Abstract
PURPOSE: Best-corrected visual acuity (BCVA) is assessed at a single standardized luminance with maximum optotype contrast, not reflecting the constantly changing daily-life viewing conditions. For a more realistic estimation of visual performance at varying object contrasts (Cs) and ambient luminances (ALs), we developed a new VA test, VA-CAL. METHODS: Landolt-C-rings between 18% and 95% Weber contrast, were presented at 1 m distance (8 Alternative Forced Choice) on a 5.7 degree field in the middle of a frosted glass screen (66 degrees), back-lit by 3060 LEDs (generating ambient luminances between 0-10,000 cd/m²). Visual acuity (VA) was measured in 14 normally sighted participants twice for 8 conditions of ambient luminance and 6 conditions of contrast using a QUEST staircase procedure. RESULTS: VA improved continuously up to an ambient luminance of 3000 to 5000 cd/m² (best mean VA ± SEM: -0.47 ± 0.03 logMAR at C = 95%, AL = 3000 cd/m²), followed by a decline of VA at higher luminances with good test-retest variability. As expected, reduced contrast leads to a lower VA (worst mean VA ± SEM: -0.03 ± 0.03 logMAR at C = 18%, AL = 0 cd/m²). A 3D plot of these data shows the VA space (VAS) extending between the contrast and luminance axes, which describes the dynamics of VA continuously changing under varying everyday life conditions. CONCLUSIONS: VA-CAL, an automated device and procedure, allows for simultaneous evaluation of VA at various contrast-luminance combinations, thus providing a more comprehensive assessment of spatial vision problems not seen with standard BCVA tests. TRANSLATIONAL RELEVANCE: The new BCVA test VA-CAL incorporates a range of everyday contrast and ambient luminance conditions for a more realistic description of visual performance.