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Gary S. Rubin, Beatriz Muñoz, Karen Bandeen–Roche, Sheila K. West; Monocular versus Binocular Visual Acuity as Measures of Vision Impairment and Predictors of Visual Disability. Invest. Ophthalmol. Vis. Sci. 2000;41(11):3327-3334.
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purpose. To examine the relationship between monocular and binocular visual
acuities as predictors of visual disability in a population-based
sample of individuals 65 years of age and older.
methods. Two thousand five hundred twenty community-dwelling residents of
Salisbury, Maryland, between the ages of 65 and 84 years of age were
recruited for the study. Corrected visual acuity was measured
monocularly and binocularly using ETDRS charts. Reading speed, face
discrimination, and self-reported difficulty with visual tasks were
results. Binocular acuity is predicted with reasonable accuracy by acuity in the
better eye alone, but not by the widely used American Medical
Association (AMA) weighted-average algorithm. The AMA algorithm
significantly underestimates binocular acuity when the interocular
acuity difference exceeds one line. Monocular acuity and binocular
acuity were significantly better predictors of reading speed than the
AMA weighted score or a recently proposed Functional Vision Score
(FVS). Monocular acuity in the better eye, binocular acuity, and the
AMA and FVS algorithms were equally good predictors of self-reported
vision disability. None of the acuity measures were good predictors of
face recognition ability.
conclusions. The binocular acuities of older individuals can be inferred from
measures of monocular acuity. There is little evidence for binocular
inhibition when the monocular acuities in the two eyes are unequal, as
opposed to the widely used AMA algorithm for computing binocular visual
impairment. For tasks that are strongly associated with visual acuity,
such as reading, this association can be captured from measures of
monocular acuity and does not require separate assessment of binocular
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