/50, in pseudophakic eyes and in healthy controls with no more than 1+ NS and no visual complaints, using the Manifold Contrast Vision Meter. Outcomes included Area under the Log CSF (AULCSF) and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd). A subgroup analysis as performed on cataract eyes with VA ≥ 20/25.

Results

A total of 167 eyes were included, 58 eyes in the cataract group, 77 controls, and 32 pseudophakic eyes with respective median AULCSF of 1.053 (0.352) vs 1.228 (0.318) vs 1.256 (0.360). In our multivariate regression model, cataract was associated with significantly reduced AULCSF (P= 0.04, β= −0.11) and contrast threshold at 6 cpd (P= 0.01, β= −0.16) compared to controls. Contrast threshold at 6 cpd was significantly reduced even in the subgroup of cataractous eyes with VA ≥ 20/25 (P=0.02, β=−0.16).

Conclusion

The novel qCSF test detected disproportionate significant contrast deficits at 6 cpd in cataract eyes; this remained significant even in the cataractous eyes with VA ≥ 20/25. CSF testing may enhance cataract evaluation and surgical decision-making, particularly in patients with subjective visual complaints despite good VA.

Adaptive Design Optimization for a Mnemonic Similarity Task

The Mnemonic Similarity Task (MST: Stark et al., 2019) is a modified recognition memory task designed to place strong demand on pattern separation. The sensitivity and reliability of the MST make it an extremely valuable tool in clinical settings, where it has been used to identify hippocampal dysfunction associated with healthy aging, dementia, schizophrenia, depression, and other disorders. As with any test used in a clinical setting, it is especially important for the MST to be administered as efficiently as possible. We apply adaptive design optimization methods (Lesmes et al., 2015; Myung et al., 2013) to optimize the presentation of test stimuli in accordance with previous responses. This optimization is based on a signal-detection model of an individual's memory capabilities and decision-making processes. We demonstrate that the adaptive design optimization approach generally reduces the number of test stimuli needed to provide these measures.

Hierarchical Bayesian modeling of contrast sensitivity functions in a within-subject design

Recent development of the quick contrast sensitivity function (qCSF) method has made it possible to obtain accurate, precise, and efficient contrast sensitivity function (CSF) assessment. To improve statistical inference on CSF changes in a within-subject design, we developed a hierarchical Bayesian model (HBM) to compute the joint distribution of CSF parameters and hyperparameters at test, subject, and population levels, utilizing information within- and between-subjects and experimental conditions. We evaluated the performance of the HBM relative to a non-hierarchical Bayesian inference procedure (BIP) on an existing CSF dataset of 112 subjects obtained with the qCSF method in three luminance conditions (Hou, Lesmes, Kim, Gu, Pitt, Myung, & Lu, 2016). We found that the average d's of the area under log CSF (AULCSF) and CSF parameters between pairs of luminance conditions at the test-level from the HBM were 33.5% and 103.3% greater than those from the BIP analysis of AULCSF. The increased d' resulted in greater statistical differences between experimental conditions across subjects. In addition, simulations showed that the HBM generated accurate and precise CSF parameter estimates. These results have strong implications for the application of HBM in clinical trials and patient care.

Binocular Interactions in Glaucoma Patients With Nonoverlapping Visual Field Defects: Contrast Summation, Rivalry, and Phase Combination

Purpose

In glaucoma, visual field defects in the left and right eye may be non-overlapping, resulting in an intact binocular visual field. In clinical management, these patients are often considered to have normal vision. However, visual performance also relies on binocular processing. The aim of this study was to evaluate binocular visual functions in glaucoma patients with intact binocular visual field, normal visual acuity, and stereoscopy.

Methods

We measured in 10 glaucoma patients and 12 age-similar controls: (1) monocular and binocular contrast sensitivity functions (CSF) using a modified quick CSF test to assess binocular contrast summation, (2) dominance during rivalry, and (3) contrast ratio at balance point with a binocular phase combination test. A mirror stereoscope was used to combine the left and right eye image (each 10° horizontally by 12° vertically) on a display.

