Assessing visual acuity across five disease types: ETDRS charts are faster with clinical outcome comparable to Landolt Cs

BackgroundGiven the diversity of visual acuity tests being employed across the world, we compared two frequently applied tests: ETDRS charts and an eight-orientation projected Landolt C test in accordance with ISO 8596 and DIN 58220 part 3. The goals of the investigation were to determine (i) test agreement and (ii) test–retest reliability, to assess (iii) test durations, and (iv) the acceptance of the tests by the examinees as well as the subjects’ coping with the tests as rated by the examiner.MethodsSeventy-five adult subjects with a visual acuity of ≥0.2 (4/20) were included in one of the following groups: normal, media opacity, maculopathy, optic neuropathy, (post)chiasmal lesion, or amblyopia. Visual acuity testing was carried out monocularly, in balanced randomized order and in two runs for each test on the same eye, applying forced choice.ResultsAgreement: Within each group, all tests were performed similarly, within ±0.048 logMAR. Reliability: Across all subject groups, with a probability of 95 %, test–retest differences were <0.18 logMAR for both ETDRS and Landolt tests. Duration: The Landolt test lasted, on average, 1.8 times longer than ETDRS charts (p < 0.001). Acceptance: Examinees preferred the ETDRS test (p < 0.001), the examiner on average had no preference.ConclusionThe Landolt C test and the ETDRS test yielded comparable results in visual acuity and test–retest reliability in all disease groups. The ETDRS test was usually faster and more accepted by both examiners and examinees than the Landolt test.

[1]  F. Rintelen.  Deutsche Ophthalmologische Gesellschaft , 1938 .

[2]  R. Aitken.  Measurement of feelings using visual analogue scales. , 1969, Proceedings of the Royal Society of Medicine.

[3]  I L Bailey,et al.  New Design Principles for Visual Acuity Letter Charts* , 1976, American journal of optometry and physiological optics.

[4]  F. Ferris,et al.  New visual acuity charts for clinical research. , 1982, American journal of ophthalmology.

[5]  Rice Ta,et al.  The early treatment diabetic retinopathy study. , 1982 .

[6]  G. J. G. Upton,et al.  An Introduction to Statistical Modelling , 1983 .

[7]  Robert McGill,et al.  The Many Faces of a Scatterplot , 1984 .

[8]  J. Petersen.  [Erroneous vision determination and quantitative effects]. , 1993, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.

[9]  A Arditi,et al.  On the statistical reliability of letter-chart visual acuity measurements. , 1993, Investigative ophthalmology & visual science.

[10]  David J. Sheskin,et al.  Handbook of Parametric and Nonparametric Statistical Procedures , 1997 .

[11]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[12]  B. Rassow,et al.  Anschluß von Buchstaben-Optotypen an den Landolt-Ring für verschiedene Bereiche der Sehschärfe , 1999 .

[13]  B. Rassow,et al.  [Correlation of letter optotypes with Landholt ring for different degrees of visual acuity]. , 1999, Klinische Monatsblatter fur Augenheilkunde.

[14]  Roy Robertson,et al.  An Introduction to Statistical Modelling , 2000, Technometrics.

[15]  I. Murdoch,et al.  The development of a “reduced logMAR” visual acuity chart for use in routine clinical practice , 2001, The British journal of ophthalmology.

[16]  M. Camparini,et al.  ETDRS-fast: implementing psychophysical adaptive methods to standardized visual acuity measurement with ETDRS charts. , 2001, Investigative ophthalmology & visual science.

[17]  Fred W Fitzke,et al.  How sensitive to clinical change are ETDRS logMAR visual acuity measurements? , 2003, Investigative ophthalmology & visual science.

[18]  N. Shah,et al.  Validation of a computerised logMAR visual acuity measurement system (COMPlog): comparison with ETDRS and the electronic ETDRS testing algorithm in adults and amblyopic children , 2007, British Journal of Ophthalmology.

[19]  E. Turiel.  The Development of Morality , 2007 .

[20]  Peter K Kaiser,et al.  Prospective evaluation of visual acuity assessment: a comparison of snellen versus ETDRS charts in clinical practice (An AOS Thesis). , 2009, Transactions of the American Ophthalmological Society.

[21]  N. Prins.  Psychophysics: A Practical Introduction , 2009 .

[22]  G. Teichler.  Untersuchungenzum Vergleich der Sehzeichen Landolt-Ring, E-Haken undSloan-Buchstaben (ETDRS-Letters) sowie zur Reproduzierbarkeit derVisusbestimmung , 2009 .

[23]  Pei-Chang Wu,et al.  Visual acuity as measured with Landolt C chart and Early Treatment of Diabetic Retinopathy Study (ETDRS) chart , 2011, Graefe's Archive for Clinical and Experimental Ophthalmology.

[24]  U. Schiefer,et al.  [New DIN norms for determination of visual acuity]. , 2010, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.

[25]  P. Hewson,et al.  Comparison of the ETDRS logMAR, ‘compact reduced logMar’ and Snellen charts in routine clinical practice , 2010, Eye.

[26]  U. Schiefer,et al.  Neue DIN-Normen zur Sehschärfebestimmung , 2010, Der Ophthalmologe.

[27]  G. Teichler,et al.  Vergleich von Landoltring- und ETDRS-Buchstaben-Sehschärfe bei Augengesunden und Patienten mit unterschiedlichen Augenerkrankungen , 2011 .

[28]  R. Becker,et al.  [Comparison of visual acuity measured using Landolt-C and ETDRS charts in healthy subjects and patients with various eye diseases]. , 2011, Klinische Monatsblatter fur Augenheilkunde.

[29]  Michael Bach,et al.  The dynamics of practice effects in an optotype acuity task , 2011, Graefe's Archive for Clinical and Experimental Ophthalmology.

[30]  Anne Marsden,et al.  International Organization for Standardization , 2014 .