title: Differences in vision between clinic and home and the effect of lighting in older adults with and without glaucoma.
abstract: OBJECTIVE
  Patients often report greater visual difficulties at home than expected from vision testing in the clinic. Such discordance may be owing to worse vision in the home than measured in clinic.
  
  
  OBJECTIVE
  To compare vision measured between the clinic and home and evaluate factors, including lighting, associated with these differences.
  
  
  METHODS
  This cross-sectional study conducted from 2005-2009 involved 126 patients with glaucoma and 49 without glaucoma recruited from the Glaucoma and Comprehensive Eye Clinics at Washington University, St Louis, Missouri. Patients underwent clinic and home visits, were aged 55 to 90 years, were consecutively recruited, and met inclusion criteria for this study. A total of 166 eligible patients refused participation.
  
  
  METHODS
  Participants underwent clinic and home visits randomized to order of completion. At each visit, masked and certified examiners measured binocular distance visual acuity (DVA) with a nonbacklit chart, near visual acuity (NVA), contrast sensitivity (CS), CS with glare, and lighting.
  
  
  METHODS
  Differences in vision between the clinic and home.
  
  
  RESULTS
  The mean scores for all vision tests were significantly better in the clinic than home for participants with and without glaucoma (P < .05, matched-pair t tests). For DVA, 29% of participants with glaucoma read 2 or more lines better in the clinic than home and 39% with advanced glaucoma read 3 or more lines better. For the entire sample, 21% of participants read 2 or more lines better in the clinic than home for NVA and 49% read 2 or more triplets better in the clinic for CS with glare. Lighting was the most significant factor associated with differences in vision between the clinic and home for DVA, NVA, and CS with glare testing (P < .05, multiple regression model). Median home lighting was 4.3 times and 2.8 times lower than clinic lighting in areas tested for DVA and NVA, respectively. Home lighting was below that recommended in 85% or greater of participants.
  
  
  CONCLUSIONS
  Vision measured in the clinic is generally better than vision measured at home, with differences mainly owing to poor home lighting. Knowledge that vision discrepancies between patient report and clinical testing may be owing to home lighting may initiate clinician-patient discussions to optimize home lighting and improve the vision of older adults in their homes.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Anjali M
authors.initials: AM
authors.lastname: Bhorade
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri2Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Perlmutter
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Brad
authors.initials: B
authors.lastname: Wilson
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jamie
authors.initials: J
authors.lastname: Kambarian
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri4currently in a fellowship, San Diego, California.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California, San Francisco.
authors.forename: Melike
authors.initials: M
authors.lastname: Pekmezci
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Mae
authors.initials: M
authors.lastname: Gordon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015350:Contrast Sensitivity / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D019466:Glare; D005901:Glaucoma / Q000503:physiopathology*; D006792:House Calls; D006801:Humans; D008027:Light; D008029:Lighting; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000503:physiopathology*; D015348:Vision, Binocular / Q000502:physiology*; D014785:Vision, Ocular; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology