Assessment of a Clinical Test for Detection of Alteration in Visual Perception Due to Astigmatism

Eyal Gal,1,2 Joan Gispets,2 Arnold Wilkins,3 Meira Zyroff,1 Efrat Netanya‌,1 Liat Gantz1 1Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel; 2University Vision Centre, Universitat Politècnica de Catalunya, Terrassa, Barcelona, Spain; 3Department of Psychology, University of Essex, Colchester, UKCorrespondence: Liat Gantz; Eyal Gal, Department of Optometry and Vision Science, Hadassah Academic College, 37 Hanevi’im St, Jerusalem, Jerusalem, 9101001, Israel, Email [email protected]; [email protected]: Astigmatism blurs the retinal image of a circular spot along a particular orientation rendering it an elliptical shape. Astigmatic patients demonstrate adaptation to residual astigmatic blur that may affect their discrimination between oval and circular targets. The Wilkins Egg and Ball Test (WEBT) was created to detect altered visual perception due to residual astigmatic blur by discriminating a circle within a row of oval elements. This prospective, cross-sectional study examined the utility of WEBT in detecting uncorrected residual astigmatism on the perception of form symmetry in astigmatic and keratoconic participants as well as normal participants with induced astigmatism at four primary meridians.Methods: The mean search time (sT) and number of errors (noE) of 33 non-astigmatic controls (mean age: 24± 5, range: 18– 43, 6 males), 23 astigmatic participants (mean age: 36± 12, range: 18– 43, 6 males) and 13 keratoconic participants (N=22 eyes, mean age: 36± 12, range: 18– 58, 6 males) were measured under baseline, and 2.00 DC induced cylinder at four primary meridians, and for uncorrected, spherical-correction only, and fully corrected conditions, respectively. Mean sT and noE were converted to Z-scores, combined for each condition, and compared using repeated measures ANOVA with post-hoc analysis.Results: Combined Z-scores for the controls were significantly worse (p< 0.001) for all induced cylinder conditions. The induced 180° condition was significantly better than 45° and 90° conditions (p=0.04), but not the 135° condition. For both astigmatic and keratoconic cohorts, Z-scores of the uncorrected condition were significantly worse than the fully corrected condition (both p< 0.01), but the fully corrected and spherical-only conditions did not differ significantly (p=0.06 and p=0.05, respectively).Conclusion: In accommodating young adults, WEBT detected altered visual perception due to overall blur, and moderate-high amounts of uncorrected induced astigmatism and keratoconus, but is not useful as a tool for detection of altered visual perception due to small residual astigmatic blur.Keywords: astigmatism, Wilkins egg and ball test, visual search, keratoconus, search time, number of error