Psychophysics, reliability, and norm values for temporal contrast sensitivity implemented on the two alternative forced choice C-Quant device

Age-related change in flicker thresholds with rod- and cone-enhanced stimuli

PURPOSE

Rod and cone photoreceptor-specific tests can be time-consuming. A new non-invasive test is described. The test is based on the measurement of flicker modulation thresholds with rod- and cone-enhanced visual stimuli, which requires only minimum adaptation time. Here, we investigated how the rod-and cone-mediated flicker thresholds vary with age.

METHODS

Monocular thresholds with rod and cone-enhanced stimuli were measured in 140 healthy adults, (age range: 18-75 years), foveally (0°) and at four parafoveal locations, at an eccentricity of 5° in each of the four quadrants using five, adaptive, interleaved staircases. Temporal frequencies, stimulus sizes, background luminance and spectral composition, were adjusted appropriately to achieve approximately 1 log unit separation in sensitivity between the rod- and cone-enhanced stimuli. Spectrally calibrated, 'neutral density' filters were used to enable adequate control of display luminance for rod enhanced stimuli.

RESULTS

The magnitude of central and parafoveal rod thresholds was significantly higher than the central and parafoveal cone thresholds, respectively (p < 0.001) in both the age groups. However, the rate of increase in central rod thresholds (y = 0.45x-12.79; linear regression equation) was not significantly steeper than the rate of increase in central (y = 0.29x-8.53) cone thresholds (p = 0.15). Centrally, cone thresholds showed a better correlation with rod central thresholds for the age > 45 years (Spearman correlation, ρ = 0.74, p < 0.001) compared to age ≤ 45 years (ρ = 0.41, p < 0.001).

CONCLUSIONS

Thresholds with rod- and cone-enhanced stimuli are largely invariant below 45 years of age and increase rapidly above this age. This age-wise normative database can be used as an effective functional-marker to assess photoreceptor sensitivities in retinal diseases.

Straylight as an Indicator for Cataract Extraction in Patients with Retinal Dystrophy

PURPOSE

Straylight reduces retinal sensitivity, which is particularly relevant in conditions with retinal dysfunction, such as retinitis pigmentosa (RP). Retinitis pigmentosa is associated with posterior subcapsular cataract (PSC), a cataract type that is known to cause severe disability glare (i.e., straylight). Study purposes were (1) to determine the severity of disability glare before and after cataract extraction (CE) in subjects with retinal dystrophy; (2) to study possible aggravation of disability glare due to the combination of retinal degradation and increased straylight from PSC; and (3) to evaluate whether straylight can be used to support the possible benefit of (early) CE.

DESIGN

Prospective, comparative study.

PARTICIPANTS

Sixteen patients (25 eyes) with retinal dystrophy scheduled for CE participated.

METHODS

Cataract severity was graded according to the Lens Opacities Classification System (LOCS) III. Preoperatively and postoperatively, corrected distance visual acuity (CDVA), spatial contrast sensitivity with the Pelli-Robson chart, and straylight were tested. Retinal function was assessed with Goldmann visual field and temporal contrast sensitivity (TCS). Temporal contrast sensitivity is a flicker test to evaluate central retinal sensitivity isolated from the eye's optical quality. Central retinal structure was assessed with spectral-domain OCT and fundus autofluorescence.

MAIN OUTCOME MEASURES

Preoperative and postoperative straylight were measured using the C-Quant (Oculus Optikgeräte GmbH, Wetzlar, Germany) and expressed as the logarithm of the straylight parameter s: log(s).

RESULTS

The average straylight value was 1.75 preoperatively and 1.45 postoperatively, 7.1 and 3.5 times higher than in a healthy young eye, respectively. Functionally significant improvement, defined as >0.20 log, was found in 72% of eyes for straylight and in 20% of eyes for CDVA. The CDVA and TCS were significantly correlated. Only straylight improvement was related to preoperative values; therefore, straylight was the only parameter that could be used to support postoperative improvement. In retinal dystrophy, eyes with cataract and a preoperative straylight value ≥1.66 log(s), a 50% chance of functionally significant log(s) improvement can be expected.

