Pendahuluan

The leading causes of blindness in the developed world are agerelated macular
degeneration (20–25 million patients), glaucoma (80 million patients by 2020), and diabetic
retinopathy (439 million diabetes patients projected for 2030). The costs of failing to treat
blindness are severe. In addition to depression and other psychosocial effects on individuals,
economic burdens include increased health care costs and lost productivity.
Untuk mengembangkan terapi baru untuk penyakit mata yang menyebabkan kebutaan,
dibutuhkan metode yang sensitif untuk mendeteksi keberadaan dan progresivitas hilangnya
penglihatan secara bertahap.
To develop new treatments for blinding eye diseases, there is an urgent need for sensitive
methods that detect the presence and progression of gradual vision loss. Early detection methods
are needed, because treatments are most effective when they are offered in the early stages of the
disease, so that significant vision loss can be avoided or delayed. The efficacy of new therapies
must be compared against existing clinical interventions, so tests that can detect small changes in
progression are essential to demonstrate clinically significant treatment outcomes. The current
clinical vision standard is letter acuity, the measurement of the smallest letter size that can be
resolved at high contrast (e.g., black letters on white background). Though useful to indicate
refractive error, acuity can be insensitive to the neuropathology presented by age-related macular
degeneration, glaucoma, and diabetic retinopathy. Acuity may not predict visual quality of life
better than questionnaires. Because of poor repeatability, acuity scores must be averaged over
several measurements, which increases testing times. Therefore, there is a pressing need for
improving functional or structural assessments to detect disease and monitor its progression.
Ketajaman tidak memprediksi kualitas visual lebih baik dari pada kuesioner. Kerana
lemahnya pengulangan, sehingga skor ketajaman harus dirata – rata untuk bebrapa pengukuran,
yang memperlama waktu pemeriksaan. Sehingga sangat dibutuhkan peningkatan pemeriksaan
fungsional atau structural untuk mendeteksi penyakit dan memantau perkembangannya.

A more comprehensive measure of visual function is contrast sensitivity, which describes

visual sensitivity at different contrasts and spatial scales. Contrast sensitivity deficits
significantly affect overall quality of life (for a review see the report of Owsley). Relative to
acuity, contrast sensitivity is correlated better with target identification in natural images,
driving, walking, and the ability to see faces. Poor contrast sensitivity is associated with an
increased risk of falls, which are predicted to cost almost 50 billion dollars annually in the
United States alone by 2020. Contrast sensitivity is impaired in a variety of ophthalmic and
neurologic conditions, including age-related macular degeneration, amblyopia, dry eye, glare,
glaucoma, myopia, ocular hypertension, cerebral lesions, and multiple sclerosis. Importantly,
contrast sensitivity may be impaired in visual neuropathologies that do not affect acuity.

Pengertian Kontra Sensitivitas

Contrast is defined as the degree of blackness to whiteness of target. Contrast threshold is the
smallest amount of contrast required to be able to see the target. Contrast sensitivity is the
reciprocal of the contrast threshold.
Contrast sensitivity measures the ability to see details at low contrast levels. Visual information
at low contrast levels is particularly important:
1. In communication, since the faint shadows on our faces carry the visual information
related to facial expressions;
2. In orientation and mobility, where we need to see such critical lowcontrast forms as the
curb, faint shadows, and stairs when walking down. In traffic, the demanding situations
are at low contrast levels, for example, seeing in dusk, rain, fog, snow fall, and at night;
3. In every day tasks, where there are numerous visual tasks at low contrast, like cutting an
onion on a light colored surface, pouring coffee into a dark mug, checking the quality of
ironing, etc.;
4. In near vision tasks like reading and writing, if the information is at low contrast as in
poor quality copies or in a fancy, barely readable invitation, etc.
Contrast sensitivity is the reciprocal of the contrast at threshold, i.e., one divided by the lowest
contrast at which forms or lines can be recognized.
If a person can see details at very low contrast, his or her contrast sensitivity is high and vice
versa. Depending on the structure of the stimulus used in the measurement - either gratings of
different size or symbols - contrast sensitivity of a person gets different values.

