GLARE TEST

ANDI AYU LESTARI

Glare in Cataract
◦ Cataract  one of the most common conditions encountered in ophthalmic
practice.
◦ Decreased vision is a common patient condition, but this may occur only under
certain lighting conditions. Patients may be sensitive to glare when driving at
night or on a sunny day. To evaluate glare, there are many devices available.

Image courtesy: https://www.cataractbirmingham.co

Wiggins, M. N., Irak-Dersu, I., Turner, S. D., & Thostenson, J. D. (2009). Glare Testing in Patients with
Cataract after Dilation. Ophthalmology, 116(7), 1332–1335.
 Glare in Cataract
◦ Cataract patients often report an increase in glare, which may vary from
increased photosensitivity in brightly lit environments to disabling glare in
the daytime or with headlights from oncoming cars.
◦ Shorter wavelengths of light cause the most scatter; the color, intensity, and
direction of lighting also affect glare.
◦ This increased sensitivity is particularly prominent with PSCs and,
occasionally, with anterior cortical lens changes.

AAO Chapter 11 : Lens & Cataract. 2020-2021 : P. 87.

 Glare in Cataract
◦ Clinically the cataract that causes the most glare related disability is the posterior

subcapsular cataract.

◦ Posterior subcapsular opacity lies just in front of the posterior capsule and has a granular

or plaque-like appearance on oblique slit lamp. This is due two reasons : (1) the entrance

angle of the peripheral light rays is more oblique than central light rays and (2) the area

that the posterior capsule cataract covers is also greater compared to nuclear cataract.

◦ The light is refracted through the lens before reaching the retina to be processed, and any

sort of opacity that disrupts light transmittance can increase light scatter particularly if the
Posterior subcapsular opacity
opacity is large and spread throughout the lens. Being prone to disability glare, makes

glare one of the biggest visual complaints and impairments experienced by those suffering

from cataracts.

Diep M, Davey PG. Glare and Ocular Diseases. In: Rumelt S, editor. Causes and Coping with Visual Impairment and Blindness [Internet]. London: IntechOpen; 2018.
Kanski, J. J., Bowling, B., Nischal, K. K., & Pearson, A. (2020). Clinical ophthalmology: A systematic approach (9th ed.). Edinburgh ; New York: Elsevier/Saunders.
 Glare Testing
◦ Testing can be done with :
◦ a nonprojected eye chart in ambient light conditions or
◦ a projected eye chart and an off-axis bright light directed at the patient.

◦ Patients with significant cataracts commonly show a decrease of 3 or more lines under
these conditions, compared with results obtained when visual acuity is tested in a
darkened room.
◦ It is best to perform this assessment prior to dilation. Glare testing performed after
dilation must be adjusted to account for the change in visual acuity after dilation; the
results may be less accurate, especially in patients with a PSC.

Wiggins, M. N., Irak-Dersu, I., Turner, S. D., & Thostenson, J. D. (2009). Glare Testing in Patients with
2

Cataract after Dilation. Ophthalmology, 116(7), 1332–1335

 Glare Testing
◦ Glare testing is most helpful in the decision for cataract surgery in
symptomatic patients with otherwise good VA under nonglare
conditions. In patients with dense cataracts and substantial visual loss,
glare testing rarely adds to the decision for surgery. 1

◦ With glare testing, the clinician attempts to

measure the degree of visual impairment
caused by the presence of a light source
located in the patient’s visual field.2

1
AAO Chapter 11 : Lens & Cataract. 2020-2021 : P. 87.
CSV-1000E from Vector Vision
2
Wiggins, M. N., Irak-Dersu, I., Turner, S. D., & Thostenson, J. D. (2009). Glare
Testing in Patients with Cataract after Dilation. Ophthalmology, 116(7), 1332–1335.
Glare Testing
Penlight Glare Test

A Kentar Arimadyo. Perbedaan Tajam Penglihatan Penderita Katarak Imatura dengan dan Tanpa Penlight Glare Test.
UNDIP. 2004.

Maltzman B. Penglight test for glare disability of cataracts.

