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New low-contrast vision charts: reliability and test characteristics in patients with multiple sclerosis

Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA, Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Monika L Baier

Department of Biostatistics, AMC Cancer Research Center, Denver, Colorado, USA

Victoria S Pelak

Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado, USA

Robert J Fox

Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Sarah Shuwairi

Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Steven L Galetta

Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA, Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Gary R Cutter

Department of Biostatistics, AMC Cancer Research Center, Denver, Colorado, USA

Maureen G Maguire

Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA, Department of Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

The quantitative assessment of visual function in multiple sclerosis (MS) clinical trials has been limited to Snellen visual acuity. The purpose of this study was to examine the inter-rater reliability and test characteristics of a new visual outcome measure, the Low-Contrast Sloan Letter Charts, in patients with MS and visually-asymptomatic volunteers. Contrast letter acuity scores (letter scores) were measured at each of four contrast levels (100, 5, 1.25 and 0.6%) by two independent raters. Inter-rater agreement was described with the intraclass correlation coefficient (ICC) and comparison of mean scores. Excellent inter-rater agreement (ICC=0.86-0.95) was demonstrated at each contrast level among MS patients (n=100) and visually-asymptomatic volunteers (n=33). Average letter scores at the lowest contrast level (0.6%) were highly variable in the MS group, even among patients with visual acuities of 20/20 or better, and among those who required no assistance for ambulation. Low-Contrast Sloan Letter Chart testing is a highly reliable method of visual assessment, and provides information on an aspect of neurologic impairment in MS which is not captured by Snellen visual acuity or ambulation status. This new method demonstrates excellent potential as a visual function outcome measure for future MS clinical trials.

Key Words: vision • contrast letter acuity • multiple sclerosis • MS • reliability • outcome measures

Multiple Sclerosis, Vol. 6, No. 3, 163-171 (2000)
DOI: 10.1177/135245850000600305


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