Associations Between Contrast Sensitivity and Aging

Abstract

Objective:
The aim of this study was to assess age-related visual functions (visual acuity and contrast sensitivity) and compare the results by different age groups.

Material and methods:
A total of 231 patients were examined. The patients were divided into 5 age groups: 10 patients in group 1, 30-39 years; 40 patients in the group 2, 40-49 years; 77 patients in the group 3, 50-59 years; 71 patients in the group 4, 60-70 years; and 33 patients in the group 5, 71-85 years. A typical Snellen's chart (the direction of the gap in Landolt C) was used for noncorrected and best-corrected visual acuity testing. Contrast sensitivity was evaluated by employing a Ginsburg Box, VSCR-CST-6500.

Results:
Noncorrected visual acuity was significantly better in the group 2 than the group 3 (0.86 [0.28] vs. 0.69 [0.33], P=0.018). Moreover, noncorrected and best-corrected visual acuity was significantly better in the group 4 than the group 5 (0.52 [0.35] vs. 0.35 [0.28], P<0.001; and 0.9 [0.21] vs. 0.69 [0.27], P<0.005, respectively). Contrast sensitivity at the nighttime without glare was significantly worse in the group 2 than the group 1 at the spatial frequencies of 3, 12, and 18 cycles per degree (P=0.001, P=0.05, and P=0.01, respectively). The patients in the group 2 had significantly worse contrast sensitivity at the nighttime and daytime with glare at the spatial frequencies of 1.5, 12, and 18 cycles per degree (P=0.054, P=0.04, and P=0.01 and P=0.011, P=0.031, and P=0.011, respectively). The greatest differences in contrast sensitivity were observed between the groups 4 and 5, and it was 2 to 4 times better in the group 4. Comparing these groups, all the differences at the nighttime and daytime with and without glare were significant.

Conclusions:
Contrast sensitivity was worst among the oldest persons (71-85 years), and it began to worsen already in the persons aged 40-49 years. Contrast sensitivity was very similar in the age groups of 40-49 and 50-59 years.

Full text

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Medicina (Kaunas) 2013;49(6)
Medicina (Kaunas) 2013;49(6):273-7
Associations Between Contrast Sensitivity and Aging
Rasa Liutkevičienė1, 2, Džastina Čebatorienė1, Giedrė Liutkevičienė3,
Vytautas Jašinskas1, Dalia Žaliūnienė1
1Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences,
2Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences,
3Maxpharma Baltija UAB, Lithuania
Key Words: contrast sensitivity; visual acuity; aging; functional acuity contrast test.
Summary. Objective. The aim of this study was to assess age-related visual functions (visual
acuity and contrast sensitivity) and compare the results by different age groups.
Material and Methods. A total of 231 patients were examined. The patients were divided into 5
age groups: 10 patients in group 1, 30–39 years; 40 patients in the group 2, 40–49 years; 77 pa-
tients in the group 3, 50–59 years; 71 patients in the group 4, 60–70 years; and 33 patients in the
group 5, 71–85 years. A typical Snellen’s chart (the direction of the gap in Landolt C) was used for
noncorrected and best-corrected visual acuity testing. Contrast sensitivity was evaluated by employ-
ing a Ginsburg Box, VSCR-CST-6500.
Results. Noncorrected visual acuity was significantly better in the group 2 than the group 3
(0.86 [0.28] vs. 0.69 [0.33], P=0.018). Moreover, noncorrected and best-corrected visual acuity
