Validation of a method to assess night myopia in a clinical setting

A study was conducted with 115 subjects who regularly drove at night to validate a refraction protocol for detecting refractive visual changes from daytime to nighttime conditions. Objective and subjective refractions were performed in both photopic and mesopic conditions, with a dark adaptation period before the mesopic subjective refraction. The results showed that in mesopic conditions, visual acuity decreased by 0.2 logMAR units on average (p < 0.01), and there was a myopic refractive shift of - 0.36 +/- 0.20 D (p < 0.01). Most subjects (92.2%) exhibited a myopic refractive shift of at least 0.12 D. Compensation of refractive shift improved mesopic visual acuity by 0.06 logMAR on average (p < 0.01) and higher refractive shifts showed higher improvement. Night Rx was preferred by 82.1% of subjects with myopic refractive shift. Gender and age did not significantly affect the refractive shift, although myopes showed a higher shift compared to emmetropes (p < 0.01). The refractive shift remained stable over time when the time slot of the day did not change (p < 0.01). Night Rx protocol proved to be a robust and accurate method for identifying drivers with refractive changes when transitioning from photopic to mesopic conditions. The high prevalence and inter-individual variability of Rx shift highlight the need of customized refraction.