Research progress on commonly used visual acuity charts for preschool children / 国际眼科杂志(Guoji Yanke Zazhi)

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.

Visual Acuity as a Measurement of Visual Function.

Visual acuity (VA) is a traditional measure of central visual function, particularly the ability of the eye to perceive details. In a clinical setting, standardized charts are commonly used to quickly assess VA. Namely, the Early Treatment of Diabetic Retinopathy Study (ETDRS) VA test chart is the gold standard for VA testing in the clinical setting. This chapter outlines the standard procedures associated with measuring VA.

Visual outcomes after surgery for childhood cataracts.

PURPOSE: To describe long-term objective and subjective visual outcomes in a group of Danish children after cataract surgery. METHODS: Follow-up examination of 56 children aged 7-18 years who had undergone uni- or bilateral cataract surgery. Subjective visual function was assessed using the Cardiff Visual Ability Questionnaire for Children (CVAQC) and compared to objective visual acuity for distance and near, contrast vision and stereopsis. RESULTS: Better visual acuity on the better seeing and contrast vision on worst seeing eye were significant predictors of increased subjective visual function in a multivariate analysis, p = 0.024. Children in the unilateral group had a significantly better CVAQC ratio compared to children in the bilateral group, median of 0.88 (range 0.50-1.00) versus 0.80 (range 0.55-0.98), p = 0.027. Reading small print, playing ball games and seeing friends in the playground were the most difficult CVAQC items in the unilateral group and reading small print, seeing the board in the classroom and seeing friends in the playground were the most difficult in the bilateral group. CONCLUSION: Children with unilateral disease often have a healthy eye to support the operated eye, why they overall have better subjective visual function. Many of the most difficult visual tasks were related to academic activities which might hamper future academical capabilities.

Vision and eye health: moving into the digital age with instrument-based vision screening.

Significant advancements in vision screening research are leading to improved design, functionality, and reliability of screening tools. Presently, two vision screening approaches are available to school nurses for children ages 3 years and older: optotype-based screening and instrument-based screening. Optotype-based screening pertains to tests of visual acuity using optotypes (e.g., pictures, letters, and numbers), which children identify to determine visual acuity. Instrument-based screening pertains to automated devices that measure amblyogenic risk factors, such as refractive error, media opacities, and eye misalignment. Differences between the two approaches; best and acceptable practice recommendations for both approaches; unacceptable tests of visual acuity; and best, acceptable, and unacceptable occluders are described.

Normative visual acuity in infants and preschool-aged children in Sydney.

PURPOSE: To provide population-based normative visual acuity (VA) by age, in children participating in the Sydney Paediatric Eye Disease Study aged 6 to <72 months. METHODS: Monocular VA was measured using the Amblyopia Treatment Study (ATS HOTV) protocol (24 to <72 months). Some children were also tested using linear ETDRS or HOTV logMAR VA charts (30 to <72 months). If unable to perform recognition acuity, the Teller Acuity Cards II (TAC II) was performed (6 to <42 months). Children with significant refractive error or ocular disease were excluded. RESULTS: Improvement in VA with age was shown on all three vision tests (all p < 0.0001). Mean VA using ATS HOTV (n = 836) was 0.13 logMAR (6/8) at <36 months, which improved to -0.01 (6/6) at 66 to <72 months. Mean ETDRS/HOTV (n = 399) VA was 0.26 logMAR (6/11) at <36 months, which improved to 0.1 (6/7.5) at 66 to <72 months. Mean monocular TAC II (n = 442) was 5.7 cycles/degree (0.72 logMAR) at 6 to <9 months and improved to 12.4 cycles/degree (0.38 logMAR) at age 30 to <33 months. Associations with ATS HOTV VA included prematurity (p = 0.027) and socio economic status (SES) factors such as home ownership (p = 0.039) and employment of one (p = 0.019) or both parents (p = 0.003). CONCLUSIONS: VA norms in children improved with age and were different according to the VA test used. Low SES was associated with poorer VA, supporting the need for test specific VA norms to be established for different populations. The ATS HOTV appears to be the best test to use for vision screening due to its lower false positive referral rate.

Comparison of the Lea Symbols and HOTV charts for preschool vision screening from age 3 to 4 . 5 years old / 国际眼科杂志(Guoji Yanke Zazhi)

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.

Visual acuity testability of children in Bama and Banki towns of Borno State, Nigeria: The need to adopt HOTV protocol in school health programmes.

