Inter-and intra-subject variation of contrast visual acuities

D.Phil. (Optometry)The measurement of Contrast Visual Acuities (contrast VA) is recognised in various studies as an important psychophysical measure of visual function, and contrast VA is often used to understand visual limitations or functional disability. Contrast VA is also useful for monitoring the effects of disease modifying therapies. High and medium contrast levels are generally used in studies to evaluate contact lens performance, the outcomes of surgical procedures and for assessing activities of daily living. Measurement of stimuli with low contrast levels are also sometimes applied in diagnosing, monitoring and evaluating disease processes and their management, especially where high contrast visual acuity remains intact. This is believed to be the first study that comprehensively investigates the reliability (or repeatability) of four contrast levels using the computerized Thomson Test Chart 2000 XPert. (A similar study with four contrast levels and both univariate and multivariate analysis as applied in this thesis has not been performed elsewhere). Although the main emphasis of this study was to explore various issues relating to short-term repeatability of contrast VA, both within and across individuals, both univariate and multivariate statistical analyses were also used in this thesis to investigate age and gender related changes in measurements of contrast VA. Together the results from this thesis provide test and re-test contrast VA reliability measures and some basic or preliminary statistical normative contrast VA values, which should aid clinicians to confidently detect abnormal measurements which, in turn, promotes good clinical practice. For this thesis and within a clinical environment to investigate inter-subject variation in contrast VA, two measurements of contrast VA at four specified contrast levels (100%, 10%, 5% and 2.5%) at a 6 metre distance were obtained for the right eyes only of 155 healthy participants. Thus, at each contrast level 155 test and re-test contrast VA measurements were determined using the computerized Thomson Test Chart 2000 XPert. All measurements were determined through the optimal refractive compensation for each right eye of the 155 participants concerned. In a subset of ten subjects or participants, samples of thirty consecutive measurements of contrast VA at each of the four contrast levels were also obtained to explore short-term intra-subject variation in contrast VA. A simple questionnaire was administered to all subjects to obtain biographical, general and ocular health histories. Visual assessment included II subjective clinical refraction, stereopsis, colour vision, direct ophthalmoscopy and biomicroscopy to understand the eyes of the participants and exclude possible factors that could cause ocular or neurological changes in the retina or in vision thereby influencing contrast VA in a detrimental fashion..