Low-contrast letter charts as a test of visual function.

Visual pathway disorders can cause visual loss that is not detected by the Snellen test: visual sensitivity to coarse detail may be depressed, even when visual sensitivity to fine detail is unaffected. Sinewave grating test targets can detect such hidden visual loss. However, electronic apparatus for generating sinewave gratings is expensive, while the inexpensive Arden plates provide no check on the patient's accuracy. We have tested 10 patients and 10 control subjects with a set of five letter charts (including the standard Snellen chart). These letter charts were of different contrasts, namely 10%, 22%, 31%, 64% and 93%, but otherwise were substantially alike. Subjects were also tested with sinewave gratings. We found good agreement between sinewave grating and letter chart findings. In particular, the charts picked up visual loss that was not detected by the standard Snellen chart: they detected visual pathway dysfunction in all seven patients whose sinewave data were abnormal. Our findings suggest that even one low-contrast letter chart could provide a valuable supplement to the standard Snellen chart. Compared with other available devices, these charts have the advantages of cheapness, simplicity and of providing the ophthalmologist with an immediate check on patients' accuracy.