Fisologi Kontra Sensitivitas

Part of a human’s ability to discern information is attributed to its capacity to perceive difference
in luminance within a field of vision. Changes in luminance create a pattern of contrast that
conveys the majority of visual information to the viewer. Our ability to detect contrast is
affected by overall brightness of a scene and the intensity of ambient and background light.
Finely patterned, fuzzy or detailed objects may generally require sensitivity to finer grades of
contrast. Large objects require less sensitivity to contrast.

Rod sensors in the human eye are in the vicinity of 100 times more sensitive to luminance than
the colour sensitive cones. They are most concentrated in the areas of the retina that are used for
greater than ten degree fields of vision. To demonstrate how humans use this extra sensitivity,
astronomers looking for increased contrast in faint star fields, avert their gaze so that the rod
sensors come into play.

Within a range, each human’s ability to detect contrast and perceive changes in contrast is
slightly different depending upon age and other physiological factors. Humans are better at
detecting changes in contrast (differential) rather than absolute luminance values. For a given set
of viewing circumstances, a “just noticeable difference” or Just Noticeable Differences (JND) of
contrast is the threshold luminance difference between two areas that is required to just detect
that difference. Detection (perception) accuracy is dependant upon size of the object or pattern
(spatial frequency) and the time span that it is visible (temporal frequency).

For most luminance reference points, a JND of 2% difference in luminance between subject and
background is average. This is moderated to around 4% where the background luminance is
greatly different to two subject’s luminance being compared and is a demonstration of lateral
inhibition. These properties are described graphically in an earlier figure.

In a Modulation Transfer Function (MTF) test, an observer is asked to compare the contrasts of
two sine-wave gratings. One is a reference grating with fixed contrast and spatial frequency.
Second is a variable contrast grating with a different spatial frequency to the reference grating.
The observing subject is required to select the contrast setting in the variable grating so that the
intensities of the light and dark regions of the two gratings appears identical. In this experiment
contrast is defined as:

1. Contrast = (Imax – Imin)/(Imax + Imin)

This is known as the Michelson contrast definition, where Imax and Imin are the maximum and
minimum values of the grating intensities. Plotting relative sensitivity against spatial frequency
for a range of standard contrast ratios allows the MTF of the human vision system to be
illustrated.

In evaluating the contrast of anti aliased, grayscale text, Levien finds that it does not capture the
difference in perceived contrast between high contrast, bi-level text rendering and lower contrast,
antialiased text. He prefers a Root Mean Square (RMS) contrast measure that is equivalent to
the standard deviation of the luminance.

2. Crms = 1/N ( N ∑L2(x, y) – ( ∑L(x, y) )2 )1/2

In a study of contrast of natural images, Levien found the RMS contrast model was the most
reliable indicator of visible images.

Contrast sensitivity has an effect on how we perceive uniformity of intensity of coloured,

monochromatic light and white light. Ramamurthy et. al., using monochromatic, high intensity,
coloured LEDs developed a set of contrast sensitivity functions to determine how we perceive
contrast in different colour ranges. Results from their study are used to choose LEDs of
appropriate luminance for use in arrays as backlighting for signs to maintain uniform intensity
across the field of vision.

Human contrast sensitivity is not only limited to changes or differences in intensity but also to
differences of colour. Colour contrast can be achieved by altering the colour elements of hue,
lightness, saturation and colour ordering. Visual effects similar to Mach banding and other
optical phenomena can be stimulated by appropriate colour combination techniques. Physical
phenomena are often correlated with cultural meaning and as such colour choices and
combinations can be used to convey meaning and meta-information for information visualisation
and data mining. Mark Wang [15] of Stanford University explores the perceptual use of colour.

Type of contrast sensitivity

1. Spatial contrast sensitivity
Detection of striped patter at various levels of contrast and spatial frequency. Sine waves
gratings of parallel light and dark bands. Measured with stationary gratings. Width of the
bar is defined as spatial frequency. High spatial frequency ( narrow bars) , low spatial
frequency (wide bars). Spatial frequency increase sexponentially from left to right. The
contrast also varies logarithmatically from 100 % at the bottom to about 0,5 % at the top.

