Central Contrast Sensitivity as an Outcome Measure in Randomized Controlled Trials in Glaucoma—A Systematic Review
Abstract
1. Introduction
2. Methods
2.1. Search Strategy
2.2. Inclusion and Exclusion Criteria
2.3. Data Extraction and Quality Assessment
3. Results
3.1. Characteristics of the Included Studies
3.2. Reporting of CCS as a Primary or Secondary Outcome
3.3. Follow-Up Time
3.4. Types of Contrast Sensitivity Tests Used
3.5. Format of Data Outcome
3.6. Study Participants
3.7. Type of Glaucoma
3.8. Interventions
3.9. Types of RCTs Included
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Author, Year Publication Type RCT Type | N Patients (HC) | CCS Test Used | Outcome Reporting of CCS | Intervention | Last Follow-Up | Main Finding |
---|---|---|---|---|---|---|
Muermans, 1990 [22] Abstract Crossover | 20 | NR | Primary | Timolol eyedrops or Placebo eyedrops | 2 test sessions and 14 d washout | Data did not show any drug effects on performance for temporal modulation fields and spatial CS. |
Balazsi, 1991 [23] Abstract, Crossover | 15 | NR | NR | Timolol eyedrops or Saline eyedrops | 2 test sessions and 14 d washout | No significant effect of timolol on visual fields, temporal modulation, or CS in treatment-naive patients. |
Bonomi, 1992 [24] Published paper Parallel group | 20 | Nicolet CS2000 | NR | Dapiprazole 0.5% x 3 or Placebo | 6 mo | No change in visual or contrast sensitivity in either group. |
Bose, 1992 [25] Published paper Crossover | 14 [17] | Pelli-Robson chart and Vistech near-contrast sensitivity chart | NR | Nimodipine capsules 60 mg once or Placebo once | 2 h per arm 3 d washout | Contrast sensitivity was reduced in NTG eyes and improved following nimodipine treatment. |
Drance, 1998 [26] Published paper Parallel group | 68 | Custom setup | NR | Betatoxolol 0.5% x 2 or Timolol 0.5% x 2 or Pilocarpine 2% x 4 | 24 mo | No significant differences in contrast sensitivity between groups. |
Evans, 1999 [27] Published paper Crossover | 11 | CSV-1000E | NR | Betaxolol 0.25% x 2 or Timolol 0.5% x 2 | 4 mo in total: 1 mo per arm 1 mo washout | CS improved with both drugs, but only improved significantly with betaxolol at 6 cpd. |
Harris, 1999 [28] Published paper Parallel group | 29 | CSV-1000 | NR | Dorzolamide 2% x 3 or Placebo eyedrops | 1 mo | Dorzolamide improved contrast sensitivity at low spatial frequencies in NTG patients. |
Caramazza, 1999 [29] Abstract Parallel group | 60 | NR | NR | Polyunsaturated fatty acids (PUFA) | 3 mo | Significant improvement in visual field and CS was observed after 3 months of PUFA treatment. |
Garzozi, 2001 [30] Abstract Crossover | 21 | NR | NR | Latanoprost 0.005% x 1 Dorzolamide 2% x 3 | 1 mo per arm Washout NR | Neither drug altered the contrast sensitivity. |
Sponsel, 2002 [31] Published paper Split-body | 25 | Two-step positive forced-choice algorithm (NeuroScientific) | NR | Unoprostone 0.15% x 2 or Latanoprost 0.005% x 1 + placebo | 1 mo | CS increased with both drugs, with no difference between latanoprost and unoprostone. |
Sponsel, 2002 [32] Published paper Hybrid split-body | 20 | Two-step positive forced-choice algorithm (NeuroScientific) | NR | Latanoprost 0.005% x 1 + placebo or Brimonidine 0.2% x 2 With/without Indomethacin po. 25mg x 4 | 1 mo | Both drugs improved CS, but the brimonidine group showed greater variability. |
Arend, 2003 [33] Published paper Crossover | 14 | CSV-1000 | NR | Timolol 0.5% x 2 or Dorzolamide 2% x 3 or Latanoprost 0.005% x 1 | 3 mo total 1 mo per arm | No significant change in CS after drug treatment. |
