Measurement of glare sensitivity in cataract patients using low-contrast letter charts

The Committee on Ophthalmic Procedures Assessment of the American Academy of Ophthalmology suggested using low-contrast visual acuity measured before and after adding a glare source as a test for assessing overall visual disability from immature cataracts. We have developed a test that follows the Committee's three principles of design, and we report that the effect of glare on visual acuity is considerably greater for recognizing low-contrast letters than for recognizing high-contrast letters. The effect of glare on visual acuity increases progressively as letter contrast is reduced in the stages 96%, 50%, 25%, 11% and 4%. The 25% chart (and possibly the 11% chart) gives the most suitable sensitivity for eyes with immature cataracts. Age-related brunescence and aging itself do not necessarily produce high sensitivity to glare. Sensitivity to glare was markedly different in eyes with different kinds of cataract.