Optometry and Vision Science

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This is the collection for the University of Waterloo's School of Optometry and Vision Science.

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Development of sports-specific classification for Paralympic skiers with visual impairment
(University of Waterloo, 2020-05-28) Stalin, Amritha; Dalton, Kristine
Introduction: The Paralympic Games are not only a platform for athletes with disabilities to achieve their dreams, but the Games also play a major role in changing societal attitudes towards people with disabilities and accelerating the progress towards achieving a goal of equality for all. Classification plays a significant role in making Paralympic competitions fair for all athletes. The overall purpose of the studies described in this thesis was to design evidence-based classification systems for the visually impaired category of Para nordic and Para alpine skiing. The specific objectives of the thesis were four-fold. The first and second objectives were to determine a minimum disability criterion that determines eligibility for competition and to develop additional criteria that group athletes with similar impairments into competition classes, respectively, in both Para nordic and Para alpine skiing. The third objective was to investigate the effect of the use of blindfolds on the skiing performance of Para skiers in the most severe visual impairment class, as the Paralympics rules currently mandate the use of blindfold by those skiers in Para nordic and Para alpine skiing. The final objective was to assess the validity of visual field measurements conducted with the Arc perimeter, which was the perimeter used in all the previously mentioned studies. Experiment I: Eight visual acuity and contrast sensitivity impairments and six peripheral visual field impairments were simulated in able-sighted skiers who participated in the study. The visual acuity, contrast sensitivity, and visual fields of each participant were assessed with and without the simulated impairments. The participants raced through specially designed short nordic or alpine racecourses with and without the simulated impairments and the changes in the race times with and without the simulated impairments were analyzed to identify the minimum levels of vision impairment that significantly affected skiing performance. These studies suggested that moderate reductions in visual acuity, contrast sensitivity, and visual field appear to have significant detrimental effects on nordic and alpine skiing performance. Experiment II and III: A wide range of visual functions such as static and dynamic visual acuities, light sensitivity, glare sensitivity, glare recovery, contrast sensitivity, translational and radial motion perception, and visual field was assessed binocularly in elite Para nordic and Para alpine skiers who participated in the studies. The relationships between skiing performances, which were calculated using modified Para nordic and Para alpine skiing points systems based on participants’ raw times, and the levels of visual functions assessed were analysed 1) to identify the visual functions associated with skiing performance (Experiment II) and 2) to develop sports class allocation criteria (Experiment III). It was concluded that VA and VF are the only visual functions that need to be included in the classification. It was also concluded that Para nordic and Para alpine skiers with light perception or no light perception vision performed significantly worse compared to the skiers with measurable vision and thus should be allocated to a different class than participants with measurable visual acuity. Experiment IV: Participants, who were elite Para nordic and Para alpine skiers, were asked to ski specially designed short nordic or alpine courses with and without their blindfolds in randomized orders. Time taken to complete the courses were compared between the two blindfold conditions to assess the effect of the blindfold on skiing performances. Results from these studies suggested that the blindfolds do not significantly affect performances in Para nordic and Para alpine skiers who are eligible to compete in the B1 class and that blindfolds need not be mandatory in both the sports. Experiment V: Visual acuity and visual fields were assessed binocularly in adult participants with monocular or binocular visual field defects. The functional visual field scores obtained using an Arc perimeter were compared with the functional visual field scores obtained using a Humphrey Field Analyzer, and the agreement between both methods was assessed using Bland-Altman plots to assess the validity of the visual field measurements obtained using Arc perimeter. This final study concluded that the functional scores obtained using an Arc perimeter could be used as an efficient and feasible way to assess visual fields for classification research purposes. Conclusion: The results from these studies provide evidence to support the development of sport-specific classification systems for the vision impairment category in both Para nordic and Para alpine skiing. The decision to change, or not change, the Para nordic and Para alpine skiing classification regulations for athletes with vision impairments remains at the sole discretion of the International Paralympic Committee.
