An innovative visual acuity chart for urgent and primary care settings: validation of the Runge near vision card

Matthew D Cooke,Clinton C Warren,Dennis P Han,Aniko Szabo,David V Weinberg,Kaitlin C Mckenney,Alexis Visotcky,Vesper Williams,William J Wirostko,Patricia A Winter,Eleanor A Dorsey,Krissa L Packard,Judy E Kim

doi:10.1038/s41433-019-0372-8

Matthew D Cooke, Clinton C Warren + Show 11 more

Open Access

https://doi.org/10.1038/s41433-019-0372-8

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Abstract

ObjectiveWe evaluated the Runge card, a near-vision eye chart designed for ease of use, by testing agreement in visual acuity results between it and the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. As a clinical reference point, we compared the Runge card and an electronic Snellen chart with respect to agreement with ETDRS results.MethodsParticipants consisted of adult eye clinic patient volunteers who underwent a protocol refraction, followed by testing with a Runge card, ETDRS chart, and Snellen chart. Mean logMAR visual acuities were calculated for each method. Agreement levels among the tests were assessed for the group overall and for subjects with good (ETDRS logMAR < 0.6; better than 20/80 Snellen equivalent) and poor (logMAR ≥ 0.6) acuity.ResultsOne hundred and thirty-eight participants completed testing. The mean ( ± standard deviation) logMAR visual acuities (Snellen equivalent) with Runge, ETDRS, and Snellen, respectively, were 0.66 ± 0.50 (20/91, n = 138), 0.59 ± 0.51 (20/78, n = 138), and 0.67 ± 0.62 (20/94, n = 137). Runge testing agreed similarly with ETDRS and Snellen testing, with CCC 0.92 between Runge and ETDRS, and 0.87 between Runge and Snellen (p = 0.14). Runge agreed better with ETDRS than Snellen agreed with ETDRS in participants with poor acuity (CCC = 0.79 vs. 0.63, respectively, p = 0.001) but not in those with good acuity (CCC = 0.70 vs. 0.87, respectively, p = 0.005).ConclusionVisual acuity measurements with the Runge near card agreed with measurements from the ETDRS to approximately the same degree as did the Snellen chart, suggesting potential utility of the Runge near card, particularly given its user-friendly characteristics and ease of use.

Highlights

We evaluated the Runge Near Vision Card (Runge card, Good-Lite, Elgin, Illinois), a near-vision eye chart with an innovative design intended to deal with some of the drawbacks of most of the currently used near visual acuity tests
To provide a clinically useful frame of reference we evaluated how a “Snellen” chart might perform against the Early Treatment Diabetic Retinopathy Study (ETDRS) chart
For purposes of this study, we considered a performance approximately equivalent to a Snellen chart by the Runge card to be an indicator of its potential clinical utility

Summary

Introduction

We evaluated the Runge Near Vision Card (Runge card, Good-Lite, Elgin, Illinois), a near-vision eye chart with an innovative design intended to deal with some of the drawbacks of most of the currently used near visual acuity tests. Patients with poor fixation or cognitive impairment may perform poorly with current charts, as most require that the patient locate the beginning of each line of letters even as the letters become smaller and more challenging to find. Such difficulty could create testing artifact from variable efforts of either the examiner or examinee. The Runge card provides the opportunity to test each eye on a different set of letters if so desired

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Conclusion