Ophthalmic Surgery. May: 1988: 19: 356-358.
Glare Testing
◦ One such device, the Brightness Acuity Tester (BAT),
projects a light onto a 60-mm diameter hemisphere
while the patient looks through a 12-mm central
aperture.
◦ The BAT provides uniform glare conditions that predict
outdoor visual acuity (VA) on a sunny day when used on
the medium setting. If vision decreases significantly,
this may indicate a clinically significant cataract and aid
in the decision for surgery.1

Figure (Holladay) Appearance of brightness acuity tester

(B.A.T.) when used for measuring functional outdoor acuity. 2

Wiggins, M. N., Irak-Dersu, I., Turner, S. D., & Thostenson, J. D. (2009). Glare Testing in Patients with Cataract after Dilation. Ophthalmology, 116(7), 1332–1335.
1

Holladay, Jack T et al. “Brightness acuity test and outdoor visual acuity in cataract patients.” Journal of Cataract and Refractive Surgery 13 (1987): 67–69.
2
Instrument & Test for Glare
CSV-1000E
◦ One widely known clinical tool to measure disability glare is the CSV-1000E
from Vector Vision.

◦ This device measures disability glare using contrast sensitivity at spatial

frequencies ranging from low to high. The spatial frequencies are measured
using sinusoidal gratings at varying levels of contrast.
CSV-1000E used for glare testing at varying luminance
◦ The CSV-1000E has a backlit illumination of 85 cd/m2 which can be used for and contrast sensitivity at different spatial frequencies.
Image courtesy of VectorVision.
glare testing under photopic conditions.

◦ The device can measure in mesopic conditions as well with the use of neutral
density filters which lowers illuminance to 3 cd/m2, the FDA recommended
setting for mesopic measurements.

Diep M, Davey PG. Glare and Ocular Diseases. In: Rumelt S, editor. Causes and Coping with Visual Impairment and Blindness [Internet]. London: IntechOpen; 2018.
 CSV-1000E
◦ The test consists of eight levels
of contrast for each spatial
frequency. There are 8 columns
consisting of two circles each,
one which contains the sinusoidal
gratings.
◦ The subject is tasked with
identifying which of the two
circles contain the grating for
each of the columns. The
responses are recorded and
converted to a logarithmic scale.

Diep M, Davey PG. Glare and Ocular Diseases. In: Rumelt S, editor. Causes and Coping with Visual Impairment and Blindness [Internet]. London: IntechOpen; 2018.
Instrument & Test for Glare
Berkeley glare test
◦ The Berkeley Glare Test has long been used for glare testing in clinic and
research. The Berkeley Glare test measures visual acuity optotypes and
different contrast levels under glare conditions.
◦ A chart of varying levels of contrast is placed in the device, behind the opal
Plexiglas screen which has a back illumination of 85 cd/m2.

Epiglare test
• The EpiGlare tester is a LED light emitting device that can be attached to a phoropter. There are four LED

lights placed evenly around the aperture of the device. Under induced glare conditions, the subjects are asked

to read off an EDTRS chart to assess their CDVA.

• The study also incorporated a Functional Vision Questionnaire that assessed the subjects driving and glare EpiGlare tester designed by Dr. Alice Epitropoulos
can be easily attached to phoropter for clinical use
experiences. An additional question was asked after glare testing on how closely the test resembled their glare

problems while nighttime driving.

Diep M, Davey PG. Glare and Ocular Diseases. In: Rumelt S, editor. Causes and Coping with Visual Impairment and Blindness [Internet]. London: IntechOpen; 2018.
 EpiGlare Test

Youtube courtesy beye.com https://www.youtube.com/watch?

v=GZ5Liy_dBvM
Conlusion

◦ It appears that glare testing can serve as a good indicator of visual function and may also be affected in disease states. As
various new treatment modalities become available for age related macular degeneration, glaucoma and newer intraocular
lens surgeries and laser refractive surgeries, treatment outcome may be better assessed using visual function tasks that are
more difficult to perform and are more realistic of “real” world activities. To this accord a combination of glare testing with
contrast discrimination may be well suited

Wiggins, M. N., Irak-Dersu, I., Turner, S. D., & Thostenson, J. D. (2009). Glare Testing in Patients with Cataract after Dilation. Ophthalmology, 116(7), 1332–1335.
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◦ Terimakasih boscu