was significantly better in the group 4 than the group 5 (0.52 [0.35] vs. 0.35 [0.28], P<0.001; and
0.9 [0.21] vs. 0.69 [0.27], P<0.005, respectively). Contrast sensitivity at the nighttime without
glare was significantly worse in the group 2 than the group 1 at the spatial frequencies of 3, 12, and
18 cycles per degree (P=0.001, P=0.05, and P=0.01, respectively). The patients in the group 2
had significantly worse contrast sensitivity at the nighttime and daytime with glare at the spatial
frequencies of 1.5, 12, and 18 cycles per degree (P=0.054, P=0.04, and P=0.01 and P=0.011,
P=0.031, and P=0.011, respectively). The greatest differences in contrast sensitivity were observed
between the groups 4 and 5, and it was 2 to 4 times better in the group 4. Comparing these groups,
all the differences at the nighttime and daytime with and without glare were significant.
Conclusions. Contrast sensitivity was worst among the oldest persons (71–85 years), and it be-
gan to worsen already in the persons aged 40–49 years. Contrast sensitivity was very similar in the
age groups of 40–49 and 50–59 years.
Correspondence to R. Liutkevičienė, Department of Ophthal-
mology, Medical Academy, Lithuanian University of Health
Sciences, Eivenių 2, 50028 Kaunas, Lithuania
E-mail: rliutkeviciene@gmail.com
Introduction
Optical and neuron degenerative changes of the
visual system that inuence a steady decrease in
visual acuity are observed from the age of approxi-
mately 40 years (1). With aging, people’s vision be-
comes less clear; big objects can be seen clearly, but
problems occur when people try to discern minor
things and minor details. Additionally, senile mio-
sis develops, the eye lenses become less clear and
stiffer, and the accommodation and convergence re-
serves start to decrease (1). These changes reduce
the access of light to the retina. Some authors sug-
gest that contrast sensitivity starts decreasing from
the age of 20 years (2). These processes are believed
to progress due to the atrophy of the retinal gan-
glion cell layer (1). Ganglion cells help determine
contrast and quickly evaluate the differences in light
intensity (3).
The visual acuity test is the simplest method,
which is most commonly used by ophthalmologists,
to examine the function of vision. An optotype chart,
which contains 12 rows of signs (letters, numbers,
rings with a gap, and drawings of various objects), is
used for the examination of visual acuity. According
to Snellen, visual acuity can be expressed in spatial
frequencies; however, the highest spatial frequencies
are evaluated by the standard visual acuity test only
under conditions of maximum contrast (V=1.0 match
30 cycles per degree when contrast is 100%); hence,
contrast sensitivity is partially evaluated. Therefore,
optotypes can be seen even with decreased contrast
sensitivity. The Snellen’s chart provides limited infor-
mation about functional vision (4).
Functional or “practical” vision is described as
our day-to-day vision, i.e., what people see and how
they process this information (5). A regular Snel-
len’s chart allows evaluating the patients’ ability to
determine black letters on a white background from
the distance, but it does not show visual quality (5),
whereas the functional acuity contrast test (FACT)
is considered to be more informative and accurate in
examining and evaluating visual functions.
For a detailed visual examination, various func-