2. Temporal contrast sensitivity

Temporal contrast sensitivity is measure d with gratings that reverse contrast at various
rates over time. Here contrast sensitivity function is generated for the time related
processing in the visual system by presenting a uniform target field modulated sinusoidal
in time. Both the system provides more complete and systematic data on the status of
visual performance.
The shape of the contrast sensitivity function varies with factors :
 Luminance
 Target size
 Grating motion
 Grating shape

Neural mechanism of contrast sensitivity

Campbell and Green gave the concepts of different visual channels for handling information
about bands of spatial frequencies. This concept indicates that the retina is not uniform. Fovea is
specialized for high acuity and is responsible for high spatial frequencies. In the retina periphery,
only low frequency channels are represented.
M and P pathways
Ganglion cells divided into :
  P- cells are small, slow conducting axon that input into parvocellular layers of the lateral
geniculate body. P- cells have higher spatial resolution.
 M-cells are large, fast conducting axons that input into the magnocellular layers. M-cells
have higher contrast sensitivity and temporal resolution and lower spatial resolution.

Channel Theory
CSF is a function of several independent parallel detecting mechanism. Each channels is highly
sensitive to some particular spatial frequency. Visual world is broken into its separate spatial
frequency components and this information is then passed in separates channels to the cortex,
where it reconstructed. Visual system consists of 4 to 6 spatial frequency channels. CSF
channels could be due to a series of ganglion cells that have receptive fields of the different sizes
so that they are maximally sensitive to different spatial frequencies. Stimuli smaller that the
center receptive field only produce a partial response from the ganglion cell. Stimuli larger that
the center receptive field also stimulate the surrounding area so that the overall response from
ganglion cell is reduced.

Symptoms of contrast sensitivity

1. Have problems with night driving, including inability to see traffic lights
2. May require extra light to read
3. Their eyes may become tired when they read or watch television
4. Not being able to see spots on the clothes, counters, or dishes
5. Missing facial gesture

Fungsi Kontra Sensitivitas

The contrast sensitivity function (CSF) is a measure of contrast thresholds for a range of object
sizes and is conventionally measured by finding the threshold contrast of sine wave gratings of
varying spatial frequencies (sizes). The spatial frequency of a grating is the number of cycles
(one dark and one light band) per degree of visual angle. The finer the grating, the more cycles
per degree (c.p.d.), the higher the spatial frequency. In Figure 1 three sine waves are shown, A
and B have the same spatial frequency, while C has a higher spatial frequency. Contrast is a
measure of the difference between the luminance of the object and the luminance of its surround.
For grating-based tests, where there are equal areas of light and dark, contrast ( Cgrating) may be
defined as:

Lmax and Lmin are the maximum and minimum luminances in the grating respectively. In Figure
1, B and C have the same contrast, while A has a higher contrast. The contrast of A = (35-5) /
(35+5) = 0.75, while the contrast of B and C = (22.5- 17.5)/(22.5+17.5) = 0.125. Contrast is
often expressed as a percentage, hence these become 75 per cent and 12.5 per cent respectively.
If A and C represented gratings at threshold, the contrast sensitivity would be 1/0.75 = 1.3 and
1/0.125 = 8. At medium spatial frequencies (two to five c.p.d.) contrast sensitivity may be as
high as 500, and hence a grating with a contrast of l/500 = 0.002 is at threshold.
For measurement of contrast sensitivity, typically the contrast of a grating at a given spatial
frequency is varied and this is repeated over the range of spatial frequencies of interest. This is
then plotted, as shown in Figure 2, with contrast sensitivity versus spatial frequency. For higher
spatial frequencies (greater than 10 c.p.d.), the CSF is approximately limited by the optical
performance of the eye, the neural aspects of the visual system being as good as, or better than
the optical performance. For lower spatial frequencies the CSF is attenuated principally due to
neural factors. The shape of the CSF varies with many factors including luminance, temporal
characteristics,” target size’ grating motioni and grating shape (for example, square, sine) and
thus can vary between different tests and between different studies. If the same conditions are
always used with the same test then the shape of the CSF will remain the same unless there is
some visual dysfunction.
Optical degradation can affect contrast sensitivity. Spherical refractive error reduces contrast
sensitivity in proportion to the spatial frequency, with a minimal effect on low, a moderate
reduction for medium and a greater reduction for higher spatial frequencies. Astigmatic
refractive error can produce ‘notch’ defects, where only the medium spatial frequencies are
reduced. Monocular diplopia, such as with a bifocal contact lens, can also produce a notch
defect.
Figure 1. Three sine waves. A and B have the same spatial frequency, while C has a higher
spatial frequency. B and C have the same contrast (Equation l), while A has a higher contrast.

