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Farassat N, Jehle V, Heinrich SP, Lagrèze WA, Bach M. The Freiburg Acuity Test in Preschool Children: Testability, Test-Retest Variability, and Comparison With LEA Symbols. Transl Vis Sci Technol 2024; 13:14. [PMID: 38502142 PMCID: PMC10959192 DOI: 10.1167/tvst.13.3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose To determine the testability, performance, and test-retest variability (TRV) of visual acuity (VA) assessment using the Freiburg Visual Acuity Test (FrACT) compared to the LEA Symbols Test (LEA) in preschool children. Methods In 134 preschool children aged 3.0 to 6.8 years, monocular VA of each eye was measured twice with a four-orientation Landolt C version of the FrACT and once with the LEA. FrACT runs were preceded by a binocular run for explanatory purposes. Test order alternated between subjects. Optotypes were presented on a computer monitor (FrACT) or on cards (LEA) at a distance of 3 m. Results Overall, 68% completed the FrACT (91/134 children) and 88% completed the LEA (118/134 children). Testability depended on age: FrACT, 19% (<4 years) and 87% (≥4 years); LEA, 70% (<4 years) and 95% (≥4 years). Mean ± SD VA difference between tests was 0.11 ± 0.19 logarithm of the minimum angle of resolution [logMAR], with LEA reporting better acuity. The difference depended on age (0.27 ± 0.23 logMAR [<4 years], 0.09 ± 0.18 logMAR [≥4 years], P < 0.001) and on test sequence (higher age dependence of FrACT VAs for LEA first, P < 0.001). The 95% limits of agreement for the FrACT TRV were ±0.298 logMAR. Conclusions The examiner-independent FrACT, using international reference Landolt C optotypes, can be used to assess VA in preschool children aged ≥4 years, with reliability comparable to other pediatric VA tests. Translational Relevance Use of the automated FrACT for VA assessment in preschool children may benefit objectivity and validity as it is a computerized test and employs the international reference Landolt C optotype.
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Affiliation(s)
- Navid Farassat
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vanessa Jehle
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven P. Heinrich
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A. Lagrèze
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bach
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hussaindeen JR, Ramakrishnan B, Ravi A, SundarRaj M, Rakshit A, Nosofsky RM, Candy TR. Discrimination of paediatric acuity test optotypes by 6-year-old children. Ophthalmic Physiol Opt 2023; 43:964-971. [PMID: 37272135 PMCID: PMC10524911 DOI: 10.1111/opo.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare the discrimination performance of 6-year-old children for optotypes from six paediatric visual acuity tests and to fit Luce's Biased Choice Model to the data to estimate the relative similarities and bias for each optotype. METHODS Full data sets were collected from 20 typically developing 6-year-olds who had passed a vision screening. They were presented with single optotypes labelled 6/12 at a distance of 9 m and were asked to identify the optotype using a matching task containing all optotypes from the relevant test. The data were combined to form a confusion matrix for each test and a biased choice model was fitted to the data. RESULTS Median correct performance varied from 40% to 100% across optotypes, with the HOTV test having the highest values. Estimates of the similarity of each pair of optotypes indicated equal values for all pairs in the Landolt C, HOTV, Lea numbers and Tumbling E tests. The values differed for the picture tests, that is Lea Symbols and Allen figures. The estimates of bias for each individual optotype also indicated different values with the picture tests. CONCLUSIONS Previous studies of the threshold acuity of young children and adults have indicated differences in acuity estimates across paediatric tests. A recognition acuity task typically requires resolving the difference information between optotypes. The performance of the 6-year-olds here reveals variance in similarity and bias values for picture tests, particularly for the Allen figures when compared with the Lea Symbols. Ideally, this analysis should be performed when designing new tests, and these results motivate progression from the use of current picture tests to well calibrated letter or number tests at the earliest possible age.
