Testing Visual Function by Assessment of the Optomotor Reflex in Glaucoma.

Optomotor response/reflex (OMR) is a fast and efficient first-in-line visual screening method, especially for rodents. It has the potential to evaluate both the scotopic and photopic visions of nonrestrained animals through tracking head movement, providing a quantitative estimate of visual functions. In restrained animals, optokinetic response (OKR), compensatory eye movements for visual shifts in the surroundings, is utilized. Both OMR and OKR capitalize on an individual's innate reflex to stabilize images for the purpose of capturing clear vision. The two reflexes have similar reliability when evaluating stimulus luminance, contrast, spatial frequency, and velocity. They have emerged as powerful tools to evaluate the efficacy of pharmacological treatments and phenotypes of subjects undergoing study. With OMR and OKR accurately assessing visual acuity (VA) as well as contrast sensitivity (CS), the gold standards for measuring clinical vision, they provide reliable and easily accessible results that further eye and brain research. These methods of sight evaluation have been used in multiple animal models, particularly mice and zebrafish. Through OMR assays, these animal models have been utilized to investigate retinal degenerative diseases, helping researchers differentiate between worsening stages. Alongside tests such as optical coherence tomography (OCT), OMR provides confirmation of visual status, where increased OMR function often correlates with improved visual status. OMR has continued to be used outside of glaucoma in various retinal diseases, such as retinitis pigmentosa (RP), diabetic retinopathy, and age-related macular degeneration.In this chapter, we will introduce the concept and application of visual stimulus-induced head or eye reflex movement in different animal species and experimental models of eye diseases, such as glaucoma and other neurodegenerative disorders, and in patients with glaucoma.

The dichoptic contrast ordering test: A method for measuring the depth of binocular imbalance.

In binocular vision, the relative strength of the input from the two eyes can have significant functional impact. These inputs are typically balanced; however, in some conditions (e.g., amblyopia), one eye will dominate over the other. To quantify imbalances in binocular vision, we have developed the Dichoptic Contrast Ordering Test (DiCOT). Implemented on a tablet device, the program uses rankings of perceived contrast (of dichoptically presented stimuli) to find a scaling factor that balances the two eyes. We measured how physical interventions (applied to one eye) affect the DiCOT measurements, including neutral density (ND) filters, Bangerter filters, and optical blur introduced by a +3-diopter (D) lens. The DiCOT results were compared to those from the Dichoptic Letter Test (DLT). Both the DiCOT and the DLT showed excellent test-retest reliability; however, the magnitude of the imbalances introduced by the interventions was greater in the DLT. To find consistency between the methods, rescaling the DiCOT results from individual conditions gave good results. However, the adjustments required for the +3-D lens condition were quite different from those for the ND and Bangerter filters. Our results indicate that the DiCOT and DLT measures partially separate aspects of binocular imbalance. This supports the simultaneous use of both measures in future studies.

Development and Validation of a Novel Night-Time Hazard Visibility Test.

Purpose: Night-time driving is dangerous, with increased crash rates, particularly involving vulnerable road users. A Night-Time Hazard Visibility Test (NHVT) was developed and validated by exploring the effects of refractive and cataract blur on performance. Methods: The NHVT comprised video clips of night-time roads from the driver's perspective, including different hazards (pedestrians, cyclists, and vehicles). Participants responded when they first recognized hazards requiring them to take evasive action to avoid a collision. In experiment 1, there were 16 young visually normal drivers (mean age = 22.3, standard deviation [SD] = 2.2 years) who completed 2 NHVT sets, viewed separately through best-correction and refractive blur (+1.00 diopter sphere [DS]). In experiment 2, a refined version of the NHVT was administered to an additional 16 young visually normal drivers (mean age = 21.1, SD = 1.2 years) with best-correction and cataract blur. The order of visual conditions and NHVT sets were counterbalanced. Results: In experiment 1, refractive blur significantly reduced photopic visual acuity (VA) compared to best-corrected vision (+0.09 vs. -0.21 logMAR, P < 0.001) and delayed response times by 0.69 seconds (3.10 vs. 2.41 seconds, P < 0.001) compared to best-corrected vision. In experiment 2, cataract blur reduced VA compared to best-corrected vision (+0.03 vs. -0.17 logMAR, P < 0.001) and delayed response times by 0.63 seconds (2.92 vs. 2.29 seconds, P < 0.001). Conclusions: The NHVT was sensitive to refractive and cataract blur, providing preliminary support of its validity as a measure of night-time hazard visibility performance. Translational Relevance: The NHVT has potential as an off-road assessment of visibility for night driving and application for assessment of drivers with different refractive corrections and ocular diseases.

