Visual Acuity Norms in Pre-School Children: The Multi-Ethnic Pediatric Eye Disease Study

Abstract

Purpose To provide population-based normative data for monocular visual acuity (VA) and interocular differences in VA (IOD), in African-American and Hispanic children 30–72 months of age without visually significant refractive errors or ophthalmic abnormalities. Methods In a population-based cohort of children in the Multi-Ethnic Pediatric Eye Disease Study, monocular HOTV VA measurements using the Amblyopia Treatment Study protocol were analyzed using continuous and dichotomous outcomes for VA and IOD, after excluding subjects with ophthalmic abnormalities or refractive error. Results The analysis cohort consisted of 1722 African-American and Hispanic children aged 30 to 72 months. Mean logMAR VA improved with age (P<0.0001) and male gender (p=0.0008). The proportion of children achieving VA 20/40 or better was associated with age (p<0.0001), but not ethnicity or gender, and was 81%, 94%, 99% and virtually 100% in children aged 30–35, 36–47, 48–59, and 60–72 months of age, respectively. The most stringent VA threshold that excluded <5% of normal children was 20/63, 20/50, 20/32, and 20/32 for children aged 30–35, 36–47, 48–59, and 60–72 months, respectively. Children attending preschool or daycare achieved VA 20/32 more often than those not attending, after age adjustment (P=0.01), as did children from higher-income families (p=0.04). There was no association between mean absolute IOD and age (P=0.45), ethnicity (P=0.12), or gender (P=0.19). The proportion of children achieving an IOD of 0–1 lines was higher in males than females (P=0.02); it did not vary by age (P=0.06) or ethnicity (P=0.17). IOD of two or more lines occurred in 6% of normal children. Conclusions Visual acuity test performance in normal preschool children improves with age. We propose new age-specific thresholds for defining abnormal monocular VA using HOTV optotypes in children between 2 and 5 years of age, for use in screening, clinical practice and research.

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A new computer-based pediatric vision-screening test

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Optical Coherence Tomography in the Diagnosis of Optic Pathway Gliomas

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