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Affiliation(s)
- Jameel Rizwana Hussaindeen
- Elite School of Optometry, Units of Medical Research Foundation, Chennai, India
- Sankara Nethralaya, Units of Medical Research Foundation, Chennai, India
| | | | - Aishwarya Ravi
- Sankara Nethralaya, Units of Medical Research Foundation, Chennai, India
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Monisha SundarRaj
- Sankara Nethralaya, Units of Medical Research Foundation, Chennai, India
| | - Archayeeta Rakshit
- Elite School of Optometry, Units of Medical Research Foundation, Chennai, India
- Sankara Nethralaya, Units of Medical Research Foundation, Chennai, India
| | - Robert M Nosofsky
- Psychological & Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - T Rowan Candy
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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Anstice NS, Thompson B. The measurement of visual acuity in children: an evidence‐based update. Clin Exp Optom 2021; 97:3-11. [DOI: 10.1111/cxo.12086] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/02/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicola S Anstice
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,
| | - Benjamin Thompson
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,
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Margines JB, Huang C, Young A, Mehravaran S, Yu F, Mondino BJ, Coleman AL. Refractive Errors and Amblyopia Among Children Screened by the UCLA Preschool Vision Program in Los Angeles County. Am J Ophthalmol 2020; 210:78-85. [PMID: 31647932 DOI: 10.1016/j.ajo.2019.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To summarize the results of 5 years of vision screening with the University of California, Los Angeles (UCLA) Preschool Vision Program (UPVP). DESIGN Retrospective evaluation of a screening program. METHODS The UPVP performed visual acuity and undilated noncycloplegic refractive screening using an autorefractor on 93,097 children between 2012 and 2017. Of these, 79,451 children, who were between 3 and 5 years old, were screened for the first time, and 14,259 were referred for full cycloplegic examination if they met specific refractive criteria for myopia, hyperopia, astigmatism, or anisometropia. UPVP performed 6779 cycloplegic examinations on this population. Data from the right eye only were included in this analysis. RESULTS Of the examined population, hyperopia was found in 61% (4018), myopia in 20% (1336), and astigmatism in 93% (6122) of children. Latino children had higher rates of astigmatism and worse visual acuity compared to all other races/ethnicities. An astigmatism cutoff of ≥1.50 diopters (D) in either eye correctly predicted the need for glasses 93% of the time; increasing this cutoff to ≥1.50 D in both eyes increased the positive predictive value to 96%. Refractive amblyopia was found in 780 children (1.0% of the screened population and 11.5% of the examined population), and of these, 211 (27%) were bilaterally amblyopic. CONCLUSIONS These data represent the largest published sample of vision screening results on preschool-aged children, provide additional insight on the proportion of common refractive errors and their association with race/ethnicity, and can inform screening criteria to more accurately identify children who need intervention to prevent permanent vision loss.
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Functional and anatomical outcomes following surgical management of persistent fetal vasculature: a single-center experience of 44 cases. Graefes Arch Clin Exp Ophthalmol 2018; 256:495-501. [DOI: 10.1007/s00417-017-3886-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/17/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022] Open
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Inal A, Ocak OB, Aygit ED, Yilmaz I, Inal B, Taskapili M, Gokyigit B. Comparison of visual acuity measurements via three different methods in preschool children: Lea symbols, crowded Lea symbols, Snellen E chart. Int Ophthalmol 2017. [PMID: 28639088 DOI: 10.1007/s10792-017-0596-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to compare three different methods to measure visual acuity (VA) in healthy and amblyopic preschool children: a Snellen E chart (SE), a single Lea symbols (SLS), and a crowded Lea symbols (CLS). METHODS Seventy-eight eyes of 54 patients (28 females, 26 males) were included in this cross-sectional, comparative study. The control group consisted of 30 healthy cases, and the amblyopic group consisted of 24 patients with amblyopia. Best-corrected VA (BCVA) measurements with SLS, CLS, and SE were compared in control eyes (CE), amblyopic eyes (AE), and fellow eyes (FE) separately. RESULTS The mean age of the cohort was 5.7 ± 0.7 years (range 5-7 years). The mean refractive error was +1.02 ± 0.36 D (diopter, spherical equivalent) in CE, +5.59 ± 2.45 D in AE, and +3.96 ± 2.38 D in FE. The median BCVA (logMAR) was (in order of SLS, CLS, and SE) 0.00 [interquartile range (IQR) 0.10], 0.10 (IQR 0.10), 0.00 (IQR 0.10) in CE, 0.25 (IQR 0.33), 0.35 (IQR 0.30), 0.25 (IQR 0.38) in AE, and 0.10 (IQR 0.08), 0.10 (IQR 0.00), 0.10 (IQR 0.10) in FE. There was no statistically significant difference between the three methods in terms of the CE or FE (p > 0.05). In contrast, there was a statistically significant difference in AE (p < 0.05). The mean VA measurement with SLS was higher compared with CLS in AE. A positive and strong correlation between the three charts was found in all of the groups (p < 0.001). CONCLUSION We found SLS, CLS, and SE to be consistent: all three methods can be used to obtain measurements of VA in healthy and amblyopic preschool children.
