Contrast Sensitivity Testing in Healthy and Blurred Vision Conditions Using a Novel Optokinetic Nystagmus Live-Detection Method.

Purpose The aim of the current study was to develop and validate an automated contrast sensitivity (CS) test using a live- detection of optokinetic nystagmus (OKN) and an adaptive psychometric procedure. In addition, the study sought to replicate the known effect of defocus on CS for the OKN-based measurements in emmetropic participants. Methods Fifteen participants viewed a horizontally moving grating while their eyes were tracked with an infra-red (IR) eye-tracker. To simulate the clinical conditions of the CS measurements, the participants were stimulated monocularly as the left eye was occluded by an IR filter. The horizontal eye position was continuously analyzed for OKN responses, and the stimulus contrast was changed by an adaptive psychometric method depending on the outcome. Furthermore, the newly proposed OKN live-detection was verified against an offline analysis and an expert-observer judgement. The OKN-based CS was measured for six spatial frequencies at normal vision and three levels of defocus using spherical convex lenses. Results The newly proposed OKN live-detection method showed a sufficient detection performance for implementation of adaptive procedures, and the detection rate is similar or better compared to offline detection methods. Spatial frequency and defocus had a significant effect on the OKN-based CS (P < 0.0001 for both). Conclusions The current study presents a novel method to measure motion CS in an automated way, combining the real-time detection of OKN and an adaptive psychometric procedure. Furthermore, the known effect of defocus on CS was successfully replicated with the newly developed tool. Translational Relevance OKN-based CS is a novel approach to assess spatial vision, which is sensitive to subtle effects of defocus, allowing use with nonverbal patients and infants. Furthermore, the newly developed tool may improve the performance of such measurements.