Estimating Visual Acuity Without a Visual Acuity Chart.

Purpose: This study explored whether visual acuity (VA) can be inferred from self-reported ability to recognize everyday objects using a set of yes/no questions. Methods: Participants answered 100 yes/no questions designed to assess their ability to recognize familiar objects at typical viewing distances, such as distinguishing between a full moon and a half moon on a clear night. The questions demanded VA ranging from normal to severe vision impairment. Responses were analyzed using item response theory, and the results were compared with participants' VA values. Results: We recruited 385 participants from 4 sites in the United States. Participants had a mean age of 56.7 years with VA ranging from -0.3 to 2.0 logarithm of the minimum angle of resolution (logMAR) (mean = 0.58). A strong relationship was observed between participants' estimated vision ability and their VA (r = -0.72). The linear relationship can be used to predict each participant's VA based on their estimated vision ability. The average signed and unsigned prediction errors were 0 and 0.24 logMAR, respectively, with a coefficient of repeatability of 0.59 logMAR between the estimated VA and measured VA. The same linear function was used to determine the VA limit required for each question. For instance, the VA limit for the moon question was 1.0 logMAR. Conclusions: Yes/no questions about everyday visual activities have the potential to estimate an individual's VA. Future refinements may enhance reliability. Translational Relevance: The survey provides insights into the real-world visual capabilities of people with low vision, making it potentially useful for telehealth applications.

Comparison of the accommodative amplitude measured with and without the use of a specialised accommodative rule in children.

OBJECTIVE: To determine the agreement between measurements of accommodative amplitude (AoA) in children using a specialised accommodative rule and measurments without it. METHODS: A total of 502 children underwent optometric examinations, including the measurement of visual acuity, objective and subjective refraction. AoA measurements were done with and without the Berens accommodative rule. The measurements of AoA were conducted monocularly using a -4 D lens. A fixation stick containing English letters equivalent to 20/30 visual acuity and a long millimetre ruler was used to measure AoA without the accommodative rule. This measurement was performed by the two trained examiners. The agreement between these methods was reported by 95% limits of agreement (LoA) and interclass correlation coefficient (ICC). RESULTS: The mean age of the participants was 11.7±1.3 years (range: 9-15 years) and 52.4% were male. The mean AoA with and without the accommodative rule was 20.02±6.02 D and 22.46±6.32 D, respectively. The 95% LoA between the two methods was -12.5 to 7.5 D, and the ICC was 0.67 (95% CI 0.63 to 0.70). The 95% LoA was narrower in higher age groups and males compared with females (18.92 vs 20.87). The 95% LoA was narrower in hyperopes (16.83 D) compared with emmetropes (18.37 D) and myopes (18.27 D). The agreement was not constant and decreased in higher values of AoA. CONCLUSION: There is a poor and non-constant agreement between the measurements of the AoA with and without the accommodative rule. The mean AoA was 2.5 D lower with using the accommodative rule.

Automated visual acuity estimation by optokinetic nystagmus using a stepped sweep stimulus.

PURPOSE: To describe an automatic system for objective measurement of visual acuity (VA) using optokinetic nystagmus (OKN). This pilot study tested the system's sensitivity and specificity for detecting reduced VA in healthy adults by comparing VA-OKN to VA with an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart (VA-ETDRS). METHODS: Adult participants (age 30 ± 12 years) with either reduced VA (n = 11, VA-ETDRS > 0.20 logMAR) or normal VA (n = 12, VA-ETDRS ≤ 0.20 logMAR) completed monocular VA-OKN measurements in each eye. The VA-OKN stimulus was an array of drifting (5°/s) vanishing discs presented in descending/ascending size order (0.00-1.00 logMAR in 0.10 steps). The stimulus was stepped every 2 s, and 10 sweeps were shown per eye (five ascending and five descending). Eye-tracking data determined when OKN activity ceased (descending sweep) or began (ascending sweep), which was used to determine VA-OKN for each sweep. The estimates were averaged across sweeps to produce an automated VA-OKN. The automated sweeps were then provided in randomised order to a reviewer blinded to the VA-ETDRS findings who determined a final VA-OKN for an eye. RESULTS: A single randomly selected eye from each observer was used for analysis. The sensitivity and specificity of VA-OKN using the same 0.20 logMAR threshold as VA-ETDRS was 100%. Comparisons between the VA-OKN and VA-ETDRS measures were made for participants in the reduced VA group. There was no significant difference between VA-OKN and VA-ETDRS (p = 0.55) and the two measures produced comparable values (r2 = 0.84, 95% limits of agreement = 0.19 logMAR, intra-class correlation coefficient = 0.90 [95% CI:0.68-0.97]). CONCLUSIONS: Visual acuity using optokinetic nystagmus correctly identified a VA deficit in adults and for those with a VA deficit, VA-OKN was strongly correlated with the gold-standard clinical measure of VA. OKN is a promising method which has the potential for use in cognitively impaired adults and pre-verbal children.

