Eye (2017) 31, 753–761 © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/17 www.nature.com/eye 1 2 3 4 SPARCS and Pelli– L Gupta , V Cvintal , R Delvadia , Y Sun , CLINICAL STUDY E Erdem5, C Zangalli6,LLu7, SS Wizov8, Robson contrast J Richman8, E Spaeth9 and GL Spaeth8 sensitivity testing in normal controls and patients with cataract Abstract Purpose To determine the ability of the newly Introduction 1George Washington University developed internet-based Spaeth/Richman Visual acuity (VA) is commonly used to evaluate School of Medicine, Contrast Sensitivity (SPARCS) test to assess Washington, DC, USA vision. Subjects with cataracts, however, may contrast sensitivity centrally and peripherally in have good VA even though they report poor 2Instituto de Oftalmologia cataract subjects and controls, in comparison vision.1,2 To more thoroughly assess vision in Tadeu Cvintal, Sao Paulo, Brazil with the Pelli–Robson (PR) test. cataract subjects, VA can be supplemented with 3 Methods In this prospective cross-sectional Department of a test of contrast sensitivity (CS), the threshold to Anesthesiology, George study, cataract subjects and age-matched normal Washington University Hospital, distinguish an object from its background.3 CS controls were evaluated using the SPARCS and Washington, DC, USA influences numerous aspects of people’s vision, PR tests. Contrast sensitivity testing was 4 including VA, visual field, motion detection, Department of performedineacheyetwiceinastandardized Ophthalmology, The Third testing environment in randomized order. dark adaptation, and pattern recognition. CS is People’s Hospital of Chengdu, ’ Sichuan, China SPARCS scores were obtained for central, right also a useful assessment of people s functional vision,4 and decreased CS has been found to be upper (RUQ), right lower (RLQ), left upper 5Faculty of Medicine, Department (LUQ), and left lower quadrants (LLQ). PR responsible for the symptoms of poor vision in of Ophthalmology, University of 2 Cukurova,Adana,Turkey scores were obtained for central contrast people with cataracts. Decreased CS may ’ fi sensitivity. PR and SPARCS scores in cataract hinder people s ability to discriminate traf c 6Department of Ophthalmology, subjects were compared with controls. signs and faces and perform tasks such as State University of Campinas, Sao Paulo, Brazil Intraclass correlation coefficients (ICC) and walking, going up and down stairs, dialing a 5–7 BlandAltmananalysiswereusedtodetermine telephone, reading and driving. In fact, CS is 7Department of Ophthalmology, test–retest reliability and correlation. better than VA in predicting many aspects of Fujian Medical University Union 7,8 Hospital, Fuzhou, Fujian, China Results A total of 162 eyes from 84 subjects functional vision. – 8 were analyzed: 43 eyes from 23 cataract The Pelli Robson (PR) test is a well- Glaucoma Research Center, established, commonly used CS test. It is a chart Wills Eye Hospital, Philadelphia, subjects, and 119 eyes from 61 controls. The PA, USA mean scores for SPARCS centrally were 13.4 showing letters of constant size but decreasing 9 and 14.5 in the cataract and control groups, contrast. It is readily available, inexpensive, Independent Researcher, Philadelphia, PA, USA respectively (P = 0.001). PR mean scores were quick, consistent, and easy to administer; it 3 1.31 and 1.45 in cataract and control groups, evaluates CS centrally. It requires recognition of Correspondence: Po – letters using pattern recognition and cognition, L Gupta, Glaucoma Research respectively ( 0.001). ICC values for test Center Wills Eye Hospital, 840 fl retest reliability for cataract subjects were 0.75 so its results may be in uenced by the Walnut Street, for PR and 0.61 for the SPARCS total. There intelligence and literacy level of the subjects Suite 1140, Philadelphia, PA 19107, USA was acceptable agreement between the ability tested. Tel/Fax: +1 (215) 928-3285. of PR and SPARCS to detect the effect of The Spaeth/Richman Contrast Sensitivity E-mail: [email protected] cataract on central contrast sensitivity. (SPARCS) test is a CS test that can be performed Received: 5 June 2016 Conclusions Both SPARCS and PR on a computer with access to the Internet. It Accepted in revised form: demonstrate a significant influence of cataract evaluates CS centrally and in four peripheral 1 December 2016; Published online: on contrast sensitivity. SPARCS offers the quadrants and scores them separately. Because it 20 January 2017 advantage of determining contrast sensitivity contains contrast gratings instead of letters, low peripherally and centrally, without being literacy level subjects may be tested as reliably as This study was presented as a influenced by literacy. literate subjects. The