Skip to main content

Advertisement

SpringerLink
Log in

Trichromatic critical flicker frequency as potential visual test in cataract and macula disease patients

  • Cataract
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the capacity of critical flicker frequency (CFF) in discriminating cataract eyes with or without macula disease using trichromatic flickers, and to develop a model to predict postoperative best corrected visual acuity (BCVA).

Methods

Patients were divided into two groups based on the presence or absence of macular disease. CFF threshold measurements of red (R-CFF), green (G-CFF), and yellow (Y-CFF) flickers were conducted both preoperatively and postoperatively. A generalized estimating equations model (GEE) was employed to examine the relationship between CFF threshold and 3-month postoperative BCVA.

Results

A total of 115 eyes were enrolled, with 59 eyes in the cataract alone group and 56 eyes in the cataract with macular disease group completing the follow-up. R-CFF was found to be consistent before and after cataract removal (P = 0.06), even in cases where OCT was not performed successfully (P > 0.05). Y-CFF showed the highest AUC (0.798) for differentiating ocular comorbidities. According to the GEE model, in patients with a CFF threshold below 26 Hz, the odds ratios for achieving a postoperative VA of 20/40 or better were 34.8% for R-CFF, 26.0% for G-CFF, and 24.5% for Y-CFF.

Conclusion

CFF emerges as a promising tool for predicting postoperative BCVA, providing valuable supplementary insights when fundus examination is obstructed. R-CFF demonstrates the best resistance to cataracts, while Y-CFF exhibits the highest sensitivity both in identifying macular diseases and predicting postoperative BCVA of 20/40 or better.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Miller KM, Oetting TA, Tweeten JP, Carter K, Lee BS, Lin S, Nanji AA, Shorstein NH, Musch DC (2022) Cataract in the adult eye preferred practice pattern. Ophthalmology 129. DOI https://doi.org/10.1016/j.ophtha.2021.10.006

  2. Young CEC, Seibold LK, Kahook MY (2020) Cataract surgery and intraocular pressure in glaucoma. Curr Opin Ophthalmol 31:15–22. https://doi.org/10.1097/icu.0000000000000623

    Article  PubMed  Google Scholar 

  3. Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD (2003) Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies. Am J Ophthalmol 135:849–856. https://doi.org/10.1016/s0002-9394(02)02253-5

    Article  PubMed  Google Scholar 

  4. Starr MR, Mahr MA, Barkmeier AJ, Iezzi R, Smith WM, Bakri SJ (2018) Outcomes of cataract surgery in patients with exudative age-related macular degeneration and macular fluid. Am J Ophthalmol 192:91–97. https://doi.org/10.1016/j.ajo.2018.05.014

    Article  PubMed  Google Scholar 

  5. Peterson SR, Silva PA, Murtha TJ, Sun JK (2018) Cataract Surgery in Patients with diabetes: management strategies. Semin Ophthalmol 33:75–82. https://doi.org/10.1080/08820538.2017.1353817

    Article  PubMed  Google Scholar 

  6. Thompson DA, Iannaccone A, Ali RR, Arshavsky VY, Audo I, Bainbridge JWB, Besirli CG, Birch DG, Branham KE, Cideciyan AV, Daiger SP, Dalkara D, Duncan JL, Fahim AT, Flannery JG, Gattegna R, Heckenlively JR, Heon E, Jayasundera KT, Khan NW, Klassen H, Leroy BP, Molday RS, Musch DC, Pennesi ME, Petersen-Jones SM, Pierce EA, Rao RC, Reh TA, Sahel JA, Sharon D, Sieving PA, Strettoi E, Yang P, Zacks DN, Monaciano C (2020) Advancing clinical trials for inherited retinal diseases: recommendations from the Second Monaciano Symposium. Transl Vis Sci Technol 9:2. https://doi.org/10.1167/tvst.9.7.2

    Article  PubMed  PubMed Central  Google Scholar 

  7. O’Day DM (1993) Management of cataract in adults. Quick reference guide for clinicians. The cataract management guideline panel of the agency for health care policy and research. Arch Ophthalmol 111:453–459. https://doi.org/10.1001/archopht.1993.01090040045026

    Article  CAS  PubMed  Google Scholar 

  8. Vianya-Estopa M, Douthwaite WA, Noble BA, Elliott DB (2006) Capabilities of potential vision test measurements: clinical evaluation in the presence of cataract or macular disease. J Cataract Refract Surg 32:1151–1160. https://doi.org/10.1016/j.jcrs.2006.01.111

    Article  PubMed  Google Scholar 

  9. Hecht S, Shlaer S, Verrijp CD (1933) Intermittent stimulation by light: Ii. The measurement of critical fusion frequency for the human eye. J Gen Physiol 17:237–249. https://doi.org/10.1085/jgp.17.2.237

