ABSTRACT
Preschool age(3-6 years old)is a critical period for visual development, and it is crucial to detect and treat visual problems in preschool children as early as possible. Visual acuity charts are important tools for screening visual issues in children. In China, the commonly used charts are the standard logarithmic visual acuity chart and the pediatric optotype chart, while overseas, the Lea, HOTV, and ETDRS visual acuity charts are frequently employed. Numerous studies have reported the measurability, repeatability, and sensitivity of these three charts in diagnosing visual-related problems in children. However, the application of these three charts is relatively limited in China. This article provides a comprehensive review of the design principles, clinical applications, and characteristics of these three visual acuity charts, so as to better understand their applicability and limitations in preschool children, and provide reference for the selection and improvement of vision examination methods in the future.
ABSTRACT
Objective@#To compare cooperation degree and visual acuity difference between Lea Symbols chart and ETDRS chart in Chinese preschool children.@*Methods@#A prospective self-control study design was performed.Two hundred and forty-one children aged from 42 months to 78 months in Quanzhou Quangang Experimental Kindergarten were enrolled and the mean age was (61.9±10.3) months.Among them, 132 pre-school children had normal refractive index.All children completed comprehensive ophthalmological examinations and measurement of monocular visual acuity using Lea Symbols chart and ETDRS chart.All monocular visual acuity scores were recorded in LogMAR form.This study followed the Declaration of Helsinki and this study protocol was approved by Medical Ethics Committee of The Second Affiliated Hospital of Fujian Medical University (No.2017[62]). Written informed consent was obtained from all guardians before entering the study.@*Results@#The cooperation degrees of Lea Symbols chart and ETDRS chart were 96.7% and 95.0% in 42-78 months of children, respectively, with no significant difference between the two visual acuity tables (χ2=1.669, P>0.05). The visual acuity measured by Lea Symbols chart was positively correlated with that measured by ETDRS chart (rs=0.726, P<0.001). The measurement consistency of the two chart was good (Kappa=0.531). Among 132 normal refractive children, the visual acuity level measured by Lea Symbols chart was higher than that measured by ETDRS chart (W=-7.461, P<0.001); the measurement consistency of the two visual acuity chart was good (Kappa=0.467). There was no significant difference between the two charts in measuring the binocular vision difference (W=-0.889, P=0.374); the visual acuity levels of boys measured by Lea Symbols chart and ETDRS chart were higher than those of girls, and the difference was statistically significant (U=-3.352, -4.679; both at P<0.001); the visual acuity values measured by Lea Symbols chart and ETDRS chart were negatively correlated with age (rs=-0.423, -0.437; both at P<0.001); the visual acuity measured by Lea Symbols chart was higher than that measured by ETDRS chart in different age groups, and the differences were statistically significant (all at P<0.001).@*Conclusions@#The measurement of visual acuity by Lea Symbols chart and ETDRS chart can be achieved with a high cooperation degree in 42 months and older children.The visual acuity measured by Lea Symbols chart is higher than that measured by ETDRS chart.In the preschool children's vision screening, we should pay attention to the difference between the two kinds of visual charts, and be careful to judge the abnormal vision.
