Validation of the DYOP visual acuity test

PURPOSE: The dynamic optotype (DYOP) visual acuity (VA) test is based on motion detection rather than element resolution and has been proposed for routine clinical assessment. This investigation examined the validity, inter- and intra-session repeatability and subjective preference for the DYOP versus a static letter chart and examined its utility in detecting astigmatic defocus. METHODS: VA of 103 participants was measured three times with the letter and DYOP charts and repeated within two weeks in 75 participants who also rated their subjective experience. The VA of 29 participants was measured using DYOP, letter, Landolt C, and Tumbling E charts, with habitual correction and astigmatism induced with +1.00, +2.00 or +3.00 cylinders at 45, 60, 90 and 180°. RESULTS: The charts differed by a mean of 0.02 logMAR, with 81% of the measurements within one line of acuity. Inter-session, intraclass correlation coefficients, within-subject SD and repeatability were 0.03 logMAR, 0.95, 0.11 and 0.30 versus 0.01 logMAR, 0.92, 0.15 and 0.42 for the DYOP and letter charts, respectively. The DYOP was significantly more frustrating (1.79 vs.1.36), with 59% preferring the letter chart. The DYOP was least affected by induced astigmatism. CONCLUSIONS: The DYOP and letter charts differed significantly in their mean values with wide limits of agreement. DYOP had better within-subject SD and narrower limits of agreement between sessions, though clinically insignificant, and performed significantly worse for the detection of uncorrected astigmatism. Thus, it is difficult to recommend this test for the clinical determination of refractive error.