Results

Area under the monocular and binocular CSF was lower in glaucoma compared to healthy (P < 0.001), but the binocular contrast summation ratio did not differ (P = 0.30). For rivalry, the percentage of time of mixed percept was 9% versus 18% (P = 0.056), the absolute difference of the percentage of time of dominance between the two eyes 19% versus 10% (P = 0.075), and the rivalry rate 8.2 versus 12.1 switches per minute (P = 0.017) for glaucoma and healthy, respectively. Median contrast ratio at balance point was 0.66 in glaucoma and 1.03 in controls (P = 0.011).

Conclusions

Binocular visual information processing deficits can be found in glaucoma patients with intact binocular visual field, normal visual acuity, and stereoscopy.

Test-retest Reliability of the qReading Method in Normally Sighted Young Adults

SIGNIFICANCE

We recently developed a novel Bayesian adaptive method, qReading, to measure reading function. The qReading method has both the efficiency and excellent test-retest reliability in normally sighted young adults to make it an excellent candidate for future studies of its value in diagnosis and longitudinal evaluation of treatment and/or rehabilitation outcomes.

PURPOSE

A novel Bayesian adaptive method, qReading, was recently developed to measure reading function. Here we performed a systematic assessment of the test-retest reliability of the qReading method.

METHODS

The variability of five repeated measurements of the reading curve was examined in two settings: within session and between sessions. For the within-session design, we considered two subpopulations: naive observers and experienced observers. All observers were normally sighted young adults. For each set of data, in addition to examining the intrinsic precision of the qReading method (the half width of the credible interval of the posterior distribution of the estimated performance), we computed four metrics to assess repeatability: standard deviation, Bland-Altman coefficient of repeatability, correlation coefficient, and Fractional Rank Precision.

RESULTS

Extrinsic factors such as observer, time interval between repeated measures, and observer experience all contribute to the variation across measurements. Nevertheless, the four metrics consistently show that the variability across five repeated measurements is small for each set of data. This is true even without taking learning effects into account (standard deviations, ≤0.092 log10 units; Bland-Altman coefficient of repeatability, ≤0.15 (log10)2 units; correlation coefficient, ≥0.91; and Fractional Rank Precision, ≥0.81).

CONCLUSIONS

The qReading method has excellent test-retest reliability in normally sighted young adults.

Measuring Contrast Sensitivity Function With Active Learning in Retinal Vein Occlusion: A New Endpoint of Visual Function

BACKGROUND AND OBJECTIVE

To characterize contrast sensitivity function (CSF) in patients with retinal vein occlusion (RVO) compared to age-matched controls using novel computerized contrast sensitivity (CS) testing with active learning algorithms.

PATIENTS AND METHODS

CSF was prospectively measured in RVO patients with visual acuity (VA) greater than 20/200 and age-matched controls using the novel Manifold Contrast Vision Meter implementing quantitative CSF testing. Outcomes included area under the Log CSF (AULCSF), contrast acuity (CA), and CS thresholds at 1, 1.5, 3, 12, and 18 cycles per degree (cpd). A sub-analysis was performed on RVO eyes with good acuity (VA ≥ 20/30).

RESULTS

Twenty-two eyes with RVO and 63 control eyes were included. Mean AULCSF (± standard deviation) in RVO eyes was 0.817 (0.28) compared to 1.217 (0.28) in controls (P < .0001). Mean contrast acuity in the RVO group was 1.054 (0.19) versus 1.286 ± 0.16 in controls (P < .0001). For individual spatial frequencies, CS loss at 6.0 cpd was most prominent in the RVO group. In 10 RVO eyes with VA of 20/30 or greater, mean AULCSF was 0.978 versus 1.217 in control eyes. (P = .008).

CONCLUSIONS

CSF in eyes with RVO was found to be significantly reduced compared to age-matched controls. CSF seems to be a promising visual function endpoint with potential applications in clinical practice and future clinical trials. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:392-400.].

Investigation of the Relationship Between Subjective Symptoms of Visual Fatigue and Visual Functions

Purpose

To investigate whether the severity of symptoms of visual fatigue might be associated with clinical visual measures and basic visual functions, such as accommodation, vergence, and contrast sensitivity.