[On the issue of diagnostic accuracy of methods for analyzing the parameters of regular astigmatism]. / K voprosu o diagnosticheskoi tochnosti metodov indikatsii pokazatelei regulyarnogo astigmatizma.

Accurate measurement of astigmatism parameters is the basis for prescribing modern means of optical correction. In recent years, another direction for correcting astigmatism has emerged - implantation of toric intraocular lenses (TIOL). PURPOSE: This study evaluates the diagnostic accuracy of various methods for measuring the parameters of regular astigmatism. MATERIAL AND METHODS: The study included 83 patients (122 eyes) with regular astigmatism exceeding 1.0 D. Three groups were formed depending on the type of astigmatism. Spherical and cylindrical (power and axis) components of refraction were determined using automatic refractometry. The results were refined with subjective tests: power and axis tests with a cross-cylinder. The criterion for diagnostic accuracy was the level of corrected visual acuity. To assess the impact of cylinder position on visual acuity, discrete deviations of the axis of trial astigmatic lenses from the correct position (determined based on subjective tests) were modeled at 5, 10, and 15 degrees in both clockwise and counterclockwise directions. RESULTS: In the overall sample of observations, coincidence of results was found only in one-third of cases, with a tendency for discrepancies in data between the two methods in nearly 70% of cases. Statistical processing revealed significant differences only in the magnitude of the cylinder in the group with against-the-rule astigmatism (p<0.0005). An increase in maximum visual acuity corrected based on subjective test data was noted. With a deviation of the cylinder axis from the correct position by 10-15 degrees, regardless of the type of astigmatism, a significant tendency for a decrease in visual acuity was identified. At the same time, with a deviation of the cylinder axis within 5 degrees, a significant decrease in visual acuity was noted only in with-the-rule astigmatism and counterclockwise deviation. CONCLUSION: To achieve maximum visual acuity in the correction of regular astigmatism, objective method data must be refined with subjective tests. The results of modeling the deviation of the axis of the corrective lens from the proper position can be considered when evaluating the functional outcomes of TIOL implantation.

A new, adaptive, self-administered, and generalizable method used to measure visual acuity.

SIGNIFICANCE: Angular Indication Measurement (AIM) is an adaptive, self-administered, and generalizable orientation-judgment method designed to interrogate visual functions. We introduce AIM Visual Acuity (VA) and show its features and outcome measures. Angular Indication Measurement VA's ability to detect defocus was comparable with that of an Early Treatment of Diabetic Retinopathy Study (ETDRS) letter chart and showed greater sensitivity to astigmatic blur. PURPOSE: This proof-of-concept study introduces Angular Indication Measurement and applies it to VA. METHODS: First, we compared the ability of AIM-VA and ETDRS to detect defocus and astigmatic blur in 22 normally sighted adults. Spherical and cylindrical lenses in the dominant eye induced blur. Second, we compared repeatability over two tests of AIM-VA and ETDRS. RESULTS: A repeated-measure analysis of variance showed a main effect for defocus blur and test. For the astigmatism experiment, an interaction between blur and orientation was found. Pairwise comparisons showed that AIM was more sensitive to astigmatic-induced VA loss than ETDRS. Bland-Altman plots showed small bias and no systematic learning effect for either test type and improved repeatability with more than two adaptive steps for AIM-VA. CONCLUSIONS: Angular Indication Measurement VA's ability to detect defocus was comparable with that of an ETDRS letter chart and showed greater sensitivity to induced astigmatic blur, and AIM-VA's repeatability is comparable with ETDRS when using two or more adaptive steps. Angular Indication Measurement's self-administered orientation judgment approach is generalizable to interrogate other visual functions, e.g., contrast, color, motion, and stereovision.

