title: Evaluation of single pixel step sizes in visual acuity assessment.
abstract: OBJECTIVE
  Adaptive thresholding procedures (e.g., ZEST) benefit from testing near the current estimate of threshold. Therefore, small increments may improve precision of these techniques. We evaluated the validity of visual acuity assessment when letters are not constrained to a multiple of 5 pixels high.
  
  
  METHODS
  Snellen letters were presented over a ±5 pixel range spanning the final threshold estimate. Sizes that were a multiple of 5 pixels (e.g., 20 and 25) were presented 160 times, and other sizes were presented 40 times. This resulted in 320 letter presentations at multiples of 5 and at non-multiples of 5. Post hoc ZEST procedures were used to compute acuity threshold estimates based on testing at those two sets of sizes. Two subjects participated: subject 1 for the right and left eyes and subject 2 in two sessions with binocular viewing. Psychometric functions were fit to the data and were used to model simulated observers. Simulations were run for each data set, and the number of presentations at each size matched the number presented to the subject. Ninety percent limits for proportion correct at each letter size were determined from the simulation data, and these limits were used as criteria for identifying outliers in the subject's data.
  
  
  RESULTS
  No significant difference in acuity thresholds were found when letters were rendered in multiples of 5 pixel heights vs. letters without this constraint. Empirical data fell within the bounds defined by simulations, with no idiosyncratic results found for either set of letter sizes.
  
  
  CONCLUSIONS
  Letter sizes that do not conform to a multiple of 5 pixel letter height yield valid acuity scores. This facilitates adaptive psychometric procedures for acuity testing, such as ZEST and QUEST, in which letter sizes are selected to be as close to the current estimate of threshold size as possible.
authors.affiliation: College of Optometry, The Ohio State University, Columbus, Ohio 43210, USA. atoole@optometry.osu.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Toole
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Raasch
authors.forename: Nick
authors.initials: N
authors.lastname: Fogt
authors.forename: Tyson J
authors.initials: TJ
authors.lastname: Brunstetter
mesh_terms: D006801:Humans; D011594:Psychometrics / Q000379:methods*; D012684:Sensory Thresholds; D014787:Vision Tests / Q000592:standards*; D014792:Visual Acuity