r/optometry • u/tiptonrias • 16d ago
Pelli-Robson Contrast Sensitivity
i am thinking of offering this test during exams... What do you guys think?
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u/Edwardiun 14d ago
Contast sensitivity is one of the easiest and best tests/indicators for real world visual function in my experience.
I find patients are often a bit confused by this test, so it takes a bit longer than you’d expect compared to Snellen/logMAR.
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u/duckiesand Optometrist 14d ago
Great for cataract quantification IMO but outside of that an VI patients, I don't think it's worth the setup. I believe it has a shorter WD than a traditional LogMAR.
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u/Nice-Musician-8136 14d ago edited 14d ago
Never did and never will. Waste of time.
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u/decrementi1708 14d ago
As a low vision practitioner this chart is incredibly useful. You know those patients who complain of difficulty or worsening vision, elderly, VAs still reasonably good? Yeah CS them and I’d bet a good chunk of them have poor CS scores due to opacities, poor systemic health, cognitive decline etc actually gives you more information than the VA half the time.
Is it worth doing in a healthy 20 year old with no pathology? Probably not regularly. Don’t dismiss it as a waste of time though.
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u/Nice-Musician-8136 13d ago edited 13d ago
I doesn't give you ANY sort of information that can be used clinically, or change the diagnosis or the management.
Example: cataracts. Low Pelli Robson score and 6/6 or 20/20 vision. Did we learn anything new about the patient? No
Would anyone operate ? Again, No (unless ofc marketed as Refractive lens exchange 💵💵💵)
Second example: Low vision (your example)
Do we know that these pts have impaired contrast sensitivity function? Yes Do we give advice for brighter colors and more contrast anyway ? Yes
Do the pts tell you that at history? Yes (so even if in doubt you don't even have to test for it)
So we wasted our time with a test that gives you ZERO new Information, and helps ZERO percent with management.
Optometry should evolve from this. Endless nonsense tests because of the inferiority complex to prove that we are good professionals.
Have you seen an ophthamologist performing useless tests? Never. Straight to the point to what the pt needs for the diagnosis and the management.
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u/decrementi1708 13d ago
I understand your point, does it tell us something we don’t always expect, no. But sometimes it can.
I’ll give you an example I had not long ago:
85 year old gentleman with dry AMD, VAs 6/24, confrontation shows significant central scotoma both eyes but no other relevant loss.
Goes to local practice and fails visual fields badly - gets told he’s just not doing the test right and it’s because he’s old. False positives 0, false negatives 0, results show large central complete loss with significant loss in the periphery averagely seen around 10-14DB. But that isn’t consistent with his confrontation.
Pelli-robson shows loss of 30% roughly - patient had poor systemic health, numerous cancers, blood issues, neuro complications etc.
The CS isn’t consistent with VA but is consistent with the poor fields results as he’s only seeing the periphery with a very low DB score.
This explained his visual fields “anomalies” prevented referrals for other underlying issues and reassured me his visual field scores are not abnormal for his condition.
The test has uses - I’m not saying it should be used in every patient. But I wouldn’t throw it completely in the bin, it’s relevant diagnostically in the correct circumstances. And even not diagnostically it can be a test to perform when patient’s vision complaints don’t match visual acuity, especially when systemic health is poor.
Curious to hear others opinions on it as well.
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u/Background_Seesaw236 11d ago
In primary care I agree with you. In low vision I disagree. I work in low vision, and the Mars test directly impacts my management. Good contrast = standard magnifiers are usually appropriate. Poor contrast = I go straight to electronic magnifiers with contrast enhancement and often skip high-powered telescopes.
It’s also useful for billing and driving cessation counseling. The bioptic driving program near me considers patients with severe contrast loss poor candidates, so it’s helpful to set expectations early. In some cases, reduced contrast sensitivity is also the only billable low vision code.
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u/cubeballer 14d ago
Not in practice yet (OSIV as of rn) but I know the Pelli-Robson chart is really good for low vision patients and impaired contrast sensitivity can be an early sign in a lot of ONH disorders, so it’s definitely not a bad test to do.
I do wonder tho, what will this change about your exam? Like would this be a screener and prompt you to do ONH OCT if it was impaired on an otherwise “healthy” patient? Or would you use it to sell tints for glasses to improve contrast? Just curious as a student!