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Neuroophthalmology. 2017 Apr 27;41(5):247-252. doi: 10.1080/01658107.2017.1305422. eCollection 2017 Oct.

Validation of Simplified Visual Acuity Testing Protocols in Amyotrophic Lateral Sclerosis.

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University of Illinois College of Medicine, Chicago, Illinois, USA.
Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.


High- and low-contrast visual acuity (HCVA, LCVA) are potential quantitative markers of neurological dysfunction in amyotrophic lateral sclerosis (ALS). The complex nature and duration of gold standard (GS) protocols precludes widespread use in neurology settings. This study compares simplified to GS visual acuity (VA) protocols. Monocular HCVA and LCVA were measured in ALS (n = 10) and control (n = 4) subjects using six protocols, varying by two chart and three refraction methods. Intraclass correlation coefficients between simplified and GS protocols ranged from 0.83 to 0.98 (HCVA, excellent agreement) and 0.56 to 0.75 (LCVA, moderate agreement). Differences between LCVA and GS protocols exceeded test-retest reliability. Simplified HCVA protocols using LCD (liquid crystal display) tablet charts and/or pinhole correction produced valid measurements. None of the modified LCVA testing protocols produced valid measurements.


Amyotrophic lateral sclerosis; LCD tablet; high-contrast visual acuity; low-contrast visual acuity; pinhole

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