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Affiliation(s)
- Asli Inal
- University of Health Sciences Prof. Dr. N. Reşat Belger Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.
| | - Osman Bulut Ocak
- University of Health Sciences Prof. Dr. N. Reşat Belger Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Ebru Demet Aygit
- University of Health Sciences Prof. Dr. N. Reşat Belger Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Ihsan Yilmaz
- University of Health Sciences Prof. Dr. N. Reşat Belger Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Berkay Inal
- University of Health Sciences Okmeydanı Research and Training Hospital, Istanbul, Turkey
| | - Muhittin Taskapili
- University of Health Sciences Prof. Dr. N. Reşat Belger Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Birsen Gokyigit
- University of Health Sciences Prof. Dr. N. Reşat Belger Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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Bušić M, Bjeloš M, Petrovečki M, Kuzmanović Elabjer B, Bosnar D, Ramić S, Miletić D, Andrijašević L, Kondža Krstonijević E, Jakovljević V, Bišćan Tvrdi A, Predović J, Kokot A, Bišćan F, Kovačević Ljubić M, Motušić Aras R. Zagreb Amblyopia Preschool Screening Study: near and distance visual acuity testing increase the diagnostic accuracy of screening for amblyopia. Croat Med J 2016; 57:29-41. [PMID: 26935612 PMCID: PMC4800325 DOI: 10.3325/cmj.2016.57.29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To present and evaluate a new screening protocol for amblyopia in preschool children. METHODS Zagreb Amblyopia Preschool Screening (ZAPS) study protocol performed screening for amblyopia by near and distance visual acuity (VA) testing of 15 648 children aged 48-54 months attending kindergartens in the City of Zagreb County between September 2011 and June 2014 using Lea Symbols in lines test. If VA in either eye was >0.1 logMAR, the child was re-tested, if failed at re-test, the child was referred to comprehensive eye examination at the Eye Clinic. RESULTS 78.04% of children passed the screening test. Estimated prevalence of amblyopia was 8.08%. Testability, sensitivity, and specificity of the ZAPS study protocol were 99.19%, 100.00%, and 96.68% respectively. CONCLUSION The ZAPS study used the most discriminative VA test with optotypes in line as they do not underestimate amblyopia. The estimated prevalence of amblyopia was considerably higher than reported elsewhere. To the best of our knowledge, the ZAPS study protocol reached the highest sensitivity and specificity when evaluating diagnostic accuracy of VA tests for screening. The pass level defined at ≤0.1 logMAR for 4-year-old children, using Lea Symbols in lines missed no amblyopia cases, advocating that both near and distance VA testing should be performed when screening for amblyopia.
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Affiliation(s)
| | - Mirjana Bjeloš
- Mirjana Bjeloš, University Eye Clinic, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia,
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Karacorlu M, Hocaoglu M, Sayman Muslubas I, Arf S. Long-term functional results following vitrectomy for advanced retinopathy of prematurity. Br J Ophthalmol 2016; 101:730-734. [DOI: 10.1136/bjophthalmol-2016-309198] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/13/2016] [Accepted: 08/24/2016] [Indexed: 11/03/2022]
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Cotter SA, Cyert LA, Miller JM, Quinn GE. Vision screening for children 36 to <72 months: recommended practices. Optom Vis Sci 2015; 92:6-16. [PMID: 25562476 PMCID: PMC4274336 DOI: 10.1097/opx.0000000000000429] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 06/10/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described. RESULTS There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction. CONCLUSIONS The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be maintained at http://nationalcenter.preventblindness.org.
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Affiliation(s)
- Susan A Cotter
- *OD, MS, FAAO †PhD, OD, FAAO ‡MD, MPH §MD, MSCE Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California (SAC); Northeastern State University Oklahoma College of Optometry, Tahlequah, Oklahoma (LAC); University of Arizona College of Medicine, Tucson, Arizona (JMM); and Department of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ)
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Candy TR, Mishoulam SR, Nosofsky RM, Dobson V. Adult discrimination performance for pediatric acuity test optotypes. Invest Ophthalmol Vis Sci 2011; 52:4307-13. [PMID: 21436270 DOI: 10.1167/iovs.10-6391] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare adult discrimination performance on nine pediatric visual acuity tests to determine the consistency of optotype design. METHODS After their binocular acuity was measured with each test, eight adult observers (mean age, 27 years ± 6.3 SD; three emmetropes and five corrected myopes) were shown isolated single optotypes from the Allen figures, HOTV, Landolt C, Lea Numbers, Lea Symbols, Lighthouse, Patti Pics, Precision Vision numbers, and Tumbling E tests. A one-interval, two-alternative forced-choice protocol was used at a single distance, and each optotype was paired with all optotypes from the same chart. Confusion matrices were generated for each test and Luce's (1963) biased-choice model was fit to each matrix to derive measures of pairwise similarity between the optotypes. RESULTS The acuities from the Allen figures (P < 0.001) and HOTV (P = 0.029) were the only ones to differ significantly from the reference Landolt C. The choice-model analyses of the confusion matrices revealed that the Allen figures, HOTV, Lighthouse, Patti Pics, and Precision Vision numbers tests all had significant differences in discriminability of optotypes within the test. CONCLUSIONS Pediatric acuity test optotypes are not all equally discriminable to adult observers with normal vision and no ocular disorders. The current data suggest that care must be taken when presenting limited numbers of optotypes, as is done with young patients.