CONCLUSIONS

In patients with retinal dystrophy, straylight caused by cataract substantially aggravates visual disability, whereas CDVA is less affected. Therefore, straylight is a valuable (additional) indicator for beneficial CE in patients with retinal dystrophy and cataract.

Performance of a differential contrast sensitivity method to measure intraocular scattering

Increased intraocular scatter degrades quality of vision, especially in the presence of glare sources. Standard tests, such as visual acuity, are not well suited to capture this condition. There are specific methods to measure intraocular scatter, but require dedicated instruments. In this work, we propose a method to estimate the amount of scatter by combining to sequential measurements of the contrast sensitivity function for two conditions, with and without a glare source. We applied the approach in a group of young subjects with no know ocular pathology fitted with photographic diffusing filters. The straylight estimates were compared with those provided by two alternative techniques, one based on the compensation comparison method and the other the optical integration. The results obtained with the three approaches were in a good agreement, demonstrating the feasibility of the proposed method.

Influence of macular pigment optical density spatial distribution on intraocular scatter

PURPOSE

This study evaluated the summed measures of macular pigment optical density (MPOD) spatial distribution and their effects on intraocular scatter using a commercially available device (C-Quant, Oculus, USA).

METHODS

A customized heterochromatic flicker photometer (cHFP) device was used to measure MPOD spatial distribution across the central 16° using a 1° stimulus. MPOD was calculated as a discrete measure and summed measures across the central 1°, 3.3°, 10° and 16° diameters. Intraocular scatter was determined as a mean of 5 trials in which reliability and repeatability measures were met using the C-Quant. MPOD spatial distribution maps were constructed and the effects of both discrete and summed values on intraocular scatter were examined.

RESULTS

Spatial mapping identified mean values for discrete MPOD [0.32 (s.d.=0.08)], MPOD summed across central 1° [0.37 (s.d.=0.11)], MPOD summed across central 3.3° [0.85 (s.d.=0.20)], MPOD summed across central 10° [1.60 (s.d.=0.35)] and MPOD summed across central 16° [1.78 (s.d.=0.39)]. Mean intraocular scatter was 0.83 (s.d.=0.16) log units. While there were consistent trends for an inverse relationship between MPOD and scatter, these relationships were not statistically significant. Correlations between the highest and lowest quartiles of MPOD within the central 1° were near significance.

CONCLUSIONS

While there was an overall trend of decreased intraocular forward scatter with increased MPOD consistent with selective short wavelength visible light attenuation, neither discrete nor summed values of MPOD significantly influence intraocular scatter as measured by the C-Quant device.

Correlation of visual quality with satisfaction and function in a normal cohort of pseudophakic patients

PURPOSE

To select a normal post-cataract-surgery cohort, determine visual quality parameters, and compare these parameters with self-reported satisfaction and visual function.

SETTING

John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN

Retrospective cohort study.

METHODS

A cohort of pseudophakic patients was selected based on uneventful surgery, good corrected visual acuity (no worse than logMAR 0.02), and lack of ocular complaints or pathology including dry-eye syndrome or posterior capsule opacification. A single-piece high-refractive-index acrylic intraocular lens, age 50 or older, and at least 1 year out from surgery were other inclusion criteria. Testing included logMAR corrected distance visual acuity (CDVA), mesopic 10% contrast logMAR CDVA with and without glare, straylight determination, Rasch-modified National Eye Institute Visual Function questionnaire 11R (NEI VF-11R), custom pseudophakic dysphotopsia survey, and overall satisfaction question. Correlations were determined between these parameters.

RESULTS

Of the 2953 patients considered, 70 patients met all criteria, provided consent, and enrolled. Only pseudophakic dysphotopsia (r = -0.60; P<.0001) and the NEI VF-11R (r = -0.44; P<.0001) correlated with overall satisfaction. In addition, pseudophakic dysphotopsia correlated with the NEI VF-11R (r = 0.58; P<.0001).

CONCLUSIONS

When evaluating a highly controlled population with expected high satisfaction after cataract surgery, pseudophakic dysphotopsia was clearly the only significant dissatisfier. Furthermore, dysphotopsia highly correlated with the NEI VF-11R questionnaire; thus, symptoms of dysphotopsia are also seen to have functional significance. A shortened NEI VFQ survey and satisfaction correlated strongly with the full survey.