Assessing the impact of glazing and window shade systems on view clarity.

Windows provide access to daylight and outdoor views, influencing building design. Various glazing and window shade materials are used to mitigate glare, overheating and privacy issues, and they affect view clarity. Among them, we evaluated the effect of window films, electrochromic (EC) glass, and fabric shades on view clarity. We conducted an experiment with 50 participants using visual tests adapted from clinical vision tests (visual acuity, contrast sensitivity, color sensitivity) and images displayed on a computer monitor in a controlled laboratory. Window films and EC glass tints outperformed fabric shades in visual acuity, contrast sensitivity and view satisfaction with the exception of the darkest EC tint state and dark grey VLT 3% shade for color sensitivity and view satisfaction. The EC tints pose internal reflection issues and fabric shades are preferred for visual privacy. Window films and EC glass hinder participants' blue-green color discrimination while fabric shades also decrease red-yellow color discrimination. Visual acuity predicts view satisfaction and contrast sensitivity is the strongest predictor for visual privacy. Generally, higher visible light transmittance and lower solar reflectance (darker color) enhance human visual performance. The proposed workflow provides an experimental procedure, identifies the primary variables and establishes a predictive framework for assessing view clarity of fenestration.

Evaluating a web-based visual acuity and refractive error self-assessment tool in myopic children.

INTRODUCTION: Demands for myopia management are rising. A web-based tool that allows home-performed self-assessments of visual acuity (VA) and refractive error may enable hybrid care pathways and aid in identifying those with deteriorating visual performance. The tool has been validated in adult populations, but has yet to be evaluated in children. This study compared home-performed VA and refraction self-assessments to conventional measurements obtained at the clinic in a population of myopic children. METHODS: Myopic children aged ≥6 years old were invited to perform web-based eye tests at home, assisted by a parent. At two myopia control clinics, they also underwent measurements of VA using a Snellen chart and refractive error using cycloplegic autorefraction. Agreement between the tests, repeatability of the web-based test and associations between clinical characteristics and web-based test accuracy were evaluated. RESULTS: A total of 147 children were enrolled, of whom 116 (51% male; mean age 13 ± 3 years; mean spherical equivalent refraction (SEQ) -5.58 ± 3.05) performed the web-based tests at home. Overall, the home-performed VA self-assessment and the Snellen chart assessment at the clinic agreed well (mean difference 0.03 ± 0.11 logMAR). A significant proportional bias was identified (ß 0.65, p < 0.001), indicating underestimated web-based VA scores when the child's vision declined. The sensitivity to detect VA poorer than 0.10 logMAR was 94%; the specificity was 71%. The web-based refractive error algorithm measured more myopia progression compared to clinic observations (mean difference SEQ 0.40 ± 0.51 dioptres). Age, sex or use of atropine drops were not significantly associated with test accuracy. CONCLUSIONS: The web-based test for self-assessing vision, performed at home by children with assistance from their parents, yielded VA scores with a precision similar to Snellen chart testing conducted in a clinical setting. However, the web-based refractive error algorithm overestimated myopia progression and requires recalibration for this specific age group.

Development and validation of the Thai version of MNREAD acuity charts.

PURPOSE: To develop and validate MNREAD acuity charts in the Thai language (MNREAD-TH). METHODS: In total, 180 Thai sentences were generated using words specific to the primary 1-3 students. Each sentence contained 60 characters divided into three lines with even left and right margins and was evaluated by instructors in the education program in Thai. The selected 118 sentences were tested in 20 adults and 20 children by measuring reading time and recording the errors. Sentences with extremely high or low mean reading speeds were excluded. The remaining sentences were selected for contributing to the MNREAD-TH charts. For validation, the charts were tested in another 20 normal-sighted adult groups. RESULTS: In total, 118 sentences were tested on 20 adults (range: 23-58 years) and 20 primary school students (age: 8-9 years). The mean (SD) reading speeds in adult and children's groups were 134.09 (12.45) and 71.33 (10.77) words/min (wpm), respectively. After removing the sentences that deviated by ±1 SD from the mean reading speed, repeatedly had difficulty words, and had low subjective scoring, 60 matched sentences between the groups were selected to develop three versions of the MNREAD-TH chart. The intraclass correlation coefficients between charts were 0.85 for reading acuity, 0.94 for maximum reading speed, and 0.79 for critical print size. CONCLUSION: The MNREAD-TH charts can be reliably used for evaluating reading performance in Thai people for both children and adults with either normal sight or low vision. These charts are standardized and helpful in clinical trials involving reading.