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Medicina (Kaunas) 2013;49(6)
tions, such as cognitive perception, health of the
visual system, and the central processing function,
are tested. Studies have shown that the assessment
of visual acuity with the typical Snellen’s chart using
Landolt’s rings (C optotypes) alone is insufcient
for the visual function testing because it provides
limited information about the central vision; thus, it
is necessary to determine not only visual acuity, but
also contrast sensitivity (6).
The aim of this study was to assess age-related
visual functions (visual acuity and contrast sensitiv-
ity) and compare the results by different age groups.
Material and Methods
The study was conducted in the Department of
Ophthalmology, Hospital of Lithuanian University
of Health Sciences, after the permission (No. BE-
2-14) from Kaunas Regional Ethics Committee for
Biomedical Research was obtained.
In total, 231 patients were examined. The patients
were divided into the following 5 age groups: group
1, 10 patients (19 eyes) aged 30–39 years; group 2,
40 patients (80 eyes) aged 40–49 years; group 3,
77 patients (153 eyes) aged 50–59 years; group 4,
71 patients (142 eyes) aged 60–70 years; and group
5, 33 patients (66 eyes) aged 71–85 years. In this
study, visual acuity, transparency of the cornea and
the lens, and the fundus were investigated in the
patients. Biomicroscopy was performed in order to
assess corneal and lenticular transparency. Noncor-
rected and best-corrected visual acuity (measured in
decimals from 0.1 to 1.0) was evaluated using Land-
olt’s rings (C optotypes) by the Snellen’s test at a
5-m distance from the chart.
The lenses were evaluated by biomicroscopy. The
lenses were examined using a slit lamp, positioning
the illumination source at a 45° angle and the light
beam being split to a 2-mm width.
During each examination, refraction was per-
formed, intraocular pressure was measured, and the
iris color was noted using the slit lamp. The pupils
of the subjects were dilated with 1% tropicamide or
1% cyclogyli. After the dilation of the pupils, fundos-
copy was performed with an ophthalmoscope of the
direct monocular type and the slit lamp, using a dou-
ble aspheric lens of +78 diopters. Peripheral retinal
examination was performed using an indirect oph-
thalmoscope. The results of the ophthalmic examina-
tion were recorded on standardized forms that were
developed for this study. Stereoscopic color fundus
photographs of the macula were obtained at 45° and
30° to the fovea for a detailed fundus analysis.
The inclusion criteria were as follows: 1) age of
30 to 85 years; 2) no other eye disorders found dur-
ing a detailed ophthalmological examination; and 3)
consent to participate.
The exclusion criteria were as follows: 1) related
eye disorders (high refractive error, cloudy cornea,
opacity of the lens [nuclear, cortical, and posteri-
or subcapsular cataract], keratitis, acute or chronic
uveitis, glaucoma, neovascular age-related macular
degeneration or geographic atrophy, diseases of the
optic nerve, etc.); 2) systemic illnesses (diabetes
mellitus, oncological diseases, systemic tissue dis-
orders, chronic infectious diseases, conditions after
organ or tissue transplantation, etc.); 3) nongraded
color images of the fundus because of obscuration
in the eye optic system or because of the quality of
fundus photography; and 4) functional acuity con-
trast test (FACT) value of 0.
Contrast sensitivity was measured by employ-
ing a Ginsburg Box, VSCR-CST-6500 with a FACT
chart at photopic (in the daytime, 85 cd/m2) and
mesopic (in the nighttime, 3 cd/m2) luminance with
and without glare at 5 standard spatial frequencies:
1.5, 3, 6, 12, and 18 cycles per degree (6). Contrast
sensitivity testing was performed in the presence of
best-corrected visual acuity.
Statistical analysis was performed using the
SPSS/W 13.0 program (Statistical Package for the
Social Sciences for Windows, Inc., Chicago, Illinois,
USA). The χ2 test was used for comparison of the
frequencies of qualitative variables. A statistically
signicant difference was considered if P<0.05.
Results
Table 1 shows noncorrected and best-corrected
visual acuity by age groups. Noncorrected visual
acuity was signicantly better in the group 2 than
in the group 3 (P=0.018). Moreover, noncorrected
and best-corrected visual acuity was better in the
group 4 compared with the group 5 (P<0.001 and
P<0.005, respectively) (Table 1).
The comparison of contrast sensitivity at the
nighttime without glare between the groups 1 and 2
showed that contrast sensitivity was signicantly
Parameter Age Groups, Years
30–39 40–49 50–59 60–70 71–85
Noncorrected visual acuity
Best-corrected visual acuity
0.89 (0.28)
0.98 (0.14)
0.86 (0.28)
0.98 (0.13)
0.69 (0.33)
0.97 (0.11)
0.52 (0.35)
0.9 (0.21)
0.35 (0.28)
0.69 (0.27)
Values are mean (standard deviation).
Table 1. Patients Groups and Results of Visual Acuity
Rasa Liutkevičienė, Džastina Čebatorienė, Giedrė Liutkevičienė, et al.

