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Abdelshafy Tabl A, Bendary M, Abdelshafy Tabl M. Accuracy of Mobile-Based Vision Chart in Clinical Practice during the COVID-19 pandemic. Ophthalmic Epidemiol 2024; 31:107-111. [PMID: 37114364 DOI: 10.1080/09286586.2023.2207202] [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: 03/27/2022] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE The accuracy of mobile-based visual acuity testing in clinical practice is debatable. This study aimed to analyze the accuracy of mobile-based distant vision chart in comparison to the standard chart projector. METHODS In this cross-sectional study, monocular distant best-corrected visual acuity (BCVA) in 571 eyes of 288 subjects was measured twice, using the Tumbling E vision chart by standard chart projector and repeated using mobile-based vision chart application with screen mirroring on a 22-inch monitor. The decimal results of BCVA were compared to analyze the accuracy of the mobile-based chart in comparison to the standard vision chart projector. RESULTS The mean age of the studied patients was 29 ± 14 years. The most frequent refractive error was hyperopia (35.4%), followed by emmetropia (26.7%), myopia (22.9%), and astigmatism (14.9%). The mean BCVA in decimal form was 0.9 ± 0.2 and 0.91 ± 0.26 by the standard and mobile-based charts, respectively. An excellent agreement was reported between both tests as the intraclass correlation coefficient (ICC) was 0.976, with a confidence interval (CI) of 0.965-0.982. Bland-Altman analysis revealed that most visual acuity differences between both methods lie on the equality line or within the allowed difference zone. CONCLUSIONS The mobile-based vision chart is an economical, accessible, and accurate way for distant vision assessment, and its results are comparable to the standard chart projector in clinical practice.
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Affiliation(s)
| | - Mohamed Bendary
- Department of Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
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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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Sapkota A, Sitaula S, Shrestha GS, Joshi ND, Koirala B, Paudel N. Agreement between Lea Symbols and Patti Pics visual acuity in children and adults. JOURNAL OF OPTOMETRY 2023:S1888-4296(23)00003-1. [PMID: 36717317 DOI: 10.1016/j.optom.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/25/2022] [Accepted: 01/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patti Pics (PP) and Lea Symbols (LS) are commonly used by eye care practitioners worldwide. Although the relationship between the two tests is fairly well understood, the availability of different chart designs (single optotypes, multiple optotypes, multiple optotypes with crowding box) merits futher understanding. The purpose of this study is to explore the agreement between the acuity measures obtained with Patti Pics and Lea Symbols in children and adults and compare their performance with the Sloan Letter (SL) chart in adults. METHODS Monocular visual acuity was obtained from ninety-three 3 to 5-year-old children using Patti Pics and Lea Symbols. Acuities were also obtained from 113 adults using the same tests under identical conditions. Acuity results obtained with the pediatric tests were compared with the gold-standard Sloan Letter chart in adults. The Bland-Altman method was implemented to compare the level of agreement between tests. RESULTS Patti Pics yielded worse visual acuity than the Lea Symbols by approximately half a logMAR line in both children (mean difference: -0.07 ± 0.07 logMAR, p <0.01) and adults (Mean difference: -0.05 ± 0.06 logMAR, p <0.01). The 95% limits of agreement between Lea Symbol acuity and Patti pics acuity in children was ± 0.14 logMAR. Mean difference between the Sloan Letter chart and Lea Symbols acuity was not statistically significant (p = 0.08) in adults but the difference was statistically significant between PP and SL (p<0.001). The 95% limits of agreement between LS and SL and between PP and SL was ± 0.19 logMAR and ± 0.22 logMAR, respectively. CONCLUSION Patti Pics consistently underestimated visual acuity as compared to Lea Symbols both in children and adults although the differences were not clinically significant. The LS and PP did not yield clinically significant differences in acuities when compared with Sloan letters in adults.
