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

Graefes Arch Clin Exp Ophthalmol. 2021 Jun;259(6):1651-1657. doi: 10.1007/s00417-020-04987-z. Epub 2020 Oct 31.


Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Agreement; Double-pass; Low contrast; Optical quality; Prediction; Visual acuity.

MeSH terms

  • Eye*
  • Humans
  • Retrospective Studies
  • Vision Disorders*
  • Visual Acuity