Methods

In this study, 104 students were recruited (25 males, 79 females, Age 23.4 ± 2.5) for this study. Those with high myopia, strabismus, anisometropia, eye disease or history of ophthalmological surgery were excluded. The included subjects completed a questionnaire that assesses the severity of visual fatigue. Then, binocular accommodative facility, vergence facility and contrast sensitivity using a quick contrast sensitivity function approach were measured in a random sequence. Next, the correlations between each symptom of visual fatigue in the questionnaire and accommodative facility, vergence facility and contrast sensitivity were examined.

Results

Factor analysis indicated that visual fatigue, as captured by the scores of a subset of the questionnaire items, could be strongly related to binocular accommodative facility and binocular contrast sensitivity, but not to vergence facility. We also found that binocular accommodative facility and contrast sensitivity at high spatial frequencies are related.

Conclusion

Our findings suggest that visual fatigue is related to the ability of human observers to encode visual details through their binocular vision.

Active Learning of Contrast Sensitivity to Assess Visual Function in Macula-off Retinal Detachment

PURPOSE

To characterize the contrast sensitivity function (CSF) in patients with successful repair of macula-off rhegmatogenous retinal detachment (RD) using an adaptive computerized contrast testing device.

METHODS

CSF was prospectively measured in macula-off RD patients following successful repair and age-matched controls at W. K. Kellogg Eye Center and Massachusetts Eye and Ear, employing the active learning device Manifold Contrast Vision Meter (Adaptive Sensory Technology, San Diego, CA). Outcome measures included average area under the CSF curve (AULCSF), CS thresholds at 1-18 cycles per degree (cpd) and best correctd visual acuity (BCVA) in RD eyes fellow eyes and controls. A sub-analysis was performed in eyes with BCVA of 20/30 or better.

RESULTS

Twenty-three macula-off RD eyes status post repair, fellow healthy eyes and 45 age-matched control eyes underwent CSF testing. The mean BCVA of the 23 RD eyes was 0.250 logMAR, significantly reduced compared to fellow eyes 0.032 (p<0.001) and controls 0.026 (p< 0.00001). There was a statistically significant reduction in AULCSF in RD eyes compared to the fellow eyes (p<0.0001) and to age-matched controls (Z-score -0.90, p<0.0001) and CSF reduction across all spatial frequencies. In the 15 RD eyes with BCVA of 20/30 or better, the mean CSF was significantly reduced compared to fellow eyes (p=0.0158) and controls (p=0.0453).

CONCLUSIONS

CSF in macula-off RD eyes following repair was significantly reduced compared to fellow eyes and age-matched controls. CSF seems to be a promising visual function endpoint with potential applications in the clinical practice and future clinical trials.

Effect of Initial Aflibercept, Laser, or Observation on Low-Contrast Visual Acuity in Eyes With Diabetic Macular Edema and Good Vision: Ancillary Study Within a Randomized Clinical Trial

Purpose

To describe 2.5% low-contrast visual acuity (VA) among eyes with good vision despite center-involved diabetic macular edema and compare changes after initial management with aflibercept, laser, or observation.

Methods

This was an ancillary study within a multicenter randomized clinical trial (DRCR Retina Network Protocol V). Participants had diabetes and 1 study eye with center-involved diabetic macular edema and a VA of 20/25 or better randomly assigned to aflibercept (n = 112), focal/grid laser (n = 146), or observation (n = 129). Eyes in the laser and observation groups received aflibercept if VA met prespecified worsening criteria.

Results

Participants had median age of 60 years, 37% were female and 70% were non-Hispanic White. At baseline, the mean ± standard deviation (SD) high-contrast VA was 85.2 ± 3.6 letters (Snellen equivalent 20/20), mean ± SD 2.5% low-contrast VA was 47.6 ± 18.9 letters (Snellen equivalent 20/125), and low-contrast VA letter score was 2 SDs or more below the age-specific normative values in 23%. At 2 years, the mean change ± SD in low-contrast VA in the aflibercept, laser, and observation groups was 2.7 ± 20.1, –2.0 ± 19.6, and –3.1 ± 20.8 letters (adjusted difference, aflibercept vs. laser, 5.3 [95% confidence interval, –0.2 to 10.8], P = 0.06; aflibercept vs. observation, 5.5 [95% confidence interval –0.2 to 11.2], P = 0.06; and laser vs. observation, 0.2 [95% confidence interval –4.6 to 5.0], P = 0.94).

