September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Visual acuity testing: feedback affects neither outcome nor reproducibility, but leaves participants happier
Author Affiliations & Notes
  • Michael Bach
    Eye Center, University of Freiburg, Freiburg, Germany
  • Kerstin Schäfer
    Eye Center, University of Freiburg, Freiburg, Germany
  • Footnotes
    Commercial Relationships   Michael Bach, None; Kerstin Schäfer, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Michael Bach, Kerstin Schäfer; Visual acuity testing: feedback affects neither outcome nor reproducibility, but leaves participants happier. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Assessment of visual acuity is a well standardized procedure at least for expert opinions and clinical trials. It is often recommended not giving patients feedback on the correctness of their responses. As this viewpoint has not been quantitatively examined so far, we systematically assessed possible effects of feedback on visual acuity testing.

Methods : In 40 normal participants we presented Landolt Cs in 8 orientations using the automated Freiburg Acuity Test (FrACT, <>). Over a run comprising 24 trials, the acuity threshold was measured with an adaptive staircase procedure. In an ABCDDCBA scheme, trial-by-trial feedback was provided in 2 x 4 conditions: (A) no feedback, (B) acoustic signals indicating correctness, (C) visual indication of correct orientation, and (D) a combination of (B) and (C). After each run the participants judged their comfort. Main outcome measures were absolute visual acuity (logMAR), its test-retest agreement (limits of agreement) and participants’ comfort estimates on a 5-step symmetric Likert scale.

Results : Feedback influenced acuity outcome significantly (p=0.02), but with a tiny effect size: 0.02 logMAR poorer acuity for (D) compared to (A), even weaker effects for (B) and (C). Test-retest agreement was high (limits of agreement: ± 1.0 lines) and did not depend on feedback (p>0.5). The comfort ranking differed markedly (p<0.0001): The condition (A) –no feedback– was on average “slightly uncomfortable”, the other three conditions were “slightly comfortable”.

Conclusions : Feedback affected neither reproducibility nor the acuity outcome to any relevant extent. The participants, however, reported markedly greater comfort with any kind of feedback. We conclude that systematic feedback (as implemented in FrACT) offers nothing but advantages for routine use.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.


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