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Affiliation(s)
- T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana ., USA
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Khandekar R, Parast N, Arabi A. Evaluation of 'vision screening' program for three to six-year-old children in the Republic of Iran. Indian J Ophthalmol 2010; 57:437-42. [PMID: 19861745 PMCID: PMC2812762 DOI: 10.4103/0301-4738.57151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Since 1996, vision screening of three to six-year-old children is conducted every year in Iran. We present outcomes of project review held in August 2006. Materials and Methods: Kindergarten teachers examined vision by using Snellen's illiterate ‘E’ chart. They used torchlight to detect strabismus. On a repeat test, if either eye had vision <20/30, the child was referred to the optometrist. A pediatric ophthalmologist examined and managed children with strabismus or amblyopia. Provincial managers supervised the screening program. The evaluator team assessed the coverage, yield, quality and feasibility, and cost-effectiveness of vision screening, as well as magnitude of amblyopia, and its risk factors. Result: In 2005, 1.4 million (67%) children were examined in all provinces of Iran. Opticians examined 90,319 (61%) children with defective vision that were referred to them. The prevalence of uncorrected refractive error, strabismus and amblyopia was 3.82% (95% CI 3.79 – 3.85), 0.39% (95% CI 0.38 – 0.40) and 1.25% (95% CI 1.24 – 1.26) respectively. Validity test of 7,768 children had a sensitivity of 74.5% (95% CI 72.7 – 76.3) and specificity of 97.2% (95% CI 96.7 – 97.7). The cost of amblyopia screening was US $ 1.5 per child. While the cost of screening and treating one child with amblyopia was US $ 245. Conclusion: A review of the vision screening of children in Iran showed it with screening and useful exercise and had a yield of 1:21. The coverage of vision screening was low and the management of children with amblyopia, low vision and refractive error needed strengthening.
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Affiliation(s)
- Rajiv Khandekar
- Ophthalmologist and Epidemiologist, Low Vision Care expert, Advisor, Eye and Ear Health care, Ministry of Health, Oman.
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Clarke N, Shacks J, Kerr ARE, Bottrell CL, Poulsen MK, Yin L. Use of a Noncycloplegic Autorefractor to Perform Vision Screening in Preschools. J Sch Nurs 2008; 24:158-63. [PMID: 18557675 DOI: 10.1177/1059840544556677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early detection and treatment of vision disorders in children are important to avoid lifelong visual impairment; however, preschool vision-screening rates are low. Traditional methods of screening lack the precision of objective tests and are difficult to administer in preschoolers. This study adopted a method using school nurses to conduct vision screening in preschoolers with a portable autorefractor. In addition, the effectiveness of the school nurse in conducting follow-up was evaluated. In a sample of 600 children, more than 98% completed the screening, and 7% were referred for follow-up evaluation. Seventeen percent of parents had plans to follow-up after receiving a brochure indicating that their child would benefit from a comprehensive eye exam. However, after a conversation with the school nurse, 86% had plans to schedule an evaluation with an eye care professional. Of the 15 students with known follow-up, 10 received glasses. The described method is effective in identifying young children with potential vision problems and facilitating their correction after contact made by the school nurse.
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Affiliation(s)
- Noreen Clarke
- Noreen Clarke, RN, MSN, is the project director of Child Health-Works, Childrens Hospital Los Angeles, Los Angeles, CA
| | - Janice Shacks
- Janice Shacks, RN, BSN, is a nurse liaison at Infant Preschool Support Services, Los Angeles Unified School District, Los Angeles, CA
| | - Amanda R. E. Kerr
- Amanda R. E. Kerr, MA, is a project coordinator at Child Health-Works, Childrens Hospital Los Angeles, Los Angeles, CA
| | - Christine L. Bottrell
- Christine L. Bottrell, BA, is a consultant at Child Health-Works, Childrens Hospital Los Angeles, Los Angeles, CA
| | - Marie Kanne Poulsen
- Marie Kanne Poulsen, PhD, is a professor of pediatrics at Childrens Hospital Los Angeles, Los Angeles, CA
| | - Larry Yin
- Larry Yin, MD, MSPH, is an assistant professor of pediatrics, Childrens Hospital Los Angeles, Los Angeles, CA
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