Description and Evaluation of a Visual Acuity Assessment Paradigm Based on Spatial Frequency-Modulated Form Discrimination.

Purpose: To describe and evaluate a visual acuity assessment paradigm based on spatial frequency-modulated form discrimination for induced and disease-driven vision loss. Methods: The Patterned-Optotype-in-Noise Task (POINT) consisted of arrow-shaped random noise patterns, each with a 1/f2 amplitude spectrum overlaid on a low-pass filtered background. Stimulus difficulty varied logarithmically across 22 levels by adjusting the background cutoff spatial frequency, relative to foreground. Monocular acuity was measured for POINT stimuli and letter optotypes in 20 adults (21-46 years) with 0-4D of induced blur and in 50 patients (9-77 years) with vision impairment from ocular pathologies/uncorrected refractive error. Results: The POINT demonstrated systematic loss in visual acuity with induced optical blur and eye pathologies, like the standard letter acuity test (P < 0.001). The losses with induced blur in the POINT followed standard Fourier optics predictions of spatial-frequency discrimination between the background and foreground pattern. The test-retest repeatability of POINT was also comparable to letter acuity testing (mean difference ± 95% limits of agreement: +0.04 units ± 0.2 units), but with limited agreement in the acuity measures obtained between the two tests. Conclusions: The POINT is a reliable technique for estimating visual acuity with induced and disease-driven vision loss. However, caution should be exercised when directly comparing these outcomes to standard letter acuity tests owing to fundamental differences in stimulus construction and task requirements. Translational Relevance: The POINT offers a physiologically and theoretically grounded complement to standard assessment of visual acuity in clinical, research and public eye health settings.