New test uses newspaper to assess near visual function

Charleston, SC-A new test to assess near visual function uses a newspaper with various sizes of type ranging from 3 to 24 Revised American Point-Type to determine how well patients read in the real world. Patients are tested for reading speed in a 3-minute period.

"There are numerous ways to treat presbyopia: lenticular options, corneal surgery, scleral surgery, and surgical monovision," Dr. Vroman said. "However, we don't know how to compare these presbyopic treatments.

In attempting to find a standardized method to evaluate near vision reproducibly, he said, "we tried to think of something that we could test that is an activity common to most of our patients, something that could be standardized, inexpensive, and easy to administer."

Their search ended with the newspaper.

The investigators worked with a local publication, the Post and Courier, to format the newspaper in a way that allowed standardized testing of patients, Dr. Vroman explained. They used several copies of a special edition because the newspaper (reading test) had different-sized fonts and standardized paragraphs; however, previous articles published in the newspaper were used.

The newspaper has multiple font sizes, with eight key sizes ranging from 3- to 24-point type. Only paragraphs with these sizes of type were measured, because these type sizes correspond to Snellen acuities of 20/20 to 20/200 (logMar acuity of 1 to 0). The investigators used a reading distance of 32 cm.

"Within the paragraphs that we created, there are exactly 100 words in six to seven sentences," he said. "The education levels for patients required to read the [created] newspaper ranged from fifth grade to eighth grade, which is about the standard for American newspapers and magazines."

To validate the newspaper test, Dr. Vroman and colleagues tried it among their patients, aged 18 to 85 years. The patients were included in the study if English was their primary language, if they had completed at least a high school education, and if they had a best-corrected distance visual acuity of 20/20.

The patients were divided among four groups: a control group of subjects aged fewer than 35 years, a control group of patients aged more than 60 years, patients in whom bilateral monofocal IOLs set for distance had been implanted, and patients with apodized diffractive IOLs (AcrySof ReSTOR, Alcon Laboratories). The subjects were tested to measure their reading speed per minute and were considered unable to read the newspaper if they missed 20 words or required more than 3 minutes to read a paragraph, Dr. Vroman said.

The investigators found that those in the control group of younger subjects read quickly and that those in the control group of older subjects read slightly slower than the subjects in the other control group but read with consistent speed. The subjects with monofocal IOLs, with either corrected or best distance-corrected vision, read the larger point sizes more easily than the smaller ones; as the text decreased in size, the subjects experienced difficulty until they no longer could read it. Those with monofocal IOLs no longer could read the 7-point text. Results in the group of patients with the apodized diffractive IOLs were the same as results in the older control group, but those in the former group were not able to read at the same level as the subjects in the younger control group.

To expand their database, he said, the researchers are adding patients in whom a second-generation refractive multifocal IOL (ReZoom, Advanced Medical Optics) or an accommodating IOL (crystalens, eyeonics inc.) has been implanted.

"We would like to be able to apply this method to a number of therapies for presbyopia so that we can accurately determine how patients are functioning in the real world, not just based on Jaeger and Snellen acuities," Dr. Vroman said. "We hope we can standardize tests at all distances so that we can know how patients function with these lenses."