Macular pigment and visual performance in glare: benefits for photostress recovery, disability glare, and visual discomfort.

PURPOSE One theory of macular pigment's (MP) presence in the fovea is to improve visual performance in glare. This study sought to determine the effect of MP level on three aspects of visual performance in glare: photostress recovery, disability glare, and visual discomfort. METHODS Twenty-six subjects participated in the study. Spatial profiles of MP optical density were assessed with heterochromatic flicker photometry. Glare was delivered via high-bright-white LEDs. For the disability glare and photostress recovery portions of the experiment, the visual task consisted of correct identification of a 1° Gabor patch's orientation. Visual discomfort during the glare presentation was assessed with a visual discomfort rating scale. Pupil diameter was monitored with an infrared (IR) camera. RESULTS MP level correlated significantly with all the outcome measures. Higher MP optical densities (MPODs) resulted in faster photostress recovery times (average P < 0.003), lower disability glare contrast thresholds (average P < 0.004), and lower visual discomfort (P = 0.002). Smaller pupil diameter during glare presentation significantly correlated with higher visual discomfort ratings (P = 0.037). CONCLUSIONS MP correlates with three aspects of visual performance in glare. Unlike previous studies of MP and glare, the present study used free-viewing conditions, in which effects of iris pigmentation and pupil size could be accounted for. The effects described, therefore, can be extended more confidently to real-world, practical visual performance benefits. Greater iris constriction resulted (paradoxically) in greater visual discomfort. This finding may be attributable to the neurobiologic mechanism that mediates the pain elicited by light.