Diabetes can cause visual loss that is not detected by standard reading tests such as the Snellen test but can be detected by low-contrast letter charts. This visual loss is quite different from loss caused by refractive error. These low-contrast charts are diagnostically at least as sensitive as the sinewave grating contrast sensitivity test. They are inexpensive, and the test is brief and simple. Preliminary evidence is that patients with diabetes who have abnormal low-contrast chart results give abnormal intravenous fluorescein (IVF) test results, even though visual acuity is normal. Low-contrast charts also detect visual loss in patients with ocular hypertension, glaucoma, and Parkinson's disease, including patients with normal visual acuity.
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