REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

Comparative characteristics of changes in visual acuity according

to test lighting in healthy people and in patients with myopia

Tamara Gumarovna Tlupova *

Diana Arsenovna Teuvazhukova **

Aslan Alekseevich Teuvov ***

Arthur Mukharbievich Baziev ****

Irina Korneevna Tkhabisimova *****

Aslan Zhamalovich Zhashuev ******

ABSTRACT

The objective of the work consisted of comparing the characteristics of the changes in visual

acuity as a function of the illumination of the tests in healthy individuals and in patients with

myopia, examining two groups (50 people each): a control group of healthy individuals and

patients with high myopia with visual acuity with optimal correction above 1.0. Visual acuity

was determined under different lighting conditions (from 50Lx to 400Lx) using optotype

tables with a small step of 0.05, and increasing the function δ, which is the difference between

these values. δ in healthy individuals is 0.7, and in individuals with myopia it is equal to 0.55,

which is a fairly high indicator and confirms the absence of contraindications to attract this

category of patients to various types of visually strenuous work, including driving.

KEY WORDS: lighting; myopia; visual acuity.

*

Candidate of Medical sciences, Associate Professor of General surgery Kabardino-Balkarian State

University named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0002-8231-7348 E-

mail: ttlupova@gmail.com

*

Clinical resident North Ossetian State Medical Academy Vladikavkaz, Russia. ORCID:

https://orcid.org/0000-0002-2025-0045 E-mail: di.teu.00@mail.ru

*

** Candidate of Medical sciences, Associate Professor of General surgery Kabardino-Balkarian State

University named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0003-3405-937X E-

mail: teuw@mail.ru

*

*** Candidate of Medical sciences, Associate Professor of General surgery Kabardino-Balkarian State

University named after H.M. Berbekov Nalchik, Russia. ORCID: https://orcid.org/0000-0001-6360-6577 E-

mail: bazzaarth76@mail.ru

*

****Candidate of Medical sciences, Associate Professor of General surgery Kabardino-Balkarian State

University named after H.M. Berbekov Nalchik, Russia. ORCID https://orcid.org/0000-0003-4065-989X E-

mail: tkhabisim@mail.ru

*

*****Candidate of Medical sciences, Assistant at the Department of Faculty and Endoscopic Surgery

Kabardino-Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID

https://orcid.org/0000-0002-6223-430X E-mail: ASG1911@mail.ru

Recibido: 10/02/2021

Aceptado: 15/04/2021

408

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

Características comparativas de los cambios en la agudeza visual

según la iluminación de la prueba en personas sanas y en pacientes

con miopía

RESUMEN

El objetivo del trabajo consistió en comparar las característica de los cambios en la agudeza

visual en función de la iluminación de las pruebas en individuos sanos y en pacientes con

miopía, examinando dos grupos (50 personas cada uno): un grupo control de individuos

sanos y pacientes con miopía alta con agudeza visual con corrección óptima por encima de

1

4

, 0. La agudeza visual se determinó en condiciones de iluminación diferente (de 50Lx a

00Lx) utilizando tablas de optotipos con un pequeño paso de 0.05, y el incremento de la

función δ, que es la diferencia entre estos valores. δ en individuos sanos es 0.7, y en

individuos con miopía es igual a 0.55, que es un indicador bastante alto y confirma la

ausencia de contraindicaciones para atraer a esta categoría de pacientes a varios tipos de

trabajos visualmente extenuantes, incluso al conducir.

PALABRAS CLAVE: iluminación; miopía; agudeza visual.

Introduction

For several decades, myopia remains one of the urgent problems of

ophthalmopathology (Avetisov et al., 2020; Avetisov, 2002; Hayashi et al., 2006; Horgan et

al., 2005; Nishi et al., 2008). This is due to both the high prevalence of the disease (up to

4

5% of children and 25% of the adult population) and the disabling consequences of

complicated myopia (1st or 2nd place among the causes of disability) (Avdeeva et al., 2018;

Proskurina and Tarutta, 2020; Tarutta et al., 2020; Pucci et al., 2001; Zhukova and

Smirnitskaya, 2014). Myopia can lead to severe irreversible processes and permanent

disability. People with myopia are often limited in their choice of specialty, and the

detection of myopia at the professional examination of drivers of vehicles may serve as a

reason for rejection of hiring.

