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Yang J, Alshaikh E, Yu D, Kerwin T, Rundus C, Zhang F, Wrabel CG, Perry L, Lu ZL. Visual Function and Driving Performance Under Different Lighting Conditions in Older Drivers: Preliminary Results From an Observational Study. JMIR Form Res 2024; 8:e58465. [PMID: 38922681 PMCID: PMC11237778 DOI: 10.2196/58465] [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: 03/15/2024] [Revised: 05/04/2024] [Accepted: 05/04/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear. OBJECTIVE This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare. METHODS Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions. RESULTS Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=-0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=-0.24; P=.007), larger SDspeed (r=-0.19; P=.04), greater SDLP (r=-0.22; P=.007), and longer reaction times (r=-0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=-0.32; P<.001), greater SDLP (r=-0.26; P=.001) and longer reaction times (r=-0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions. CONCLUSIONS Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results.
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Affiliation(s)
- Jingzhen Yang
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States
| | - Enas Alshaikh
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Deyue Yu
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Thomas Kerwin
- Driving Simulation Laboratory, The Ohio State University, Columbus, OH, United States
| | - Christopher Rundus
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Fangda Zhang
- Center for Injury Research and Policy at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Cameron G Wrabel
- Driving Simulation Laboratory, The Ohio State University, Columbus, OH, United States
| | - Landon Perry
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, United States
- NYU-ECNU Institute of Brain and Cognitive Science at NYU Shanghai, Shanghai, China
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Zhao Y, Lesmes LA, Dorr M, Lu ZL. Collective endpoint of visual acuity and contrast sensitivity function from hierarchical Bayesian joint modeling. J Vis 2023; 23:13. [PMID: 37378989 DOI: 10.1167/jov.23.6.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
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.
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Affiliation(s)
- Yukai Zhao
- Center for Neural Science, New York University, New York, NY, USA
| | | | - Michael Dorr
- Adaptive Sensory Technology Inc., San Diego, CA, USA
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, USA
- NYU-ECNU Institute of Brain and Cognitive Neuroscience, Shanghai, China
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Liu X, Wang Y, Ying X, Zhang F, Huang J, Yu H, Wang Q, Zheng M, Hou F, Lesmes L, Lu ZL, Lu F, Mao X. Contrast Sensitivity Is Associated With Chorioretinal Thickness and Vascular Density of Eyes in Simple Early-Stage High Myopia. Front Med (Lausanne) 2022; 9:847817. [PMID: 35402440 PMCID: PMC8988058 DOI: 10.3389/fmed.2022.847817] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/01/2022] [Indexed: 12/18/2022] Open
Abstract
ObjectiveTo evaluate the contrast sensitivity function (CSF), chorioretinal thickness and vascular density as well as their relationships in subjects with simple early-stage high myopia.MethodsEighty-one young subjects were enrolled in this study. They were categorized into the simple high myopia group (sHM, n = 51) and the low-moderate myopia group (control group, n = 30). Monocular CSF under best correction was measured with the qCSF method. Retinal superficial and deep vascular density, inner and outer retinal thickness and choroidal thickness were measured using optical coherence tomography angiography.ResultsThe area under log CSF (AULCSF) and cutoff spatial frequency (Cutoff SF) of the sHM group were significantly reduced compared to those of the control group (P = 0.003 and P < 0.001, respectively). The parafoveal and perifoveal retinal thickness, deep vascular density and choroidal thickness were also significantly reduced in the sHM group (all P < 0.05). Multiple regression analysis revealed that AULCSF was significantly correlated with retinal deep vascular density, outer retinal thickness in the parafoveal and perifoveal areas (all P < 0.05).ConclusionCompared to low to moderate myopic eyes, patients with simple high myopia have thinner retinal and choroidal thickness, lower retinal vascular density, and reduced contrast sensitivity. Moreover, the CSF was correlated with the measures of chorioretinal structure and vasculature. The results suggest that the CSF is a sensitive functional endpoint in simple early-stage high myopia.