ABSTRACT
Objective To compare cooperation degree and visual acuity difference between Lea Symbols chart and ETDRS chart in Chinese preschool children. Methods A prospective self-control study design was performed. Two hundred and forty-one children aged from 42 months to 78 months in Quanzhou Quangang Experimental Kindergarten were enrolled and the mean age was (61. 9±10. 3) months. Among them,132 pre-school children had normal refractive index. All children completed comprehensive ophthalmological examinations and measurement of monocular visual acuity using Lea Symbols chart and ETDRS chart. All monocular visual acuity scores were recorded in LogMAR form. This study followed the Declaration of Helsinki and this study protocol was approved by Medical Ethics Committee of The Second Affiliated Hospital of Fujian Medical University ( No. 2017 [ 62 ] ) . Written informed consent was obtained from all guardians before entering the study. Results The cooperation degrees of Lea Symbols chart and ETDRS chart were 96. 7％ and 95. 0％ in 42-78 months of children,respectively, with no significant difference between the two visual acuity tables (χ2=1. 669,P>0. 05). The visual acuity measured by Lea Symbols chart was positively correlated with that measured by ETDRS chart (rs=0. 726,P<0. 001). The measurement consistency of the two chart was good ( Kappa=0. 531 ) . Among 132 normal refractive children, the visual acuity level measured by Lea Symbols chart was higher than that measured by ETDRS chart (W=-7. 461,P<0. 001);the measurement consistency of the two visual acuity chart was good (Kappa=0. 467). There was no significant difference between the two charts in measuring the binocular vision difference (W=-0. 889,P=0. 374);the visual acuity levels of boys measured by Lea Symbols chart and ETDRS chart were higher than those of girls,and the difference was statistically significant (U=-3. 352,-4. 679;both at P<0. 001);the visual acuity values measured by Lea Symbols chart and ETDRS chart were negatively correlated with age ( rs =-0. 423,-0. 437;both at P<0. 001 );the visual acuity measured by Lea Symbols chart was higher than that measured by ETDRS chart in different age groups,and the differences were statistically significant (all at P<0. 001). Conclusions The measurement of visual acuity by Lea Symbols chart and ETDRS chart can be achieved with a high cooperation degree in 42 months and older children. The visual acuity measured by Lea Symbols chart is higher than that measured by ETDRS chart. In the preschool children's vision screening,we should pay attention to the difference between the two kinds of visual charts, and be careful to judge the abnormal vision.
ABSTRACT
The preschool age is an important stage for the development of children's vision.Visual problems can affect visual development of children,so it is necessary for preschool children to have vision examination.As an important method of preschool vision screening,visual acuity charts can be used for early screening of eye diseases in children.The benefits of screening before school entry have been demonstrated in practice.There are many kinds of visual acuity charts that can be used to test the vision acuity of preschool children aged 3 to 6 years.This review introduced the design of visual acuity charts and lists several types of charts for screening of preschool children.Simultaneously,we have analyzed a number of papers that compared preschool vision screening methods.The vision examination on children aged 3 to 6 years was necessary to discover various visual impairments.Choosing an appropriate visual acuity chart is the focus of low vision rehabilitation research.
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AlM:To evaluate the applicability and the development of the normal visual acuity from age 3 to 3. 5 years using Lea Symbols and HOTV charts. METHODS:lt was a survey research study. Totally, 133 preschoolers ( 266 eyes ) between 3 to 4. 5 years old recruited from two kid-gardens in Guangzhou were tested with both the Lea Symbols chart and the HOTV chart. Outcome measures were monocular logarithm of the minimum angle of resolution ( logMAR) visual acuity and inter-eye acuity difference in logMAR units for each test. RESULTS: The testability rates of the two charts were high (96. 24% vs 92. 48%, respectively), but difference was not statistically significant (P>0. 05). The difference between the two kind of monocular vision was not statistically significant (the right eye: t=0. 517, P=0. 606;the left eye: t = - 0. 618, P = 0. 538 ). There was no significant difference between different eye ( Lea Symbols chart:t=0. 638, P=0. 525; HOTV chart: t= -0. 897, P=0. 372). The visual acuities of the boys were better than those of the girls, but the difference was not statistically significant (P>0. 05). The results which came from visual acuities with the two charts for the corresponding age groups (3-year-old group, 3. 5-year-old group, 4-year-old group, 4. 5-year-old group) indicated that the visual acuities of the preschoolers were improving with increasing age, but the difference among the visual acuities with the Lea Symbols chart was not statistically significant (the right eye:F=2. 662, P=0. 052;the left eye:F=1. 850, P=0. 143). However the difference among the visual acuities with the HOTV chart was statistically significant (the right eye:F=4. 518, P=0. 005;the left eye:F=3. 893, P=0. 011). CONCLUSlON: Both Lea Symbols and HOTV chars are accepted and appropriate for preschool vision screening from 3 to 4. 5 years old. The monocular visual acuity of preschoolers from age 3 to 4. 5 years could be assessed was similar using the two charts. There is no correlation between visual acuity and different eye. There is no statistical difference between the genders. The results further demonstrate that the preschoolers whose age reached three years old have the ability to accept the Subjective vision checks. Also the development of the normal visual acuity is faster in the early stage.