Exploration of the Underlying Visual Perceptual and Cognitive Mechanisms of Dynamic Visual Acuity
(University of Waterloo, 2024-01-25) Hudecki, Heather; Dalton, Kristine
Purpose: Dynamic visual acuity (dynamic VA) is a complex, perceptual ability of the visual system that involves determining fine details of objects as they move across one’s field of view (1–4). Over the years, there has been increasing interest in dynamic VA because of its apparent relevance to everyday life, and its ability to account for motion, which static VA is unable to do. Dynamic VA has a crucial role in a variety of real-world situations and daily tasks that involve functioning in a dynamic environment, such as driving, piloting, crossing a busy intersection, and many ball sports (5–8). In addition, dynamic VA is an essential element involved in one’s ability to adapt to moving and changing environments (1). Although various research has been performed, dynamic VA as a visual function is not very well understood. This study was designed to investigate the potential underlying neurophysiological mechanisms that may be associated with dynamic VA. Methods: This study was an observational analysis of visual and cognitive function data collected from 130 participants. Participants were members of the University of Waterloo Department of Psychology Research Experiences Group (i.e., SONA), the University of Waterloo undergraduate and graduate community, the University of Waterloo Optometry Program, and the Kitchener-Waterloo Community. Five visual function tasks were studied including static visual acuity (static VA), horizontal and random dynamic VA, global motion (GM), global form (GF), and local motion (LM), along with two cognitive tasks, multiple object tracking (MOT) and the Stroop task. Static VA was measured first at each study visit to confirm participant eligibility, followed by horizontal and random motion dynamic VA (randomized order). After dynamic VA, the remaining visual and cognitive function tasks were measured in a randomized order. Static VA (LogMAR) was tested with an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Binocular dynamic VA (LogMAR; moV&, V&mp Vision Suite) was assessed using tumbling E optotypes moving in a horizontal (left to right) or unpredictable random motion. GM perception, and LM perception were assessed using random dot kinematograms (RDKs), GF perception was tested using Glass patterns, Stroop was assessed using word stimuli, and MOT was tested using randomly moving ball stimuli. Experimental effects, including the effects of participant age, participant gender, and testing order were examined for each task independently using one-way independent measures ANOVAs (age and visual function task order), and two-sample t-tests (gender and dynamic VA task order). Tukey post-hoc test was used to further evaluate any significant order effects found with the one-way independent measures ANOVAs. Correlation plots, matrices, and tables including Pearson correlation coefficients were calculated to examine the relationships between dynamic VA performance and the visual function tasks. Backwards stepwise regression analyses were conducted to determine which visual or cognitive function tasks were most predictive of dynamic VA performance. The correlation and regression analyses were performed separately for horizontal and random dynamic VA. Results: Highly significant correlations were found between horizontal dynamic VA and random dynamic VA (r = 0.49, p = 4.84e-9), static VA (r = 0.48, p = 6.35e-9), and LM (r = 0.32, p = 2.47e-4); a weak, significant correlation also noted with GM (r = 0.23, p =9.16e-3). Highly significant correlations with random dynamic VA were found with static VA (r = 0.46, p = 4.39e-8) and horizontal dynamic VA (r = 0.49, p = 4.84e-9); weak, significant correlations were found with LM (r =0.16, p = 6.43e-2), and GF (r = 0.15, p = 9.89e-2). Statistically significant predictors for horizontal dynamic VA were static VA (p = 6.09e-4), LM (p = 3.96e-2), and random dynamic VA (p = 1.20e-4) . GM (p = 0.139) was not a significant predictor of horizontal dynamic VA but still had a trend towards a positive relationship with the task. Static VA (p = 7.85e-4) and horizontal dynamic VA (p = 8.14e-5) were the only statically significant predictors of random dynamic VA, but there were also trends towards positive relationships between random dynamic VA and LM (p = 8.70e-2), and GF (p = 0.135). Additional analyses determined there to be no age or gender effects on any of the visual function tasks. A statistically significant order effect was present for GF (F(2, 127) = [4.92], p = 1.02e-3), but no other tasks. Conclusion: Horizontal dynamic VA appears to be most closely related to random dynamic VA, static VA, GM, and LM, suggesting the dorsal stream and V1 pathway may be the underlying neurophysiological pathways associated with processing horizontal dynamic VA. This is in comparison to random dynamic VA, which was most closely connected with horizontal dynamic VA, static VA, GF, and LM, suggesting the neuro pathways involved with random dynamic VA could be the ventral stream and V1 pathway. Further research is required to confirm and validate such neurophysiological mechanisms are associated with both horizontal and random dynamic VA.
