Current status of contrast sensitivity and glare testing in evaluation of the cataract patient

In summary, scientific evidence regarding the clinical utility of glare tests has been disappointing to date. Theoretically, one would expect glare tests to be more sensitive and specific to forward light scatter caused by cataracts. Whereas it has been easy to demonstrate increased disability glare, even in patients with early lens opacities, recent studies have not been able to establish a relationship between glare test scores and perceived glare disability. In considering the potential utility of glare and contrast sensitivity tests, there is an additional application that has not received widespread attention. The vast majority of cataract surgeries performed on eyes without other ocular disease are successful. Acuity, contrast sensitivity, and disability glare score return to normal levels. Patients with other vision-limiting eye disease, such as age-related maculopathy, however, are at higher risk of an unsuccessful outcome, whereas success is typically defined as an acuity of 20/40 or better. Nevertheless, these 'unsuccessful' surgeries may result in improved visual function and facilitate future visual rehabilitation. Contrast sensitivity and glare testing may provide a means of determining the extent to which visual function in complicated cataract cases is compromised by excess light scatter and provide a better predictor of overall success in patients whose visual acuity will not return to normal after cataract extraction.