275
Medicina (Kaunas) 2013;49(6)
worse in the group 2 at the spatial frequencies of
3, 12, and 18 cycles per degree (P=0.001, P=0.05,
and P=0.01, respectively) (Table 2). At the daytime
without glare, no signicant differences in contrast
sensitivity between the groups 1 and 2 were docu-
mented at all spatial frequencies. Similar compari-
sons of contrast sensitivity at the nighttime and day-
time with glare revealed that the patients in the group
2 had signicantly worse contrast sensitivity at the
spatial frequencies of 1.5, 12, and 18 cycles per de-
gree (P=0.054, P=0.04, and P=0.01 and P=0.011,
P=0.031, and P=0.011, respectively) (Table 3).
The comparison of contrast sensitivity between
the groups 2 and 3 showed signicant differences
at the nighttime with glare at a spatial frequency of
3 cycles per degree (P=0.001) and at the daytime
without glare at the spatial frequencies of 6 and 12
cycles per degree (both P=0.05) (Tables 2 and 3).
The greatest differences in contrast sensitivity
were observed comparing the groups 4 and 5 (Ta-
bles 2 and 3). Contrast sensitivity was 2 to 4 times
better in the group 4, i.e., younger group, than the
group 5. All the differences in contrast sensitivity at
the nighttime and daytime with and without glare
were signicant.
Discussion
It has been reported that a decrease in contrast
sensitivity is directly associated with patients’ age
and visual acuity. The FACT is a very sensitive
method used for the evaluation of the visual system
and may help detect the onset of the disease even
when visual acuity is still intact. This examination
method also allows observing changes in the dis-
ease, such as progression or recovery. In some coun-
tries, the FACT is used to diagnose visual disability.
There are many studies (2, 7–13) analyzing age-
related changes in contrast sensitivity, but to our
knowledge, age-related changes in contrast sensitiv-
ity with and without glare in the Lithuanian popula-
Contrast Sensitivity Age Groups, Years
30–39 40–49 50–59 60–70 71–85
At nighttime at different spatial frequencies,
cycles per degree
1.5
3
6
12
18
81.8 (20.6)
100.8 (45.6)
75.8 (42.1)
28.8 (14.2)
16.1 (15.1)
73.4 (26.9)
88.4 (50.3)*
74.9 (48.6)
23.9 (20.3)*
10.4 (7.1)*
69.4 (23.2)
85.3 (41.1)
72.8 (46.5)
22.5 (14.0)
9.02 (6.2)
68.2 (36.4)
80.4 (53.9)
57.7 (51.3)
15.2 (13.7)
6.3 (6.2)
26.7 (25.2)†
25.3 (23.4)†
8.2 (6.8)†
2.3 (2.3)†
1.6 (1.2)†
At daytime at different spatial frequencies,
cycles per degree
1.5
3
6
12
18
71.9 (22.8)
106.5 (39.2)
111.0 (42.7)
45.5 (23.5)
24.0 (16.2)
66.0 (26.0)
104.7 (44.6)
106.5 (56.7)
45.3 (30.9)
20.0 (17.3)
64.0 (22.9)
97.4 (40.8)
96.9 (53.7)‡
37.8 (34.9)‡
16.7 (9.2)
61.2 (30.6)
90.4 (50.8)
82.6 (55.8)
30.2 (29.3)
12.2 (5.3)
31.5 (28.8)†
38.4 (38.6)†
22.4 (20.4)†
6.3 (6.1)†
1.2 (1.1)†
Values are mean (standard deviation).
*P<0.05 as compared with the 30–39-year age group. ‡P<0.05 as compared with the 40–49-year age group.
†P<0.05 as compared with the 60–70-year age group.
Table 2. Contrast Sensitivity at the Nighttime and Daytime Without Glare According
to the Functional Acuity Contrast Test by Age Groups
Contrast Sensitivity Age Groups, Years
30–39 40–49 50–59 60–70 71–85
At nighttime at different spatial frequencies,
cycles per degree
1.5
3
6
12
18
77.7 (23.8)
95.3 (43.8)
69.0 (32.5)
25.2 (16.8)
10.8 (9.6)
68.8 (27.6)*
91.8 (48.5)
64.0 (52.8)
22.2 (17.5)*
6.7 (3.7)*
66.9 (30.1)
79.9 (49.0)‡
62.6 (49.3)
18.8 (6.0)
5.9 (4.9)
61.3 (33.2)
74.5 (53.3)
45.7 (37.5)
10.3 (7.1)
2.2 (2.1)
26.6 (24.2)†
24.5 (24.7)†
7.2 (4.3)†
2.2 (1.6)†
0.4 (0.3)†
At daytime at different spatial frequencies,
cycles per degree
1.5
3
6
12
18
84.3 (19.8)
111.8 (39.9)
117.6 (45.4)
53.6 (26.9)
25.3 (19.3)
74.6 (29.2)*
105.2 (47.1)
111.3 (55.8)
42.5 (36.4)*
18.4 (18.4)*
72.5 (23.2)
102.9 (35.4)
108.7 (26.9)
41.8 (35.9)
16.3 (13.1)
64.4 (30.7)
89.6 (51.2)
83.3 (59.2)
31.2 (23.4)
14.5 (8.1)
31.2 (26.4)†
35.7 (32.3)†
25.4 (23.2)†
4.1 (4.2)†
2.2 (2.1)†
Values are mean (standard deviation).
*P<0.05 as compared with the 30–39-year age group. ‡P<0.05 as compared with the 40–49-year age group.
†P<0.05 as compared with the 60–70-year age group.
Table 3. Contrast Sensitivity at the Nighttime and Daytime With Glare According
to the Functional Acuity Contrast Test by Age Groups
Associations Between Contrast Sensitivity and Aging