Investigation of vision strategies used in a dynamic visual acuity task
(University of Waterloo, 2017-10-24) Yee, Alan; Dalton, Kristine
Purpose: Dynamic visual acuity (DVA), the ability to resolve fine details of a moving target, requires spatial resolution and accurate oculomotor control. Individuals who engage in activities in highly dynamic visual environments are thought to have superior dynamic visual acuity and utilize different gaze behaviours (fixations, smooth pursuits, and saccades). This study was designed to test the hypothesis that athletes and video game players (VGPs) have superior DVA to controls. Furthermore, the study was designed to investigate why DVA may be different between groups. Methods: A pre-registered, cross-sectional study examined static visual acuity (SVA), DVA, smooth pursuit gains, and gaze behaviours (fixations, smooth pursuits, and saccades) in 46 emmetropic participants (15 athletes, 11 VGPs, and 20 controls). Athletes were members of varsity teams (or equivalent) who played dynamic sports (such as hockey, soccer, and baseball) for more than 1 year with a current participation of more than 6 hours per week. VGPs played action video games four times per week for a minimum of one hour per day. Controls did not play sports or video games. SVA (LogMAR) was tested with an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. DVA (LogMAR; mov&, V&mp Vision Suite) was tested with Tumbling E optotypes that moved either horizontally (left to right) or randomly (Brownian motion) at 5°/s, 10°/s, 20°/s, or 30°/s. Task response time was measured by averaging the amount of time it took to respond to each letter per trial (i.e random 30°/s, horizontal 10°/s, etc.) which indicated the time it took for a motor response to occur. Smooth pursuit gains were tested with El-Mar eye tracker while participants completed a step-ramp task with the same respective velocities as the DVA task. A one-way independent measures ANOVA was used to analyze smooth pursuits. Relative duration of gaze behaviours were measured with the Arrington eye tracker while participants performed the DVA task. A one-way independent measures ANOVA was used to test for group differences in SVA. A one-way ANOVA was used to test for group and speed differences in DVA. A repeated-measures two-way ANOVA was used to compare gaze behaviours of the first five and last five letters of 30°/s velocity. Results: SVA was not significantly different between groups (p=0.595). Random motion DVA at 30°/s was significantly different between groups (p=0.039), specifically between athletes and controls (p=0.030). Thus, athletes were better than controls at random 30°/s. Horizontal motion DVA at 30°/s was also significantly between groups (p=0.031). Post-hoc analysis revealed a significant difference between athletes and VGPs (p=0.046). This suggests that athletes were better than VGPs at horizontal 30°/s. DVA task response time per letter was not significantly different between groups for horizontal motion at 30°/s (p=0.707) or random motion at 30°/s (p=0.723). Therefore, the motor response times were similar between groups at both motion types. Smooth pursuit gains were not significantly different between group at 30°/s (p=0.100) which indicates similar physiological eye movements. Eye movement gaze behaviours of horizontal motion at 30°/s were not significant between each groups for fixations (p=0.598), smooth pursuits (p=0.226), and saccades (p=0.523). Similarly, there was no significant difference in gaze behaviours for random motion at 30°/s between groups, for fixation (p=0.503), smooth pursuits (p=0.481), and saccades (p=0.507). Thus, gaze behaviours for horizontal and random motion were similar for all groups. Conclusion: Athletes exhibited superior DVA for randomly moving targets compared to controls, and superior DVA for horizontally moving targets compared to VGPs. The task response times, gaze behaviours and smooth pursuit gains of each group were not significantly different. Therefore task response times, smooth pursuit gains and gaze behaviours cannot explain the superior DVA displayed by the athletes. Further research is required in order to determine why DVA in athletes is superior at 30°/s.
