Introducing a new method to assess vision: Computer-adaptive contrast-sensitivity testing predicts visual functioning better than charts in multiple sclerosis patients

BACKGROUND: Impaired low-contrast visual acuity (LCVA) is common in multiple sclerosis (MS) and other neurological diseases. Its assessment is often limited to selected contrasts, for example, 2.5% or 1.25%. Computerized adaptive testing with the quick contrast-sensitivity function (qCSF) method allows assessment across expanded contrast and spatial frequency ranges. OBJECTIVE: The objective of this article is to compare qCSF with high- and low-contrast charts and patient-reported visual function. METHODS: We enrolled 131 consecutive MS patients (mean age 39.6 years) to assess high-contrast visual acuity (HCVA) at 30 cm and 5 m, low-contrast vision with Sloan charts at 2.5% and 1.25%, qCSF and the National Eye Institute Visual Functioning Questionnaire (NEIVFQ). Associations between the different measures were estimated with linear regression models corrected for age, gender and multiple testing. RESULTS: The association between qCSF and Sloan charts (R(2 )= 0.68) was higher than with HCVA (5 m: R(2 )= 0.5; 30 cm: R(2 )= 0.41). The highest association with NEIVFQ subscales was observed for qCSF (R(2) 0.20–0.57), while Sloan charts were not associated with any NEIVFQ subscale after correction for multiple testing. CONCLUSION: The qCSF is a promising new outcome for low-contrast vision in MS and other neurological diseases. Here we show a closer link to patient-reported visual function than standard low- and high-contrast charts.