Conclusions

There was no significant difference between treatment groups in low-contrast VA change from baseline to 2 years. Considering the range of the 95% confidence intervals, however, the study may have been underpowered to detect a clinically meaningful benefit between treatment groups.

Translational Relevance

Low-contrast VA, an important visual function, is decreased in eyes with diabetic macular edema.

Measuring the Contrast Sensitivity Function in Non-Neovascular and Neovascular Age-Related Macular Degeneration: The Quantitative Contrast Sensitivity Function Test

Age-related macular degeneration (AMD) affects various aspects of visual function compromising patients' functional vision and quality of life. Compared to visual acuity, contrast sensitivity correlates better with vision-related quality of life and subjectively perceived visual impairment. It may also be affected earlier in the course of AMD than visual acuity. However, lengthy testing times, coarse sampling and resolution, and poor test-retest reliability of the existing contrast testing methods have limited its widespread adoption into routine clinical practice. Using active learning principles, the qCSF can efficiently measure contrast sensitivity across multiple spatial frequencies with both high sensitivity in detecting subtle changes in visual function and robust test-retest reliability, emerging as a promising visual function endpoint in AMD both in clinical practice and future clinical trials.

Normal- and Low-Luminance Automated Quantitative Contrast Sensitivity Assessment in Eyes With Age-Related Macular Degeneration

PURPOSE

To assess the effectiveness of an active learning approach to measuring the contrast sensitivity function (CSF) in patients with various degrees of dry age-related macular degeneration (AMD) under multiple luminance conditions.

DESIGN

Cross-sectional study.

METHODS

Patients with AMD (26 intermediate AMD, 19 AMD with subretinal drusenoid deposits [SDD], 20 geographic atrophy [GA]) and 23 age-matched controls were tested with the Manifold Contrast Vision Meter (Adaptive Sensory Technology) and the qCSF algorithm, which applies active learning to estimate a model of the CSF's global shape. Testing was performed under conditions of standard and low luminance. For each AMD severity, the area under log CSF (AULCSF) and contrast sensitivities at individual spatial frequencies were calculated for analysis. Low-luminance deficits (LLDs) for visual acuity (VA) and AULCSF were calculated as the difference between standard and low luminance values.

RESULTS

Progressive decreases in AULCSF were observed as disease severity increased. For standard luminance, pairwise comparisons revealed significant differences between control/intermediate AMD (P < .0005), control/SDD (P < .0005), control/GA (P < .0005), and intermediate AMD/GA (P < .005). Similarly, for low luminance, pairwise comparisons revealed significant differences between the controls and each disease group (all P < .0005), in addition to significant differences between intermediate AMD/SDD (P < .005), and intermediate AMD/GA (P < .005). No correlations were found between LLD VA and LLD AULCSF in any AMD groups.

CONCLUSIONS

Contrast sensitivity measured via qCSF under both standard- and low-luminance conditions correlates with advancing stages of dry AMD. The interaction between luminance and contrast sensitivity appears to reflect a different aspect of visual function than the interaction between luminance and VA.

Sensitivity and Stability of Functional Vision Tests in Detecting Subtle Changes Under Multiple Simulated Conditions

Purpose

To explore whether subtle changes in visual quality can be detected using different measures of visual function against the quick contrast sensitivity function test (quick CSF).

Methods

Sixty participants, aged 17 to 34 years, were enrolled. Participants' vision was degraded by 0.25 D undercorrection (0.25 D), 60% neutral density filter brightness reduction (60% ND), and 0.8 Bangerter foil optical diffusion (0.8BAN). Visual function tests including visual acuity and contrast sensitivity (CSV-1000E and quick CSF) were measured with participant's best-corrected vision and under simulated visual degradation conditions. Test sensitivities in detecting differences were compared.

Results

Statistically significant visual acuity degradation was observed in the 0.8BAN condition only (Pcorrected < 0.001). With CSV-1000E and outliers removed, significant CS degradation was observed in all spatial frequencies, area under log CSF (AULCSF) in the 0.8BAN condition (Pcorrected < 0.001 for all), medium and high spatial frequencies and AULCSF in the 60%ND condition (Pcorrected,6cpd = 0.002, Pcorrected,12cpd = 0.005, Pcorrected,18cpd = 0.001, Pcorrected,AULCSF < 0.001) and the 0.25 D condition (Pcorrected,6cpd = 0.011, Pcorrected,12cpd = 0.013, Pcorrected,18cpd = 0.015, Pcorrected,AULCSF < 0.001). With the quick CSF, significant CS degradation was observed in all simulated visual conditions in all spatial frequencies, cutoff frequency and AULCSF (Pcorrected < 0.001 for all). Test-retest reliability of the quick CSF method was high; coefficient of repeatability ranged from 0.14 to 0.18 logCS.