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Fu J, Wang Y, Tan S, Xu G, Zhou H, Xu Q, Wei S (2021) The clinical application of critical flicker fusion frequency in demyelinating optic neuritis. Adv Ophthalmol Pract Res 17;1(2):100011. https://doi.org/10.1016/j.aopr.2021.100011

  11. Xu G, Fu J, Qi H, Li L, Chen W, Gao Y, Ma T, Ye Z, Li Z (2023) The theory of critical flicker fusion frequency and its application in cataracts. Adv Ophthalmol Pract Res 3:29–32. https://doi.org/10.1016/j.aopr.2022.10.002

    Article  PubMed  Google Scholar 

  12. Young MT, Braich PS, Haines SR (2018) Critical flicker fusion frequency in demyelinating and ischemic optic neuropathies. Int Ophthalmol 38:1069–1077. https://doi.org/10.1007/s10792-017-0561-z

    Article  PubMed  Google Scholar 

  13. Mankowska ND, Marcinkowska AB, Waskow M, Sharma RI, Kot J, Winklewski PJ (2021) Critical flicker fusion frequency: a narrative review. Medicina (Kaunas) 57. DOI https://doi.org/10.3390/medicina57101096

  14. Vianya-Estopà M, Douthwaite WA, Pesudovs K, Noble BA, Elliott DB (2004) Development of a critical flicker/fusion frequency test for potential vision testing in media opacities. Optom Vis Sci 81:905–910

    PubMed  Google Scholar 

  15. del Romo GB, Douthwaite WA, Elliott DB (2005) Critical flicker frequency as a potential vision technique in the presence of cataracts. Invest Ophthalmol Vis Sci 46:1107–1112. https://doi.org/10.1167/iovs.04-1138

    Article  PubMed  Google Scholar 

  16. Douthwaite WA, Vianya-Estopa M, Elliott DB (2007) Predictions of postoperative visual outcome in subjects with cataract: a preoperative and postoperative study. Br J Ophthalmol 91:638–643. https://doi.org/10.1136/bjo.2006.093401

    Article  PubMed  Google Scholar 

  17. Shankar H, Pesudovs K (2007) Critical flicker fusion test of potential vision. J Cataract Refract Surg 33:232–239. https://doi.org/10.1016/j.jcrs.2006.10.042

    Article  PubMed  Google Scholar 

  18. Simunovic MP (2016) Acquired color vision deficiency. Surv Ophthalmol 61:132–155. https://doi.org/10.1016/j.survophthal.2015.11.004

    Article  PubMed  Google Scholar 

  19. Vemala R, Sivaprasad S, Barbur JL (2017) Detection of early loss of color vision in age-related macular degeneration—with emphasis on drusen and reticular pseudodrusen. Invest Ophthalmol Vis Sci 58:247–254. https://doi.org/10.1167/iovs.17-21771

    Article  Google Scholar 

  20. Niwa Y, Muraki S, Naito F, Minamikawa T, Ohji M (2014) Evaluation of acquired color vision deficiency in glaucoma using the Rabin cone contrast test. Invest Ophthalmol Vis Sci 55:6686–6690. https://doi.org/10.1167/iovs.14-14079

    Article  CAS  PubMed  Google Scholar 

  21. Kurtenbach A, Schiefer U, Neu A, Zrenner E (1999) Preretinopic changes in the colour vision of juvenile diabetics. Br J Ophthalmol 83:43–46. https://doi.org/10.1136/bjo.83.1.43

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Cho N-C (2000) Selective loss of S-cones in diabetic retinopathy. Archives of Ophthalmology 118. DOI https://doi.org/10.1001/archopht.118.10.1393

  23. Stifter E, Sacu S, Weghaupt H, König F, Richter-Müksch S, Thaler A, Velikay-Parel M, Radner W (2004) Reading performance depending on the type of cataract and its predictability on the visual outcome. J Cataract Refract Surg 30:1259–1267. https://doi.org/10.1016/j.jcrs.2003.11.051

    Article  PubMed  Google Scholar 

  24. Eisen-Enosh A, Farah N, Burgansky-Eliash Z, Polat U, Mandel Y (2017) Evaluation of critical flicker-fusion frequency measurement methods for the investigation of visual temporal resolution. Sci Rep 7:15621. https://doi.org/10.1038/s41598-017-15034-z

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  25. Verriest G (1963) Further studies on acquired deficiency of color discrimination*. J Opt Soc Am 53:185–195. https://doi.org/10.1364/JOSA.53.000185

    Article  ADS  CAS  PubMed  Google Scholar 

  26. Hood DC, Greenstein VC (1988) Blue (S) cone pathway vulnerability: a test of a fragile receptor hypothesis. Appl Opt 27:1025–1029. https://doi.org/10.1364/AO.27.001025