276
Medicina (Kaunas) 2013;49(6)
tion by the different age groups have been evaluated
for the rst time. Our study showed that contrast
sensitivity in the 40–49-year age group decreased
at high spatial frequencies as well; it remained very
similar in the age groups of 40–49 and 50–59 years
and was much worse in the oldest group, i.e., patients
aged 71–85 years. Our results are in agreement with
those of the study performed by Owsley et al. (2).
This study revealed that contrast sensitivity began
decreasing at the age of 40 to 50 at higher spatial
frequencies (2). Shahina et al. carried out a study of
younger and older patients’ groups and reported that
contrast sensitivity decreased with older age, too (7).
Nio et al. examined 100 healthy persons aged 20
to 69 years and conrmed that contrast sensitivity
showed age-related changes at a spatial frequency of
8 cycles per degree (9). A Japanese study evaluated
contrast sensitivity in a group of patients aged 40
to 79 years, whose visual acuity was 1.0 or better,
and reported that 9.4% of the patients with intact
visual acuity had lower contrast sensitivity (9). Hoh-
berger et al. conrmed a signicant relationship be-
tween age and a decrease in contrast sensitivity (10).
Crassini et al. examined groups of younger persons
(mean age, 20.4 years) and older persons (mean age,
64.4 years) when visual acuity and the visual system
function were intact (11). The study results suggest-
ed that the contrast sensitivity of younger persons
was better compared with older persons, but only
at high spatial frequencies (11). Our results are also
in agreement with those of the study by Robert et
al., who investigated FACT changes in 2 groups of
healthy persons: a younger group with a mean age of
18.5 years and an older group with a mean age of 73
years (12). The authors demonstrated that contrast
sensitivity at low and medium spatial frequencies
was 3 times better in the group of younger patients
than in the group of older patients (12). Greene et
al. investigated the relationship between aging and
visual acuity as well as between aging and contrast
sensitivity (13). The authors examined a group of
young persons (mean age, 19.5 years) and a group
of older persons (mean age, 68.4 years) and showed
that contrast sensitivity signicantly decreased in
the group of older patients (13). Such results imply
that the FACT is useful when evaluating age-related
changes in the visual system (13). Ross et al. evalu-
ated 2 age groups: one with participants aged 20 to
30 years and the other with participants aged 50 to
87 years (8). Older observers had reduced contrast
sensitivity at all spatial frequencies when compared
with their younger counterparts. This was particular-
ly obvious at medium and high spatial frequencies.
In the age range 50 to 87 years, there was a linear
decline in contrast sensitivity with age at medium
and high spatial frequencies. Within this age range,
the responses to low spatial frequencies appeared to
be independent of age (8). Our results are in dis-
agreement with those of the study by Ross et al.,
because our results revealed that the FACT results
were worse at low spatial frequencies (1.5 cycles per
degree) in the younger age groups and in the old-
est age group, especially, when we evaluated con-
trast sensitivity in the nighttime and daytime with
glare, but when contrast sensitivity without glare
was evaluated, only one statistically signicant re-
sult at a medium spatial frequency was found, i.e., in
the nighttime without glare, the results were worse
in 40–49-year age group at a spatial frequency of 3
cycles per degree. Deterioration of contrast sensi-
tivity at medium spatial frequencies may be due to
an impact of glare at younger age and due to lens
opacities at older age (14). Rouhiainen et al. have
reported a signicant association between contrast
sensitivity and lens opacication at low and medium
frequencies in posterior subcapsular opacities (14).
Therefore, it seems likely that cataract (cortical or
posterior subcapsular) should be primarily respon-
sible for the trend of decreasing contrast sensitivity
with age in subjects with good visual acuity (14). It
has also been determined that glare reduces contrast
sensitivity in older persons, especially the ones who
are diagnosed with cataract (15). The study by Hoh-
berger et al. also proved a close relationship between
decreasing contrast sensitivity and age and contrib-
uted to the existing knowledge by determining and
describing the inuence of cataract on decreasing
contrast sensitivity (10).
Conclusions
Contrast sensitivity decreased with age, and it is
attributed to age-related changes in the optical sys-
tem.
Statement of Conflict of Interest
The authors state no conict of interest.
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Received 21 February 2012, accepted 30 May 2013
Associations Between Contrast Sensitivity and Aging