In the onset of myopia, both genetic factors and environmental factors play a role,

such as illumination in the room for work, illumination of the workplace, illumination of

the surrounding field, etc. Failure to comply with certain rules can lead already in the early

stages to degenerative-dystrophic processes, damage the scotopic apparatus of the retina,

followed by the involvement of photopic structures, expressed in a decrease in distance

409

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

visual acuity and impaired twilight vision. As the disease progresses, light adaptation also

decreases, color vision is impaired, and central and paracentralscotomas appear (Aller,

2014; Aller and Wildsoet, 2013; Hayashi, Yoshida and Hayashi, 2006; Holden et al., 2014;

Proskurina and Tarutta, 2020; Tarutta et al., 2012; Tarutta et al., 2015; Tarutta et al., 2020).

Therefore, it seems to us especially important to study visual acuity depending on the

illumination of the tests (OT) in persons suffering from myopia.

The purpose of our work was to carry out a comparative characteristic of changes in

visual acuity depending on the illumination of tests in healthy individuals and in patients

with myopia.

1

. Material and research methods

Since in our country the requirements for admission when driving a car are one of

the most stringent in the world, this category of workers was selected for examining

healthy persons. The peculiarity of this study is that it was first conducted in Kabardino-

Balkar Republic (the authors did not find analogs of this study in the available published

literature). We examined 50 healthy drivers (control group A) of the transport company

No. 1 in the city of Nalchik, which has its own modern, well-equipped polyclinic. All the

studied patients signed the form of informed consent for the participation in the study. The

main condition for the selection was the absence of road accidents among drivers of

vehicles during its work. Accident data were taken from individual driver cards that were

held by the HR department. Another condition is that they are somatically healthy people

who do not complain about the general condition of the body and the organ of vision in

particular. Drivers worked on GAZ 24-10 and RAF vehicles (belonging to categories B and

D according to the International classification) on urban routes with a regular load during a

1

2-hour work shift according to a shift schedule (1 shift - from 6 to 18 hours, 2 shift - from 18

to 6 o'clock). Corrected visual acuity in all the subjects was at least 1.0, the intraocular

pressure, visual field, and color perception were normal.

Group A1 was formed from patients of the same age (50 people) to compare the

obtained data with similar results of the corresponding age. Group A1 included patients

with high myopia, and their visual acuity with optimal correction should have been higher

than 1.0. The study of visual functions included not only a study using generally accepted

410

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

methods (visual acuity, refraction, tonometry, etc.), but also more subtle

ophthalmoergonomic tests (accommodation, CFFF, visual productivity, etc.) or exceeded

them, were admitted to further research.

All surveyed were men aged 20 to 55 years (average age - 37.08 10.19) with work

experience from 3 to 30 years (average 17.73 6.06).

The study of visual acuity was carried out in 2 stages. First, visual acuity is

determined with standard illumination, and then a study was carried out with a decrease in

illumination from a minimum of 50 Lx to a maximum of 400 Lx. The range of illumination

was chosen taking into account the fact that an increase in the illumination of optotypes

above 400 Lx and below 50 Lx does not reveal a significant change in visual acuity

(

Tlupova et al., 2006).

The purpose of the experiment is to determine the magnitude of the increment of the

function δ, which is the difference between these values. It is necessary to compare the

obtained value of the increment of the function δ with the norm established by us and, if a

decrease in this indicator is detected, to raise the question of admission to driving. The

second stage of the study is the most important, because even in healthy people who do not

complain about the general health of the body and the organ of vision, in particular, a

decrease in visual acuity is possible when the light conditions deteriorate, which is

dangerous for driving at twilight and at night.

