Clinical comparison of three techniques for evaluating visual function behind cataract.

The aim of the study was to compare the ability of displacement threshold hyperacuity to identify reduced retinal/neural function in cataract patients with that of the potential acuity meter (PAM) and laser interferometer. Fifty-two patients (mean age 72.0 +/- 10.8 years) admitted for extracapsular cataract extraction were randomly selected for inclusion in the study. Patients underwent routine refraction and logMAR acuity measurement on the eve of cataract surgery. Following pupillary dilation and in random order, the oscillatory displacement threshold (ODT; defined as the smallest detectable displacement of an object) was determined, and predictions of the post-operative acuity were obtained using the PAM and Rodenstock Retinometer (RR). Patients were re-examined approximately 7 weeks post-operatively when logMAR acuities and ODTs were remeasured. On the basis of the results of an independent fundus examination, patients were assigned to either a normal or a pathology group. Increasing cataract density adversely affected the predictions provided by the PAM (p = 0.0001) and ODT (p = 0.0001) techniques, but not the RR (p = 0.137). One-factor ANOVA revealed that pre-operative ODT (p = 0.0001), PAM (p = 0.0001) and RR (p = 0.0004) measures successfully distinguished patients with retinal/neural pathology from normals. Pre-operative cut-off levels to distinguish normal from pathology cases were retrospectively determined for each technique. The cut-off values for the PAM and ODT techniques yielded higher sensitivity and specificity values than was the case for the RR. The results suggest that the predictive abilities of the PAM and ODT techniques are similar, and superior to that of the RR. Further work involving larger numbers of patients with posterior segment pathology is necessary to reveal which technique provides the best means of assessing retinal/neural function in the presence of ocular media opacities.