Newspaper serves as functional reading test for multifocal lenses

Researchers pair with local newspaper to print near visual tests that represent an everyday task for multifocal lens patients.

Issue: July 1, 2006

ByKatrina Altersitz

To test the functional near vision of patients after presbyopia-correcting surgery, one study used a common visual task: reading the newspaper. With fonts correlating to standard visual tests, researchers hope to measure patients’ visual function in their daily lives.

David T. Vroman, MD, presented his results with this test at the American Society of Cataract and Refractive Surgery meeting and spoke of his hope to functionally test all presbyopic procedures and all visual distances.

“We tried to think of something we could test that is a common activity that most of our patients do, something that could be standardized, that would be inexpensive and easy to administer,” Dr. Vroman said in his presentation. “We came up with something that wasn’t revolutionary. It’s the newspaper.”

Creating the test

Dr. Vroman explained that there are many new treatments for presbyopia, but standard tests are insufficient to compare outcomes.

“There’s a lot of interest in presbyopia treatment and correction, yet we don’t really have a good way to measure how all of these treatments are going to perform,” he told Ocular Surgery News in a follow-up interview.

One patient with scleral expansion bands, for example, tested J1 but “had no ability to read a word or a paragraph,” he said. Most vision tests use high-contrast charts with unrelated words or short sentences that do not test the patient’s ability to perform day-to-day tasks, he said.

“That patient couldn’t use her eye to see up close, yet we were documenting J1,” he said. “We knew that was not accurate. That was not functional vision.”

The researchers discussed what could be used as a universal near-vision task to test the success of these treatments.

“We thought probably one of the easiest things to test and develop and one of the most common near activities is reading the newspaper,” Dr. Vroman told OSN. “That’s how the concept came together.”

The next step was contacting the local newspaper, The Charleston (S.C.) Post & Courier, where they found a partner, Janet Conyers, in their pursuit who fulfilled the need to make the test as realistic as possible.

“They published all the papers. They helped us pick text. They taught us all about fonts and the different types of fonts that there are,” he said. “Then they print them as needed for us.”

The newspapers were made up of 100-word, six- or seven-sentence paragraphs in font sizes from 3 to 24 point type. Dr. Vroman said that those sizes correspond to Snellen acuities of 20/20 to 20/200 and logMAR 1 to 0.

Functional testing

Dr. Vroman and colleagues evaluated the newspaper test in a study that included patients with monofocal and multifocal IOLs, as well as control subjects with no IOL. Subjects were required to speak English as their primary language, to have a high school education and best corrected vision of 20/20, and to be between the ages of 18 and 85 years. The subjects were then split into four groups.

People without IOLs were in the control groups: under 35 years (30 subjects) and over 60 years (eight subjects). The other subjects were either bilateral monofocal patients (six subjects) or bilateral Alcon ReSTOR patients (16 subjects).

The study subjects were instructed to read the printed newspaper out loud while it was positioned 32 cm from their eyes. As they went from the largest font to the smallest font, reading time was measured as words per minute and errors were recorded.

“We considered them unable to read it if they were physically unable to read it, missed 20 words or if it took more than 3 minutes in a paragraph,” Dr. Vroman said in his presentation.

Best corrected and uncorrected monofocal vision results were as he expected, Dr. Vroman said.

“You can see that the larger fonts, they can do pretty well reading some of the print, but as the fonts get smaller, naturally, they can’t read any more,” he said.

With the bilateral ReSTOR patients, both best corrected and uncorrected vision closely mimicked the 60-year-old control group.

“There were no statistical differences in these groups,” he said. “However, they don’t reach the 35-year-old control mark either.”

Further investigation

The differences between monofocal and multifocal lenses pushed Dr. Vroman to continue his research and look into other presbyopic treatments.

“Though monofocal lenses don’t do as bad as we might expect, they don’t do as well as the multifocal lenses,” Dr. Vroman told OSN. “Right now we’re trying to determine how patients with a variety of different lenses function.”

This test is currently being expanded into a multicenter clinical trial assessing multifocal lenses, he added.

“We feel like we’re trying to find some standard way to reproducibly evaluate near vision,” Dr. Vroman said in his presentation. “We would like to be able to apply this to multiple presbyopic therapies so that we know really how patients are functioning, not just Jaeger letters, not just Snellen letters.”

He told OSN that the researchers are also gathering data on more traditional tests to compare the results with the newspaper test.

“When we’re evaluating new technologies and techniques, our standard measurements of Snellen acuity are probably not adequate to give us a full understanding of how our patients are doing,” he said. “We need to be looking for functional visual tests to help compare and contrast therapies, to help surgeons make good clinical decisions.”

Dr. Vroman said he hopes functional tests will be developed for intermediate and distance vision as well.

“We need to have a standard, and this is a fairly straightforward and easy test of near functional vision,” he said. “Ideally we would have functional vision tests for near, intermediate and distance, and that’s the long-term goal.”

For more information:

David T. Vroman, MD, can be reached at the Storm Eye Institute, Medical University of South Carolina, 167 Ashley Ave., P.O. Box 250676, Charleston, SC 29425; 843-792-8100; fax: 843-792-0720; e-mail: vromandt@musc.edu.

Katrina Altersitz is an OSN Staff Writer who covers all aspects of ophthalmology.