Conclusions

Compared with visual acuity and chart-based CS tests, the quick CSF method provided more reliable and sensitive measures to detect small visual changes.

Translational Relevance

The quick CSF method can provide sensitive and reliable measures to monitor disease progression and assess treatment outcomes.

Quality of Vision Following LASIK and PRK-MMC for Treatment of Myopia

INTRODUCTION

Femtosecond-assisted thin flap, laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy with mitomycin-C (PRK-MMC) are the two most common refractive surgical procedures used to enhance visual capability in the U.S military. The purposes of the study were to examine effects on quality of vision following LASIK and PRK-MMC using a novel computer-based quick contrast sensitivity function (qCSF) test.

MATERIALS AND METHODS

This prospective clinical study included 58 active duty U.S. military service members who elected LASIK (n = 29) or PRK-MMC (n = 29) refractive surgery for myopia (nearsightedness) treatment. Monocular photopic and mesopic quality of vision of the right eyes in spectacle correction preoperatively and unaided right eyes at four postoperative follow-up visits (1 week, 2 weeks, 1 month, and 3 months) were examined using the qCSF device. Two qCSF parameters, area under a log CSF (AULCSF) between 1.5 and 18 cycles per degree, and CSF cutoff acuity (CSF Acuity), were collected using a 50-trial setting at a 4-m testing distance. General linear model (GLM) Repeated-measures Analysis of Covariance was used to examine effects on quality of vision following LASIK and PRK-MMC. Post hoc testing with Bonferroni correction was used for pairwise comparisons, and preoperative cylinder refraction was used as a covariate. Two-tailed independent t-test was used to compare preoperative and postoperative parameters between LASIK and PRK-MMC. Pearson's correlation, Bland-Altman plots, and multiple linear regression were used to examine the relationship among the qCSF and other vision tests.

RESULTS

Quality of vision, AULCSF, and CSF Acuity returned to the preoperative baseline at postoperative 2 weeks under mesopic condition and at postoperative 1 month under photopic condition after PRK-MMC. In comparison, photopic and mesopic quality of vision were not significantly different from the baseline at any of the four postoperative visits following LASIK. Changes of CSF Acuity from the baseline after LASIK were significantly better under photopic than mesopic condition by 0.067 ± 0.014 logarithm of the minimum angle of resolution (logMAR); P < .001). Quality of vision was not significantly different between the LASIK and PRK-MMC groups at postoperative 1 and 3 months. When predicting photopic AULCSF (overall model fit R2 = 0.47), 5% contrast acuity (beta = -0.43), visual acuity in 100% contrast (beta = -0.18), and residual refraction in spherical equivalent (beta = 0.20) were significant predictors (P ≤ .001), while high-order aberrations (beta = -0.07, P = .22) were not significant predictors. Visual acuity (beta = -0.12, P = .07) and high-order aberrations (beta = -0.04, P = .58) were not significant predictors of mesopic AULCSF. Bland-Altman plots show that photopic CSF Acuity and visual acuity had a mean difference of 0.19 ± 0.01 logMAR with limits of agreement (LOAs) at -0.01 and 0.39 logMAR. Photopic CSF Acuity and 5% contrast acuity had a mean difference of -0.06 ± 0.01 logMAR with LOAs at -0.33 and 0.21 logMAR.

CONCLUSION

Quality of vision recovers at postoperative 1 week after LASIK and at postoperative 1 month after PRK-MMC. The standard black-on-white high-contrast, chart-based visual acuity test is weak in predicting quality of vision. The qCSF detects mild-to-moderate visual changes and is suitable for quality of vision assessment following refractive eye surgery.

