ETDRS-Fast: Implementing psychophysical adaptive methods to standardized visual acuity measurement with ETDRS charts

PURPOSE. TO measure visual acuity (VA) on Early Treatment Diabetic Retinopa thy Study (ETDRS) charts with a modified faster procedure (ETDRS-Fast), bas ed on adaptive psychophysics methods and to assess the method's validity an d reproducibility. METHODS. Whereas the standard method for measuring VA with the ETDRS charts requires that the subject read all the letters beginning with the top row, in the ETDRS-Fast procedure, the subject is asked to read only one letter per row until a mistake is made. Then, following simple rules, the examiner finds a row from which the subject can begin reading all the letters downw ard, thus making the method identical with the standard method near thresho ld. VA determination was performed twice with both methods in 57 subjects i n two separate sessions to assess validity and reproducibility. RESULTS. In both sessions the correlation between the two procedures was hi gh (intraclass correlation coefficient 0.95), confirming the validity of th e ETDRS-Fast procedure. Reproducibility was good for both procedures, with intraclass correlation coefficients of 0.94 for the standard and 0.96 for t he ETDRS-Fast method. The ETDRS-Fast procedure allowed a significantly shor ter test duration (-30%; P < 0.0001). CONCLUSIONS. Adaptive procedures allow accurate and fast determination of p sychophysical thresholds by reducing the number of stimulus presentations w hen the subject is far from threshold. In the ETDRS-Fast method a few simpl e rules applied to optotype chart reading allow adaptation to each patient' s level of VA. The ETDRS-Fast procedure significantly reduces test time and still yields results that are as accurate as those obtained with the stand ard method.