**Author details**

Eitan Z. Rath1,2\*

\*Address all correspondence to: erath@netvision.net.il

1 Department of Ophthalmology, Galilee Medical Center, Nahariya, Israel

2 Faculty of Medicine, Bar-Ilan University, Safad, Israel

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52 Causes and Coping with Visual Impairment and Blindness


**Section 2**

**Evaluation of Visual Impairment**

**Evaluation of Visual Impairment**

**Chapter 4**

Provisional chapter

**Glare and Ocular Diseases**

Glare and Ocular Diseases

My Diep and Pinakin Gunvant Davey

My Diep and Pinakin Gunvant Davey

http://dx.doi.org/10.5772/intechopen.74687

acuity, mesopic, photopic

1. Introduction

Abstract

Additional information is available at the end of the chapter

Glare is the result of veiling luminance from the different light sources we are exposed to in our everyday lives. The luminance from glare can cause problems ranging from the discomfort of our eyes to vision loss. All individuals are affected by glare issues but those problems are intensified in patients living with ocular diseases. Therefore, understanding the effects of glare is applicable to elucidating visual function and pathology. This makes glare testing highly necessary in both clinic and research. However, there are many components involved in glare testing that makes attaining valid results difficult. This is evident in the flaws of current glare devices and the lack of a standardization of measuring glare. Despite the insufficiency of most glare devices, evaluating those weaknesses can

DOI: 10.5772/intechopen.74687

Keywords: glare, disability glare, cataract, glaucoma, macular degeneration, stereopsis, corneal diseases, keratoconus, glare testing, glare devices, contrast sensitivity, visual

Our eyes are exposed to numerous light sources and at various intensities such as the rays from the sun or light from the headlights of driving cars. When we visually experience a veiling luminance from any light source it is a phenomenon known as glare. There are different types of glare: disability glare, discomfort glare, dazzling glare, and scotomatic glare [1]. We commonly experience discomfort glare when the intensity of the light source causes an uneasiness or annoyance on our eyes. Furthermore, we also regularly encounter disability glare. Disability glare is the scattering of light that enters our eyes that leads to visual impairment. Since disability glare directly affects our visual ability, it has been a focus of research, which

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

potentially lead to a better understanding of glare and glare testing.

particularly is important in an aging population and various disease states.

Additional information is available at the end of the chapter

#### **Chapter 4** Provisional chapter

#### **Glare and Ocular Diseases** Glare and Ocular Diseases

My Diep and Pinakin Gunvant Davey My Diep and Pinakin Gunvant Davey

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74687

#### Abstract

Glare is the result of veiling luminance from the different light sources we are exposed to in our everyday lives. The luminance from glare can cause problems ranging from the discomfort of our eyes to vision loss. All individuals are affected by glare issues but those problems are intensified in patients living with ocular diseases. Therefore, understanding the effects of glare is applicable to elucidating visual function and pathology. This makes glare testing highly necessary in both clinic and research. However, there are many components involved in glare testing that makes attaining valid results difficult. This is evident in the flaws of current glare devices and the lack of a standardization of measuring glare. Despite the insufficiency of most glare devices, evaluating those weaknesses can potentially lead to a better understanding of glare and glare testing.

DOI: 10.5772/intechopen.74687

Keywords: glare, disability glare, cataract, glaucoma, macular degeneration, stereopsis, corneal diseases, keratoconus, glare testing, glare devices, contrast sensitivity, visual acuity, mesopic, photopic