Evaluation of the SpotChecks contrast sensitivity test in healthy adults.

PURPOSE: SpotChecks is a new contrast sensitivity (CS) test designed for self-monitoring of vision. This study assessed the test-retest repeatability of take-home SpotChecks, in-office SpotChecks and near Pelli-Robson charts in healthy adults. METHODS: One eye of 61 healthy adults with near visual acuity (VA) of 6/9 or better (age range 22-84, mean 49 [18] years) was tested during two office visits (mean 10 [8] days apart). Each visit included high-contrast VA, then 12 randomly ordered CS tests (6 different SpotChecks and 6 different Pelli-Robson) under the same lighting (luminance 110 cd/m2), all at near in the same eye with habitual correction. The same eye was self-tested with take-home SpotChecks once a day on 6 days between the office visits. SpotChecks was scored by the logCS at the highest line with ≥2 errors. Pelli-Robson was scored by [0.05 × number of letters read correctly - 0.15]. Repeatability of logCS was defined as 1.96 2 Sw, Sw representing within-subject standard deviation. Comparison for repeatability was performed with Bootstrap hypothesis test. RESULTS: SpotChecks and Pelli-Robson showed similar intra-session or inter-visit repeatability (p = 0.14-0.81). Inter-day repeatability for take-home SpotChecks was 0.18 logCS, the same as that from the first measurements of two office visits with SpotChecks or Pelli-Robson. Inter-visit repeatability improved to 0.15 by using the average of two repeated measurements for SpotChecks (p = 0.02) or three repeated measurements for Pelli-Robson (p = 0.04). Age showed a small effect on logCS (-0.015/decade, p = 0.02) for both SpotChecks and Pelli-Robson. Mean logCS was 0.05 lower in those ≥50 years (SpotChecks 1.84 [0.10] and Pelli-Robson 1.77 [0.10]) compared with those <50 years of age (SpotChecks 1.89 [0.07] and Pelli-Robson 1.83 [0.07]). CONCLUSIONS: SpotChecks showed good repeatability with take-home and in-office testing in healthy adults, making it a promising tool for monitoring disease progression at home.

Investigating the impact of asymmetric macular sensitivity on visual acuity chart reading in choroideremia.

INTRODUCTION: Degeneration in choroideremia, unlike typical centripetal photoreceptor degenerations, is centred temporal to the fovea. Once the fovea is affected, the nasal visual field (temporal retina) is relatively spared, and the preferred retinal locus shifts temporally. Therefore, when reading left to right, only the right eye reads into a scotoma. We investigate how this unique property affects the ability to read an eye chart. METHODS: Standard- and low-luminance visual acuity (VA) for right and left eyes were measured with the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. Letters in each line were labelled by column position. The numbers of letter errors for each position across the whole chart were summed to produce total column error scores for each participant. Macular sensitivity was assessed using microperimetry. Central sensitivity asymmetry was determined by the temporal-versus-nasal central macular difference and subsequently correlated to a weighted ETDRS column error score. Healthy volunteers and participants with X-linked retinitis pigmentosa GTPase regulator associated retinitis pigmentosa (RPGR-RP) were used as controls. RESULTS: Thirty-nine choroideremia participants (median age 44.9 years [IQR 35.7-53.5]), 23 RPGR-RP participants (median age 30.8 years [IQR 26.5-40.5]) and 35 healthy controls (median age 23.8 years [IQR 20.3-29.0]) were examined. In choroideremia, standard VA in the right eye showed significantly greater ETDRS column errors on the temporal side compared with the nasal side (p = 0.002). This significantly correlated with greater asymmetry in temporal-versus-nasal central macular sensitivity (p = 0.04). No significant patterns in ETDRS column errors or central macular sensitivity were seen in the choroideremia left eyes, nor in RPGR-RP and control eyes. CONCLUSION: Difficulty in tracking across lines during ETDRS VA testing may cause excess errors independent of true VA. VA assessment with single-letter optotype systems may be more suitable, particularly for patients with choroideremia, and potentially other retinal diseases with asymmetric central macular sensitivity or large central scotomas including geographic atrophy.

