Reliability of Mesopic Measures of Visual Acuity and Contrast Sensitivity and Their Correlation with Rod and Cone Function in Retinitis Pigmentosa

Abstract

Background: Mesopic conditions elicit both rod and cone responses, and they are more commonly encountered in daily life than are scotopic conditions; yet visual function outcome measures of mesopic visual acuity (VA) or contrast sensitivity (CS) are rarely evaluated. Objective: In retinitis pigmentosa (RP), we explored whether visual reductions in mesopic versus photopic conditions were correlated with cone or rod function, as well as the between-visit test-retest variability in mesopic measures. Methods: At each of two visits, 22 RP subjects completed mesopic and photopic ETDRS VA and Pelli-Robson chart CS tests obtained with and without a U23 NoIR 4% transmission filter; testing of perifoveal scotopic cone or rod sensitivity with the AdaptDx; and the Rabin Cone Contrast Test (CCT). Results: A greater CS reduction in mesopic versus photopic conditions was significantly related to absence of scotopic rod function (p = 0.038) or longer self-reported duration of night vision loss (p = 0.044). VA reductions >0.2 logMAR in mesopic versus photopic conditions were significantly related to reduced cone-mediated scotopic sensitivity (p = 0.038). Significant predictors of the CCT ratio of S-cone to M- and L-cone sensitivity were mesopic VA (p = 0.038) and absence of AdaptDx rod function (p = 0.008). Test-retest 95% coefficients of repeatability were not significantly different when comparing between photopic and mesopic tests of VA (0.16 and 0.12 logMAR, respectively) or CS (0.21 and 0.24 logCS, respectively). Conclusions: Perifoveal scotopic rod and cone function measured with the AdaptDx was significantly correlated with mesopic CS and VA, respectively, which had good, acceptable test-retest repeatability; thus, they appear to be suitable outcome measures to monitor mesopic visual function in clinical practice or trials. RP subjects with reduced mesopic VA and no perifoveal rod function had a greater loss of sensitivity for S-cones than for L-/M-cones.