SPARCS and Pelli– Robson contrast sensitivity

testing in normal controls and patients with

cataract

L Gupta1, V Cvintal2, R Delvadia3, Y Sun4, E Erdem5, C Zangalli6, L Lu 7, SS Wizov8, J Richman8,

E Spaeth9 and GL Spaeth8

Muhammad Rhema Adinegara

dr. Riski Prihatningtias Sp.M
Introduction
• CS influences numerous aspects of people’s vision, including VA, visual
field, motion detection, dark adaptation, and pattern recognition

• In fact, CS is better than VA in predicting many aspects of functional

vision.

• The Pelli–Robson (PR) test is a well established, commonly used CS test.

It is a chart showing letters of constant size but decreasing contrast.

• The Spaeth/Richman Contrast Sensitivity (SPARCS) test is a CS test that

can be performed on a computer with access to the Internet. It evaluates
CS centrally and in four peripheral quadrants and scores them separately
 Objective
• To determine the ability of the newly developed internet-based Spaeth/Richman
Contrast Sensitivity (SPARCS) test to assess contrast sensitivity centrally and
peripherally in cataract subjects and controls, in comparison with the Pelli–Robson
(PR) test.

“ How Spaeth/Richman Contrast Sensitivity (SPARCS) test to assess

contrast sensitivity centrally and peripherally in cataract subjects and
controls, in comparison with the Pelli–Robson (PR) test in cataract
subject? “
Subject & Methods
Testing was carried out at the Wills Eye
Hospital Glaucoma Research Center between
January 2010 and August 2013

Control 162 eye

Cataract

119 eye from 61 subject 43 eye from 23

subject

Pelli Robson SPARCS

Data Analysis
Metods
Cataract
Inclusion criteria were :
1. Inclusion criteria required
subjects to be 18 years of
age or older,
2. Able to fully informed
consent, and either a
cataract subject or healthy
control
Control
Inclusion criteria were :
1. VA ≤ 20/40
2. No ocular or neurological
pathology affecting their
vision, which was confirmed
during the clinical
evaluation.
3. Previous cataract surgery is
nevermind
Metods
Exclusion criteria were :
1. Those who could not speak or understand sufficient English
2. had cognitive impairment
3. Eyes with nuclear opacities 4+, anterior subcapsular, posterior
subcapsular and cortical opacities affecting the visual axis
4. Cataract subjects were excluded if their ocular history included
optic nerve, cornea, or retinal diseases; previous surgeries; or
ocular trauma
Clinical evaluation
• This examination included :
(1) Snellen VA,
(2) refraction,
(3) intraocular pressure via Goldmann Applanation tonometry,
(4) a slit-lamp and fundus examination,
(5) an optic nerve examination in which vertical CDR
(6) monocular Humphrey Visual field (24-2 SITA),
(7) monocular PR and SPARCS tests
 Variable

Dependant Independant
Contras sensitivitas cataract
STATISTIC ANALYSIS

• Data was analyzed using SAS software, version 9.2 and later (SAS Institute
Inc, Cary, NC, USA)
• Groups were compared with respect to eye level data using mixed effects
linear regression to account for correlation among eyes from the same
subject
• The 5 SPARCS position scores were modeled jointly using mixed effects
linear regression
• Pairwise comparisons of means were conducted at each position and P-
values for these comparisons were adjusted using the Bonferroni method.
• And also use Fisher exact and Wilcoxon range.
RESULT
DISCUSSION
• SPARCS better detects decreases in CS with worsening cataract
severity. While the PR test was only able to detect statistically
significant differences in CS between 3+ nuclear sclerosis and
controls, the SPARCS test was able to detect a statistically significant
reduction in CS for subjects with 2+ or 3+ nuclear sclerosis when
compared to controls.

• SPARCS has certain limitations including subject fatigue. A full SPARCS

assessment of both eyes typically takes 5-10min. In this study, fatigue
was negligible. If the technician identified subject fatigue, the subject
was given rest time and the test was restarted
THE LIMITATION
• The significant difference in age between the two groups is a limitation of
this study. This may have affected the results, as CS declines with age
• In addition, the younger group may have had better scores because they
were better able to understand the tasks; however, the test is relatively
• Easy to understand and a technician was present to answer questions and
ensure that the subject understood throughout testing. The test could also
be restarted. The small sample size of the group of cataract subjects is also
a limitation. Although an even larger group or more agematched group
would provide stronger data, we feel that the strength of the data offers
useful insight that could be developed further in future studies.
Conclusion
• Both SPARCS and PR demonstrate a significant influence of cataract
on contrast sensitivity. SPARCS offers the advantage of determining
contrast sensitivity peripherally and centrally
Critritical Appraisal
 SPARCS and Pelli– Robson contrast sensitivity testing in normal controls and
patients with cataract
Section 1: Internal validity
In this study this criterion
is:
1.1 The study addresses an appropriate and clearly focused question. Addressed

