Computerized method of visual acuity testing: adaptation of the amblyopia treatment study visual acuity testing protocol11Additional technical information about the Electronic Visual Acuity Tester and the Amblyopia Treatment Study visual acuity testing protocol application can be obtained from the lead author (pmoke@jaeb.org).

Moke, Pamela S.; Turpin, Andrew; Beck, Roy W.; Holmes, Jonathan M.; Repka, Michael X.; Birch, Eileen E.; Hertle, Richard W.; Kraker, Raymond T.; Miller, Joseph M.; Johnson, Chris

doi:10.1016/s0002-9394(01)01256-9

Cited by 202 publications

(81 citation statements)

References 3 publications

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“…Monocular visual acuity testing was performed at distance (Amblyopia Treatment Study protocol) 15 . If reduced visual acuity was found on initial testing (visual acuity worse than 20/40 or interocular difference of two or more lines), visual acuity testing with full correction was repeated after cycloplegia.…”

Section: Methodsmentioning

confidence: 99%

Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia

Kulp¹,

Ciner

Maguire

et al. 2017

Optom Vis Sci

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Significance Among 4- and 5- year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) are associated with moderate, uncorrected hyperopia (3–6D) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc). Purpose To compare attention, visual motor and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten, and evaluate their associations with visual function. Methods Participants were 4 and 5 years of age with either hyperopia (≥3D to ≤6D, astigmatism≤1.5D, anisometropia≤1D) or emmetropia (hyperopia≤1D; astigmatism, anisometropia, and myopia each <1D), without amblyopia or strabismus. Examiners masked to refractive status administered tests of attention (sustained, receptive and expressive), VMI, and VP. Binocular visual acuity (VA), stereoacuity, and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity, and parent/caregiver’s education. Results 244 hyperopes (mean +3.8D±SD0.8) and 248 emmetropes (+0.5D±0.5) completed testing. Mean sustained attention score was worse in hyperopes compared to emmetropes (mean difference: −4.1, p<0.001 for 3–6D). Mean receptive attention score was worse in 4–6D hyperopes compared to emmetropes (by −2.6, p=0.01). Hyperopes with reduced near VA (20/40 or worse) had worse scores than emmetropes (−6.4, p<0.001 for sustained attention; −3.0, p=0.004 for receptive attention; −0.7, p=0.006 for VMI, −1.3, p=0.008 for VP). Hyperopes with stereoacuity of 240 arc secs or worse scored significantly worse than emmetropes (−6.7, p<0.001 for sustained attention; −3.4, p=0.03 for expressive attention, −2.2, p=0.03 for receptive attention; −0.7, p=0.01 for VMI, −1.7, p<0.001 for VP). Overall, hyperopes with better near visual function generally performed similarly to emmetropes. Conclusions Moderately hyperopic children were found to have deficits in measures of attention. Hyperopic children with reduced near visual function also had lower scores on VMI and VP than emmetropic children.

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Section: Methodsmentioning

confidence: 99%

Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia

Kulp¹,

Ciner

Maguire

et al. 2017

Optom Vis Sci

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“…First was crowded monocular BCVA using the electronic Early Treatment Diabetic Retinopathy Study protocol 21,22 for children at least 7 years old or the Amblyopia Treatment Study HOTV protocol for children younger than 7 years. 23,24 Second was a stereoacuity component (Randot Preschool Stereoacuity and Stereo Butterfly Tests; Stereo Optical, Inc). Third was extent of suppression scotoma using the Worth 4-dot test at 7 different distances.…”

