Purpose: It is well known that acuity slowly decreases in the later decades of life. We wish to determine the extent by which 4-year longitudinal acuity changes can be accounted for by changes in optical quality, or combination of optical quality metrics and of age between 50 and 80 years.
Methods: High-contrast logMAR acuity, 35 image quality metrics, 4 intraocular scatter metrics, and 4 Lens Opacification Classification System III metrics and entry age were measured on one eye of each of the 148 subjects. Acuity change between baseline and the last visit was regressed against change in each metric for all eyes and a faster changing subset of 50 eyes with a gain or loss of four or more letters.
Results: Average change across 148 subjects was a 1.6 ± 4 letter loss (t148 = 4.31, p < 0.001) and loss for the faster changing subset was 3.4 ± 6.1 letters (t50 = 2.73, p = 0.008). The multiple-regression model for faster changing eyes included change in point spread function entropy, posterior subcapsular cataract, and trefoil and baseline age (sequential r2 adjusted values of 0.19, 0.27, 0.32, and 0.34, respectively; p = 1.48 × 10−4 for the full four-factor model). The same variables entered the multiple-regression model for the full 148 data set where most of the acuity measurements were within test-retest error and accounted for less of the variance (r2 adjusted = 0.15, p = 2.37 × 10−5).
Conclusions: Despite being near noise levels for the measurement of acuity, change in optical quality metrics was the most important factor in eyes that lost or gained four or more letters of acuity. These findings should be generalizable given that our 4-year acuity change is essentially identical to other studies and indicate that these optical quality markers can be used to help identify those on a faster track to an acuity change.