Abstract
Purpose :
Most epidemiologic studies define presbyopia as the inability to see binocularly either N6 or N8 at 40 cm (20/40 or 20/50 on the Snellen chart); however, it remains unclear whether this threshold accurately detects patients who need presbyopia treatment in the real world. This study investigated the clinically relevant optimal cutoff point of the near visual acuity (NVA) for detecting presbyopia.
Methods :
We enrolled consecutive individuals with free of ophthalmic surgeries, aged ≥20 years with a binocular corrected distance visual acuity (CDVA) of ≥20/25 between December 17, 2020, and December 19, 2021, at two healthcare facilities in Japan. The binocular distance-corrected NVA (DCNVA) at 40 cm, accommodative amplitude, self-awareness of presbyopia, and Near Activity Visual Questionnaire (NAVQ) scores were examined. We used the receiver operating characteristic plots to determine the optimal threshold of the DCNVA for diagnosing presbyopia. The sensitivity and specificity at each cutoff point of DCNVA compared with the diagnosis of presbyopia (accommodative amplitude of <2.5 diopters) were evaluated. The optimal threshold was determined using the Youden index.
Results :
Of 115 subjects (73 men, 63.5%; mean age, 42.5±10.8 years), we identified 74 (64.3%) patients with presbyopia. The proportion of participants who had no difficulty performing near-vision tasks (the least quartile of the NAVQ score) decreased markedly when the NVA decreased to 20/20 (>0.00 logarithm of the minimum angle of resolution [logMAR]). Based on the receiver operating characteristic curves, the sensitivity and specificity for diagnosing presbyopia were high with the optimal threshold of 0.00 logMAR for DCNVA (sensitivity: 56.76%, specificity: 92.68%). At the commonly used cutoff point of 0.40 logMAR (20/50), the sensitivity was decreased to 9.46% and 1.35% for DCNVA while the specificity was very high (100% for both). Presbyopic status characterized by the optimal NVA threshold was significantly related with both subjective symptoms (awareness of presbyopia, higher NAVQ score) and objective parameters (decreased accommodation) related to presbyopia (P<0.001).
Conclusions :
The NVA of 0.00 logMAR (20/20) can be the optimal threshold for diagnosing presbyopia, at least in developed countries.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.