Section: Methodsmentioning

confidence: 99%

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Kelly

Jost

Dao³

et al. 2016

JAMA Ophthalmol

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174

209

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IMPORTANCE Fellow eye patching has long been the standard treatment for amblyopia, but it does not always restore 20/20 vision or teach the eyes to work together. Amblyopia can be treated with binocular games that rebalance contrast between the eyes so that a child may overcome suppression. However, it is unclear whether binocular treatment is comparable to patching in treating amblyopia.OBJECTIVES To assess the effectiveness of a binocular iPad (Apple Inc) adventure game as amblyopia treatment and compare this binocular treatment with patching, the current standard of care. DESIGN, SETTING, AND PARTICIPANTSThis investigation was a randomized clinical trial with a crossover design at a nonprofit eye research institute. Between February 20, 2015, and January 4, 2016, a total of 28 patients were enrolled in the study, with 14 randomized to binocular game treatment and 14 to patching treatment.INTERVENTIONS Binocular game and patching as amblyopia treatments. MAIN OUTCOMES AND MEASURESThe primary outcome was change in amblyopic eye best-corrected visual acuity (BCVA) at the 2-week visit. Secondary outcomes were change in stereoacuity and suppression at the 2-week visit and change in BCVA at the 4-week visit. RESULTS Among 28 children, the mean (SD) age at baseline was 6.7 (1.4) years (age range, 4.6-9.5 years), and 7 (25%) were female. At baseline, the mean (SD) amblyopic eye BCVA was 0.48 (0.14) logMAR (approximately 20/63; range, 0.3-0.8 logMAR [20/40 to 20/125]), with 14 children randomized to the binocular game and 14 to patching for 2 weeks. At the 2-week visit, improvement in amblyopic eye BCVA was greater with the binocular game compared with patching, with a mean (SD) improvement of 0.15 (0.08) logMAR (mean [SD], 1.5 [0.8] lines) vs 0.07 (0.08) logMAR (mean [SD], 0.7 [0.8] line; P = .02) after 2 weeks of treatment. These improvements from baseline were significant for the binocular game (mean [SD] improvement, 1.5 [0.8] lines; P < .001) and for patching (mean [SD] improvement, 0.7 [0.8] line; P = .006). Depth of suppression improved from baseline at the 2-week visit for the binocular game (mean [SD], 4.82 [2.82] vs 3.24 [2.87]; P = .03) and for patching (mean [SD], 4.77 [3.10] vs 2.57 [1.67]; P = .004). Patching children crossed over to binocular game treatment, and all 28 children played the game for another 2 weeks. At the 4-week visit, no group difference was found in BCVA change, with children who crossed over to the binocular games catching up with children treated with binocular games, for a mean (SD) improvement of 0.17 (0.10) logMAR (mean [SD], 1.7 [1.0] lines) for the binocular game vs a mean (SD) improvement of 0.16 (0.12) logMAR (mean [SD], 1.6 [1.2] lines) for the patching crossover (P = .73). CONCLUSIONS AND RELEVANCEA binocular iPad game was effective in treating childhood amblyopia and was more efficacious than patching at the 2-week visit. Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.TRIAL REGISTRATION clinicaltrials....

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“…In order to minimize potential bias, the pediatric optometrist did not review the JVAS screening results until the eye examination was completed. The eye examination included measurement of visual acuity using the Amblyopia Treatment Study HOTV (ATS-HOTV) visual acuity protocol 10,11 for <7-year-olds and the electronic ETDRS visual acuity protocol for 7-year-olds. 12 Ocular alignment testing was performed at distance and near fixation using simultaneous prism cover test and prism and alternating cover test; ocular motility was assessed and pupils were examined.…”

Section: Methodsmentioning

confidence: 99%

A new computer-based pediatric vision-screening test

Yamada

Hatt

Moke

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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Background We developed and validated the Jaeb Visual Acuity Screener (JVAS), a computerized visual acuity-based screening program for children that employs a rapid, age-specific, standardized algorithm for vision screening in the medical home that is available for download at no cost. Methods A total of 175 children aged 3 to <8 (median, 6) years were screened with the JVAS before undergoing a complete eye examination (gold standard). The JVAS presented 2 large single surround optotypes (20/100 and 20/80) and then 5 optotypes at a predetermined, age-specific normal threshold. Failure on the gold standard examination was determined using recently published referral criteria and published visual acuity norms for age. We evaluated the sensitivity and specificity of the JVAS for detecting reduced visual acuity, amblyopia, and amblyopia risk factors. JVAS pass/fail paradigms evaluated were inability to identify 3 of 4, 3 of 5, and 4 of 5 age-appropriate optotype presentations. Results Screening testability for the JVAS was high, at 100%. Sensitivity of the JVAS ranged from 88% to 91%, and specificity from 73% to 86%, with positive predictive value ranging from 66% to 79% and negative predictive value from 92% to 93% (ranges reflect different pass/fail paradigms). Conclusions The new JVAS provides an effective and practical method for screening 3- to 7-year-olds using any Windows-based computer. Providing the JVAS free-of-charge to pediatricians and school systems would standardize currently fragmented visual acuity-based screening practices.

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Cited by 202 publications

References 3 publications

Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia

Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

A new computer-based pediatric vision-screening test

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