Purpose: Contrast sensitivity functions (CSFs) were measured under various optical conditions in healthy observers together with CSFs from selected patients. Threshold increases across the spatial frequency range were compared with predictions of a theoretical optical model based on modulation transfer functions.
Methods: Contrast thresholds for various spatial frequencies were determined with a computer-automated method of ascending limits in a control group and a group of patients with various visual pathway diseases ranging from retinal disorders, such as diabetic retinopathy, to neural disorders, such as multiple sclerosis. For normal control subjects, simulated contrast sensitivity losses also were effected by manipulating pupil diameter and dioptric blur. Modulation transfer functions of the eye's optics in polychromatic light were calculated. The wave aberration function included standard spherical aberration, coma, and small amounts of irregular aberrations.
Results: Experimentally, slight dioptric blur (e.g., 0.4 to 0.75 D) introduced increased CSF thresholds within either a narrow or broad bandwidth. For the latter, decreased CSF sensitivity occurred across a spatial frequency range as broad as 1 log unit, from low spatial frequencies (2 cyc/deg), and for pupil sizes equal to or larger than 3 mm. Predictions based on an optical model are qualitatively and quantitatively in agreement with these findings. Contrast sensitivity losses of the patients were neither specific nor selective to the pathologic condition at hand. Furthermore, various CSF losses optically induced in the control subjects were indistinguishable from nonoptically induced pathologic CSF profiles.
Conclusions: Selective broad-band contrast sensitivity loss may be optically induced by slight refractive error. As a result, selective contrast sensitivity loss at lower and intermediate spatial frequencies concurrent in patients with various pathologic, neuro-ophthalmologic conditions cannot be a priori attributed to neural factors without carefully controlled and well-defined optical variables.