Beatriz Antona

Repeatability and agreement in the measurement of horizontal fusional vergences.

Purpose:  This study was designed to determine the repeatability of fusional vergence ranges measured using the rotary prisms in the phoropter and in free space using the prism bar. The level of agreement between the two methods was also investigated.

Bayesian model of Snellen visual acuity.

A Bayesian model of Snellen visual acuity (VA) has been developed that, as far as we know, is the first one that includes the three main stages of VA: (1) optical degradations, (2) neural image representation and contrast thresholding, and (3) character recognition. The retinal image of a Snellen test chart is obtained from experimental wave-aberration data. Then a subband image decomposition with a set of visual channels tuned to different spatial frequencies and orientations is applied to the retinal image, as in standard computational models of early cortical image representation. A neural threshold is applied to the contrast responses to include the effect of the neural contrast sensitivity. The resulting image representation is the base of a Bayesian pattern-recognition method robust to the presence of optical aberrations. The model is applied to images containing sets of letter optotypes at different scales, and the number of correct answers is obtained at each scale; the final output is the decimal Snellen VA. The model has no free parameters to adjust. The main input data are the eyes optical aberrations, and standard values are used for all other parameters, including the Stiles-Crawford effect, visual channels, and neural contrast threshold, when no subject specific values are available. When aberrations are large, Snellen VA involving pattern recognition differs from grating acuity, which is based on a simpler detection (or orientation-discrimination) task and hence is basically unaffected by phase distortions introduced by the optical transfer function. A preliminary test of the model in one subject produced close agreement between actual measurements and predicted VA values. Two examples are also included: (1) application of the method to the prediction of the VAin refractive-surgery patients and (2) simulation of the VA attainable by correcting ocular aberrations.

Normal Values for the Size of a Halo Produced by a Glare Source

PURPOSE To determine the size of a halo in the visual field induced by bright light in healthy eyes of all ages using the Vision Monitor (MonCv3; Metrovision, Pérenchies, France) and to assess the repeatability of the method. METHODS Measurements were made in the right eyes of 147 healthy subjects (mean age: 48.2 ± 16.2 years) who were classified into six age groups. Using the Vision Monitor, optotypes of low luminance were presented at a distance of 2.5 m. The visual angle subtended by the radius of the halo was calculated in minutes of arc (arc min). The repeatability of the method was determined in a subset of 37 subjects older than 50 years by calculating the Bland-Altman coefficient of repeatability. RESULTS The mean radius of the halo was 111.6 ± 39.8 arc min. Halo radius started to increase significantly from the age of 50 to 59 years. The relationship between halo radius and age (r = 0.65; P < .0001) was described by fitting a power function to the data. Halo size was independent of gender. The coefficient of repeatability of the method was ±44 arc min. CONCLUSIONS Halo size increases with age following a power model. The normal halo size values provided could help clinicians distinguish between normal or abnormal glare problems. The intersession repeatability observed for halo size measurement indicates this method could be useful for assessing visual impairment caused by glare.

Comparing methods of determining addition in presbyopes

Background:  The use of plus lenses to compensate for the reduction in the range of accommodation associated with presbyopia, brings the near point of accommodation to a comfortable distance for near visual tasks. Our aim was to compare the tentative near addition determined using the most common procedures with the final addition prescribed in presbyopic patients.

The Computer-Vision Symptom Scale (CVSS17): development and initial validation.

PURPOSE To develop a questionnaire (in Spanish) to measure computer-related visual and ocular symptoms (CRVOS). METHODS A pilot questionnaire was created by consulting the literature, clinicians, and video display terminal (VDT) workers. The replies of 636 subjects completing the questionnaire were assessed using the Rasch model and conventional statistics to generate a new scale, designated the Computer-Vision Symptom Scale (CVSS17). Validity and reliability were determined by Rasch fit statistics, principal components analysis (PCA), person separation, differential item functioning (DIF), and item-person targeting. To assess construct validity, the CVSS17 was correlated with a Rasch-based visual discomfort scale (VDS) in 163 VDT workers, this group completed the CVSS17 twice in order to assess test-retest reliability (two-way single-measure intraclass correlation coefficient [ICC] and their 95% confidence intervals, and the coefficient of repeatability [COR]). RESULTS The CVSS17 contains 17 items exploring 15 different symptoms. These items showed good reliability and internal consistency (mean square infit and outfit 0.88-1.17, eigenvalue for the first residual PCA component 1.37, person separation 2.85, and no DIF). Pearsons correlation with VDS scores was 0.60 (P < 0.001). Intraclass correlation coefficient for test-retest reliability was 0.849 (95% confidence interval [CI], 0.800-0.887), and COR was 8.14. CONCLUSIONS The Rasch-based linear-scale CVSS17 emerged as a useful tool to quantify CRVOS in computer workers. : Spanish Abstract.

Intra‐examiner repeatability and agreement in accommodative response measurements

Purpose:  Clinical measurement of the accommodative response (AR) identifies the focusing plane of a subject with respect to the accommodative target. To establish whether a significant change in AR has occurred, it is important to determine the repeatability of this measurement. This study had two aims: First, to determine the intraexaminer repeatability of AR measurements using four clinical methods: Nott retinoscopy, monocular estimate method (MEM) retinoscopy, binocular crossed cylinder test (BCC) and near autorefractometry. Second, to study the level of agreement between AR measurements obtained with the different methods.

