Graphic blur representation of vision loss in patients with posterior segment disease using results of high contrast, discriminated target central fields

Stephen H. Sinclair¹, G. Aktan², P. Presti³ (¹Philadelphia, ²Duzce/Turkey, ³Atlanta)

Background: Images representing the vision of eyes with retinal disease have been presented
in the past but with no verification of authenticity. Central visual field testing with discriminated targets has allowed production of simulations using a blur paradigm to represent loss of resolution due to spherical blur, but these simulations have not been validated for vision loss due to macular or optic nerve disease.
Patients and Methods: 30 patients with monocular pathology (3 CSDME with DR, 2 atrophic ARMD, 8 ARMD CNVM, 8 RVO, 3RAO, and 6 following RD repair) underwent discriminated target central visual field testing (MAVES). The simulation automatically generated by the program utilizing a blur algorithm for the threshold resolution obtained at each intercept was compared with a black and white picture that was altered by the patient with the assistance of the physician using Adobe PhotoShop filtering tools.
Results: 24 of the patients stated that the composite picture, generated from the visual field data, when viewed with their good eye, closely represented what they observed in the eye with pathology. Six of the patients felt that the visual field simulation was not correct because of severe distortions or contrast alterations within the scotomas that were not represented. Five of the patients felt that the MAVES simulation was better than that produced with Adobe Photo Shop manipulation while 13 felt that the images were very similar, and six that the MAVES images were somewhat inferior, primarily because of unrepresented luminance changes or because of contrast loss (either in darker portions of the image or in lighter portions).
Conclusion: 80% of the patients with posterior segment pathology in one eye noted that a composite picture generated from the discriminated target visual field testing presented a reasonable simulation of their vision abnormalities for black and white images. This method, therefore, appears reasonable to simulate the vision loss of individuals having posterior segment pathology as has been previously reported for spectacle blur. In the future visual field contrast sensitivity data as well as measured distortions will be added to the simulations.

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