Contrast sensitivity is a measure of the ability to discern different
luminances in a static
image. It varies with age, increasing to a maximum around 20 years at
spatial frequencies of about 2–5 cpd; aging then progressively attenuates contrast sensitivity beyond this peak. Factors such as cataracts and
diabetic retinopathy also reduce contrast sensitivity. In the sweep grating figure below, at an ordinary viewing distance, the bars in the middle appear to be the longest due to their optimal spatial frequency. However, at a far viewing distance, the longest visible bars shift to what were originally the wide bars, now matching the spatial frequency of the middle bars at reading distance.
Contrast sensitivity and visual acuity Visual acuity is a parameter that is frequently used to assess overall vision. However, diminished contrast sensitivity may cause decreased visual function in spite of normal visual acuity. For example, some individuals with
glaucoma may achieve 20/20 vision on acuity exams, yet struggle with
activities of daily living, such as driving at night. As mentioned above, contrast sensitivity describes the ability of the visual system to distinguish bright and dim components of a static image. Visual acuity can be defined as the angle with which one can resolve two points as being separate since the image is shown with 100% contrast and is projected onto the fovea of the retina. Thus, when an
optometrist or
ophthalmologist assesses a patient's visual acuity using a
Snellen chart or some other
acuity chart, the target image is displayed at high contrast, e.g., black letters of decreasing size on a white background. A subsequent contrast sensitivity exam may demonstrate difficulty with decreased contrast (using, e.g., the Pelli–Robson chart, which consists of uniform-sized but increasingly pale grey letters on a white background). To assess a patient's contrast sensitivity, one of several diagnostic exams may be used. Most charts in an ophthalmologist's or optometrist's office will show images of varying contrast and
spatial frequency. Parallel bars of varying width and contrast, known as sine-wave gratings, are sequentially viewed by the patient. The width of the bars and their distance apart represent spatial frequency, measured in cycles per degree. Studies have demonstrated that contrast sensitivity is maximum for spatial frequencies of 2-5 cpd, falling off for lower spatial frequencies and rapidly falling off for higher spatial frequencies. The upper limit for the human vision system is about 60 cpd. The correct identification of small letters requires the letter size be about 18-30 cpd.
Contrast threshold can be defined as the minimum contrast that can be resolved by the patient. Contrast sensitivity is typically expressed as the
reciprocal of the threshold contrast for detection of a given pattern (i.e., 1 ÷ contrast threshold). Using the results of a contrast sensitivity exam, a contrast sensitivity curve can be plotted, with spatial frequency on the horizontal, and contrast threshold on the vertical axis. Also known as contrast sensitivity function (CSF), the plot demonstrates the normal range of contrast sensitivity, and will indicate diminished contrast sensitivity in patients who fall below the normal curve. Some graphs contain "contrast sensitivity acuity equivalents", with lower acuity values falling in the area under the curve. In patients with normal visual acuity and concomitant reduced contrast sensitivity, the area under the curve serves as a graphical representation of the visual deficit. It can be because of this impairment in contrast sensitivity that patients have difficulty driving at night, climbing stairs and other activities of daily living in which contrast is reduced. Recent studies have demonstrated that intermediate-frequency sinusoidal patterns are optimally-detected by the retina due to the center-surround arrangement of neuronal receptive fields. In an intermediate spatial frequency, the peak (brighter bars) of the pattern is detected by the center of the receptive field, while the troughs (darker bars) are detected by the inhibitory periphery of the receptive field. For this reason, low- and high-spatial frequencies elicit excitatory and inhibitory impulses by overlapping frequency peaks and troughs in the center and periphery of the neuronal
receptive field. Other environmental, physiological, and anatomical factors influence the neuronal transmission of sinusoidal patterns, including
adaptation. Decreased contrast sensitivity arises from multiple etiologies, including retinal disorders such as
age-related macular degeneration (ARMD),
amblyopia, lens abnormalities, such as
cataract, and by higher-order neural dysfunction, including
stroke and
Alzheimer's disease. In light of the multitude of etiologies leading to decreased contrast sensitivity, contrast sensitivity tests are useful in the characterization and monitoring of dysfunction, and less helpful in detection of disease. == Contrast threshold ==