The Optometric Management of Concussion
(University of Waterloo, 2022-01-31) Yeboah, Anne Marie; Dalton, Kristine; Irving, Elizabeth
Traumatic brain injury is a major public health problem that affects millions of people annually and hundreds of people experience brain injury daily. Many of these individuals develop visual symptoms. Optometrists play a prominent role in the management of patients with concussion-associated vision deficits and persistent concussion symptoms. At present, there is no accepted optometric standard of care for individuals with concussion. Patients receiving optometric concussion related care would benefit from a standardized evidence-based concussion management process. The purpose of this project was to determine the current assessment methods and prescribing practices of optometrists seeing individuals with persistent concussion-associated vision deficits in private practice and at a university academic optometry clinic. Study 1: A retrospective review examined the frequency of visual assessments and management strategies at an academic university optometry clinic. A total of 238 patient files were examined. Of the 238 patient files, 119 individuals had persistent concussion symptoms (concussed group) and 119 individuals did not have concussion (non-concussed cohort). The frequency of visual assessments (ocular structure and visual function) and management strategies were determined. A chi square test was used to compare the frequency of assessments and management strategies between cohorts. In the concussed group, an emphasis on visual function and management strategies, for example assessments of vergence, saccades, pursuits and stereopsis were observed in comparison to the reference group. In non-concussed individuals, ocular structure assessments (e.g., posterior segment, anterior segment and confrontation visual field) were more prevalent than in the concussed cohort. It is important to note that ocular structure assessments did not include assessments conducted by the referring optometrists. Diagnostic drugs, for example tropicamide and anesthetics, were used more commonly in the non-concussed group, while cycloplegia was more prevalent in the concussed group. Study 2: A 6-question online survey was distributed to optometric provincial and national regulators and associations in Canada. Questions pertaining to visual assessments, prescribed medications and supplements, advice about daily living activity, appointment duration and appointment follow-up were asked. Analysis consisted of binning and determining the frequency of responses. Of the 199 responses received, 142 were completed and analysis was only conducted from these responses. A total of 128 optometrists managed concussion and 13 optometrists did not. The top reasons for optometrists who did not manage concussion was referral and no training. Ocular structure assessments were more prevalent than visual function and management strategies of concussion. Optometrists most frequently recommended Omega 3 (54%) and oral supplements (38%). The majority of optometrist’s (64%) advice on daily living activity was to limit physical and cognitive activity, the second most common suggestion was to rest (12%). The majority of optometrists, 57%, employed 30 to 60-minute assessments and over one-fifth conducted follow-up appointments within 2-months. Conclusion: This project informs optometrists on the state of concussion management in Canadian private practice and at a university academic optometry clinic. Findings can be used to aid in the development of standardized strategies for the optometric management of concussion and related regulatory decisions. This can lead to reductions in persistent post-concussive symptoms, improved patient outcomes, and overall improved quality of life.
Understanding concussion in para athletes with vision impairment
(University of Waterloo, 2023-02-15) Teodoro, Juliette; Dalton, Kristine; Irving, Elizabeth
Sports-related concussions occur in para sport as they do in able-bodied sport. There is evidence to suggest athletes with vision impairment (VI) may be more likely to sustain concussion injuries compared to athletes with other impairment types. However, there is limited understanding of best practices in concussion assessment and management for athletes with VI. Symptoms intrinsic to pre-existing conditions in para athletes are also commonly seen in athletes suffering from a concussion, which makes the assessment and management of concussion more challenging in the para athlete population. Perspectives and experiences of VI para sport athletes and coaches with concussion are also poorly understood. The purpose of this project was to understand how concussions are currently assessed and managed in elite para athletes with vision impairment, to move toward establishing clinical practice guidelines and critical research priorities in concussion management for elite athletes with VI. The secondary objective of this thesis was to understand the perspectives, experiences, and knowledge of elite athletes with VI and coaches concerning concussion in VI para sport. A two-round Delphi study was conducted to solicit the opinions of healthcare professionals, researchers, and administrators in VI para sport concerning concussion assessment and management practices. Eight out of the nine interested participants completed the first-round survey; seven of those completed the second-round survey. Five out of eight participants were sports medicine physicians, and the remaining three participants had a background in physical therapy. Experts identified that VI athletes may exhibit different observable signs of concussion (e.g., lack of blank look, balance issues at baseline, etc.) compared to able-bodied athletes. Experts unanimously agreed that pre-season baseline testing is necessary for para athletes with VI. While most experts (86%) agreed the SCAT5 currently represents the most effective assessment tool available for the evaluation of suspected concussion, one expert disagreed and explained that the SCAT5 is too complex for regular sideline use. Some experts suggested prescribing a longer period of initial rest or doubling the time between return-to-sport steps for athletes with VI. Experts came to a unanimous consensus that there is a lack of after-care in VI para sport in addition to the lack of on-site specially trained medical support. Elite para athletes with VI and coaches were invited to participate in a single-round survey study. The survey questions covered the following topics: Demographics; Concussion incidence, recognition, response, assessment, and management; Return-to-sport; and Education. Analysis consisted of categorizing written responses and analyzing response frequencies. A total of 8 participants (athletes (n = 4); coaches (n = 4)) from elite VI para sport took part. Athletes were found to have less awareness of medics at sidelines, assessment tools, how decisions are made to investigate for concussion, and the need for concussion assessments than coaches. Athletes were also more likely to not report incidents with reasons for not reporting including “don’t think it’s serious”, “time and money”, and “misdiagnosis because of underlying conditions”. Coaches are not considering athlete involvement in return-to-play decisions. Athletes and coaches agreed that it is important for medical professionals to have concussion education but differ on the need for education of athletes and guides. Athletes reported having little and poor quality concussion education. Future investment in the provision of specially trained on-site medical support is needed to ensure the safety and well-being of VI para athletes. Education strategies should prioritize informing para athletes of the potential long-term consequences of concussion, so they understand the significance of failing to report concussion symptoms and of neglecting concussion injury protocol.