Evans, 2003 [34] Published paper Parallel group | 16 | CSV-1000E | NR | Timolol 0.5% x 1 + placebo or Brimonidine 0.2% x 2 | 3 mo | Brimonidine improved CS. The effect may reflect neuroprotection rather than IOP reduction. |
Harris, 2003 [35] Published paper Parallel group | 20 | NR | NR | Dorzolamide 2% x 3 or Latanoprost 0.005% x 1 | 1 mo | No conclusions regarding contrast sensitivity were drawn. |
Catoira, 2004 [36] Abstract Crossover | 31 | CSV-1000 | NR | Timolol 0.5% + Dorzolamide 2% x 2 or Brimonidine 0.2% | 1 mo Details NR | A lower IOP was associated with better visual function in POAG. |
Fea, 2004 [37] Abstract Parallel group | 30 | MAV Professional | Primary | Cyticholine i.m | 2 wk | Citicoline improved visual function and contrast sensitivity. |
Siesky, 2004 [38] Abstract Crossover | 15 | CSV-1000 | NR | Brimonidine 0.2% x 3 or Timolol 0.5% x 2 + placebo | 4 mo total 2 mo per arm | Significant association found between CS and retrobulbar blood flow in POAG patients. |
Siesky, 2006 [39] Published paper Crossover | 16 | CSV-1000 | NR | Tomolol x 1 + Dorzolamide x 1 + Placebo x 1 or Timolol x 2 + Latanoprost | 3 mo total 1 mo per arm 2 wk washout | No difference in CS between treatments. |
Evans, 2008 [40] Published paper Crossover | 20 | CSV-1000E | Primary | Latanoprost 0.005% x 1 or Timolol 0.5% x 1 | 6 mo total 3 mo per arm No washout | Latanoprost significantly improved the central CS more than timolol in POAG patients. |
Prata, 2009 [41] Published paper Parallel group | 54 | Functional Acuity Contrast Test (FACT) | NR | Timolol 0.5% or Brimonidine 0.2% or Travoprost 0.004% | 1 mo | Visual quality, VF MD, and high-frequency CS improved with treatment; no link to IOP or differences between drugs. |
Casson, 2014 [21] Published paper Crossover | 16 + 7 * | CSV-1000 | Primary | 50% topical glucose or Saline 0.9% 50% topical glucose or Saline 8% | 2–3 wk total 15–30 min per arm 2–3 wk washout | Topical glucose significantly improved CS at 12 cpd; non-significant increases were seen at 3, 6, and 18 cpd. |
Guo, 2014 [42] Published paper Crossover | 35 | Functional Acuity Contrast Test (FACT) | NR | Ginko biloba extract tablets or Placebo | 4 mo total 1 mo per arm 2 mo washout | Ginkgo biloba showed no significant effect on CS compared to the placebo. |
Aerie, 2019 [43] Published paper Parallel group | 207 | CSV-1000E | NR | Netarsudil solution of either 0.01%, 0.02%, or 0.04% or Placebo | 1 mo | No conclusions were drawn with regard to CS. |
Azizzadeh, 2019 [44] Published paper Parallel group | 80 | OPTEC Functional Vision Analyzer | Primary | Timolol 0.5% or Travoprost 0.004% or Dorzolamide 2% or Brimonidine 0.2% | 15 min | Timolol and brimonidine caused temporary CS changes at 1.5, 3, and 18 cpd in POAG patients. |
Trevino, 2019 [45] Abstract Parallel group | 21 | Pelli–Robson chart and CSV-1000 | NR | LPI temporally OD + LPI superiorly OS or LPI superiorly OD + LPI temporally OS | 1 mo | CS remained unchanged after superior or temporal LPI. |
Marino, 2020 [46] Published paper Crossover | 109 | Spaeth/Richman contrast sensitivity test (SPARCS) | Primary | Citicoline 500 mg, homotaurine 50 mg, and vitamin E 12 mg (CIT/HOMO/VITE) +/− current topical treatment | 8 mo total 4 mo per arm No washout | Preliminary data suggest that combined CIT/HOMO/VITE may enhance CS and vision-related quality of life in mild glaucoma. |
Loughman, 2021 [47] Published paper Parallel group | 62 | OPTEC Functional Vision Analyzer | Secondary | Capsules containing 10 mg lutein, 10 mg meso-zeaxanthin, and 2mg zeaxanthin | 18 mo | The study found an improvement in glare-affected mesopic contrast sensitivity. |