five areas are presented in poster at the Association for – Research in Vision and Eye (2017) 31, 753 761; doi:10.1038/eye.2016.319; two irregular sequences, so even with retesting, Ophthalmology in Orlando, FL, published online 20 January 2017 memorizing the answer sequence is unlikely. USA on May 4, 2014. Spaeth/Richman contrast sensitivity and cataracts L Gupta et al 754 This study aimed to compare the SPARCS test to the PR subjects were given a comprehensive ophthalmic clinical test in the evaluation of subjects with cataracts. examination. Subjects were not routinely dilated. This examination included (1) Snellen VA, which was then converted to the logarithm of the minimum angle of Materials and methods resolution (logMAR), (2) refraction, (3) intraocular Subjects pressure via Goldmann Applanation tonometry, (4) a slit-lamp and fundus examination, (5) an optic nerve This prospective cross-sectional study was approved by examination in which vertical cup-to-disc (C/D) ratio the Institutional Review Board of Wills Eye Hospital and was assessed, (6) monocular Humphrey Visual field was conducted in accordance with the Declaration of (24-2 Swedish Interactive Threshold Algorithm Standard Helsinki and the Health Insurance Portability and Strategy; Carl Zeiss Meditec Inc., Dublin, CA, USA), and Accountability Act. The trial was registered on the (7) monocular PR and SPARCS tests. Spherical and ClinicalTrials.gov database (NCT01300949). Testing was cylindrical refractions were obtained by averaging three carried out at the Wills Eye Hospital Glaucoma Research consecutive readings with an autorefractor (Topcon Center between January 2010 and August 2013. The KR-8000 auto keratorefractometer, Japan). control group included 119 eyes from 61 subjects while the cataract subject group included 43 eyes from 23 subjects. Groups of 23 and 61 subjects provided 80% CS Assessment power to detect a moderately large effect size of 0.7 or Each subject was administered the PR test and the ’ greater. Power was greater for this study s sample since SPARCS test monocularly twice. The order of the tests most subjects had data from both eyes. was either PR, SPARCS, rest, then SPARCS, PR or Prior to participating, all subjects were given an SPARCS, PR, rest, then PR, SPARCS. A technician explanation of the study. Written informed consent was explained and administered each test. The second test was obtained from all study participants. Inclusion criteria administered by a different technician to prevent testing required subjects to be 18 years of age or older, able to bias. The results of one technician were hidden from the provide fully informed consent, and either a cataract other. Testing order was randomized before subject subject or healthy control. Those who could not speak or enrollment using a randomization list generated from fi understand suf cient English or had cognitive http://www.randomizer.org/. The non-tested eye was impairment were excluded. covered with an occluder. Both tests were performed in Cataract subjects were recruited from the Cataract and each eye with the subject’s habitual eyeglasses correction ’ Primary Eye Care service of Wills Eye Hospital. Subjects if needed. Testing was conducted in a room with lenses were graded according to the Lens Opacities fluorescent lighting and no windows to minimize glare fi 9 Classi cation System II (LOCS II). Eyes with nuclear and reflections and ensure uniform testing conditions. opacities 4+, anterior subcapsular, posterior subcapsular and cortical opacities affecting the visual axis were PR test excluded due to the limited number of subjects in this population that could be recruited. The remaining The PR chart is a large wall-mounted chart, 59 cm wide subjects were divided into three groups: 1+ nuclear and 84 cm high, with 16 triplets of Sloan letters of sclerosis; 2+ nuclear sclerosis; and 3+ nuclear sclerosis. constant size.10 From top to bottom and left to right, each Cataract subjects were excluded if their ocular history triplet decreases in contrast by 0.15 log units from 100% included optic nerve, cornea, or retinal diseases; previous (0.00 log units) to 0.56% (2.25 log units). Each letter surgeries; or ocular trauma. subtends 2.8° at the test distance of 1 meter. In this study, The control group included volunteers and subjects the chart was illuminated by multiple incandescent recruited from unrelated studies conducted at the Wills lamps. Testing ended when the subject failed to identify 2 Eye Hospital Glaucoma Research Center. Controls were of the 3 letters in a triplet correctly, and the log CS score required to have a best-corrected VA ≤ 20/40 and no ocular was recorded. The test was performed twice and the or neurological pathology affecting their