Ocular hypertension in myopia: analysis of contrast sensitivity

Purpose: we evaluated the evolution of contrast sensitivity reduction in patients affected by ocular hypertension and glaucoma, with low to moderate myopia. We also evaluated the relationship between contrast sensitivity and mean deviation of visual field. Material and methods: 158 patients (316 eyes), aged between 38 and 57 years old, were enrolled and divided into 4 groups: emmetropes, myopes, myopes with ocular hypertension (IOP≥21 ±2 mmHg), myopes with glaucoma. All patients underwent anamnestic and complete eye evaluation, tonometric curves with Goldmann’s applanation tonometer, cup/disc ratio evaluation, gonioscopy by Goldmann’s three-mirrors lens, automated perimetry (Humphrey 30-2 full-threshold test) and contrast sensitivity evaluation by Pelli-Robson charts. A contrast sensitivity under 1,8 Logarithm of the Minimum Angle of Resolution (LogMAR) was considered abnormal. Results: contrast sensitivity was reduced in the group of myopes with ocular hypertension (1,788 LogMAR) and in the group of myopes with glaucoma (1,743 LogMAR), while it was preserved in the group of myopes (2,069 LogMAR) and in the group of emmetropes (1,990 LogMAR). We also found a strong correlation between contrast sensitivity reduction and mean deviation of visual fields in myopes with glaucoma (coefficient relation = 0.86) and in myopes with ocular hypertension (coefficient relation = 0.78). Conclusions: the contrast sensitivity assessment performed by the Pelli-Robson test should be performed in all patients with middle-grade myopia, ocular hypertension and optic disc suspected for glaucoma, as it may be useful in the early diagnosis of the disease. Introduction Contrast can be defined as the ability of the eye to discriminate differences in luminance between the stimulus and the background. The sensitivity to contrast is represented by the inverse of the minimal contrast necessary to make an object visible; the lower the contrast the greater the sensitivity, and the other way around. Contrast sensitivity is a fundamental aspect of vision together with visual acuity: the latter defines the smallest spatial detail that the subject manages to discriminate under optimal conditions, but it only provides information about the size of the stimulus that the eye is capable to perceive; instead, the evaluation of contrast sensitivity provides information not obtainable with only the measurement of visual acuity, as it establishes the minimum difference in luminance that must be present between the stimulus and its background so that the retina is adequately stimulated to perceive the stimulus itself. The clinical methods of examining contrast sensitivity (lattices, luminance gradients, variable-contrast optotypic tables and lowcontrast optotypic tables) relate the two parameters on which the ability to distinctly perceive an object depends, namely the different luminance degree of the two adjacent areas and the spatial frequency, which is linked to the size of the object. The measurement of contrast sensitivity becomes valuable in the diagnosis and follow up of some important eye conditions such as glaucoma. Studies show that contrast sensitivity can be related to data obtained with the visual perimetry, especially with the perimetric damage of the central area and of the optic nerve head.