Office Techniques for Detecting Optic Neuropathies Brightness Sense Compared to Traditional Screening Tests

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Abstract
This Study Evaluated Relationships Between Brightness Sense And Visual Acuity, Optic Disc Changes, Afferent Pupillary Defect, And Color Vision In 88 Patients With Optic Neuropathies. To Assess Screening Sensitivity, Patients In Four Disease Categories (Optic Neuritis, n=47; Ischemic Optic Neuropathy, N = 23; Compressive Lesions, N = 8; Other Neuropathies, N = 10) Were Classified As Normal Or Abnormal On Each Measure. Overall, Brightness Sense Was The Most Sensitive Measure In Detecting Optic Neuropathies And Color Vision Was The Least Sensitive Measure. Only Optic Disc Changes Differentiated Significantly Between Disease Groups (P < 0.001). For Patients With Ischemic Optic Neuropathy Optic Disc Changes And Visual Acuity Were The Most Sensitive Measures. Brightness Sense Was Significantly Decreased From Normal In All Groups (P < 0.0001), But Did Not Vary Significantly Between Groups. In Patients With Optic Neuritis, Brightness Sense Was Significantly Correlated With The Afferent Pupillary Defect (r=−0.47), Color Vision (r=0.43) And Visual Acuity (R =−0.47). Visual Acuity And Brightness Sense Can Be Easily Used By Paramedical Personnel In The Initial Screening For Optic Neuropathies. Greater Skill Is Required To Evaluate The Afferent Pupillary Defect And Especially The Optic Disc Changes That Are Most Likely To Help In Distinguishing Between Various Optic Neuropathies.

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