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Affiliation(s)
- Xinting Liu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yanli Wang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | | | - Fen Zhang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jing Huang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hang Yu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qian Wang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Miaoran Zheng
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fang Hou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Luis Lesmes
- Adaptive Sensory Technology, Inc., San Diego, CA, United States
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science, Department of Psychology, New York University, New York, NY, United States
- NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
- *Correspondence: Zhong-Lin Lu,
| | - Fan Lu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Fan Lu,
| | - Xinjie Mao
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Xinjie Mao,
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Zhao Y, Lesmes LA, Hou F, Lu ZL. Hierarchical Bayesian modeling of contrast sensitivity functions in a within-subject design. J Vis 2021; 21:9. [PMID: 34792537 PMCID: PMC8606820 DOI: 10.1167/jov.21.12.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Yukai Zhao
- Center for Neural Science, New York University, New York, NY, USA
| | | | - Fang Hou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, USA
- NYU-ECNU Institute of Brain and Cognitive Science, Shanghai, China
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Age norms for grating acuity and contrast sensitivity in children using eye tracking technology. Int Ophthalmol 2021; 42:747-756. [PMID: 34622374 DOI: 10.1007/s10792-021-02040-4] [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: 02/25/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
KEY MESSAGES Visual acuity is the most used method to assess visual function in children. Contrast sensitivity complements the information provided for visual acuity, but it is not commonly used in clinical practice. Digital devices are increasingly used as a method to evaluate visual function, due to multiple advantages. Testing with these devices can improve the evaluation of visual development in children from a few months of age. Visual acuity and contrast sensitivity tests, using eye tracking technology, are able to measure visual function in children across a wide range of ages, objectively, quickly and without need of an experienced examiner. PURPOSE To report age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking technology and to validate the grating acuity test. METHODS In the first project of the study, we examined healthy children aged between 6 months and 7 years with normal ophthalmological assessment. Grating visual acuity (VA) and contrast sensitivity (CS) were assessed using a preferential gaze paradigm with a DIVE (Device for an Integral Visual Examination) assisted with eye tracking technology to provide age norms. For the validation project, we compared LEA grating test (LGT) with DIVE VA in a group of children aged between 6 months and 4 years with normal and abnormal visual development. RESULTS Fifty-seven children (2.86 ± 1.55 years) were examined with DIVE VA test and 44 successfully completed DIVE CS test (3.06 ± 1.41 years). Both, VA and CS values increased with age, mainly along the first two years of life. Sixty-nine patients (1.34 ± 0.61 years) were included in the DIVE VA test validation. The mean difference between LGT and DIVE VA was - 1.05 ± 4.54 cpd with 95% limits of agreement (LoA) of - 9.95-7.84 cpd. Agreement between the two tests was higher in children younger than 1 year with a mean difference of - 0.19 ± 4.02 cpd. CONCLUSIONS DIVE is an automatic, objective and reliable tool to assess several visual function parameters in children, and it has good agreement with classical VA tests, especially for the first stage of life.
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Silverman RF, Kasetty M, Vingopoulos F, Katz R, Cho J, Lesmes LA, Zacks DN, Kim LA, Miller JB. Measuring Contrast Sensitivity Function With Active Learning in Retinal Vein Occlusion: A New Endpoint of Visual Function. Ophthalmic Surg Lasers Imaging Retina 2021; 51:392-400. [PMID: 32706897 DOI: 10.3928/23258160-20200702-04] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/04/2020] [Indexed: 11/20/2022]
Abstract
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.].
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Thomas M, Silverman RF, Vingopoulos F, Kasetty M, Yu G, Kim EL, Omari AA, Joltikov KA, Choi EY, Kim LA, Zacks DN, Miller JB. Active Learning of Contrast Sensitivity to Assess Visual Function in Macula-off Retinal Detachment. JOURNAL OF VITREORETINAL DISEASES 2021; 5:313-320. [PMID: 34458662 DOI: 10.1177/2474126420961957] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Merina Thomas
- Retina Division, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239
| | - Rebecca F Silverman
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
| | - Megan Kasetty
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
| | - Gina Yu
- Retina Division, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Esther L Kim
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
| | - Amro A Omari
- Retina Division, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Katherine A Joltikov
- Retina Division, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Eun Y Choi
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
| | - David N Zacks
- Retina Division, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA 02114
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Vingopoulos F, Wai KM, Katz R, Vavvas DG, Kim LA, Miller JB. Measuring the Contrast Sensitivity Function in Non-Neovascular and Neovascular Age-Related Macular Degeneration: The Quantitative Contrast Sensitivity Function Test. J Clin Med 2021; 10:2768. [PMID: 34202569 PMCID: PMC8268144 DOI: 10.3390/jcm10132768] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (F.V.); (R.K.)