Figure 2. A typical contrast sensitivity function. Higher contrast is required to detect smaller
objects (high spatial frequency). Even with 100 per cent contrast (contrast sensitivity = 1) objects
finer than about 30 to 60 cycles per degree (c.p.d.) cannot be distinguished. This resolution limit
is related to visual acuity. Peak contrast sensitivity of better than one per cent contrast (contrast
sensitivity > 100) is found at medium spatial frequencies of about 3 to 5 c.p.d.
Figure 3. A square wave can be produced by the addition of suitable sine waves which include
the fundamental frequency and all the odd harmonics each at the appropriate amplitude.
Theoretically, any object can be ‘decomposed’ into a series of sine waves (Fourier analysis). In
other words, with sine waves of just the right size and shape, it is possible to ‘recreate’ the
object. As an example, it is possible to produce a square wave using a series of sine waves of
suitable amplitude and frequency as shown in Figure 3. The square wave is formed from a
combination of the fundamental frequency (the same spatial frequency as the square wave) and
the odd harmonics (three, five, or seven times the spatial frequency of the square wave) of
appropriate amplitude. These harmonics are important when we consider letter targets which are
effectively composed of small square wave elements. Modern image analysis computer programs
are able to perform Fourier analysis and can modify images by enhancing or removing different
spatial frequencies.*“ It is possible to produce a letter chart using these principles where, unlike
a Snellen chart, the letters disappear almost as soon as they are out of focus.’ This mathematical
‘trickery’ is a fundamental principal of optic and implies that the CSF is a relatively basic aspect
of vision. In practical terms, low spatial frequencies (less than 0.5 c.p.d.) are related to the
detection of large objects. Low spatial frequency detection helps us to avoid being run down by a
bus, although the bus would be unrecognizable from any other large ‘blobs’. Medium spatial
frequency (2 to 6 c.p.d.) detection allows recognition of the ‘blob’ as a bus rather than a truck
and helps one find the door. Fine detail requires high spatial frequency (greater than 10 c.p.d.)
detection allowing us to read the number of the bus. Most tasks require medium spatial
frequencies and, fortunately, medium spatial frequencies are at the peak of the CSF. While letters
comprise many spatial frequencies, a 6/60 letter is approximately 3 c.p.d., a 6/6 letter
approximately 30 c.p.d. and a 6/3 letter approximately 60 c.p.d.

The patient who experiences a reduction in contrast sensitivity at low and medium spatial
frequencies may have a greater functional visual loss and require
earlier referral than a patient who only experiences a reduction in high spatial frequency contrast
sensitivity (that is, visual acuity). A reduction in contrast sensitivity for low and medium spatial
frequencies would reduce the ability to detect large to moderately sized objects under reduced
contrast conditions (for example, a rainy day) thereby seriously compromising a patient’s
orientation and mobility. Contrast sensitivity reductions and information from other vision tests
should be used to assess functional vision. For example, peak contrast sensitivity and visual field
extent are correlated with orientation and mobility and reduced contrast letter sensitivity is
correlated with reduced driving skills.
Measurement of a full CSF can be very time-consuming. While the CSF is conventionally
measured at a range of spatial frequencies and many early studies measured such a range, it
would appear that often this is unnecessary. It has been suggested that the measurement of two or
three wellchosen spatial frequencies will adequately describe the CSE In conjunction with
conventional visual acuity a measure at or near the peak of the CSF appears to be a good clinical
compromise. The new clinical charts allow a measurement of medium spatial frequency
sensitivity to be taken quickly