Lee, 2021 [48] Published paper Crossover | 38 | Functional Acuity Contrast Test (FACT) chart in OPTEC 6500P | NR | Korean Red Ginseng 1.0 g x 3/day or Placebo | 4 mo total 1 mo per arm 2 mo washout | Red ginseng improved CS and ocular pain in glaucoma; the effect may relate to retinal perfusion, not dry eye. |
Hunter, 2022 [49] Abstract Parallel group | 54 | Functional Vision Analyzer | Primary | 10 mg lutein + 10 mg meso-zeaxanthin + 2 mg zeaxanthin or Placebo | 18 mo | Higher MPOV was linked to better CS and faster PRT; carotenoid supplementation may improve visual function in OAG. Further work is required to determine its longer-term effects on visual function. |
Kitnarong, 2023 [50] Published paper Parallel group | 32 | OPTEC Functional Vision Analyzer | Primary | BF-IOL (AcrySof) or UVB-IOL (Tecnis) | 2 mo | Cataract surgery improved VA and CS in glaucoma patients; no CS difference between UVB-IOL and BF-IOL. |
Cadena, 2024 [51] Published paper Parallel group | 16 | Pelli–Robson chart | Primary | Repetitive transorbital alternating current stimulation (rtACS) | 6 wk | Significant VR-QoL improvements were observed with rtACS. |
Name of Test (Frequency %) | Description |
---|---|
CSV-1000 and CSV-1000E (33%) | A standalone device with several test plates that can be attached to its backlit screen. The recommended test distance is 8 ft/2.5 m. The background luminance is auto-calibrated to 85 cd/m2. It consists of four rows of gratings labeled A–D. Each row contains eight pairs of circular patches, one with a sine wave grating and the other being blank. The contrast gradually decreases from left to right. The rows differ according to their cpd from top to bottom, at 3, 6, 12, and 18, respectively. Additionally, there is a single, larger grating of high contrast at the start of each row that serves as a sample. The patient’s task is to identify the patch with the gratings. This test is conducted for all four cpd plates to produce a contrast sensitivity curve [54]. |
FACT chart (9%) | A printed chart with five rows of increasing cpd of 1.5, 3, 6, 12, and 18. Each row consists of nine sine-wave gratings of decreasing contrast, oriented either vertically or at 15 degrees to either the right or left. The patient’s task is to determine what orientation the gratings have. This is performed for all five spatial frequencies/rows to produce a contrast sensitivity curve. The recommended test distance is 3 m [55,56]. |
Pelli–Robson chart (9%) | A printed chart with Sloan letters. The letters are of equal size and have varying contrast levels. There are eight rows of letters, each consisting of two triplets. The change in contrast from one triplet to another is 0.15 log units, starting from the upper left, with 100% contrast (Weber contrast), to the lower right, with 0.56% contrast [57]. The cpd of the Pelli–Robson chart is a more complex matter, one that is perhaps without much meaning. Unlike gratings, which can be described according to a few parameters (orientation, contrast level, and cpd), letters are more complex and contain a variety of spatial frequencies, orientations, and contrast. Nevertheless, the size of the letters will indeed affect the range of spatial frequencies, and, in the literature, it has been reported to be in the lower range of 1 cpd [52] and 1.3 cpd [53] at 1 m. |