Combination of 2 test methods, single-picture optotype visual acuity chart and spot™ vision screener, in the eye health screening program for 3-year-old children in Tokyo: A retrospective, observational study.

To evaluate the usefulness of the Tokyo Metropolitan Government's Eye Health Screening Program for 3-year-old children, which combines the Single-Picture Optotype Visual Acuity Chart (SPVAC) and Spot™ Vision Screener (SVS) tests. This was a retrospective, observational, matched study. Patients who underwent the eye health screening program and had abnormalities were classified into 3 groups according to the outcomes of the SPVAC (SPVAC-passed, SPVAC-P; SPVAC-failed, SPVAC-F) and SVS (SVS-passed, SVS-P; SVS-failed, SVS-F) tests as follows: SPVAC-P/SVS-F, SPVAC-F/SVS-P, and SPVAC-F/SVS-F. We evaluated the age at examination, SPVAC and SVS test success rates, and SVS refractive power. Additionally, the rates of refractive error, amblyopia, and strabismus were compared among the 3 groups. The SPVAC-P/SVS-F, SPVAC-F/SVS-P, and SPVAC-F/SVS-F groups comprised 158, 28, and 74 eyes, respectively. The mean age was 37.4 months. The success rates of the SPVAC and SVS tests were 69.8% and 96.2%, respectively. The mean SVS hyperopia value in the SPVAC-F/SVS-F group (2.71 ±â€…1.50 D) was significantly higher than that of the SPVAC-P/SVS-F group. The mean SVS astigmatism and myopia values were -2.21 diopter (D) ±â€…1.09 D and -3.40 ±â€…1.82 D, respectively; they did not differ significantly from that of the SPVAC-P/SVS-F group. Significant differences were observed in the refractive error, amblyopia, and strabismus rates among the 3 groups. Regarding disease determination, no significant difference was observed among participants who passed and failed the SPVAC test, regardless of the outcome of the other test. However, a significant difference was observed between those passing and failing the SVS tests. The SPVAC method used to screen 3-year-old children should be modified to commence at 42 months of age or be replaced with a single Landolt C test. The SVS test is useful for screening younger patients. Furthermore, the SVS test showed that the degree of hyperopia was higher in patients who did not pass the SPVAC test.

Development and Validation of Performance-Based Assessment of Daily Living Tasks in Age-Related Macular Degeneration.

Purpose: To establish the reliability and validity of five performance-based activities of daily living task tests (ADLTT), to correlate structure to function, to evaluate the impact of visual impairment (VI) on age-related macular degeneration (AMD), and to develop new outcome measures. Methods: A multidisciplinary team developed five ADLTTs: (1) reading test (RT); (2) facial expression (FE) recognition; (3) item search (IS) task; (4) money counting (MC) task; and (5) making a drink (MD), tested with binocular and monocular vision. ADLTTs were tested for known-group (i.e., difference between AMD group and controls) and convergent (i.e., correlation to other measures of visual function), validity metrics, and test-retest reliability in 36 patients with VI (visual acuity (logMAR VA > 0.4) in at least one eye caused by AMD versus 36 healthy controls without VI. Results: Compared to controls, AMD patients had a slower reading speed (-77.41 words/min; P < 0.001); took longer to complete MC using monocular worse eye and binocular vision (15.13 seconds and 4.06 seconds longer compared to controls, respectively; P < 0.001); and MD using monocular worse eye vision (9.37 sec; P = 0.033), demonstrating known-group validity. Only RT and MC demonstrated convergent validity, showing correlations with VA, contrast sensitivity, and microperimetry testing. Moderate to good test-retest reliability was observed for MC and MD (interclass correlation coefficient = 0.55 and 0.77; P < 0.001) using monocular worse eye vision. Conclusions: Real-world ADL functioning associated with VI-related AMD can be assessed with our validated ADLTTs, particularly MC and MD. Translational Relevance: This study validates visual function outcome measures that are developed for use in future clinical practice and clinical trials.

Comparison of Foraging Interactive D-prime and Angular Indication Measurement Stereo with different methods to assess stereopsis.