| | - Karen M. Wai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (K.M.W.); (D.G.V.); (L.A.K.)
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (F.V.); (R.K.)
| | - Demetrios G. Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (K.M.W.); (D.G.V.); (L.A.K.)
| | - Leo A. Kim
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (K.M.W.); (D.G.V.); (L.A.K.)
| | - John B. Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (F.V.); (R.K.)
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (K.M.W.); (D.G.V.); (L.A.K.)
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Chen Z, Zhuang Y, Xu Z, Chan LYL, Zhang S, Ye Q, Feng L, Lu ZL, Li J. Sensitivity and Stability of Functional Vision Tests in Detecting Subtle Changes Under Multiple Simulated Conditions. Transl Vis Sci Technol 2021; 10:7. [PMID: 34100925 PMCID: PMC8196408 DOI: 10.1167/tvst.10.7.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/22/2021] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Zhipeng Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lily Y. L. Chan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Shenglan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhong-Lin Lu
- Division of Arts and Sciences, New York University Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, USA
- New York University–East China Normal University Institute of Brain and Cognitive Neuroscience, Shanghai, China
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Stalin A, Creese M, Dalton KN. Do Impairments in Visual Functions Affect Skiing Performance? Front Neurosci 2021; 15:648648. [PMID: 34054409 PMCID: PMC8155621 DOI: 10.3389/fnins.2021.648648] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023] Open
Abstract
Nordic and alpine skiing-related visual tasks such as identifying hill contours, slope characteristics, and snow conditions increase demands on contrast processing and other visual functions. Prospective observational studies were conducted to assess the relationships between skiing performance and a broad range of visual functions in nordic and alpine skiers with vision impairments. The study hypothesized that contrast sensitivity (CS), visual acuity (VA), and visual field (VF) would be predictive of skiing performance. Binocular static VA, CS, light sensitivity, glare sensitivity, glare recovery, dynamic VA, translational and radial motion perception, and VF were assessed in elite Para nordic (n = 26) and Para alpine (n = 15) skiers. Skiing performance was assessed based on skiers’ raw race times. Performance on the visual function tests was compared with skiing performances using Kendall’s correlations (with and without Bonferroni–Holm corrections) and linear multivariable regressions (p < 0.05 considered significant). None of the vision variables were significantly correlated with performance in Para nordic or Para alpine skiing after Bonferroni–Holm corrections were applied. Before applying the corrections, VF extent (ρ = -0.37, p = 0.011), and static VA (ρ = 0.26, p = 0.066) demonstrated the strongest correlations with Para nordic skiing performance; in Para alpine skiing, static VA and CS demonstrated the strongest correlations with downhill (static VA: ρ = 0.54, p = 0.046, CS: ρ = -0.50, p = 0.06), super G (static VA: ρ = 0.50, p = 0.007, CS: ρ = -0.51, p = 0.017), and giant slalom (static VA: ρ = 0.57, p = 0.01, CS: ρ = -0.46, p = 0.017) performance. Dynamic VA and VF were significantly associated with downhill (ρ = 0.593, p = 0.04) and slalom (ρ = -0.49, p = 0.013) performances, respectively. Static VA was a significant predictor of giant slalom [(F(3,11) = 24.71, p < 0.001), and R of 0.87], super G [(F(3,9) = 17.34, p = 0.002), and R of 0.85], and slalom [(F(3,11) = 11.8, p = 0.002), and R of 0.80] performance, but CS and VF were not. Interestingly, static VA and CS were highly correlated in both Para nordic (ρ = -0.60, p < 0.001) and Para alpine (ρ = -0.80, p < 0.001) skiers. Of the vision variables, only static VA and VF were associated with skiing performance and should be included as the in Para nordic and Para alpine classifications. The strong correlations between static VA and CS in these skiers with vision impairment may have masked relationships between CS and skiing performance.
