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Editors Selection IGR 15-4

Miscellaneous: Effect of lighting conditions on visual performance

Comment by Kelly Muir on:

55408 Differences in vision between clinic and home and the effect of lighting in older adults with and without glaucoma, Bhorade AM; Perlmutter MS; Wilson B et al., JAMA ophthalmology, 2013; 131: 1554-1562

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This investigation was undertaken to examine the complaint heard commonly by clinicians that vision is worse at home than when tested in the clinic. In this cross-sectional study of 126 adults with glaucoma and 49 adults without glaucoma, Bhorade et al. examined visual acuity (distance and near), contrast sensitivity (with and without glare) in the clinic and at home. Examiners also measured light intensity in both settings. Participants were aged 55-90 years, did not have vision-threatening diseases (other than glaucoma in the glaucoma group), visually significant cataracts, nor history of treatment with miotics. In the total sample, the mean visual acuity was better at home than in the clinic for all measures. In 21% of participants, near visual acuity measured two or more lines better in the clinic than in the home. The difference in contrast sensitivity at home and in the clinic was greatest for participants with advanced glaucoma, although the study included fewer participants in this group. For all participants, median lighting levels were 4.2 times higher in the clinic than in the home for distance acuity testing.

This study supports the practice of recommending improved lighting conditions in the home to optimize visual performance in all patients, especially in those with advanced glaucoma

In a multiple regression of factors associated with visual performance, the difference in light intensity at home versus the clinic was the most important factor in the disparity between clinic and home performance on visual acuity testing at distance and near and contrast sensitivity with glare. This study supports the practice of recommending improved lighting conditions in the home to optimize visual performance in all patients, especially in those with advanced glaucoma.

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