Taylor Laura J, Josan Amandeep S, MacLaren Robert E
Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Ophthalmic Physiol Opt. 2025 Jul;45(5):1158-1163. doi: 10.1111/opo.13504. Epub 2025 Jun 2.
Standard visual acuity (VA) is often insensitive to subtle changes in vision that result from inherited retinal disease. Low luminance VA (LLVA) has grown in popularity as an alternative acuity measure. A new test, the Moorfields Acuity Chart (MAC) has been designed as a more sensitive and repeatable test for use in patients with age-related macular degeneration. The study explores the utility and repeatability of standard VA, LLVA and the MAC in a mixed cohort of patients with inherited retinal disease.
Participants were recruited as part of the visual function in retinal degeneration study (Ethics Reference 20/WM/0283). Standard VA was obtained using the Early Treatment of Diabetic Retinopathy study (ETDRS) chart placed at 4 m. LLVA was obtained using the same ETDRS chart with the addition of a 2.0-log unit neutral density filter. MAC VA was obtained using standard clinic room lighting. All participants completed repeated testing.
Thirty-five patient participants and 36 healthy controls, with logMAR 1.00 (6/60) or better, completed testing. Both LLVA and MAC VA were reduced compared to standard VA in patient participants and healthy controls (linear mixed model: p < 0.001). All three acuity tests show comparable sensitivity, specificity and repeatability. A subset of participants (patient participants n = 34, healthy controls n = 35) completed microperimetry. Post hoc analysis of microperimetry volume sensitivity correlated significantly with all of the acuity tests and showed no significant difference in the gradient of the slopes. This suggests that VA, LLVA and MAC VA decline at a consistent rate with disease progression.
All three acuity tests could be considered viable outcome measures for clinical trials. For patients with early to moderate inherited retinal disease (logMAR 1.00 (6/60) or better), no single acuity chart appeared significantly beneficial.
标准视力（VA）通常对遗传性视网膜疾病导致的视力细微变化不敏感。低亮度视力（LLVA）作为一种替代视力测量方法越来越受欢迎。一种新的测试——摩尔菲尔德视力表（MAC）已被设计用于年龄相关性黄斑变性患者，是一种更敏感且可重复的测试。本研究探讨了标准VA、LLVA和MAC在遗传性视网膜疾病混合患者队列中的效用和可重复性。
参与者作为视网膜变性视觉功能研究的一部分被招募（伦理参考号20/WM/0283）。使用放置在4米处的糖尿病视网膜病变早期治疗研究（ETDRS）视力表获得标准VA。使用相同的ETDRS视力表并添加一个2.0对数单位的中性密度滤光片获得LLVA。MAC视力在标准诊室照明下获得。所有参与者都完成了重复测试。
35名患者参与者和36名健康对照，其最小分辨角对数（logMAR）为1.00（6/60）或更好，完成了测试。与标准VA相比，患者参与者和健康对照的LLVA和MAC VA均降低（线性混合模型：p < 0.001）。所有三种视力测试均显示出相当的敏感性、特异性和可重复性。一部分参与者（患者参与者n = 34，健康对照n = 35）完成了微视野检查。微视野容积敏感性的事后分析与所有视力测试均显著相关，并且斜率梯度无显著差异。这表明VA、LLVA和MAC VA随疾病进展以一致的速率下降。
所有三种视力测试都可被视为临床试验可行的结局指标。对于早期至中度遗传性视网膜疾病（logMAR 1.00（6/60）或更好）的患者，没有一种视力表显示出明显的优势。