The Validation of a Novel Dynamic Visual Acuity Test, and Examination of the Effects of Different Factors on Dynamic Visual Acuity
(University of Waterloo, 2018-05-22) Hirano, Mariko; Dalton, Kristine
Purpose: When a target is in motion, two thresholds can be measured: dynamic visual acuity (DVA, the smallest target size at which an observer can resolve target detail) and speed threshold (the fastest target speed at which an observer can resolve target detail). Many different factors can influence DVA and speed threshold, including target trajectory, velocity, size, contrast, and colour. The limitation with research to date is that there is no standardized, validated tool with which to assess either DVA or speed thresholds. The Vision & Motor Performance Lab at the University of Waterloo School of Optometry has recently developed a distance visual acuity chart (moV&, V&MP Vision Suite) that can measure static visual acuity, DVA, and speed thresholds. moV& allows for the specifications of target trajectory, speed, size, contrast, and colour of both the target and background when measuring DVA. The primary objective of this dissertation is to examine the validity and repeatability of the high contrast (100% contrast), low contrast (61% and 20% contrast), and colour (red target on a white background and white target on a blue background) functions of moV&. If reliable, the data will then be used to examine the effect of target trajectory, speed, and size on DVA and speed threshold. Methods: Three cross-sectional studies were conducted in order to address the research objectives. Each experiment required participants to attend 2 study visits separated by a minimum of 14 days. All participants completed the static visual acuity tests before completing the dynamic tests in a randomized order. Experiment 1 (n = 25) determined the validity and repeatability of moV& using targets at 100% contrast. At each visit, static and dynamic visual acuity was measured using Snellen, ETDRS, and moV& charts. Experiment 2 determined the repeatability of the low contrast and coloured functions of moV&. Participants were assigned to either the contrast (n=21) or colour (n=21) study block. For the contrast block, low contrast (61% and 20% contrast) static and dynamic visual acuities were measured using Snellen and moV& charts. For the colour block, coloured optotype and background (red target on a white background, white target on a blue background) static and dynamic visual acuities were measured using the ETDRS and moV& charts. Experiment 3 (n = 67) examined the effect of target trajectory, speed, and size on DVA and speed threshold using the targets studied in Experiments 1-2. Data from Experiments 1 and 2 was used to determine the effect of target trajectory, speed, and size on DVA and speed threshold. A repeated measure ANOVA was used to compare static moV& visual acuity to ETDRS and Snellen charts. Test-retest reliability was determined via Lin’s correlation coefficient of concordance (CCC). Three-way ANOVA was used to determine the effect of trajectory, speed, and size on DVA and speed thresholds. Results: moV& yielded similar high contrast static visual acuity when compared to the EDTRS and Snellen charts. All high contrast static and dynamic visual acuities demonstrate good test-retest repeatability (CCCs ranged 0.451 to 0.953). moV& static visual acuities were significantly better than Snellen at both 61% and 20% contrast (p<0.05) with good repeatability (CCC61% = 0.80 and CCC20% = 0.60). CCCs for DVAs ranged from 0.05 to 0.74, but were better at 61% contrast. For the coloured targets, moV& coloured static visual acuities were significantly better than ETDRS black and white static visual acuities (p<0.05) and coloured DVA demonstrated good test-retest repeatability (CCCs ranged from 0.50 to 0.88, and were similar for both colours). Trajectory had a significant effect on dynamic visual acuity for all contrast and colour combinations, and a significant effect on speed threshold for all optotypes except the white target on a blue background (p = 0.153). Target speed had a significant effect on dynamic visual acuity for all contrast and colour combinations tested except the red target on a white background (p = 0.112), while target size had a significant effect on speed threshold for all optotypes. Discussion: moV& high contrast static visual acuity is comparable to both the Snellen and ETDRS charts. moV& static visual acuity demonstrated good repeatability for all optotypes tested. moV& DVA demonstrated good test-retest repeatability for targets at 100% contrast, red targets on a white background, and white targets on a blue background. At 61% and 20% contrast, test-retest repeatability was worse, especially at 20% contrast. Target trajectory, speed, and size have an effect on dynamic visual acuity and speed threshold, with the exception of a few optotype colour combinations. Further research is needed to explore the role of a wider range of target contrasts and colours on DVA and speed threshold.