Functional reallocation of sensory processing resources caused by long-term neural adaptation to altered optics

The eye’s optics are a major determinant of visual perception. Elucidating how long-term exposure to optical defects affects visual processing is key to understanding the capacity for, and limits of, sensory plasticity. Here, we show evidence of functional reallocation of sensory processing resources following long-term exposure to poor optical quality. Using adaptive optics to bypass all optical defects, we assessed visual processing in neurotypically-developed adults with healthy eyes and with keratoconus – a corneal disease causing severe optical aberrations. Under fully-corrected optical conditions, keratoconus patients showed altered contrast sensitivity, with impaired sensitivity for fine spatial details and better-than-typical sensitivity for coarse spatial details. Both gains and losses in sensitivity were more pronounced in patients experiencing poorer optical quality in their daily life and mediated by changes in signal enhancement mechanisms. These findings show that adult neural processing adapts to better match the changes in sensory inputs caused by long-term exposure to altered optics.

Psychophysical Validation of a Novel Active Learning Approach for Measuring the Visual Acuity Behavioral Function

Purpose

To evaluate the performance of the quantitative visual acuity (qVA) method in measuring the visual acuity (VA) behavioral function.

Methods

We evaluated qVA performance in terms of the accuracy, precision, and efficiency of the estimated VA threshold and range in Monte Carlo simulations and a psychophysical experiment. We also compared the estimated VA threshold from the qVA method with that from the Electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) and Freiburg Visual Acuity Text (FrACT) methods. Four repeated measures with all three methods were conducted in four Bangerter foil conditions in 14 eyes.

Results

In both simulations and psychophysical experiment, the qVA method quantified the full acuity behavioral function with two psychometric parameters (VA threshold and VA range) with virtually no bias and with high precision and efficiency. There was a significant correlation between qVA estimates of VA threshold and range in the psychophysical experiment. In addition, qVA threshold estimates were highly correlated with those from the E-ETDRS and FrACT methods.

Conclusions

The qVA method can provide an accurate, precise, and efficient assessment of the full acuity behavioral function with both VA threshold and range.

Translational Relevance

The qVA method can accurately, precisely, and efficiently assess the full VA behavioral function. Further research will evaluate the potential value of these rich measures for both clinical research and patient care.

Effects of Intermediate-Tinted Lenses on Pistol Marksmanship and Visual Performance

INTRODUCTION

The standard issue clear or sun Military Combat Eye Protection (MCEP) is often inadequate in visually challenging training or combat environment. Intermediate-tinted lenses may offer a viable option for warfighters operating in dynamic visual conditions such as moving rapidly from bright sunny areas to darker building interiors in combat. Because the use of intermediate-tinted lenses has been delayed as a result of a potential negative impact on vision performance such as color perception, this investigation evaluated several commercially available intermediate-tinted lenses for operation performance during a U.S. military field training. Test lenses complied with all the requirements of the current MCEP except for the visible light transmittance (VLT) values that ranged between 32 and 62%.

MATERIALS AND METHODS

Study subjects consisted of 22 service members who attended a military Close Combat and Marksmanship training course in May 2019. Visual and pistol marksmanship performance of three intermediate-tinted lenses (Eye Safety Systems [ESS] Copper [32% VLT], Oakley Prizm TR45 [44% VLT], and ESS Bronze [62% VLT]) was compared to that of a standard issue MCEP, ESS Clear (90% VLT). Quick contrast sensitivity function test was used to assess quality vision (AULCSF, area under a log contrast sensitivity function) and visual acuity (CSF Acuity). Color vision was assessed by Cone Contrast Test. Pistol marksmanship (Bill Drill) was used for performance testing. A pre-survey inquired about MCEP use, and a MCEP survey during the pistol marksmanship testing inquired about lens performance and ranking.

RESULTS

AULCSF and CSF Acuity were significantly affected by the lenses (general linear model, repeated measures, P < .05). Bonferroni post hoc test showed a significant reduction of binocular AULCSF from ESS Clear to Oakley Prizm TR45 (P = .003) and ESS Copper (P < .001) and a significant reduction in binocular CSF Acuity from ESS Clear to ESS Copper (P = .001). Color vision and pistol marksmanship performance were not significantly affected by wearing different lenses (P > .05). Subjectively, there were no statistically significant differences among study lenses in perceived "clarity of vision," "ability to clearly identify the target," or "overall performance" (Friedman test and Wilcoxon signed-rank post hoc test with Bonferroni adjustment, P > .017). Participants ranked Prizm TR45 (44% VLT) and ESS Bronze (62% VLT) lenses significantly more favorably than EES Clear (P = .001 and P = .009).

