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MK Mathews, R Rothermel, SM Soll, DB Soll; The Super Pinhole Test for Potential Acuity in Eyes with Cataract . Invest. Ophthalmol. Vis. Sci. 2002;43(13):382.
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Purpose: To determine the accuracy of the Super Pinhole Test (Micro-Surgical Technology, Inc./ For-Sight of Florida, Lantana, Florida) (SPH) for predicting visual acuity after cataract surgery. Methods: 45 eyes from 36 patients were included in this consecutive case series. Preoperatively, best corrected Snellen visual acuity (BCA) was measured. Then, a different observer performed SPH testing according to the manufacturer's instructions. (The portable SPH device introduced by David J. McIntyre1, consists of a light box displaying a transilluminated Snellen chart viewed through reversible pinhole glasses). Patients then underwent phacoemulsification cataract extraction with implantation of a posterior chamber lens. BCA was again measured at minimum 3 weeks after surgery. Data analysis was performed in a method similar to the one previously described by Minkowski et al.2. In brief, patients were divided into two groups according to preoperative visual acuity. Group 1 had a visual acuity of worse than 20/200. Group 2 had a visual acuity of 20/200 or better. Success or failure of cataract surgery was defined as a postoperative vision better than / equal to 20/40 or worse than 20/40. Accuracy of the SPH test in predicting postoperative BCA and in predicting success or failure of the cataract surgery was assessed. Results: Group 1 consisted of 8 eyes, 50% of which were predicted within 1 line of BCA. 62.5% were predicted within 3 lines. Within group 2, consisting of 37 eyes, 92% were predicted within 3 lines of BCA, 78% within 2 lines and 41% within 1 line. The accuracy of the SPH test in predicting success or failure was 50% for group 1 and 54% for group 2. Resulting in a calculated sensitivity of 0.43 for group 1 and 0.45 for group 2. However 5 (63%) of the eyes within group 1 and 31 (84%) of the eyes within group 2 ended up having better BCA than predicted, resulting in SPH specificity of 1.0 for group 1 and 0.83 for group 2. Conclusion: The SPH is a quick, easy and reasonably reliable test to predict postoperative BCA after cataract surgery. It gives the cataract surgeon a way of demonstrating the expected visual outcome to patients and their relatives. Our data revealed excellent specificity of this test as well as its strong tendency to underestimate surgical outcome. In spite of the SPH being commercially available and in use for over 25 years, this report, to our knowledge, represents the first case series evaluating the accuracy of this device. References: 1. Lowry J. Ophthalmology Times.11(17):1,31,35.1986 2.Minkowski JS, Palese M, Guyton DL.Ophthalmology.90(11):1360.1983
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