    Article  ADS  CAS  PubMed  Google Scholar 

  27. Greenstein VC, Hood DC, Ritch R, Steinberger D, Carr RE (1989) S (blue) cone pathway vulnerability in retinitis pigmentosa, diabetes and glaucoma. Invest Ophthalmol Vis Sci 30:1732–1737

    CAS  PubMed  Google Scholar 

  28. Vrijland HR, van Lith GH (1983) The value of preoperative electro-ophthalmological examination before cataract extraction. Doc Ophthalmol 55:153–156. https://doi.org/10.1007/bf00140472

    Article  CAS  PubMed  Google Scholar 

  29. Herbik A, Reupsch J, Thieme H, Hoffmann MB (2014) Differential effects of optic media opacities on simultaneous multifocal pattern electroretinograms and visual evoked potentials. Clin Neurophysiol 125:2418–2426. https://doi.org/10.1016/j.clinph.2014.03.017

    Article  CAS  PubMed  Google Scholar 

  30. An J, Zhang L, Wang Y, Zhang Z (2015) The success of cataract surgery and the preoperative measurement of retinal function by electrophysiological techniques. J Ophthalmol 2015:401281. https://doi.org/10.1155/2015/401281

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chen Y (2017) Study of critical flicker fusion (CFF) function and P100 latency of visual evoked potential (VEP) in normal subjects and patients who recovered from acute optic neuritis. Int J Ophthalmol Clin Res 4. DOI https://doi.org/10.23937/2378-346x/1410067

  32. Maier M, Groneberg T, Specht H, Lohmann CP (2010) Critical flicker-fusion frequency in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 248:409–413. https://doi.org/10.1007/s00417-009-1270-8

    Article  PubMed  Google Scholar 

  33. Feigl B, Cao D, Morris CP, Zele AJ (2011) Persons with age-related maculopathy risk genotypes and clinically normal eyes have reduced mesopic vision. Invest Ophthalmol Vis Sci 52:1145–1150. https://doi.org/10.1167/iovs.10-5967

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gregori B, Papazachariadis O, Farruggia A, Accornero N (2011) A differential color flicker test for detecting acquired color vision impairment in multiple sclerosis and diabetic retinopathy. J Neurol Sci 300:130–134. https://doi.org/10.1016/j.jns.2010.09.002

    Article  PubMed  Google Scholar 

  35. Rider AT, Henning GB, Stockman A (2022) A reinterpretation of critical flicker-frequency (CFF) data reveals key details about light adaptation and normal and abnormal visual processing. Prog Retin Eye Res 87:101001. https://doi.org/10.1016/j.preteyeres.2021.101001

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by the Natural Science Foundation of China (Grant No. 82070937) and the National Natural Science Foundation for Young Scientists of China (Grant No. 82101097).

Author information

Author notes

  1. Guangcan Xu and Yu Luo contributed equally to this article.

Authors and Affiliations

  1. School of Medicine, Nankai University, Tianjin, 300071, China

    Guangcan Xu, Haolan Qi & Zhaohui Li

  2. Department of Ophthalmology, The Third Medical Center, The Chinese PLA General Hospital, Beijing, 100853, China

    Guangcan Xu, Yu Luo, Haolan Qi, Sijia Liu, Zi Ye & Zhaohui Li

  3. Medical School of Chinese PLA, Beijing, 100853, China

    Yu Luo, Sijia Liu, Zi Ye & Zhaohui Li

  4. Department of Ophthalmology, School of Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200092, China

    Junxia Fu

Authors
  1. Guangcan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haolan Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sijia Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Junxia Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zi Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhaohui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The conception and planning of the study were undertaken by Zhaohui Li and Zi Ye. Sijia Liu was responsible for the data collection. Junxia Fu analyzed the data. Guangcan Xu wrote the initial draft of the manuscript, which was later revised by Haolan Qi and Yu Luo. All authors have reviewed and approved the final version of the manuscript, and they concur with its submission to the journal.

Corresponding authors

Correspondence to Zi Ye or Zhaohui Li.

Ethics declarations

Ethical approval

The conducted studies involving human subjects adhered to the ethical guidelines of the Chinese PLA General Hospital Institutional Review Board, complying with the principles of the 1964 Helsinki Declaration and its subsequent modifications or equivalent ethical norms.

Conflict of interest

The authors declare no competing interests.

Informed consent

Informed consent was obtained from all individuals involved in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, G., Luo, Y., Qi, H. et al. Trichromatic critical flicker frequency as potential visual test in cataract and macula disease patients. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-024-06398-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00417-024-06398-w

Keywords

Search

Navigation