Monocular versus binocular visual acuity as measures of vision impairment and predictors of visual disability

Purpose. To examine the relationship between monocular and binocular visual acuities as predictors of visual disability in a population-based sample of individuals 65 years of age and older. Methods. Two thousand five hundred twenty community-dwelling residents of Salisbury, Maryland, between the ages of 65 and 84 years of age were recruited for the study. Corrected visual acuity was measured monocularly and binocularly using ETDRS charts. Reading speed, face discrimination, and self-reported difficulty with visual tasks were also determined. Results. Binocular acuity is predicted with reasonable accuracy by acuity in the better eye alone, but not by the widely used American Medical Association (AMA) weighted-average algorithm. The AMA algorithm significantly underestimates binocular acuity when the interocular acuity difference exceeds one line. Monocular acuity and binocular acuity were significantly better predictors of reading speed than the AMA weighted score or a recently proposed Functional Vision Score (FVS). Monocular acuity in the better eye, binocular acuity, and the AMA and FVS algorithms were equally good predictors of self-reported vision disability. None of the acuity measures were good predictors of face recognition ability. Conclusions. The binocular acuities of older individuals can be inferred from measures of monocular acuity. There is little evidence for binocular inhibition when the monocular acuities in the two eyes are unequal, as opposed to the widely used AMA algorithm for computing binocular visual impairment. For tasks that are strongly associated with visual acuity, such as reading, this association can be captured from measures of monocular acuity and does not require separate assessment of binocular acuity.