A device for determining visual acuity (RF Patent No. 2269921) (Tlupova et al.,

2006), which makes it possible to determine visual acuity in conditions of different

illumination using tables of optotypes with a small 0.05 step, is used for research. This

makes it possible to predict the development of various emergency situations by drivers,

whose visual acuity at the first stage of the study was quite high and was not a

contraindication to admission to driving.

2

. Results and discussion

Our results are presented in the table. A statistically significant difference in changes

in visual acuity in normal conditions and in myopia, depending on the illumination of the

tests, was established. The coefficient of reliability is less than 1.96 when the illumination of

the tests is equal to 200 lux. Probably, the given illumination is equally optimal for the

411

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

study of these categories.

Table 1. Changes in visual acuity with changes in test illumination in healthy individuals

and with myopia

Visualacuity

Illumination

Lx)

Grou

p А1

±σ

Group A

(

М

±σ

t

5

0

1,13

1,42

1,52

1,62

1,64

1,81

1,83

0,18

0,22

0,21

0,24

0,27

0,26

0,22

0,24

1,05

1,17

0,24

0,32

0,36

0,28

0,24

0,26

0,32

0,24

1,46

3,52

3,54

1,70

2,72

4,91

4,37

4,35

1

00

50

1,25

1,32

1,44

1,48

1,52

1,56

2

00

50

300

350

4

00

Morethan

1

,83

0,24

1,6

0,32

3,14

4

00

δ

0,70

0,55

M is the arithmetic mean, s the standard deviation, t s the reliability of the

difference, δis the increment of the function reflecting the difference in visual acuity at a

maximum of 400 Lx and a minimum of 50 Lx of illumination

It was determined that with an increase in the illumination of the tests from 50 to

4

00 Lx, the visual acuity of healthy persons increases by 0.70 (from 1.13 ± 0.18 to 1.83 ± 0.24),

while in myopia the magnitude of the increase in acuity vision is 0.55 (from 1.05 ± 0.24 to 1.6

±

0.32). The increase in visual acuity is more clearly seen in the figure.

Thus, it is possible to predict the magnitude of visual acuity by changing the

illumination of the tests and assume that if the subject has a visual acuity with optimal

correction equal to 0.4 at the illumination of the tests = 50 Lx, then with the illumination of

the tests = 400 Lx this value will be equal to 0.9-0.95; with a visual acuity of 0.1 (test

illumination = 50 Lx) -0.5. That is, the increment of the function δ for this category of

patients is determined and it is equal to 0.55. This can be used in the definition of

aggravation and simulation of persons sent for medical and social expertise.

412

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

1,9

1,8

1,7

1,6

1,5

1,4

1,3

1,2

1,1

1

group A

group A1

50

100 150 200 250 300 350 400

Test illumination (Lx)

Figure 1. Changes in visual acuity with changes in test illumination in healthy individuals

and with myopia

Despite the significant difference in the values obtained, it should be noted that the

visual acuity of myopes is quite high, which confirms the absence of contraindications to

attracting this category of patients to various types of visually-intense work, including

when driving.

Conclusion

A statistically significant difference in changes in visual acuity in normal conditions

and in myopia, depending on the illumination of the tests, was established, but the visual

acuity of patients with myopia is quite high; this confirms the absence of contraindications

to the attraction of this category of patients to various types of visually strenuous work,

including when driving.

References

Aller, T. (2014). Clinical management of progressive myopia. Eye, 28 (2), 147-153. DOI:

1

0.1038/eye.2013.259

413

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

Aller, T. and Wildsoet, C. (2013). Optical control of myopia has come of age: or has it?

Optometry and Vision Science, 90 (5), 135-137. DOI: 10.1097/OPX.0b013e31828b47cf

Avdeeva, O. N., Avetisov, S. E., Aklaeva, N. A., Akopov, E. L., Alekseev, V. N., Astakhov, S.

