Age norms for grating acuity and contrast sensitivity in children using eye tracking technology.

KEY MESSAGES: Visual acuity is the most used method to assess visual function in children. Contrast sensitivity complements the information provided for visual acuity, but it is not commonly used in clinical practice. Digital devices are increasingly used as a method to evaluate visual function, due to multiple advantages. Testing with these devices can improve the evaluation of visual development in children from a few months of age. Visual acuity and contrast sensitivity tests, using eye tracking technology, are able to measure visual function in children across a wide range of ages, objectively, quickly and without need of an experienced examiner. PURPOSE: To report age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking technology and to validate the grating acuity test. METHODS: In the first project of the study, we examined healthy children aged between 6 months and 7 years with normal ophthalmological assessment. Grating visual acuity (VA) and contrast sensitivity (CS) were assessed using a preferential gaze paradigm with a DIVE (Device for an Integral Visual Examination) assisted with eye tracking technology to provide age norms. For the validation project, we compared LEA grating test (LGT) with DIVE VA in a group of children aged between 6 months and 4 years with normal and abnormal visual development. RESULTS: Fifty-seven children (2.86 ± 1.55 years) were examined with DIVE VA test and 44 successfully completed DIVE CS test (3.06 ± 1.41 years). Both, VA and CS values increased with age, mainly along the first two years of life. Sixty-nine patients (1.34 ± 0.61 years) were included in the DIVE VA test validation. The mean difference between LGT and DIVE VA was - 1.05 ± 4.54 cpd with 95% limits of agreement (LoA) of - 9.95-7.84 cpd. Agreement between the two tests was higher in children younger than 1 year with a mean difference of - 0.19 ± 4.02 cpd. CONCLUSIONS: DIVE is an automatic, objective and reliable tool to assess several visual function parameters in children, and it has good agreement with classical VA tests, especially for the first stage of life.

Revisión de los principales test clínicos para evaluar la visión del color / Review of the main colour vision clinical assessment tests

Introducción: Las deficiencias congénitas en la visión del color afectan a un 8% de la población masculina y a un 0,5% de la femenina. El estudio de la visión del color es un proceso complejo debido a diversos factores: la propia psicofísica de la visión y la dificultad de establecer modelos matemáticos para su análisis, la vaga correlación de los resultados entre unos test y otros y la influencia de factores externos como la iluminación, la condición de los test o la experiencia del examinador y del paciente. En el presente documento se realiza una revisión simplificada de los principales test disponibles en la práctica clínica para evaluar la visión del color. Material y métodos: Tras realizar una filtrada revisión preliminar de la bibliografía relacionada con el estudio de la visión del color en el motor de búsqueda PubMed, se determinaron los test mayormente utilizados en la práctica clínica. Se realizó una interpretación atendiendo a su frecuencia de uso y el propósito para el que eran utilizados. A continuación, se procedió con un estudio bibliográfico de cada test en particular, atendiendo al diseño de los estímulos presentados, su población diana y su sensibilidad y especificidad. Resultados De las 95 publicaciones que mostró el buscador PubMed, en 41 de ellas los investigadores utilizaron test de colores en su metodología. De los 64 test de color utilizados, 19 eran diferentes (contando como distintos los test adaptados por grupos de investigación, 4, y aquellos realizados online, 2). El orden de empleo de los test es el siguiente: test de Ishihara (10,88%), Farnsworth-Munsell (7,04%), Farnsworth-Munsell 100 Hue (6,4%), Cambridge Colour Test (3,84%), Hardy-Rand-Rittler (3,2%), test propios desarrollados por los grupos (2,56%), el anomaloscopio (1,28%), los test online (1,28%) y, finalmente, Colour Assessment and Diagnosis (0,64%), Pflüger Trident Colour Plates (0,64%), Toothguide Training Box (0,64%), Lanthony Desaturated D-15 (0,64%), City University Test (0,64%), Universal Colour Discrimination Test (0,64%) y Rabin Cone Contrast Test (0,64%). Conclusiones El gold standard en cuanto a la evaluación de la visión del color es el anomaloscopio, instrumento incompatible con la práctica clínica diaria. Su manejo es relativamente complicado, exige disponibilidad de tiempo para su aplicación y es difícilmente comprensible por población infantil. Sin embargo, es posible alcanzar una fiel aproximación mediante la combinación de algunos de los test enumerados en este artículo. Los test expuestos son una buena alternativa para determinar la presencia de discromatopsias en ambientes cercanos a la práctica clínica diaria o en entornos menos controlados que un estudio clínico. El inconveniente principal del amplio elenco de test disponibles para el estudio de la visión del color es la dificultad para comparar los resultados entre test, ya que los datos publicados suelen tener unidades distintas, requiriendo experiencia para su correcta interpretación. En la actualidad, no existe unanimidad sobre qué test de color resulta ser el más completo; es recomendable utilizar al menos 2 para asegurar los diagnósticos y tener una información más completa sobre la percepción visual de los pacientes

Introduction: Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. Material and methods: Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. Results: From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth-Munsell (7.04%), Farnsworth-Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy-Rand-Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pflüger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). Conclusions: The Anomaloscope is the "gold standard" in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients

Review of the main colour vision clinical assessment tests. / Revisión de los principales test clínicos para evaluar la visión del color.

INTRODUCTION: Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. MATERIAL AND METHODS: Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. RESULTS: From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth-Munsell (7.04%), Farnsworth-Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy-Rand-Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pflüger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). CONCLUSIONS: The Anomaloscope is the "gold standard" in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients.