Near visual function measured with a novel tablet application in patients with astigmatism

Ananya Datta, Kathryn Richdale, Erin S Tomiyama, Chuan Hu, Anna-Kaye M Logan, Kelsea Skidmore, Moriah A Chandler, Eric R. Ritchey, James S. Wolffsohn

Research output: Contribution to journalArticlepeer-review


Clinical relevance: While the clinical focus of performance metrics is traditionally based on visual acuity, research from the field of visual impairment has demonstrated that metrics such as reading speed and critical print size correlate much more strongly with subjective patient reported outcomes and assessed ability in real-world tasks. Background: More recently, digital device use has increasingly replaced many paper-based tasks. Therefore, this study aimed to assess the correlation between standard acuity/contrast metrics and functional reading ability compared to real-world performance on an iPad-based reading task with astigmatic patients corrected wearing toric and mean spherical equivalent contact lenses. Methods: Thirty-four adult participants, with −0.75 to −1.50 D of refractive astigmatism, were enrolled in a double-masked cross-over study and fitted with toric and spherical equivalent contact lenses, in random order. A digital application was developed to assess zoom, contrast modifications, the distance at which the tablet was held, blink rate, and time to complete the reading task. High and low contrast near logMAR visual acuity were measured along with reading performance (critical print size and optimal reading speed). Results: The amount participants chose to increase tablet font size (zoom) was correlated with their high-contrast visual acuity with toric correction (r = 0.434, p = 0.010). With best sphere correction, zoom was associated with reading speed (r = −0.450, p = 0.008) and working distance (r = 0.522, p = 0.002). Text zoom was also associated with horizontal (toric: r = 0.898, p < 0.001; sphere: r = 0.880, p < 0.001) and vertical scrolling (toric: r = 0.857, p < 0.001; sphere: r = 0.846, p < 0.001). There was a significant negative association between the selection of text contrast and zoom (toric: r = −0.417, p = 0.0141; sphere: r = −0.385, p = 0.025). Conclusion: Real-world task performance allows more robust assessment of visual function than standard visual metrics alone. Digital technology offers the opportunity to better understand the impact of different vision correction options on real-world task performance.

Original languageEnglish
Pages (from-to)42-47
Number of pages6
JournalClinical and Experimental Optometry
Issue number1
Early online date17 Sept 2020
Publication statusPublished - 2021

Bibliographical note

© 2020 The Authors. Clinical and Experimental Optometry published by John Wiley & Sons Australia, Ltd on behalf of Optometry Australia

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Funding: Alcon, Fort Worth, TX (GrantNumber(s): Alcon Grant for Investigator Initiated Study)


  • contrast acuity
  • horizontal and vertical scrolling
  • iPad application
  • reading speed
  • zoom


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