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Agreement between subjective and predicted high and low contrast visual acuities with a double-pass system

  • Refractive Surgery
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To evaluate the agreement between subjective high and low contrast visual acuity (VA) and predicted values from double-pass system measurements in healthy candidates to laser refractive surgery.


Ninety-two eyes measured during the preoperative screening to laser refractive surgery were included in this retrospective analysis. High contrast subjective visual acuity (HCVA) and low contrasts at 20% (LCVA20) and 9% (LCVA9) were compared with the predicted VA obtained with a commercial double-pass system (OQAS) at the same levels of contrast, 100% (OV100), 20% (OV20), and 9% (OV9). The agreement was evaluated with Bland-Altman analysis computing the limits of agreement (LoAs) and the correlations with the spearman rho.


An underestimation of VA was obtained with the double-pass system for the highest contrast. Differences between predictive and subjective measurements were statistically significant for 100% contrast (− 0.08 logMAR, p < 0.0005), but not for 20% (− 0.03 logMAR, p = 0.07) and 9% (− 0.02 logMAR, p = 0.9) of contrasts. The LoAs increased with the decrease of contrast from 0.29 with 100% to 0.39 logMAR with 9% of contrast. A weak correlation was obtained between subjective and predicted VA (rho ≤ 0.33) that was only significant for 100% (p = 0.001) and 20% (p = 0.004) contrasts.


Mean differences between methods were reasonably small so mean results obtained for predicted VA in OQAS studies can be considered as reliable, at least in healthy subjects and for low contrast. However, limits of agreement were considerably poor which means that OQAS cannot replace individual subjective measurements of VA in clinical practice.

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  1. Martínez-Roda JA, Vilaseca M, Ondategui JC et al (2016) Double-pass technique and compensation-comparison method in eyes with cataract. J Cataract Refract Surg 42:1461–1469.

    Article  PubMed  Google Scholar 

  2. Serra P, Chisholm C, Sanchez Trancon A, Cox M (2016) Distance and near visual performance in pseudophakic eyes with simulated spherical and astigmatic blur. Clin Exp Optom 99:127–134.

    Article  PubMed  Google Scholar 

  3. Kimlin JA, Black AA, Wood JM (2017) Nighttime driving in older adults: effects of glare and association with mesopic visual function. Invest Ophthalmol Vis Sci 58:2796–2803.

    Article  PubMed  Google Scholar 

  4. Jiménez JR, Ortiz C, Hita E, Soler M (2008) Correlation between image quality and visual performance. J Mod Opt 55:783–790.

    Article  Google Scholar 

  5. Kim JM (2019) Objective assessment of visual quality and ocular scattering based on double-pass retinal images in refractive-surgery patients and emmetropes. Curr Opt Photonics 3:597–604.

    Article  Google Scholar 

  6. Liu HT, Zhou Z, Luo WQ et al (2018) Comparison of optical quality after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis. Int J Ophthalmol 11:656–661.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Qin Q, Bao L, Yang L et al (2019) Comparison of visual quality after EVO-ICL implantation and SMILE to select the appropriate surgical method for high myopia. BMC Ophthalmol 19:1–9.

    Article  Google Scholar 

  8. Fu D, Wang L, Zhou XT, Yu ZQ (2018) Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering. Int J Ophthalmol 11:456–461.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kamiya K, Shimizu K, Igarashi A et al (2012) Clinical evaluation of optical quality and intraocular scattering after posterior chamber phakic intraocular lens implantation. Invest Ophthalmol Vis Sci 53:3161–3166.

    Article  PubMed  Google Scholar 

  10. Miao H, Chen X, Tian M et al (2018) Refractive outcomes and optical quality after implantation of posterior chamber phakic implantable collamer lens with a central hole (ICL V4c). BMC Ophthalmol 18:1–7.

    Article  CAS  Google Scholar 

  11. Tan QQ, Lin J, Tian J et al (2019) Objective optical quality in eyes with customized selection of aspheric intraocular lens implantation. BMC Ophthalmol 19:152.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Park CW, Kim H, Joo C-K (2016) Assessment of optical quality at different contrast levels in pseudophakic eyes. J Ophthalmol 2016:1–8.

    Article  Google Scholar 

  13. Chen T, Yu F, Lin H et al (2016) Objective and subjective visual quality after implantation of all optic zone diffractive multifocal intraocular lenses: a prospective, case-control observational study. Br J Ophthalmol 100:1530–1535.

    Article  PubMed  Google Scholar 

  14. Liao X, Lin J, Tian J et al (2018) Evaluation of optical quality: ocular scattering and aberrations in eyes implanted with diffractive multifocal or monofocal intraocular lenses. Curr Eye Res 43:696–701.