Yu., Astakhov, Yu. S., Atkova, E. L., Brzhesky, V. V., Brovkina, A. F., Vakhova, E. S.,

Volobueva, T. M., Gorshkov, I. M., Grusha, Ya. O., Dal, N. Yu., Drozdova, E. A., Egorov, E.

A., Egorova, G. B., Erichev, V. P., Zhukova, S. I. et al. (2018). Ophthalmology: national

leadership. Moscow, 2nd ed.

Avetisov, E. S. Myopia. (2002). Moscow: Medicine, 288.

Avetisov, S. E., Fisenko, V. P., Zhuravlev, A. S. and Agaeva, L. M. (2020). Pharmacological

aspects of drug control of myopia. Bulletin of Ophthalmology, 136 (4-2), 310-316. DOI:

https://doi.org/10.17116/oftalma2020136042310

Hayashi, K., Yoshida, M. and Hayashi, H. (2006).Posterior capsule opacification in myopic

eyes. Journal of Cataract & Refractive Surgery, 32, 634-638. DOI: 10.1016/j.jcrs.2006.01.017

Holden, B., Sankaridurg, P., Smith, E., Aller, T., Jong, M. and He, M. (2014). Myopia, an

underrated global challenge to vision: where the current data takes us on myopia control.

Eye, 2, 142-146. DOI: 10.1038/eye.2013.256

Horgan, N., Condon, P. I. and Beaty, S. (2005). Refractive lens exchange in high myopia:

long term follow up. British Journal of Ophthalmology, 89 (6), 670-672. DOI:

1

0.1136/bjo.2004.052720

Nishi, Y., Mireskandari, K., Khaw, P. and Findl, O. (2008). Lens refilling to restore

accommodation. Journal of Cataract & Refractive Surgery, 35 (2), 374-382. DOI:

1

0.1016/j.jcrs.2008.10.054

Proskurina, O. V. and Tarutta, E. P. (2020). A detailed research protocol for evaluating the

effectiveness of myopia control methods. The Eye of the Eye, 22 (3, 131), 5-18. DOI:

https://doi.org/10.33791/2222-4408-2020-3-5-18

Pucci, V., Morselli, S., Romanelli, F., Pignatto, S., Scandellari, F., Bellucci, R. (2001). Clear

lens phacoemulsification for correction of high myopia Journal of Cataract & Refractive

Surgery, 27, 896-900. DOI: 10.1016/s0886-3350(01)00858-6

Tarutta, E. P., Egorova, T. S., Tarasova, N. A. and Chuvilina, M. V. (2012). The changes in

the accommodation and eye performance associated with the treatment of functional

progressing myopia. Modern optometry, 8, 33-36.

Tarutta, Е. P., Epishina, M. V., Ramazanova, K. A., Kiseleva, T. N., Milash, S. V. and

Verzhanskaya, T. Yu. (2015). Hemodynamics in eye vessels associated with nigh-time

orthokeratology: first report. Russian Ophthalmological Journal, 2, 60-64.

Tarutta, E. P., Proskurina, O. V., Markosyan, G. A., Tarasova, N. A., Milash, S. V. and

Khodzhabekyan, N. V. (2020). Basic principles of optical prevention of the onset and

progression of myopia.Russian National Ophthalmological forum, 1, 259-263. DOI:

414

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

Tamara G. Tlupova et al //Comparative characteristics of changes in visual acuity … 408-415

DOI: http://dx.doi.org/10.46925//rdluz.33.28

https://doi.org/10.21516/2072-0076-2020-13-4-7-16

Tlupova, T. G., Chernysheva, S. G., Rosenblum, Yu. Z. and Tutukov, A. Kh. (2006).A device

for determining visual acuity. RF patent No. 2269921. Published on 05/17/200420.02.2006.

Zhukova, О. V. and Smirnitskaya, E. Y. (2014). Correlations for biometric and

keratorefractive parameters of the eye-balls in children with progressing myopia.

Refraction, 198–203.

415