#### 1. Introduction

Our eyes are exposed to numerous light sources and at various intensities such as the rays from the sun or light from the headlights of driving cars. When we visually experience a veiling luminance from any light source it is a phenomenon known as glare. There are different types of glare: disability glare, discomfort glare, dazzling glare, and scotomatic glare [1]. We commonly experience discomfort glare when the intensity of the light source causes an uneasiness or annoyance on our eyes. Furthermore, we also regularly encounter disability glare. Disability glare is the scattering of light that enters our eyes that leads to visual impairment. Since disability glare directly affects our visual ability, it has been a focus of research, which particularly is important in an aging population and various disease states.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Light is focused to the retina to receive visual information of the world around us. Thus, the transmittance of light is integral to how we visually function. To this accord, the human visual system is finely tuned to allow the maximum amount of light transmission to the retina with least scatter. The retinal anatomy is also tuned to decreased sensitivity to shorter wavelength light and the retinal pigment epithelium and macular pigment allows the absorbance of stray light. However, disability glare interrupts the direction of light to the eye thereby interfering with the way we see [2]. This is especially debilitating, and the effects of glare are worsened in those who suffer from ocular pathologies. The many layers and components of the eye is involved in directing and processing light and cues to interpret our surrounding. Thus, a disease that impacts any part of the eye can exasperate disability glare decreasing the ability to see and perform daily activities such as driving.

Reduced transparency that leads to increased reflection and scatter of light can potentially cause disability glare. The disability glare along with diffraction and high-order aberration attribute to distorted retinal image, and thus impaired visual function. Components of vision such as contrast sensitivity can be hampered and if scattering is severe can lead to a deficit in visual acuity [4]. Therefore, those with corneal aberrations and abnormalities experience inten-

Glare and Ocular Diseases

59

http://dx.doi.org/10.5772/intechopen.74687

Keratoconus is a corneal dystrophy that leads to the progressive thinning of the center of cornea. Corneal thinning causes the center to protrude outward resulting in a cone shape cornea. Those with keratoconus can experience blurred vision as well as sensitivity to light [6]. Being reactive to light can make individuals with this corneal disease vulnerable to disability glare. Jinabhi and colleagues surveyed forward light scatter and visual function in subjects with mild to moderate keratoconus with no corneal scarring or history of ocular surgeries [10]. In the study, keratoconic and normal ocular healthy subjects underwent contrast sensitivity testing and glare testing to evaluate their visual function. The subjects with keratoconus exhibited lower contrast sensitivity than normal ocular subjects in testing. These results agreed with previous studies done and suggested contrast sensitivity was commonly compromised in keratoconus. Furthermore, keratoconic subjects also presented with intraocular scatter that resembled the increased scattering found in older populations or to those with early cataracts. Greater light scatter makes an individual with keratoconus more susceptible to disability glare [10]. More evidence of glare sensitivity in keratoconus could be found in a study done by Mäntyjärvi and Latinen. These researchers measured contrast sensitivity under glare conditions in keratoconic and ocular healthy subjects. The Pelli-Robson chart was used to measure contrast sensitivity. The chart contained letters of decreasing contrast that provided a quick and accessible way to measure contrast sensitivity [11]. The subjects were asked to read the Pelli-Robson chart under glare illuminance provided by the BAT. Then contrast sensitivity performance with and without glare was compared. The results of the comparison demonstrated that subjects with keratoconus experienced greater contrast sensitivity loss when tested under glare conditions than normal subjects [10]. Visual impairments being significantly greater in keratoconic subjects advocates the need for disability glare testing in measuring visual function. Disability glare performance can distinguish between normal individuals and those with ocular pathologies. Thus, in the case of corneal disease, disability glare can be a helpful diagnostic tool and could be a potential method of monitoring the disease progression. NEI VFQ (REF) or similar survey techniques can be used in conjunction to assist in evaluation

sified forms of disability glare as well as reduced contrast sensitivity and visual acuity.

of quality of vision and may be used in assessing glare related problems (Figure 1).

Glaucoma is globally the second most common cause of blindness and it affects over – millions worldwide and is a very large socio-economic burden to the health care system [12]. The risk of glaucoma increases with increase age and elevated intraocular pressure is a major risk factor in glaucoma. Lowering intraocular pressure remains the only proven alterable risk factor that has shown to slow down the disease progression. Although, the exact pathogenesis in glaucoma remains to be identified, glaucoma leads to progressive damage to the to the optic nerve fiber

2.2. Glaucoma

The impact of disability glare makes it an important visual function to measure. However, currently there is no standardized way to measure glare [3]. There are both commercial and self-made device that hope to address this problem. However, more evaluation will be necessary to solidify their validity for research and clinical use. As a result, much of disability glare in visual function and pathology is still under research.
