Visual acuity testability and comparability in Australian preschool children: The Sydney Paediatric Eye Disease Study

Abstract

Purpose To establish standardised protocols for vision screening, testability and comparability of three different vision tests were examined in a population-based, cross-sectional sample of preschool children (Sydney Paediatric Eye Disease Study). Methods Measurement of presenting monocular distance visual acuity (VA) using the Amblyopia Treatment Study (ATS) HOTV protocol, was attempted by all (1774) children agedZ24 months. In addition, in children agedZ60 months (576), VA was also tested using the logMAR retro-illuminated HOTV or Early Treatment Diabetic Retinopathy Study (ETDRS) linear charts (CSV 1000). Children able to have both eyes tested monocularly were considered. Results Testability significantly increased with age for all VA tests. The ATS HOTV with an overall testability of 80% (females: 82%, males: 78%) was the most testable of the VA tests (Po0.0001). In children aged o3 years testability was low (r47%) rising toZ80% in children agedZ3. In childrenZ60 months, testability was higher for the HOTV (94%) than the ETDRS (59%) chart. In those that did two VA tests, mean difference of the ATS HOTV compared with the HOTV(CSV) was À 0.1, and compared with ETDRS was À 0.12 (Po0.0001). Conclusions Children aged o3 years had poor VA testability, whereas those 3 years and above were highly testable using the ATS HOTV. The HOTV (CSV) retroilluminated test was appropriate for children aged 45 years, and may be possible in younger children with early educational exposure. When comparing VA measures using these tests, the higher VA attained using the ATS HOTV, needs to be taken into account.

Normative visual acuity in infants and preschool‐aged children inSydney

“…The threshold ATS HOTV VA for right and left eyes were highly correlated (Pearson's correlation = 0.79, p ≤ 0.0001), thus right eye VA were used to report monocular normative VA. Testability of the ATS HOTV and ETDRS or HOTV logMAR charts for children ≤60 months have been previously reported (Leone et al. ).…”

“…Detail of the enumeration sampling have been previously reported (Leone et al. ). A total 2462 of these children (73.8% participation rate) were examined during 2007–9.…”

“…; Leone et al. ) but does not have established VA norms in populations other than African American and Hispanic children in the United States.…”

Prevalence of anisometropia and its association with refractive error and amblyopia in preschool children

“…This included monocular visual acuity (VA) with and without glasses in children aged ≥24 months using the Electronic Visual Acuity system7 (Jaeb Center for Health Research, Tampa, Florida, USA), following the Amblyopia Treatment Study protocol 8. For children aged ≥60 months, VA was also assessed using a LogMAR chart with either the Early Treatment of Diabetic Retinopathy Study (ETDRS) or HOTV optotypes with a matching card (VectorVision CSV-1000, VectorVision Inc, Dayton, Ohio, USA) 9. The presence of strabismus was ascertained by orthoptists using cover/uncover and alternating cover tests at near (33 cm) and distance (6 m) fixation, with and without glasses (if worn) using accommodative targets.…”

Cribado de alteraciones visuales (parte 1)

“…Entre los diversos optotipos basados en el sistema logMAR, los más estudiados para el cribado visual en la infancia son los optotipos HTOV, Lea y ETDRS, estos últimos diseñados para adultos y adecuados a partir de los ocho años. Todos los símbolos de los optotipos HTOV y Lea tienen simetría vertical interna ("V" o "H" frente a "B" o "E", cuya imagen en espejo es distinta), lo que facilita su reconocimiento y puede dar lugar a la obtención de mejores resultados 73 . Cuando se utiliza el sistema logMAR, la agudeza visual media a los 4-5 años está entre 0,08 y -0,075 12,74,75 .…”