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Struggling to read more than six lines on an eye chart with fading letters may serve as a visual "yellow light" for older adults—raising red flags that routine exams sometimes fail to detect. A new University of Michigan study, published in JAMA Ophthalmology, shows that this threshold on a Pelli-Robson chart might indicate everyday vision problems that standard eye tests may miss.

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"Traditional eye charts can miss important vision changes that often occur as we age because they use high contrast with black letters on a white background," said U-M neuro-ophthalmologist Lindsey De Lott. "But we can also measure vision using letters in different shades of gray. In these lower-contrast charts, such as the one used in our study, the letters become progressively lighter and harder to see. We call this contrast sensitivity."

Researchers have long known that contrast sensitivity is a better way to detect certain vision problems, according to De Lott. "But we didn't have a threshold or number that told us where on this contrast sensitivity chart patients start to experience problems with their vision in their day-to-day lives, like trouble recognizing faces, reading print or watching television," she said.

According to the researchers, before this study, the yellow light was defined based only on patients reporting no visual problems. Now, doctors might be able to help them before they reach the red light.

"This makes the test more actionable for clinicians and more meaningful for patients," said Shu Xu, a postdoctoral fellow at U-M's Institute for Social Research. "It also provides researchers in public health, aging and the social sciences with a concrete marker for studying how vision affects older adults' independence, well-being and health outcomes."