Despite the importance of visual acuity testing in children, no standard testing protocol was found for primary school pupils. Visual acuity screening was conducted on 400 primary school pupils in Nigeria using the HOTV protocol, nearly all the pupils 390/400 (97.5 %) had good binocular vision, only 10/400 (2.5 %) had poor vision which were monocular. Of those with poor monocular vision, 6/10 (60 %) involved the right eye while 4/10 (40 %) the left eye; these pupils were referred to the ophthalmologist for further evaluation. Because of its easy usage, the HOTV protocol can be adopted by school health programmes especially for the primary school pupils.

Pruebas para la evaluación de la agudeza visual en pacientes pediátricos / Tests for the visual acuity assessment in pediatric patients

La medición de la agudeza visual en niños representa un importante reto para el optómetra por ser laboriosa y requerir conocimiento y paciencia. Según el estímulo, la agudeza visual puede dividirse en tres tipos: de detección, de resolución y de reconocimiento. Los valores de estas pueden ser diferentes y se alteran en diferente proporción en presencia de problemas visuales. El presente artículo hace una revisión de los tests de agudeza visual para niños, sobre los que se han realizado gran número de investigaciones en los últimos años: Teller, Cardiff, Lea, HOTV y las cartillas logMAR que podrían emplearse en el grupo de escolares.Conclusiones: las pruebas contempladas en esta revisión no son necesariamente las más utilizadoas en nuestra práctica clínica cotidiana; sin embargo, la actividad investigativa en torno a éstas ha aportado a la construcción de protocolos diagnósticos. El referente para una mejor práctica clínica debe ser la optometría basada en la evidencia, ya que ésta permite a los profesionales disponer de nuevos elementos de juicio objetivos, con fundamento científico, que contribuyan a la elección de la mejor alternativa para determinar la agudeza visual en los niños. El optómetra debe seguir rigurosamente los protocolos de evaluación de la agudeza visual para dar a sus mediciones mayor confiabilidad y analizar los resultados obtenidos dentro del contexto de la historia clínica. Los métodos para la evaluación de la agudeza visual pueden adaptarse de acuerdo con las habilidades, el conocimiento y la experiencia del niño que va a examinarse. Con esta revisión se evidencia la importancia de realizar estudios sobre la aplicación de estos tests en nuestro medio con el fin de evaluar su confiabilidad y utilidad en nuestros pacientes.

The visual acuity measurement in children is an important Challenger for the optometrist, given de complexity of the task and to require knowledge and patience. According to the stimulus, the visual acuity can be divided in three types: detection, resolution and recognition. The values of these can be different and they are altered in different proportion in the presence of visual problems. The present article makes an overhaul of the test of the visual acuity for children which years have generated great number of investigations in the past years: Teller, Cardiff, Lea, HOTV and logMAR charts that could be used in the school age group.Conclusions: The tests reviewed are not necessarily used commonly used our clinical daily practice, nevertheless the investigative activity concerning these has reached in the construction of diagnostic protocols. The reference for a better clinical practice must be the optometry based on the evidence, since this one allows to the professionals to have new facts that contribute to the election of the best alternative to determine the visual acuity in the children. The optometrist a must follow rigorously the protocols of evaluation of the visual acuity to give to measurements major reliability and to analyze the results obtained inside the context of the history. The methods for the evaluation of the visual acuity can be adapted in agreement with the skills, knowledge and experience of the child being examinated. There is evident the importance of realizing studies on the application of these test in order to evaluate their reliability and utility in our patients

Visual Acuity Charts Comparison for Preschool Vision Screening

We assessed the best method for preschool vision screening using four visual acuity charts. The subjects were 162 childrens(324 eyes), who were divided into all aged group(162 childrens), 3-year-old group(58 childrens), 4-year-old group(58 childrens) and 5-year-old group(46 childrens), We compared Hahn's test, HOTV test, Allen figures and E test by measuring the time required for test, the percentage of children testable with each chart, visual acuity score and consistency of score. There was no significant differences among the time of each group(p>0.05). Visual acuity score with Hahn's test was lower than that of the rest 3 tests in all aged group and 3-year-old group(p<0.05). The percentage of children testable with Hahn's test was lower than that with the other tests(p<0.05). For assessing the consistency, analysis of variance was used. E test was more variable than the other test and Allen figures showed most consistency than the other tests(p<0.05). In young chidren, there were some difficulties in measuring visual acuity with Hahn's test, and the E test caused variable results because of difficulty in distinguishing the left-right orientation, but relatively Allen figures showed consistency, high visual acuity and testability in all groups.