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Affiliation(s)
| | - Sanjeeta Sitaula
- Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal
| | - Gauri Shankar Shrestha
- Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal
| | - Niraj Dev Joshi
- Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal
| | | | - Nabin Paudel
- Center for Eye Research Ireland, Technological University Dublin, Ireland
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Crowding can impact both low and high contrast visual acuity measurements. Sci Rep 2022; 12:16338. [PMID: 36175530 PMCID: PMC9522725 DOI: 10.1038/s41598-022-20479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022] Open
Abstract
The adverse impact of adjacent contours on letter visual acuity is known as crowding but there is conflicting evidence that foveal crowding may be reduced or disappears under low contrast conditions. Potential differences in foveal crowding with contrast on clinical measurements of visual acuity, including test–retest repeatability, were assessed. Visual acuity was measured at the fovea on adult participants with normal vision under three different contrast levels (− 90, − 10 and − 5%). Three rows of 5 letters, each row differing in size by 0.05 logarithm of the minimum angle of resolution (logMAR) from largest to smallest were displayed at the center of a monitor. Crowding was varied by varying the separation between horizontally adjacent letters from 100% optotype size to 50%, 20% and 10% optotype size. Inter-row spacing was proportional to optotype size. Observers read the letters on the middle row only. Measurements continued by reducing the size of the letters until 3 or more errors were made and were repeated on two separate days. Visual acuity worsened as both letter contrast decreased and inter-optotype separation reduced (expressed as a percentage of letter width). When expressed in minutes of arc of separation the impact of crowding was the same across all contrasts. Crowding occurs for both high and low contrast charts and should be considered when assessing low contrast visual acuity. Test–retest repeatability showed little or no dependence on either contrast or inter-optotype separation.
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Cohen ADN, Mimouni M, El‐Yaniv R, Blumenthal EZ. Shortening the Early Treatment Diabetic Retinopathy Study visual acuity test utilizing a novel computer software: reproducibility in control and patient eyes. Acta Ophthalmol 2021; 99:e1281-e1288. [PMID: 33742567 DOI: 10.1111/aos.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe and compare a method of computerized visual acuity (VA) testing software to the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. METHODS Setting: Single tertiary institution. STUDY POPULATION Prospective study including right eyes of volunteers (N = 109) and patients (N = 126). INTERVENTION Subjects were tested in a random order twice with the ETDRS chart and twice with the VA software. For ETDRS, we calculated the final VA separately for each run, using four different test termination criteria (1-miss in a row, 2-miss in a row, 50% miss and per-letter). For software testing, we calculated final VA with a variety of number of letters presented. MAIN OUTCOME MEASURES The main outcome measures were reproducibility and number of letters required to exceed ETDRS reproducibility. RESULTS For ETDRS, the average number of letters presented was 55.1 ± 9, 54.3 ± 10, 53.1 ± 10 and 70 for the 1-miss, 2-miss, 50% termination and per-letter criterion. The test-retest variability (TRV) of ETDRS was 0.29, 0.42, 0.17 and 0.141 for the 1-miss in a row, 2-miss in a row, 50% and per-letter termination criteria. For the software VA test, TRV was 0.202, 0.138 and 0.112 after presenting 6, 11 and 20 letters. The reproducibility of the software was equal to the ETDRS at 11 letters and thereafter surpassed. Similar results were achieved in the patient group. CONCLUSIONS This study demonstrates that by utilizing a VA testing software, based on advanced threshold testing algorithms we were able to duplicate, and surpass, the reproducibility of the ETDRS chart while presenting much fewer letters.
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Affiliation(s)
- Amir D. N. Cohen
- Faculty of Computer Science Technion Israel Institute of Technology Haifa Israel
| | - Michael Mimouni
- Department of Ophthalmology Rambam Health Care Campus Haifa Israel
- School of Medicine Technion Israel Institute of Technology Haifa Israel
| | - Ran El‐Yaniv
- Faculty of Computer Science Technion Israel Institute of Technology Haifa Israel
| | - Eytan Z. Blumenthal
- Department of Ophthalmology Rambam Health Care Campus Haifa Israel
- School of Medicine Technion Israel Institute of Technology Haifa Israel
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Perche O, Lesne F, Patat A, Raab S, Twyman R, Ring RH, Briault S. Electroretinography and contrast sensitivity, complementary translational biomarkers of sensory deficits in the visual system of individuals with fragile X syndrome. J Neurodev Disord 2021; 13:45. [PMID: 34625026 PMCID: PMC8501595 DOI: 10.1186/s11689-021-09375-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disturbances in sensory function are an important clinical feature of neurodevelopmental disorders such as fragile X syndrome (FXS). Evidence also directly connects sensory abnormalities with the clinical expression of behavioral impairments in individuals with FXS; thus, positioning sensory function as a potential clinical target for the development of new therapeutics. Using electroretinography (ERG) and contrast sensitivity (CS), we previously reported the presence of sensory deficits in the visual system of the Fmr1-/y genetic mouse model of FXS. The goals of the current study were two-folds: (1) to assess the feasibility of measuring ERG and CS as a biomarker of sensory deficits in individuals with FXS, and (2) to investigate whether the deficits revealed by ERG and CS in Fmr1-/y mice translate to humans with FXS. METHODS Both ERG and CS were measured in a cohort of male individuals with FXS (n = 20, 18-45 years) and age-matched healthy controls (n = 20, 18-45 years). Under light-adapted conditions, and using both single flash and flicker (repeated train of flashes) stimulation protocols, retinal function was recorded from individual subjects using a portable, handheld, full-field flash ERG device (RETeval®, LKC Technologies Inc., Gaithersburg, MD, USA). CS was assessed in each subject using the LEA SYMBOLS® low-contrast test (Good-Lite, Elgin, IL, USA). RESULTS Data recording was successfully completed for ERG and assessment of CS in most individuals from both cohorts demonstrating the feasibility of these methods for use in the FXS population. Similar to previously reported findings from the Fmr1-/y genetic mouse model, individuals with FXS were found to exhibit reduced b-wave and flicker amplitude in ERG and an impaired ability to discriminate contrasts compared to healthy controls. CONCLUSIONS This study demonstrates the feasibility of using ERG and CS for assessing visual deficits in FXS and establishes the translational validity of the Fmr1-/y mice phenotype to individuals with FXS. By including electrophysiological and functional readouts, the results of this study suggest the utility of both ERG and CS (ERG-CS) as complementary translational biomarkers for characterizing sensory abnormalities found in FXS, with potential applications to the clinical development of novel therapeutics that target sensory function abnormalities to treat core symptomatology in FXS. TRIAL REGISTRATION ID-RCB number 2019-A01015-52 registered on the 17 May 2019.
