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Original Investigation | Clinical Sciences

Differences in Vision Between Clinic and Home and the Effect of Lighting in Older Adults With and Without Glaucoma

Anjali M. Bhorade, MD, MSCI1; Monica S. Perlmutter, OTD, OTR/L1,2; Brad Wilson, MA1; Jamie Kambarian1; Sidney Chang, MD1,4; Melike Pekmezci, MD3; Mae Gordon, PhD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri
2Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
3Department of Pathology and Laboratory Medicine, University of California, San Francisco
4currently in a fellowship, San Diego, California
JAMA Ophthalmol. 2013;131(12):1554-1562. doi:10.1001/jamaophthalmol.2013.4995.
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Published online

Importance  Patients often report greater visual difficulties at home than expected from vision testing in the clinic. Such discordance may be owing to worse vision in the home than measured in clinic.

Objective  To compare vision measured between the clinic and home and evaluate factors, including lighting, associated with these differences.

Design, Setting, and Participants  This cross-sectional study conducted from 2005-2009 involved 126 patients with glaucoma and 49 without glaucoma recruited from the Glaucoma and Comprehensive Eye Clinics at Washington University, St Louis, Missouri. Patients underwent clinic and home visits, were aged 55 to 90 years, were consecutively recruited, and met inclusion criteria for this study. A total of 166 eligible patients refused participation.

Exposure  Participants underwent clinic and home visits randomized to order of completion. At each visit, masked and certified examiners measured binocular distance visual acuity (DVA) with a nonbacklit chart, near visual acuity (NVA), contrast sensitivity (CS), CS with glare, and lighting.

Main Outcomes and Measures  Differences in vision between the clinic and home.

Results  The mean scores for all vision tests were significantly better in the clinic than home for participants with and without glaucoma (P < .05, matched-pair t tests). For DVA, 29% of participants with glaucoma read 2 or more lines better in the clinic than home and 39% with advanced glaucoma read 3 or more lines better. For the entire sample, 21% of participants read 2 or more lines better in the clinic than home for NVA and 49% read 2 or more triplets better in the clinic for CS with glare. Lighting was the most significant factor associated with differences in vision between the clinic and home for DVA, NVA, and CS with glare testing (P < .05, multiple regression model). Median home lighting was 4.3 times and 2.8 times lower than clinic lighting in areas tested for DVA and NVA, respectively. Home lighting was below that recommended in 85% or greater of participants.

Conclusions and Relevance  Vision measured in the clinic is generally better than vision measured at home, with differences mainly owing to poor home lighting. Knowledge that vision discrepancies between patient report and clinical testing may be owing to home lighting may initiate clinician-patient discussions to optimize home lighting and improve the vision of older adults in their homes.

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Figure 1.
Differences in the Number of Lines Read Correctly Between Clinic and Home

Results shown are for distance visual acuity (VA) (A) and near VA (B) testing for participants with and without glaucoma.

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Figure 2.
Differences in the Number of Triplets Read Correctly Between Clinic and Home

Results shown are for contrast sensitivity (A) and contrast sensitivity with glare (B) testing for participants with and without glaucoma.

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Figure 3.
Differences in Vision Between the Clinic and Home by Differences in Lighting Between the Clinic and Home

Results shown are for differences in vision between the clinic and home for distance visual acuity (VA), near VA, contrast sensitivity (CS), and CS with glare testing.

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Figure 4.
Home Lighting Levels

Home lighting in testing locations for distance visual acuity (VA) (A) and near VA (B) for participants with and without glaucoma.

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