PURPOSE: Stereopsis is a critical visual function, however clinical stereotests are time-consuming, coarse in resolution, suffer memorization artifacts, poor repeatability, and low agreement with other tests. Foraging Interactive D-prime (FInD) Stereo and Angular Indication Measurement (AIM) Stereo were designed to address these problems. Here, their performance was compared with 2-Alternative-Forced-Choice (2-AFC) paradigms (FInD Stereo only) and clinical tests (Titmus and Randot) in 40 normally-sighted and 5 binocularly impaired participants (FInD Stereo only). METHODS: During FInD tasks, participants indicated which cells in three 4*4 charts of bandpass-filtered targets (1,2,4,8c/° conditions) contained depth, compared with 2-AFC and clinical tests. During the AIM task, participants reported the orientation of depth-defined bars in three 4*4 charts. Stereoscopic disparity was adaptively changed after each chart. Inter-test agreement, repeatability and duration were compared. RESULTS: Test duration was significantly longer for 2-AFC (mean = 317s;79s per condition) than FInD (216s,18s per chart), AIM (179s, 60s per chart), Titmus (66s) or RanDot (97s). Estimates of stereoacuity differed across tests and were higher by a factor of 1.1 for AIM and 1.3 for FInD. No effect of stimulus spatial frequency was found. Agreement among tests was generally low (R2 = 0.001 to 0.24) and was highest between FInD and 2-AFC (R2 = 0.24;p<0.01). Stereoacuity deficits were detected by all tests in binocularly impaired participants. CONCLUSIONS: Agreement among all tests was low. FInD and AIM inter-test agreement was comparable with other methods. FInD Stereo detected stereo deficits and may only require one condition to identify these deficits. AIM and FInD are response-adaptive, self-administrable methods that can estimate stereoacuity reliably within one minute.

Evaluation of 3D tablet-based stereoacuity test ASTEROID in children with normal and abnormal visual acuity.

PURPOSE: To assess the utility of 3D, tablet-based, glasses-free Accurate STEReotest (ASTEROID) in children compared with the Titmus test. METHODS: Children aged 5-13 years were enrolled in a single-center, nonrandomized, observational comparison study and analyzed by age (5-7 vs 8-13 years) and visual acuity (20/25 or better in both eyes vs abnormal). Each participant underwent both the ASTEROID and Titmus stereoacuity tests. Stereoacuity was defined as fine (≤60 arcsec), moderate (61-200 arcsec), coarse (201-1199 arcsec), or very coarse to nil (≥1200 arcsec). Agreement between the tests was assessed using a weighted kappa (κ) statistic based on all four categories. RESULTS: A total of 112 children were included: 28 aged 5-7 with normal visual acuity, 30 aged 5-7 with abnormal visual acuity, 34 aged 8-13 with normal visual acuity, and 20 aged 8-13 with abnormal visual acuity. Mean ASTEROID score was 688 ± 533 arcsec (range, 13-1200 arcsec). Agreement between ASTEROID and Titmus test scores for participants overall was moderate (κ = 0.52). By subgroup, agreement was fair for children 5-7 with abnormal visual acuity (κ = 0.31), moderate for children 5-7 with normal visual acuity (κ = 0.47) and children 8-13 with normal visual acuity (κ = 0.42), and substantial for children 8-13 with abnormal visual acuity (κ = 0.76). Where ASTEROID and Titmus score group varied, ASTEROID score was poorer in 94% (47/50) of cases. CONCLUSIONS: ASTEROID is a digital, tablet-based test that evaluates global stereopsis, does not require glasses, and provides a continuum of scores. Among children, ASTEROID has good agreement with the Titmus test; however, it may be more sensitive at detecting stereovision deficits. Further study is necessary to determine which test is more accurate.

Integration of the expanded disability status scale with ambulation, visual and cognitive tests.

