Preschool Visual Acuity Screening with HOTV and Lea Symbols: Testability and Between-Test Agreement

Abstract

The vision of nearly all 3- to 5-year-old children can be screened using either HOTV letters or Lea symbols. HOTV letters may be slightly more difficult than Lea symbols for 3- to 5-year-old children, with the largest difference between acuity results on the two tests occurring in 3-year-old children.

The Potential Cost-Effectiveness of Amblyopia Screening Programs

“…PBNC preschool screening uses paid screening staff and photorefractive camera technology, 35 primarily Vision Research VisiScreen OSS-C autorefractors. They conduct elementary school screening with PBNC-certified volunteer vision screeners, school nurses, and teacher’s assistants using 10-foot acuity charts (HOTV for kindergarten and grade 1, Snellen for grades 2 and higher) 36,37 and stereopsis using the Lang Stereotest II. 38 …”

Vision Screening for Children 36 to <72 Months

“… 41 While HOTV optotypes are used more commonly in preschool-aged epidemiological studies 4 , 42 – 44 and randomized clinical trials for amblyopia, 45 – 47 most children 3 years and older can successfully complete visual acuity testing using either set of optotypes. 48 …”

“… 53 , 54 Isolated HOTV or LEA optotypes with crowding bars presented in printed format or by computer have been used successfully in large-scale studies of preschool children 5 , 28 , 44 – 46 and are considered best practice for measuring visual acuity in children aged 36 to younger than 72 months. A single line of optotypes with crowding bars on all four sides extended to form a crowding rectangle surrounding the line of optotypes 48 is also preferable to isolated optotypes without crowding bars; this type of presentation is considered acceptable practice.…”

A new computer-based pediatric vision-screening test

“…The VIP study group employed a similar approach using handheld Lea symbols or HOTV optotype cards, presenting 10/100 sized optotypes first, followed by 2 levels of smaller-sized symbols or letters at age-specific normal thresholds. 18,20 Using this approach, testability was high at 98.6% to 99.4%. 18,20 In a VIP study using the Lea symbol wheel, a 5/50 symbol was presented first, followed by 2 levels of smaller-sized symbols at age-specific normal thresholds 17 and testability was again high at 99.4%.…”

“…18,20 Using this approach, testability was high at 98.6% to 99.4%. 18,20 In a VIP study using the Lea symbol wheel, a 5/50 symbol was presented first, followed by 2 levels of smaller-sized symbols at age-specific normal thresholds 17 and testability was again high at 99.4%. 17 …”