Visual performance requirements for post-PRK police recruits

BACKGROUND: New Zealand Police regulations (1996) allow the unaided visual acuity requirement of 6/12 to be achieved following refractive surgery (except radial keratotomy or keratoplasty) provided applicants also achieve normal (95 per cent confidence limit data from the literature): glare disability, contrast sensitivity, and low luminance visual acuity, one year or more after treatment. METHODS: To confirm the limits adopted, 80 young normal adults were subjected to the tests in the regulations. To examine the operation of the current standards, the results of 34 post-photorefractive keratectomy (post-PRK) police applicants are reported. Glare disability was the loss of high contrast visual acuity (VA) with the Mentor Brightness Acuity Tester at medium intensity. Contrast sensitivity (CS) was examined using both Melbourne Edge Test thresholds and the VA difference between high and low contrast Bailey-Lovie charts. Low luminance VA was measured using high contrast Bailey-Lovie charts viewed through a one per cent transmittance filter. RESULTS: The 95 per cent confidence limits found for normal performance were as follows. Glare disability: no more than 10 letters worse than VA without glare. Contrast sensitivity: no more than 12 letters difference between high contrast and low contrast letter acuity together with an edge contrast threshold of not less than 20 dB (CS = 100). These results were close to the values adopted for the current standard. The 95 per cent confidence limit for low luminance VA was a loss of 24 letters (almost five lines) and not the three lines of loss estimated from the literature. Two of the 34 post-PRK applicants failed. One was unable to achieve 6/6 acuity with best refraction. The second could not meet the low luminance VA limit (loss no more than three lines). No failures have been due to glare disability or poor contrast sensitivity even though one applicant had obvious corneal haze.