Write the reason of your answer:

To determine the ability of the newly developed internet-based
Spaeth/Richman Contrast Sensitivity (SPARCS) test to assess contrast
sensitivity centrally and peripherally in cataract subjects and controls,
in comparison with the Pelli–Robson (PR) test
1.2 The assignment of subjects to treatment groups is randomised Addressed
Write the reason of your answer:

Testing was carried out at the Wills Eye Hospital Glaucoma Research
Center between January 2010 and August 2013. The control group
included 119 eyes from 61 subjects while the cataract subject group
included 43 eyes from 23 subjects
1.3 An adequate method is used addressed
Write the reason of your answer:
This prospective cross-sectional study

1.4 Subjects and investigators are kept ‘blind’ about treatment Yes
allocation

Testing order was randomized before subject enrollment using

a randomization list generated from
http://www.randomizer.org/.
1.5 The treatment and control groups are Addressed and yes
similar at the start of the trial

Write the reason of your answer:

Testing was carried out at the Wills Eye
Hospital Glaucoma Research Center
between January 2010 and August 2013.
The control group included 119 eyes from
61 subjects while the cataract subject group
included 43 eyes from 23 subjects.
1.6 All relevant outcomes are measured in a Addressed
standard, valid and reliable way

Write the reason of your answer:

Catarct : LOCS II
Contras sensitivitas : PR and SPARCS
1.8 What percentage of the individuals or clusters recruited into each treatment arm of the study
dropped out before the study was completed?
No dropped out

1.9 All the subjects are analysed in the groups to which they were randomly allocated

Write the reason of your answer:

There only 2 groups, catarct and normal group as a control

1.10 Where the study is carried out at more than one site, results are comparable for all sites

Write the reason of your answer:

Not addressed
Section 2: Overall assessment of the study

2.1 How well was the study done to minimise YES

bias?

A technician explained and administered each

test. These cond test was administered by a
different technician to prevent testing bias.

Both tests were performed in each eye with

the subject’s habitual eyeglasses correction if
needed

Testing was conducted in a room with

fluorescent lighting and no windows to
minimize glare and reflections and ensure
uniform testing conditions
2.2 If coded as +, or - what is the likely they dont use coded, but with some
direction in which bias might affect condition and many procedure to
the study results? minimal bias

2.3 Are the results of this study directly Yes it applicable

applicable to the patient group
targeted by this guideline?
Section 3: Description of the study (the following information is required to complete evidence tables
facilitating cross-study comparisons
3.1 Do we know who the study was funded by? [ +] Academic Institution
[ ] Healthcare Industry
The author didn’t declare the funding of this study [ ] Government [ ] NGO [ ] Public funds
[ ] Other
3.2 How many centres are patients recruited from? 1 centres

3.3 What is the social setting (ie type of environment [ ] Urban [ ] Rural [x ] Mixed
in which they live) of patients in the study?

Urban, all of participanys were choosen from

Wills Eye Hospital Glaucoma Research Center, and
cataract group from catarct primary eye care.
3.4 What criteria are used to decide who
should be INCLUDED in the study?
1. Inclusion criteria required subjects to
be 18 years of age or older,
2. Able to fully informed consent, and
either a cataract subject or healthy
control
To control group :
1. VA ≤ 20/40
2. no ocular or neurological pathology
affecting their vision, which was
confirmed during the clinical evaluation.
3. Previous cataract surgery is nevermind
3.5 What criteria are used to decide 1. Those who could not speak or
understand sufficient English
who should be EXCLUDED from the 2. had cognitive impairment
study? 3. Eyes with nuclear opacities 4+,
anterior subcapsular, posterior
subcapsular and cortical
opacities affecting the visual axis
4. Cataract subjects were excluded
if their ocular history included
optic nerve, cornea, or retinal
diseases; previous surgeries; or
ocular trauma
3.6 What intervention is investigated in the there’s no intervention
study? (Include dosage where appropriate)

3.7 What comparisons are made in the study? Not reported

(ie what alternative treatments are used to
compare the intervention with?). Include
dosage where appropriate.

3.8 What methods were used to randomise The process is blind and random
patients, blind patients or investigators, and
to conceal the randomisation process from
investigators?