    Article  PubMed  Google Scholar 

  15. Fu Y, Kou J, Chen D et al (2019) Influence of angle kappa and angle alpha on visual quality after implantation of multifocal intraocular lenses. J Cataract Refract Surg:1–7.

  16. Chu MF, Hui N, Wang CY et al (2019) Early outcomes of vision and objective visual quality analysis after cataract surgery with trifocal intraocular lens implantation. Int J Ophthalmol 12:1575–1581.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nakajima M, Hiraoka T, Yamamoto T et al (2016) Differences of longitudinal chromatic aberration (LCA) between eyes with intraocular lenses from different manufacturers. PLoS One 11:1–22.

    Article  CAS  Google Scholar 

  18. Jason McAnany J, Alexander KR, Lim JI, Shahidi M (2011) Object frequency characteristics of visual acuity. Investig Ophthalmol Vis Sci 52:9534–9538.

    Article  Google Scholar 

  19. Martínez-Roda JA, Vilaseca M, Ondategui JC et al (2016) Effects of aging on optical quality and visual function. Clin Exp Optom 99:518–525.

    Article  PubMed  Google Scholar 

  20. Fernández J, Rodríguez-Vallejo M, Tauste A et al (2019) Fast measure of visual acuity and contrast sensitivity defocus curves with an iPad application. Open Ophthalmol J 13:15–22

    Article  Google Scholar 

  21. Beck RW, Moke PS, Turpin AH et al (2003) A computerized method of visual acuity testing: adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol 135:194–205

    Article  Google Scholar 

  22. Ghasemi A, Zahediasl S (2012) Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab 10:486–489.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bunce C (2009) Correlation, agreement, and Bland-Altman analysis: statistical analysis of method comparison studies. Am J Ophthalmol 148:4–6

    Article  Google Scholar 

  24. Bland JM, Altman DG (1999) Statistical methods in medical research. Stat Methods Med Res 8:135–160

    Article  CAS  Google Scholar 

  25. Khoshnood B, Mesbah M, Jeanbat V et al (2010) Transforming scales of measurement of visual acuity at the group level. Ophthalmic Physiol Opt 30:816–823.

    Article  CAS  PubMed  Google Scholar 

  26. Hwang JS, Lee YP, Bae SH et al (2018) Utility of the optical quality analysis system for decision-making in cataract surgery. BMC Ophthalmol 18:231.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Campbell FW, Green DG (1965) Optical and retinal factors affecting visual resolution. J Physiol 181:576–593

    Article  CAS  Google Scholar 

  28. Xu CC, Xue T, Wang QM et al (2015) Repeatability and reproducibility of a double-pass optical quality analysis device. PLoS One 10:1–8.

    Article  CAS  Google Scholar 

  29. Gatinel D (2011) Double pass-technique limitations for evaluation of optical performance after diffractive IOL implantation. J Cataract Refract Surg 37:621–622.

    Article  PubMed  Google Scholar 

  30. Vega F, Millán MS, Vila-Terricabras N, Alba-Bueno F (2015) Visible versus near-infrared optical performance of diffractive multifocal intraocular lenses. Investig Opthalmology Vis Sci 56:7345.

    Article  Google Scholar 

  31. International Organization for Standardization (2016) Chart displays for visual acuity measurement. Printed, projected and electronic. In: ISO 10938. Ophthalmic optics. Geneva, Switzerland, pp. 1–6

  32. International Organization for Standardization (2018) Part 7: Clinical investigations of intraocular lenses for the correction of aphakia. In: ISO 11979-7. Ophthalmic implants — Intraocular lenses. Geneva, Switzerland, pp 1–42

  33. MacRae S, Holladay JT, Glasser A et al (2017) Special report: American academy of ophthalmology task force consensus statement for extended depth of focus intraocular lenses. Ophthalmology 124:139–141.

    Article  PubMed  Google Scholar 

  34. Sheedy JE, Bailey IL, Raasch TW (1984) Visual acuity and chart luminance. Am J Optom Physiol Optic 61:595–600

    Article  CAS  Google Scholar 

  35. Brezna W, Lux K, Dragostinoff N et al (2016) Psychophysical vision simulation of diffractive bifocal and trifocal intraocular lenses. Transl Vis Sci Technol 5:13.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Suckow M (2004) Comparison of visual acuity at multiple test distances using the ETDRS acuity chart. In: American Academy of Optometry Congress p Poster 8. Accessed 27 Oct 2020

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Correspondence to Manuel Rodríguez-Vallejo.

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This study was approved by the local ethics committee of research and was performed in adherence to the tenets of the Declaration of Helsinki. For this type of study formal consent is not required.

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Fernández, J., Rodríguez-Vallejo, M., Martínez, J. et al. Agreement between subjective and predicted high and low contrast visual acuities with a double-pass system. Graefes Arch Clin Exp Ophthalmol 259, 1651–1657 (2021).

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