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Affiliation(s)
- Amritha Stalin
- School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Marieke Creese
- School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
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11
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Has Silemek AC, Ranjeva J, Audoin B, Heesen C, Gold SM, Kühn S, Weygandt M, Stellmann J. Delayed access to conscious processing in multiple sclerosis: Reduced cortical activation and impaired structural connectivity. Hum Brain Mapp 2021; 42:3379-3395. [PMID: 33826184 PMCID: PMC8249884 DOI: 10.1002/hbm.25440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 01/24/2023] Open
Abstract
Although multiple sclerosis (MS) is frequently accompanied by visuo‐cognitive impairment, especially functional brain mechanisms underlying this impairment are still not well understood. Consequently, we used a functional MRI (fMRI) backward masking task to study visual information processing stratifying unconscious and conscious in MS. Specifically, 30 persons with MS (pwMS) and 34 healthy controls (HC) were shown target stimuli followed by a mask presented 8–150 ms later and had to compare the target to a reference stimulus. Retinal integrity (via optical coherence tomography), optic tract integrity (visual evoked potential; VEP) and whole brain structural connectivity (probabilistic tractography) were assessed as complementary structural brain integrity markers. On a psychophysical level, pwMS reached conscious access later than HC (50 vs. 16 ms, p < .001). The delay increased with disease duration (p < .001, β = .37) and disability (p < .001, β = .24), but did not correlate with conscious information processing speed (Symbol digit modality test, β = .07, p = .817). No association was found for VEP and retinal integrity markers. Moreover, pwMS were characterized by decreased brain activation during unconscious processing compared with HC. No group differences were found during conscious processing. Finally, a complementary structural brain integrity analysis showed that a reduced fractional anisotropy in corpus callosum and an impaired connection between right insula and primary visual areas was related to delayed conscious access in pwMS. Our study revealed slowed conscious access to visual stimulus material in MS and a complex pattern of functional and structural alterations coupled to unconscious processing of/delayed conscious access to visual stimulus material in MS.
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Affiliation(s)
- Arzu C. Has Silemek
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Jean‐Philippe Ranjeva
- Aix‐Marseille UniversityCNRS, CRMBMMarseille CedexFrance
- APHMHopital de la Timone, CEMEREMMarseilleFrance
| | - Bertrand Audoin
- Aix‐Marseille UniversityCNRS, CRMBMMarseille CedexFrance
- APHMHopital de la Timone, CEMEREMMarseilleFrance
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
- Klinik und Poliklinik für NeurologieUniversitätsklinikum Hamburg‐EppendorfHamburgGermany
| | - Stefan M. Gold
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
- Charité ‐ Universitätsmedizin Berlin, Freie Universität BerlinHumboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Klinik für Psychiatrie & Psychotherapie und Medizinische Klinik m.S. Psychosomatik, Campus Benjamin Franklin (CBF)BerlinGermany
| | - Simone Kühn
- Clinic for Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Lise Meitner Group for Environmental NeuroscienceMax Planck Institute for Human DevelopmentBerlinGermany
| | - Martin Weygandt
- Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research CenterBerlinGermany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research CenterBerlinGermany
| | - Jan‐Patrick Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS)Universitätsklinikum Hamburg‐Eppendorf (UKE)HamburgGermany
- Aix‐Marseille UniversityCNRS, CRMBMMarseille CedexFrance
- APHMHopital de la Timone, CEMEREMMarseilleFrance
- Klinik und Poliklinik für NeurologieUniversitätsklinikum Hamburg‐EppendorfHamburgGermany
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Rosenkranz SC, Kaulen B, Zimmermann HG, Bittner AK, Dorr M, Stellmann JP. Validation of Computer-Adaptive Contrast Sensitivity as a Tool to Assess Visual Impairment in Multiple Sclerosis Patients. Front Neurosci 2021; 15:591302. [PMID: 33708068 PMCID: PMC7940823 DOI: 10.3389/fnins.2021.591302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/02/2021] [Indexed: 12/22/2022] Open
Abstract