Visual Functions in Post-Concussion Syndrome
(University of Waterloo, 2018-10-24) Alamri, Suhailah; Dalton, Kristine
Purpose: Post-concussion syndrome (PCS) is a is a complex neurological disorder in which various concussion symptoms can last for weeks, months, or even years after sustaining the concussion. The PCS population has been shown to have some functional deficits such as balance and visual-motor integration issues in addition to their PCS symptoms. The current study has three main objectives as follows: 1) to establish a comprehensive visual function test battery for use in both control and PCS individuals, 2) to compare performance on the comprehensive visual function test battery in control and PCS individuals, 3) to determine if performance on the comprehensive visual function test battery is in any way related to the symptoms individuals with PCS experience. Methods: Forty-four participants aged 18 - 35 were recruited. The study participant groups were as follows: 1) Healthy participants with no history of concussion (Controls; n=33), and 2) Participants with PCS (n=11). Participants completed two study visits separated by 2 - 7 days. The testing protocol of visit 1 consisted of the following visual function tests: static visual perception, objective refraction, ocular alignment, ocular motility, stereopsis, accommodative function, vergence function, cyclopean eye alignment position, and King-Devick. The testing protocol of visit 2 consisted of visual-motor integration tests including visual-motor reaction time and coincidence anticipation timing, and a test of dynamic visual perception. Results: All control and PCS participants were able to complete all of the tests at each study visit. However, the PCS participants took longer time to complete the study visits as these participants needed breaks to rest between some of the tests. Control participants did not need breaks between any of the tests. A Mann-Whitney U-test was conducted to examine the difference in visual function performance between the groups. Overall, the only difference shown between the two groups was in the ocular motility, King-Devick, cyclopean eye alignment position, and the peripheral visual-motor reaction time tests. In the ocular motility test, 30% of PCS participants exhibited irregular eye movements, whereas 0% of control participants had irregular eye movements. On the King-Devick test, the control group appeared to read faster than the PCS group (p=0.04). On the cyclopean eye alignment position test, which is a measure of global visual function, the PCS group appear to have better performance and made fewer errors in alignment (p=0.03). On the peripheral visual-motor reaction time test, the PCS group also appeared to have better peripheral reaction time than the control group (p=0.04). To examine the relationship between PCS symptom severity and visual function, a Spearman correlation analysis was conducted. For the control group, stereopsis (p=0.02), distance horizontal negative fusional reserve - blur point (p=0.04), distance vertical negative fusional reserve - double point (p=0.01), and recovery point (p=0.02) were found to be significantly correlated with participant symptoms. For the PCS group, there was a statistically significant correlation for a few coincidence anticipation error measures. The vast majority of the correlations between symptom severity and visual function were not significant in either group, which suggests that performance on the visual function test battery is not predictive of participant symptoms. Conclusion: In summary, this study has applied a comprehensive visual function testing protocol that can be used in further research and clinical practice. Eye movement tests such as the Broad H oculomotor screening test, and the King-Devick test appear to have the potential to detect lingering deficits in the PCS population. Additionally, PCS related symptoms do not appear to be related to performance on the individual visual function tests used in the test battery in either the PCS or control individuals.

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