The ‘Real World’ Clinic Measured Visual Acuity Versus the Best Correct Visual Acuity Measurement in Patients Treated for Neovascular Age-Related Macular Degeneration
Abstract BACKGROUNDIn ophthalmology clinics, the visual acuity (VA) is usually measured by non-refracting healthcare professionals (HCPs). We compared the ‘real world’ or clinic measured VA versus the best-corrected visual acuity measurement in patients with neovascular age-related macular degeneration (nAMD).METHODSDuring the same clinical session using Early Treatment of Diabetic Retinopathy Study (ETDRS) vision chart, monocular distance VA was measured by non-refracting HCPs in nAMD patients and compared to the monocular distance VA measured by an optometrist with subjective refractive correction (BCVA). The study was powered to detect a difference of >5 ETDRS letters between the groups and for HCP measured VA to detect a BCVA between 6/12 and 6/96 (National Institute of Health and Care Excellence condition of approval of nAMD treatment with licensed drugs in the UK).RESULTSData from 167 patients (324 eyes) were analysed. Absolute mean difference in BCVA versus HCP measured VA was 5.71 (95% confidence interval (CI) 5.10-6.41) ETDRS letters (p-value<0.001). Using Bland-Altman method, limits of agreement between the two groups was found to be between 18.39 and -14.66 ETDRS letters. The prevalence of BCVA between 6/12 and 6/96 was 53.40% (95% CI 47.96-58.83%). In detecting this BCVA bracket, the non-refracting HCP measured VA had a sensitivity of 91.91% (95% CI 87.84-95.97%) and a specificity of 84.77% (95% CI 79.04-90.50%). CONCLUSIONSThe ‘real world’ HCP measured VA was found to have considerable inaccuracy and imprecision when compared to BCVA in nAMD patients. Unreliable VA measurement can have important implications in assessing and treating eye conditions, including nAMD.