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Affiliation(s)
- Olivier Perche
- Genetic Department, Centre Hospitalier Régional d'Orléans, Orléans, France
- UMR7355, Centre National de la Recherche Scientifique (CNRS), Orléans, France
- Experimental and Molecular Immunology and Neurogenetics, University of Orléans, Orléans, France
- Kaerus Bioscience Ltd., London, EC1Y 4YX, UK
| | | | - Alain Patat
- Kaerus Bioscience Ltd., London, EC1Y 4YX, UK
| | | | | | - Robert H Ring
- Kaerus Bioscience Ltd., London, EC1Y 4YX, UK
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sylvain Briault
- Genetic Department, Centre Hospitalier Régional d'Orléans, Orléans, France.
- UMR7355, Centre National de la Recherche Scientifique (CNRS), Orléans, France.
- Experimental and Molecular Immunology and Neurogenetics, University of Orléans, Orléans, France.
- Kaerus Bioscience Ltd., London, EC1Y 4YX, UK.
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Campo Dall'Orto G, Facchin A, Bellatorre A, Maffioletti S, Serio M. Measurement of visual acuity with a digital eye chart: optotypes, presentation modalities and repeatability. JOURNAL OF OPTOMETRY 2021; 14:133-141. [PMID: 33139229 PMCID: PMC8093539 DOI: 10.1016/j.optom.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Digital or computerised eye charts are becoming standard in the examination of visual acuity. Each instrument allows the selection of different optotypes, presentation modalities, and crowding. The aim of this study was to examine the differences in visual acuity (VA) measurement using a digital eye chart, comparing different optotypes and procedures, together with an evaluation of the repeatability of the measurement. METHODS Two groups of 52 participants aged between 18 and 31 years participated in the study. In the first experiment, VA thresholds were measured using LEA Symbols, Tumbling E, and Landolt Rings in monocular and binocular conditions using single line presentation and QUEST presentation. In the second experiment, we have compared all modalities of presentation together with a paper eye-chart and test the repeatability. RESULTS The results showed that thresholds for LEA Symbols are low. The modality of presentation affects these thresholds. For Landolt Rings and Tumbling E, the QUEST procedure gave significantly better thresholds than line presentation, while this difference was absent for LEA Symbols. In comparing all modalities of presentation, single letter and line presentation showed similar values, slightly better than block presentation. Paper eye-charts showed better values of VA. Repeatability and agreement were good for all presentations, but best for QUEST. CONCLUSIONS The QUEST modality of presentation provides a better threshold than line presentation except for LEA Symbols. Examiners using digital eye charts must take into account that not all modalities of presentation and optotypes are equivalent and give different VA thresholds. Specific thresholds need to be used for each optotype and presentation modality.