INTRODUCTION: The Expanded Disability Status Scale (EDSS) is usually calculated through a neurological examination with self-reported performance. This may lead to incorrect assessment of Functional System scores (FSs). Aim of our study was to estimate the difference between EDSS obtained during routine visits, or after specific tests. METHODS: We enrolled 670 MS patients that underwent a regular neurology consultation, and visual evaluation using optotype tables, ambulation evaluation with a rodometer, and cognitive assessment with the Brief International Cognitive assessment for MS (BICAMS). We calculated a new integrated EDSS (iEDSS) using the refined values of the FS and compared it to the standard EDSS. RESULTS: Visual, cerebral and ambulation FSs were significantly higher compared with the self-reported counterpart [+ 1.169 (95%CI 1.077, 1.262; p < 0.001), + 0.727 (95%CI 0.653, 0.801; p < 0.001) and + 0.822 (95%CI 0.705, 0.939; p < 0.001), respectively]. Mean iEDSS was higher than EDSS (+ 0.642; p < 0.001). Visual acuity tests worsened the EDSS in 31% of cases, cognitive tests in 10%, ambulation measurement in 35%, all three measurements in 59% of cases. CONCLUSIONS: Objective measurement of FSs results in a more accurate EDSS score in almost two-thirds of cases. This could lead to a more thorough evaluation of patients in the transition or progressive phase.

Scotopic and Photopic Conventional Visual Acuity and Hyperacuity - Binocular Summation.

Purpose: The purpose of this study was to determine and compare binocular summation (BiS) of conventional visual acuity (cVA) versus hyperacuity (hVA) for photopic and scotopic luminance conditions as a potential biomarker to assess the outcome of interventions on binocular function. Methods: Sixteen young adults (age range [years] = 21-31; 8 women; cVA logMAR < 0.0) participated in this study. The Freiburg Visual Acuity Test (FrACT) was used for VA testing and retested on another day. Both cVA and hVA were determined for dark grey optotypes on light grey background. Participants underwent 40 minutes of dark adaptation prior to scotopic VA testing. Binocular and monocular VA testing was performed. The eye with better VA over the 2 days of testing was selected, the BiS was quantified (binocular VA - better monocular VA) and repeated measures ANOVAs were performed. Results: Binocular VA exceeded monocular VA for all luminance conditions, VA-types, and sessions. We report BiS estimates for photopic and scotopic cVA and hVA, (logMAR BiS ± SEM [decimal BiS]): photopic = -0.01 ± 0.01 [1.03] and -0.06 ± 0.03 [1.15]; and scotopic = -0.05 ± 0.01 [1.12] and -0.11 ± 0.04 [1.28], respectively). Improvement for binocular vision estimates ranged from 0.01 to 0.11 logMAR. A repeated-measures ANOVA (RM ANOVA) did not reveal significant effects of LUMINANCE or VA TYPE on BiS, albeit a trend for strongest BiS for scotopic hVA (15% vs. 28%, photopic versus scotopic, respectively) and weakest for photopic cVA (3% vs. 12%, photopic versus scotopic conditions, respectively). Conclusions: Our results indicate that BiS of VA is relevant to scotopic and photopic hVA and cVA. It appears therefore a plausible candidate biomarker to assess the outcome of retinal therapies restoring rod or cone function on binocular vision. Translational Relevance: Binocular summation of visual acuity might serve as a clinical biomarker to monitor therapy outcome on binocular rod and cone-mediated vision.

Converting LEA to Pelli-Robson contrast sensitivity score in neuro-ophthalmology patients.

PURPOSE: The Pelli-Robson and LEA contrast sensitivity charts are commonly used in clinical settings to measure contrast sensitivity. Although the Pelli-Robson chart is considered the gold standard, it is limited by its bulky size. The LEA chart, on the contrary, offers a more practical and portable option that is still reliable. This has led to questions about whether we can predict Pelli-Robson scores based on LEA scores. This study developed a conversion method to help transition from the LEA chart to the Pelli-Robson chart and validate the conversion score. METHODS: In this retrospective study, we analyzed the relationship between LEA and the Pelli-Robson contrast sensitivity test. Our study examined a total of 120 eyes. We developed a conversion table through the equipercentile equating method. Subsequently, we assessed the reliability and accuracy of this algorithm for converting LEA results into Pelli-Robson contrast sensitivity scores. RESULTS: The study used a conversion table to convert LEA scores to Pelli-Robson scores. The conversion table achieved a reliability of 0.91 based on intraclass correlation, and the algorithm had an accuracy of 81.6% within a 1-point difference from the raw score. CONCLUSIONS: This study reported a reliable and comparable conversion algorithm for transforming LEA scores into converted estimated Pelli-Robson scores, thereby improving the usefulness of existing data in both clinical and research contexts.