CONCLUSIONS

Quality of vision and visual acuity decreased with darker lenses; however, the study lenses had insignificant impacts on pistol marksmanship and subjective acceptance. Our surveys indicated that Intermediate-tinted lenses were operationally acceptable and preferred over a standard issue MCEP. While more evaluations for color vision deficient subjects are needed, overall results suggest that commercially available intermediate-tinted lenses may be a viable option to enhance protection and performance in a visually dynamic combat environment.

ADOpy: a python package for adaptive design optimization

Experimental design is fundamental to research, but formal methods to identify good designs are lacking. Advances in Bayesian statistics and machine learning offer algorithm-based ways to identify good experimental designs. Adaptive design optimization (ADO; Cavagnaro, Myung, Pitt, & Kujala, 2010; Myung, Cavagnaro, & Pitt, 2013) is one such method. It works by maximizing the informativeness and efficiency of data collection, thereby improving inference. ADO is a general-purpose method for conducting adaptive experiments on the fly and can lead to rapid accumulation of information about the phenomenon of interest with the fewest number of trials. The nontrivial technical skills required to use ADO have been a barrier to its wider adoption. To increase its accessibility to experimentalists at large, we introduce an open-source Python package, ADOpy, that implements ADO for optimizing experimental design. The package, available on GitHub, is written using high-level modular-based commands such that users do not have to understand the computational details of the ADO algorithm. In this paper, we first provide a tutorial introduction to ADOpy and ADO itself, and then illustrate its use in three walk-through examples: psychometric function estimation, delay discounting, and risky choice. Simulation data are also provided to demonstrate how ADO designs compare with other designs (random, staircase).

A critical review: Psychophysical assessments of diabetic retinopathy

Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.

Can Psychophysics Be Fun? Exploring the Feasibility of a Gamified Contrast Sensitivity Function Measure in Amblyopic Children Aged 4-9 Years

Routine assessments of the Contrast Sensitivity Function [CSF] could be useful for the diagnosis and monitoring of amblyopia. However, current CSF measures are not clinically practical, as they are too slow, too boring, and too uncomfortable to sustain a young child's interest. Here we assess the feasibility of a more gamified approach to CSF testing, in which a maximum likelihood psychophysical algorithm (QUEST+) is combined with a largely unconstrained user interface (no fixation target, head restraints, or discrete trials). Twenty-five amblyopes (strabismic, anisometropic, or mixed) aged 4.0–9.2 years performed the gamified CSF assessment monocularly (once per eye). The test required the child to “pop” (press) grating stimuli as they “bounced” around a tablet screen. Head tracking via the tablet's front-facing camera was used to adjust for variations in viewing distance post hoc. CSFs were fitted for each eye, and Area Under the CSF (AUCSF) computed as a summary measure of sensitivity. The results showed that AUCSF measurements were able to separate moderately and severely amblyopic eyes from fellow eyes (case-control effect), and to distinguish individuals with varying degrees of vision loss (dose effect). Even the youngest children exhibited no difficulties completing the test or comprehending what to do, and most children appeared to find the test genuinely enjoyable. Informal feedback from a focus group of older children was also positive, although potential shortcomings with the present design were identified. This feasibility study indicates that gamified, child-friendly vision assessments have promise as a future means of pediatric clinical assessment. Such measures could be particularly valuable for assessing children outside of conventional eye-care facilities (e.g., home-monitoring, school screening).

Rapid, precise, and reliable measurement of delay discounting using a Bayesian learning algorithm

Machine learning has the potential to facilitate the development of computational methods that improve the measurement of cognitive and mental functioning. In three populations (college students, patients with a substance use disorder, and Amazon Mechanical Turk workers), we evaluated one such method, Bayesian adaptive design optimization (ADO), in the area of delay discounting by comparing its test-retest reliability, precision, and efficiency with that of a conventional staircase method. In all three populations tested, the results showed that ADO led to 0.95 or higher test-retest reliability of the discounting rate within 10-20 trials (under 1-2 min of testing), captured approximately 10% more variance in test-retest reliability, was 3-5 times more precise, and was 3-8 times more efficient than the staircase method. The ADO methodology provides efficient and precise protocols for measuring individual differences in delay discounting.

