Development and Validation of a Smartphone-based Contrast Sensitivity Test

Purpose: Contrast sensitivity (CS) testing is an important measure of visual function reflecting variations in everyday visual experience in different conditions and helps to identify more subtle vision loss. However, it is only infrequently used. To make this more accessible, we have developed and validated a smartphone-based CS test.

Methods: A new tumbling-E smartphone-based CS test was developed, Peek Contrast Sensitivity (PeekCS). This was field tested and refined through several iterations. Reference standard was a tumbling-E Pelli-Robson CS test (PRCS). The validation study was conducted in community clinics in Ethiopia. Test-retest variability was measured for both PRCS and PeekCS. PRCS and PeekCS were then compared. Correlation coefficients and 95% confidence intervals (CIs) were calculated; 95% limits of agreement were calculated and displayed on Bland-Altman plots.

Results: PeekCS showed strong repeatability (correlation coefficient: 0.93; 95% CI: 0.91-0.95), which was comparable with PRCS (correlation coefficient: 0.96; 95% CI: 0.95-0.97). The 95% limit of agreement for test-retest variability of PRCS and PeekCS were -0.20 to 0.21 and -0.31 to 0.29, respectively. PRCS and PeekCS were highly correlated: 0.94 (95% CI: 0.93-0.95); 95% limits of agreement -0.27 to 0.29; and mean difference 0.010 (95% CI: -0.001 to 0.022). PeekCS had a faster testing time (44.6 seconds) than PRCS (48.6 seconds): mean difference -3.98 (95% CI: -5.38 to -2.58); P < 0.001.

Conclusions: The smartphone-based PeekCS is a repeatable and rapid test, providing results that are highly comparable with the commonly used PRCS test.

Translational relevance: PeekCS provides an accessible and easy to perform alternative for CS testing, particularly in the community setting.