AIMS/BACKGROUND: Many reports have indicated that some patients with cataract can retain good visual acuity but complain of significant visual problems. This is the first in a series of papers trying to determine what causes these symptoms and whether other clinical tests can predict the real world vision loss. METHODS: The effect of a cataract simulation with a similar angular distribution of light scatter as real cataract on clinical (visual acuity, contrast sensitivity, and disability glare) and real world vision (face recognition, reading speed, and mobility orientation) was investigated. RESULTS: The simulation had a relatively small effect on visual acuity (6/6 with the simulation), but much larger effects on contrast sensitivity and low contrast acuity with and without glare. The simulation had no effect on high luminance and high contrast real world tasks, such as mobility orientation in room light and optimal reading speed. A small, but significant deterioration was found for the slightly lower contrast task of face and expression recognition. However, under low luminance conditions, substantial defects in mobility orientation were obtained (despite 6/6 acuity). CONCLUSIONS: Although the relative effect of the cataract simulation on acuity and contrast tasks is not typical of the average cataract, it can be found in those cataract patients with visual problems despite good visual acuity. This corroborates the suggestion that it is large amounts of wide angle light scatter (forward and/or backward) which are at least partly responsible for visual disability in cataract patients with good visual acuity. A patient's reported visual disability may depend on the percentage of time he or she spends under low contrast and/or low luminance conditions, such as walking or reading in dim illumination, and walking or driving at night, in fog, or heavy rain.
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