APPLIED VISUAL PERFORMANCE TESTS

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The objective of this revised proposal is to evaluate - in the context of predicting real-world visual task performance under non-ideal viewing conditions - new, clinically-practical, simple-to-administer vision tests. The focus is on the low contrast, low luminance, changing light levels, and divided attention tasks that are most problematic for the elderly. In the process, we will acquire a comprehensive description of vision function in older people. this data set will be unique in its combination of large number of older subjects, the wide range of ages including the very old, and the extensive nature of the test battery on which each person is measured. We do not aim to determine the mechanisms of vision loss associated with disease; rather, this study addresses the clinical need for practical, usable tests which predict real-world visual task performance. We will apply and validate the Smith-Kettlewell Institute Low Luminance (SKILL) card - a unique back-on-grey near visual acuity card, designed to simulate low contrast, low luminance conditions using normal office lighting. Our previous studies demonstrate that this test predicts both reading and driving performance as well as being a sensitive indicator of retinal function. We will also apply the Berkeley disability Glare test, the Smith-Kettlewell Retinal Recovery Rate test, and the Smith- Kettlewell Attentional Visual Field test. All have proven to be sensitive measures in previous published laboratory studies. We will now establish their strengths as predictors of real-world vision performance problems and their convenience for clinical use. We will take advantage of a population of 2,000 elderly people that has been pre-identified and well-characterized by our collaborator, Dr. William Satariano, a noted epidemiologist. Each participant will be given our vision test battery (consisting of the above-described tests in addition to a number of other established vision tests) as well as a validated questionnaire specifically designed to assess vision problems in daily life. We will also evaluate driving records, reading, and dim- light walking performance as quantitative measures of real-world task performance. We will determine the components of the test battery that best predict various subjectively-reported and actual task performance problems. We will also determine the relation between actual and subjectively reported visual performance difficulties. Once we have established the predictive value of these tests, they can be passed on to the clinician and other individuals who would benefit from more valid indicators of the patient's ability to meet the visual challenges of daily life.