Intraexaminer repeatability and agreement in stereoacuity measurements made in young adults

AIM To determine the repeatability and agreement of stereoacuity measurements made using some of the most widely used clinical tests: Frisby, TNO, Randot and Titmus. METHODS Stereoacuity was measured in two different sessions separated by a time interval of at least 24h but no longer than 1wk in 74 subjects of mean age 20.6y using the four methods. The study participants were divided into two groups: subjects with normal binocular vision and subjects with abnormal binocular vision. RESULTS Best repeatability was shown by the Frisby and Titmus [coefficient of repeatability (COR): ±13 and ±12s arc respectively] in the subjects with normal binocular vision though a clear ceiling effect was noted. In the subjects with abnormal binocular vision, best repeatability was shown by the Frisby (COR: ±69s arc) and Randot (COR: ±72s arc). In both groups, the TNO test showed poorest agreement with the other tests. CONCLUSION The repeatability of stereoacuity measures was low in subjects with poor binocular vision yet fairly good in subjects with normal binocular vision with the exception of the TNO test. The reduced agreement detected between the tests indicates they cannot be used interchangeably.

Repeatability of the Modified Thorington Card Used to Measure Far Heterophoria

Purpose To determine the interexaminer and intraexaminer repeatability of the modified Thorington test (TH) for distance vision in young adults and to compare these results with those observed for the heterophoria tests most commonly used in clinical practice. Agreement among tests was also assessed. Methods Distance heterophoria was quantified on two separate occasions by two examiners in 110 subjects aged 18 to 32 years (mean, 19.74 years; SD, 2.5 years) using four different tests: cover test (CT) Von Graefe, Maddox rod, and modified TH. The repeatability of the tests and agreement between them was estimated by the Bland and Altman method whereby the mean difference and the 95% limits of agreement were determined as the coefficient of repeatability (COR) and coefficient of agreement. Results The Thorington test showed best interexaminer repeatability (COR = ±1.43&Dgr;), followed closely by CT (COR = ±1.65&Dgr;), whereas best intraexaminer repeatability was observed for CT (COR = ±1.28&Dgr;) followed by TH (COR = ±1.51&Dgr;). Among the different combinations of tests, TH and CT showed best agreement indicated by the lowest coefficient of agreement (±2.23&Dgr;) and a low mean difference (−0.63&Dgr;) between measurements. Conclusions Good interexaminer and intraexaminer repeatability was observed for both TH and CT, and agreement between the two tests was also good. Given the simple administration of the TH, we recommend its clinical use to quantify distance horizontal heterophoria.

Relationship between halo size and forward light scatter

Purpose To determine the relationship between the size of a halo induced by a glare source and forward scatter or visual acuity (VA) in healthy eyes. Method Measurements were made in the right eyes of 51 healthy individuals of mean age 29.3±7.5 years. Halo radius was measured using the Vision Monitor and low luminance (1 cd/m2) optotypes presented at a distance of 2.5 m. The visual angle subtended by the radius of the halo was calculated in minutes of arc (arc min). Forward scatter or, straylight, was measured using the compensation comparison technique. Best-corrected distance VA was measured using high contrast (HC) (96%) and low contrast (LC) (10%) Bailey-Lovie logMAR letter charts under photopic (85 cd/m2) and mesopic (0.15 cd/m2) luminance conditions. Results Mean halo radius was 202±43 arc min (3.4±0.7°) and mean retinal straylight was 0.95±0.12 log units. Mean photopic distance HC-VA and LC-VA were −0.02±0.06 and 0.12±0.09 logMAR, respectively. Mean mesopic distance HC-VA and LC-VA were 0.35±0.11 and 0.74±0.11 logMAR, respectively. Forward stepwise regression analysis revealed that halo radius was significantly correlated with straylight (r=0.45) and mesopic LC-VA (r=0.48), but not with photopic HC-VA and/or LC-VA and mesopic HC-VA. Conclusions In healthy eyes, the larger the halo size induced by a given glare source, the greater the forward-scatter (straylight) and worse the mesopic LC-VA. Halo size seems to be independent of photopic HC-VA or LC-VA and mesopic HC-VA.

The validity and repeatability of the New Aniseikonia Test.

Purpose. Aniseikonia has been traditionally measured using the New Aniseikonia Test (NAT) based on red/green anaglyphs. This study was designed to establish whether the NAT is a valid and reliable test. Methods. The NAT was tested on three groups of subjects: a control group (n = 45) and two groups of participants at risk of experiencing aniseikonia, those with anisometropia greater than or equal to 1.00 D (n = 29) and those with bilateral pseudophakia (n = 26). The validity of the test was established by comparing the measured aniseikonia with that simulated with size lenses in a double-blind study. Repeatability was evaluated by comparing the results obtained at two different time points. Results. Our results indicate that the NAT underestimates aniseikonia and more so in the horizontal than in the vertical direction. Repeatability was poor, although biases were clinically insignificant. However, the 95% limits of agreement were around ±2%. The behavior of the test was similar in the three groups of subjects. Conclusions. We conclude that the repeatability of the NAT is not very high and recommend that clinicians be cautious when interpreting the results of this test.