OPTECH Functional Vision Analyser (9%) | A stand-alone electronic device with multiple visual function tests in the form of slides that can be inserted into the device. It uses the FACT chart for CS testing. The device makes it easier to control for luminance, due to the goggle-like interface in which the patient places their face for testing, minimizing light contamination from the environment. The device has two luminance options, day testing, with 85 cd/m2, and night testing, with 3.0 cd/m2. In addition, it includes a glare-testing function with various illumination levels (1, 10, 28, and 135 LUX) [58]. |
OPTEC 6500P (3%) | An older version of the OPTEC FVA |
SPARCS test (3%) | The Spaeth/Richman contrast sensitivity test (SPARCS) is a web-based test. It assesses both central and peripheral contrast sensitivity using a regular computer display. The tested contrast ranges from 100% to 0.45% (0.0 to 2.35 Log con). The test is structured by dividing the display into five areas: one central and four peripheral areas, with one in each corner. During testing, one of the five areas will display a grating of 0.4 cpd for 0.3 s; the patient should then click on the area where he/she saw the grating displayed. The result is presented as a SPARCS score, which is calculated from the results of the five areas [59]. |
MAV Professional (3%) | The system is no longer in production, and we were unable to find any other information. |
NeuroScientific (6%) | We could not find any information on this system, other than what was written in the publication in which it was used. The paper stated: “Central retinal contrast sensitivity (7-degree pattern, 1 and 4 cycles per degree, 15 reversals per second) was performed using a two-step positive forced choice algorithm (NeuroScientific 8010, New York, NY, USA).” Contacting the authors was unsuccessful. |
VCTS 6000 (3%) | A printed chart for testing contrast sensitivity at a near distance. Very similar to the FACT chart, but it is smaller (17.5 × 14 cm) and is used at a distance of 40 cm [60]. |
Nicolet CS 2000 (3%) | We were unable to find reliable information on this system. Most studies using this system are from the 1980s. |
Custom Setup (3%) | The custom setup was described as a stationary, phase-reversing, sine-wave gratings sinusoidal, flickered in counter-phase at 25 Hz and with cpd of 0, 2, 5, 8, and 10 [61]. |
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Sverstad, A.; Møller, J.R.; Virgili, G.; Azuara-Blanco, A.; Freiberg, J.; Ahrensberg, S.; Kristianslund, O.; Petrovski, G.; Kolko, M. Central Contrast Sensitivity as an Outcome Measure in Randomized Controlled Trials in Glaucoma—A Systematic Review. Life 2025, 15, 1043. https://doi.org/10.3390/life15071043
Sverstad A, Møller JR, Virgili G, Azuara-Blanco A, Freiberg J, Ahrensberg S, Kristianslund O, Petrovski G, Kolko M. Central Contrast Sensitivity as an Outcome Measure in Randomized Controlled Trials in Glaucoma—A Systematic Review. Life. 2025; 15(7):1043. https://doi.org/10.3390/life15071043
Chicago/Turabian StyleSverstad, Alexander, Jens Riis Møller, Gianni Virgili, Augusto Azuara-Blanco, Josefine Freiberg, Simone Ahrensberg, Olav Kristianslund, Goran Petrovski, and Miriam Kolko. 2025. "Central Contrast Sensitivity as an Outcome Measure in Randomized Controlled Trials in Glaucoma—A Systematic Review" Life 15, no. 7: 1043. https://doi.org/10.3390/life15071043
APA StyleSverstad, A., Møller, J. R., Virgili, G., Azuara-Blanco, A., Freiberg, J., Ahrensberg, S., Kristianslund, O., Petrovski, G., & Kolko, M. (2025). Central Contrast Sensitivity as an Outcome Measure in Randomized Controlled Trials in Glaucoma—A Systematic Review. Life, 15(7), 1043. https://doi.org/10.3390/life15071043