Background Impairment of visual function is one of the major symptoms of people with multiple sclerosis (pwMS). A multitude of disease effects including inflammation and neurodegeneration lead to structural impairment in the visual system. However, the gold standard of disability quantification, the expanded disability status scale (EDSS), relies on visual assessment charts. A more comprehensive assessment of visual function is the full contrast sensitivity function (CSF), but most tools are time consuming and not feasible in clinical routine. The quantitative CSF (qCSF) test is a computerized test to assess the full CSF. We have already shown a better correlation with visual quality of life (QoL) than for classical high and low contrast charts in multiple sclerosis (MS). Objective To study the precision, test duration, and repeatability of the qCSF in pwMS. In order to evaluate the discrimination ability, we compared the data of pwMS to healthy controls. Methods We recruited two independent cohorts of MS patients. Within the precision cohort (n = 54), we analyzed the benefit of running 50 instead of 25 qCSF trials. The repeatability cohort (n = 44) was assessed by high contrast vision charts and qCSF assessments twice and we computed repeatability metrics. For the discrimination ability we used the data from all pwMS without any previous optic neuritis and compared the area under the log CSF (AULCSF) to an age-matched healthy control data set. Results We identified 25 trials of the qCSF algorithm as a sufficient amount for a precise estimate of the CSF. The median test duration for one eye was 185 s (range 129–373 s). The AULCSF had better test–retest repeatability (Mean Average Precision, MAP) than visual acuity measured by standard high contrast visual acuity charts or CSF acuity measured with the qCSF (0.18 vs. 0.11 and 0.17, respectively). Even better repeatability (MAP = 0.19) was demonstrated by a CSF-derived feature that was inspired by low-contrast acuity charts, i.e., the highest spatial frequency at 25% contrast. When compared to healthy controls, the MS patients showed reduced CSF (average AULCSF 1.21 vs. 1.42, p < 0.01). Conclusion High precision, usability, repeatability, and discrimination support the qCSF as a tool to assess contrast vision in pwMS.
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Affiliation(s)
- Sina C Rosenkranz
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie, Hamburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Kaulen
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie, Hamburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ava K Bittner
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, United States.,Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Jan-Patrick Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie, Hamburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,APHM, Hôpital de la Timone, CEMEREM, Marseille, France.,Aix Marseille Université, CRMBM, CNRS UMR 7339, Marseille, France
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Zheng H, Wang C, Cui R, He X, Shen M, Lesmes LA, Lu ZL, Qu J, Hou F. Measuring the Contrast Sensitivity Function Using the qCSF Method With 10 Digits. Transl Vis Sci Technol 2018; 7:9. [PMID: 30479880 PMCID: PMC6238983 DOI: 10.1167/tvst.7.6.9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The Bayesian adaptive quick contrast sensitivity function (qCSF) method with a 10-letter identification task provides an efficient CSF assessment. However, large populations are unfamiliar with letters and cannot benefit from this test. To overcome the barrier, we conducted this study. METHOD A new font for digits (0∼9) was created. The digits were then filtered with a raised cosine filter, rescaled to different sizes to cover spatial frequencies from 0.5 to 16 cycles per degree (cpd), and used as stimuli in a 10-alternative forced choice (10AFC) digit identification task. With the 10AFC digit identification task, the CSFs of five young and five old observers were measured using the qCSF and Psi methods. The estimates from the latter served as reference. RESULTS The new digit font showed significantly improved similarity structure, Levene's test, F(1, 88) = 6.36, P = 0.014. With the 10-digit identification task, the CSFs obtained with the qCSF method matched well with those obtained with the Psi method (root mean square error [RMSE] = 0.053 log10 units). With approximately 30 trials, the precision of the qCSF method reached 0.1 log10 units. With approximately 75 trials, the precision of the CSFs obtained with the qCSF was comparable to that of the CSFs measured by the Psi method in 150 trials. CONCLUSIONS The qCSF with the 10 digit identification task is validated for both young and old observers. TRANSLATIONAL RELEVANCE The qCSF method with the 10-digit identification task provides an efficient and precise CSF test especially for people who are unfamiliar with letters.
