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Assessing visual acuity across five disease types: ETDRS charts are faster with clinical outcome comparable to Landolt Cs

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Abstract

Background

Given the diversity of visual acuity tests being employed across the world, we compared two frequently applied tests: ETDRS charts and an eight-orientation projected Landolt C test in accordance with ISO 8596 and DIN 58220 part 3. The goals of the investigation were to determine (i) test agreement and (ii) test–retest reliability, to assess (iii) test durations, and (iv) the acceptance of the tests by the examinees as well as the subjects’ coping with the tests as rated by the examiner.

Methods

Seventy-five adult subjects with a visual acuity of ≥0.2 (4/20) were included in one of the following groups: normal, media opacity, maculopathy, optic neuropathy, (post)chiasmal lesion, or amblyopia. Visual acuity testing was carried out monocularly, in balanced randomized order and in two runs for each test on the same eye, applying forced choice.

Results

Agreement: Within each group, all tests were performed similarly, within ±0.048 logMAR. Reliability: Across all subject groups, with a probability of 95 %, test–retest differences were <0.18 logMAR for both ETDRS and Landolt tests. Duration: The Landolt test lasted, on average, 1.8 times longer than ETDRS charts (p < 0.001). Acceptance: Examinees preferred the ETDRS test (p < 0.001), the examiner on average had no preference.

Conclusion

The Landolt C test and the ETDRS test yielded comparable results in visual acuity and test–retest reliability in all disease groups. The ETDRS test was usually faster and more accepted by both examiners and examinees than the Landolt test.

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Acknowledgments

We express our gratitude to the Deutsche Ophthalmologische Gesellschaft (DOG), which supported this research project financially. We thank our subjects for their participation in this study. Also thanks to the staff of the neuro-ophthalmologic department of the University Eye Hospital Tuebingen, where this study was carried out, for their support.

Conflict of interest statement

Author Ulrich Schiefer is consultant for HAAG-STREIT Inc., Koeniz, Switzerland and SERVIER Inc., Suresness, France.

All other authors: conflict of Interest—None.

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Authors and Affiliations

  1. Centre for Ophthalmology, University Eye Hospital, Schleichstraße 12, 72076, Tuebingen, Germany

    Simone Koenig, Felix Tonagel & Ulrich Schiefer

  2. Institute for Ophthalmic Research, University of Tuebingen, Roentgenweg 11, 72076, Tuebingen, Germany

    Ulrich Schiefer

  3. Competence Center “Vision Research”, University of Applied Sciences, Anton-Huber-Str. 23, 73430, Aalen, Germany

    Ulrich Schiefer

  4. Section Visual Function / Electrophysiology, Eye Center, Freiburg University, Killianstr. 5, 79106, Freiburg, Germany

    Michael Bach & Sven P. Heinrich

  5. Killianstr. 5, 79106, Freiburg, Germany

    Michael Bach

Authors
  1. Simone Koenig
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  2. Felix Tonagel
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  3. Ulrich Schiefer
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  4. Michael Bach
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  5. Sven P. Heinrich
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Corresponding author

Correspondence to Michael Bach.

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Koenig, S., Tonagel, F., Schiefer, U. et al. Assessing visual acuity across five disease types: ETDRS charts are faster with clinical outcome comparable to Landolt Cs. Graefes Arch Clin Exp Ophthalmol 252, 1093–1099 (2014). https://doi.org/10.1007/s00417-014-2670-y

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  • DOI: https://doi.org/10.1007/s00417-014-2670-y

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