The usefulness of Vistech and FACT contrast sensitivity charts for cataract and refractive surgery outcomes research

AIM: To investigate the repeatability and sensitivity of two commonly used sine wave patch charts for contrast sensitivity (CS) measurement in cataract and refractive surgery outcomes. METHODS: The Vistech CS chart and its descendant, the Functional Acuity Contrast Test (FACT), were administered in three experiments: (1) Post-LASIK and age matched normal subjects; (2) Preoperative cataract surgery and age matched normal subjects; (3) Test-retest repeatability data in normal subjects. RESULTS: Contrast sensitivity was similar between post-LASIK and control groups and between the Vistech and FACT charts. The percentage of subjects one month post-LASIK achieving the maximum score across spatial frequencies (1.5, 3, 6, 12, 18 cycles per degree) were (50, 33, 13, 13, 0 respectively) for FACT, but only (0, 0, 13, 4, 0 respectively) for Vistech. A small number of cataract patients also registered the maximum score on the FACT, but up to 60% did not achieve the minimum score. Test-retest intraclass correlation coefficients varied from 0.28 to 0.64 for Vistech and 0.18 to 0.45 for FACT. Bland-Altman limits of agreement across spatial frequencies were between +/-0.30 and +/-0.85 logCS for Vistech, and +/-0.30 to +/-0.75 logCS for FACT. DISCUSSION: The Vistech was confirmed as providing poorly repeatable data. The FACT chart, likely because of a smaller step size, showed slightly better retest agreement. However, the reduced range of scores on the chart due to the smaller step size led to ceiling (post-LASIK) and floor (cataract) effects. These problems could mask subtle differences between groups of patients with near normal visual function as found post-refractive or cataract surgery. The Vistech and FACT CS charts are ill suited for refractive or cataract surgery outcomes research.