Pediatrics Norms for Visual Contrast Sensitivity Using an APT VCS Tester

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Scott W. McMahon Konnor A. Kundomal Sanjay Yangalasetty


Chronic inflammatory response syndrome (CIRS) is an acute and chronic, systemic inflammatory response syndrome usually acquired following exposure to the interior environment of water-damaged buildings (WDB).  Capillary hypoperfusion is a principle mechanism of injury in CIRS patients.  Visual contrast sensitivity (VCS) testing is affected by capillary hypoperfusion and has been used to screen patients and track treatment results in CIRS cases.  Adult VCS norms for the APT VCS Tester were developed by its manufacturer but pediatric norms have not been made available.  This study evaluated VCS testing, using an APT VCS tester, on 157 consecutive pediatric patients presenting for wellness checks at a local pediatric clinic.  Thirty children were excluded. For the remaining 127 controls, means for left eyes at each CPD (cycles per degree of visual arc) were the same as for right eyes at the same testing frequency.  The mean visual contrast raw score at 1.5 CPD was 8.1 out of a possible 9 (stdev = 0.534).  The mean for 3 CPD was 8.2 (stdev = 0.531).  The mean for 6 CPD was 8.2 (stdev = 0.450).  The mean for 12 CPD was 7.8 (stdev = 0.835).  The mean for 18 CPD was 1.8 (stdev = 2.40).  Further analysis showed there was no significant difference between boys and girls, between well controlled asthmatics and those without asthma or between the cohort of ages 7-8 and any other age grouping.  The pediatric VCS norms calculated were the same as the manufacturer’s reported norms for adults.  Pediatric CIRS prevalence in this cohort was calculated as a minimum of 7.6% and a maximum of 12.7%.  Pediatric CIRS prevalence is on the same order as pediatric asthma.

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MCMAHON, Scott W.; KUNDOMAL, Konnor A.; YANGALASETTY, Sanjay. Pediatrics Norms for Visual Contrast Sensitivity Using an APT VCS Tester. Medical Research Archives, [S.l.], v. 5, n. 5, may 2017. ISSN 2375-1924. Available at: <>. Date accessed: 16 oct. 2021.
Visual contrast sensitivity; VCS; CIRS; inflammation; pediatrics; APT VCS Tester; capillary hypoperfusion; prevalence
Research Articles


Adams RJ, Courage ML. Using A Single Test To Measure Human Contrast Sensitivity From Early Childhood To Maturity. Vision Research. Volume 42, Issue 9, April 2002, Pages 1205–1210.

Berndtson K, McMahon S, Ackerley M, Rapaport S, Gupta S, Shoemaker R. Medically sound investigation and remediation of water-damaged buildings in cases of chronic inflammatory response syndrome. Published online. January 19, 2016. Retrieved February 2017.

Hitchcock EM, Dick RB, Krieg EF. "Visual Contrast Sensitivity Testing: A Comparison Of Two FACT Test Types." Neurotoxicology And Teratology 26.2 (2004): 271-277.

Hudnell HK, House D, Schmid J, Koltai D, Stopford W, Wilkins J, Savitz DA, Swinker M, Music S. Human visual function in the North Carolina clinical study on possible estuary-associated syndrome. J Toxicol Environ Health A. 2001 Apr 20;62(8):575-94.

McMahon SW. An Evaluation of Alternate Means to Diagnose Chronic Inflammatory Response Syndrome and Determine Prevalence. Medical Research Archives, Vol. 5, Issue 3, March 2017.

New York State Department Of Health Center For Environmental Health Bureau Of Toxic Substance Assessment. Tetrachloroethylene (Perc) Exposure And Visual Contrast Sensitivity (VCS) Test Performance In Adults And Children Residing In Buildings With Or Without A Dry Cleaner. March 2010.

Owsley C, Sekuler R, Siemsen D. Contrast sensitivity throughout adulthood. Vision Research. Volume 23, Issue 7, 1983, Pages 689–699.

Shoemaker R. Treatment of persistent Pfiesteria-human illness syndrome. Maryland Medical Journal 1998; 47: 64-66.

Shoemaker R. What is Mold Illness? Better yet, do people get sick after being exposed to water-damaged buildings? Retrieved February 2017.

Shoemaker R, House D. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicology and Teratology 2004; 1-18.

Shoemaker R, House D. Sick Building Syndrome (SBS) And Exposure To Water-Damaged Buildings: Time Series Study, Clinical Trial And Mechanisms. Neurotoxicology And Teratology 2006; 573-588.

Shoemaker R, House D. Characterization of chronic human illness associated with exposure to cyanobacterial harmful algal blooms predominated by Microcystis. Cyanobacterial harmful algal blooms: State of the Science and Research Needs. H Kenneth Hudnell, Editor. 2009. pg 653.

Shoemaker R, House D, Ryan J. Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case/control study. Neurotoxicology and Teratology 2010; 633-639.

Shoemaker R, Hudnell K. Possible Estuary-Associated Syndrome: Symptoms, vision, and treatment. Environmen-tal Health Perspectives 2001; 109: 539-545.

Shoemaker R, Hudnell, House D, van Kempen A, Pakes G. Atovaquone plus cholestyramine in patients coinfected with Babesia microti and Borrelia burgdorferi refractory to other treatment. Advances in Therapy 2006; 23: 1-11.

Shoemaker R, Lipsey R. Results Of Health Screening And Visual Contrast Testing. St. Bernard’s Parish, Louisiana. 2006. Published On-Line.

Shoemaker R, Rash J, Simon E. Sick Building syndrome in water damaged buildings: generalization of the chronic biotoxin associated illness paradigm to indoor toxigenic fungi. Bioaerosols, fungi, bacteria, mycotoxins and human health. Eckardt Johanning MD editor 2006.

Thayaparan K, Crossland MD, Rubin GS. Clinical Assessment Of Two New Contrast Sensitivity Charts. Br J Ophthalmol. 2007 Jun; 91(6): 749–752. Published Online 2006 Dec 13. Doi: 10.1136/Bjo.2006.109280.

Thomas G, Clark Burton N, Mueller C, Page E. Comparison of Mold Exposures, Work-related Symptoms, and Visual Contrast Sensitivity between Employees at a Severely Water-damaged School and Employees at a School without Significant Water Damage. Department Of Health And Human Services, Centers for Disease Control and Prevention. September 2010.

Wilensky JT, Hawkins A. Comparison Of Contrast Sensitivity, Visual Acuity, And Humphrey Visual Field Testing In Patients With Glaucoma. Tr Am Ophth Soc 2001;99:213-218.