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Affiliation(s)
- Haiyan Zheng
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenxiao Wang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rong Cui
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianghang He
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Menglu Shen
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Zhong-Lin Lu
- Center for Cognitive and Brain Sciences, Center for Cognitive and Behavioral Brain Imaging, and Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Jia Qu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang Hou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Dorr M, Elze T, Wang H, Lu ZL, Bex PJ, Lesmes LA. New Precision Metrics for Contrast Sensitivity Testing. IEEE J Biomed Health Inform 2018; 22:919-925. [PMID: 28650831 PMCID: PMC6706861 DOI: 10.1109/jbhi.2017.2708745] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Visual sensitivity is comprehensively described by the contrast sensitivity function (CSF), but current routine clinical care does not include its assessment because of the time-consuming need to estimate thresholds for a large number of spatial frequencies. The quick CSF method, however, dramatically reduces testing times by using a Bayesian information maximization rule. We evaluate the test-retest variability of a tablet-based quick CSF implementation in a study with 100 subjects who repeatedly assessed their vision with and without optical correction. We first discuss two commonly used measures of repeatability, intraclass correlation and the Bland-Altman Coefficient of Repeatability, and show that they are vulnerable to artifacts. Instead, we propose to formulate precision as an information retrieval task: from all repeat test scores, can we retrieve a certain individual based on their first test score? We then use rank-based analyses such as mean average precision as a better measure to compare different test metrics, and show that the highest test-retest precision is achieved using a summary statistic, the area under the log CSF (AULCSF). This demonstrates the benefit of assessment of the whole CSF compared to sensitivity at individual spatial frequencies only. AULCSF also yields best discrimination performance (99.2%) between measurements that were taken with and without glasses, respectively, even better than CSF Acuity. The tablet-based quick CSF thus enables the rapid and reliable home monitoring of visual function, which has the potential to improve early diagnosis and treatment of ophthalmic pathologies such as diabetic retinopathy or age-related macular degeneration.
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Dorr M, Wille M, Viulet T, Sanchez E, Bex PJ, Lu ZL, Lesmes L. Next-generation vision testing: the quick CSF. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2015. [DOI: 10.1515/cdbme-2015-0034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe Contrast Sensitivity Function relates the spatial frequency and contrast of a spatial pattern to its visibility and thus provides a fundamental description of visual function. However, the current clinical standard of care typically restricts assessment to visual acuity, i.e. the smallest stimulus size that can be resolved at full contrast; alternatively, tests of contrast sensitivity are typically restricted to assessment of the lowest visible contrast for a fixed letter size. This restriction to one-dimensional subspaces of a two-dimensional space was necessary when stimuli were printed on paper charts and simple scoring rules were applied manually. More recently, however, computerized testing and electronic screens have enabled more flexible stimulus displays and more complex test algorithms. For example, the quick CSF method uses a Bayesian adaptive procedure and an information maximization criterion to select only informative stimuli; testing times to precisely estimate the whole contrast sensitivity function are reduced to 2-5 minutes. Here, we describe the implementation of the quick CSF method in a medical device. We make several usability enhancements to make it suitable for use in clinical settings. A first usability study shows excellent results, with a mean System Usability Scale score of 86.5.
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Affiliation(s)
- Michael Dorr
- 1Adaptive Sensory Technology GmbH, Maria-Goeppert-Str. 1, 23562 Lübeck, Germany
| | - Manuel Wille
- 1Adaptive Sensory Technology GmbH, Maria-Goeppert-Str. 1, 23562 Lübeck, Germany
| | - Tiberiu Viulet
- 1Adaptive Sensory Technology GmbH, Maria-Goeppert-Str. 1, 23562 Lübeck, Germany
| | - Edward Sanchez
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
| | - Peter J Bex
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
| | - Zhong-Lin Lu
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
| | - Luis Lesmes
- 2Adaptive Sensory Technology, 225 Friend St, 02114 Boston, MA, USA
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