title: Reproducibility of visual acuity assessment in normal and low visual acuity.
abstract: OBJECTIVE
  To assess the reproducibility of measurements of visual acuity in both the upper and lower range of visual acuity.
  
  
  METHODS
  The retroilluminated ETDRS 1 and ETDRS 2 charts (Precision Vision) were used for measurement of visual acuity. Both charts use the same letters. The sequence of the charts followed a pseudorandomized protocol. The examination distance was 4.0 m. When the visual acuity was below 0.16 or 0.03, then the examination distance was reduced to 1 m or 0.4 m, respectively, using an appropriate near correction. Visual acuity measurements obtained during the same session with both charts were compared. A total of 100 patients (age 8-90 years; median 60.5) with various eye disorders, including 39 with amblyopia due to strabismus, were tested in addition to 13 healthy volunteers (age 18-33 years; median 24). At least 3 out of 5 optotypes per line had to be correctly identified to pass this line. Wrong answers were monitored. The interpolated logMAR score was calculated. In the patients, the eye with the lower visual acuity was assessed, and for the healthy subjects the right eye. Differences between ETDRS 1 and ETDRS 2-acuity were compared.
  
  
  RESULTS
  The mean logMAR values for ETDRS 1 and ETDRS 2 were -0.17 and -0.14 in the healthy eyes and 0.55 and 0.57 in the entire group. The absolute difference between ETDRS 1 and ETDRS 2 was (mean +/- standard deviation) 0.051 +/- 0.04 for the healthy eyes and 0.063 +/- 0.05 in the entire group. In the acuity range below 0.1 (logMAR > 1.0), the absolute difference (mean +/- standard deviation) between ETDRS 1 and ETDRS 2 of 0.072 +/- 0.04 did not significantly exceed the mean absolute difference in healthy eyes (p = 0.17). Regression analysis (|ETDRS 1 - ETDRS 2| vs. ETDRS 1) showed a slight increase of the difference between the two values with lower visual acuity (p = 0.0505; r = 0.18).
  
  
  CONCLUSIONS
  Assuming correct measurement, the reproducibilty of visual acuity measurements in the lower acuity range is not significantly worse than in normals.
authors.affiliation: Department of Ophthalmology, University of Giessen, Giessen, Germany. ralph-becker@web.de
authors.forename: Ralph
authors.initials: R
authors.lastname: Becker
authors.forename: Gunnar
authors.initials: G
authors.lastname: Teichler
authors.forename: Michael
authors.initials: M
authors.lastname: Gräf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008875:Middle Aged; D010775:Photic Stimulation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015354:Vision, Low / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*