Relationship of Contrast Sensitivity Measured Using Quick Contrast Sensitivity Function With Other Visual Functions in a Low Vision Population

Purpose

Contrast sensitivity (CS) is predictive of various aspects of an individual's functional vision, such as recognizing faces and driving. Currently available CS charts are limited in terms of the spatial frequencies they can test and/or the contrast resolution of the targets they present. The traditional methods for measuring full CS functions (CSFs) are time consuming. The purpose of this study was to examine the feasibility of using the quick CSF method in a low vision population and to assess the relationships of CS with other visual functions, which can contribute to the understanding of the functional vision.

Methods

Static visual acuity, dynamic visual acuity, CS, global motion perception thresholds, and visual field were measured binocularly in 53 individuals with low vision. The number of participants who could complete each assessment was used to assess feasibility. The relationships between CS and other visual functions were assessed using linear regressions and multiple regressions.

Results

The quick CSF was quantifiable in 34 participants of the 42 with quantifiable visual acuities. The area under the log CSF-the summary statistic of CSF-was significantly correlated with static visual acuity and dynamic visual acuity (r = -0.79 and r = -0.63, respectively; P < 0.001).

Conclusions

The qCSF is capable of measuring CS in a wide range of visual impairment severities. area under the log CSF only correlates with measures of visual acuity.

The Temporal Window of Visual Processing in Aging

Purpose

Aging affects a variety of visual functions. In this study, we aim to quantitatively investigate the temporal characteristics of visual processing in aging.

Methods

Twelve younger (24.1 ± 1.6 years) and 12 older observers (58.4 ± 3.6 years) participated in the study. All participants had normal or corrected-to-normal vision. The contrast thresholds of the participants were measured using an orientation discrimination task with white external noise masks. The target-mask stimulus onset asynchronies were 16.7 ms, 33.4 ms, 50.0 ms, 83.4 ms, and ∞ (no external noise masks) in separate conditions. The signal stimulus was carefully chosen such that it was equally visible for the younger and older participants. An elaborated perceptual template model (ePTM) was fit to the data of each participant.

Results

Without masks, there was no difference in contrast thresholds between the younger and older groups (P = 0.707). With masks, contrast thresholds in the older group elevated more than those in the younger group, and the pattern of threshold elevation differed in the two groups. The ePTM fitted the data well, with the older observers having lower template gains than the younger observers (P = 3.58 × 10-6). A further analysis of the weight parameters of the temporal window revealed that the older observers had a flatter temporal window than the younger observers (P = 0.025).

Conclusions

Age-related temporal processing deficits were found in older observers with normal contrast sensitivity to the signal stimuli. The deficits were accounted for by the inferior temporal processing window of the visual system in aging.

Psychophysics with children: Evaluating the use of maximum likelihood estimators in children aged 4-15 years (QUEST+)

Maximum Likelihood (ML) estimators such as QUEST+ allow complex psychophysical measurements to be made more quickly and precisely than traditional staircase techniques. They could therefore be useful for quantifying sensory function in populations with limited attention spans, such as children. To test this, the present study empirically evaluated the performance of an ML estimator (QUEST+) versus a traditional Up-Down Weighted Staircase in children and adults. Seventy-one children (4.7-14.7 years) and 43 adults (18.1-29.6 years) completed a typical psychophysical procedure: Contrast Sensitivity Function (CSF) determination. Some participants were tested twice with the same method (QUEST+ or Staircase), allowing test-retest repeatability to be quantified. Others were tested once each with either method (QUEST+ and Staircase), allowing accuracy to be quantified. The results showed that QUEST+ was more efficient: In both children and adults, approximately half the number of ML trials were required to attain comparable levels of accuracy and reliability as a traditional Staircase paradigm, and plausible CSF estimates could be made in even the youngest children. The ML procedure was also as robust as the Staircase to lapses in concentration, and its performance did not depend on prespecifying correct model priors. The results show that ML estimators could greatly improve our ability to study sensory processes and detect impairments in children, although important practical considerations for-and-against their use are discussed.