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Affiliation(s)
| | - Alessio Facchin
- Department of Psychology, University of Milano Bicocca, Milano, Italy; Optics and Optometry Research Center, University of Milano Bicocca, Milano, Italy; Institute of Research and Studies in Optics and Optometry, Vinci, Italy.
| | | | - Silvio Maffioletti
- Degree Course of Optics and Optometry, University of Torino, Italy; Institute of Research and Studies in Optics and Optometry, Vinci, Italy
| | - Marina Serio
- Degree Course of Optics and Optometry, University of Torino, Italy; Department of Physics, University of Torino, Italy
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Pluháček F, Musilová L, Bedell HE, Siderov J. Number of flankers influences foveal crowding and contour interaction differently. Vision Res 2020; 179:9-18. [PMID: 33271404 DOI: 10.1016/j.visres.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022]
Abstract
Nearby flanking objects degrade visual resolution. If the flankers are similar to the acuity target, this influence is called crowding (CW), whereas if the flanking stimuli are simple bars then the phenomenon is known as contour interaction (CI). The aim of this study was to compare the influence of the number and position of flankers on foveal CW and CI to investigate possible differences in mechanism of these two effects. Five normal observers viewed single, foveally presented Sloan letters surrounded by 1, 2 or 4 flankers (either a Sloan letter or one-stroke-width bars), presented at several edge-to-edge separations. Single flankers were presented in the right, left, top or bottom position, 2 flankers were placed equally to the right and left or top and bottom of the central target, and 4 flankers were equally spaced in all four directions. Percent correct letter identification was determined for each type, number, position and separation of flankers and confusion matrices were constructed for separations equal to 20% and 100% letter width. Increasing the number of flankers caused an increase in the magnitude of both phenomena. CW showed a greater magnitude than CI for higher numbers of flankers. Analysis of confusion matrices suggests that in addition to the edge-to-edge interaction that appears to mediate CI, letter substitution and feature pooling contribute significantly to CW when higher numbers of flankers are presented. Foveal CW is more strongly influenced by an increase in the number of flankers than CI, which can be explained by the presence of additional interaction effects.
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Affiliation(s)
| | - Lenka Musilová
- Department of Optics, Palacký University Olomouc, Czech Republic.
| | | | - John Siderov
- Vision and Hearing Sciences, Anglia Ruskin University, United Kingdom.
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Abstract
Purpose Grouping of flankers from the target can modulate crowding in adults. Visual acuity in children is measured clinically using charts with targets and different flankers to enhance spatial interactions. We investigated grouping effects on interactions using visual acuity letters, flanked by contours and letters, in children. Methods Visual acuity for isolated and flanked letters was measured in 155 three- to 11-year old children and 32 adults. Flankers were one stroke width from the target and were a box or four bars and black or red letters. Magnitudes of interaction were flanked minus isolated logMAR acuities. Psychometric function slopes were also examined. Results Magnitudes of interaction by contours did not change significantly with age. They were 0.047 ± 0.014 logMAR more with bars than a box. Interaction from flanking letters reduced with age, adults being not different from 9- to 11-year-olds for black and red letter surrounds. It was weaker by 0.033 ± 0.013 logMAR when a black letter was surrounded by red rather than black letters. Psychometric function slopes for visual acuity were steepest for the youngest children (3-5 years). Conclusions For contour and letter flankers, grouping effects on interaction magnitude are age independent. Grouping bars into a box forming a single object reduces magnitude of effect. Grouping letter flankers by color and ungrouping them from the target reduce interaction magnitude by ∼8%, suggesting that luminance-defined form dominates. Differently colored letter flankers of high-luminance contrast on acuity charts could draw attention to the target but retain significant interaction strength.
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Affiliation(s)
- Sarah J. Waugh
- Anglia Vision Research, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| | - Monika A. Formankiewicz
- Anglia Vision Research, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
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Facchin A, Maffioletti S, Martelli M, Daini R. Different trajectories in the development of visual acuity with different levels of crowding: The Milan Eye Chart (MEC). Vision Res 2019; 156:10-16. [DOI: 10.1016/j.visres.2019.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/06/2023]
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Pluháček F, Siderov J. Mesopic visual acuity is less crowded. Graefes Arch Clin Exp Ophthalmol 2018; 256:1739-1746. [DOI: 10.1007/s00417-018-4017-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/18/2018] [Accepted: 04/03/2018] [Indexed: 01/01/2023] Open
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Paudel N, Jacobs RJ, Sloan R, Denny S, Shea K, Thompson B, Anstice N. Effect of simulated refractive error on adult visual acuity for paediatric tests. Ophthalmic Physiol Opt 2017; 37:521-530. [PMID: 28656671 DOI: 10.1111/opo.12387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Although vanishing optotype preferential-looking tasks are commonly used to measure visual acuity (VA), the relative sensitivity of these tests to refractive error is not well understood. To address this issue, we determined the effect of spherical and astigmatic simulated refractive errors on adult VA measures obtained using vanishing optotypes, picture optotypes and Sloan letters. METHODS VA was determined uniocularly for adults under conditions of spherical (0.0-3.0 DS; n = 23) and astigmatic (0.0-3.0 DC at 90° and 180°; n = 20) defocus using the Cardiff Acuity Test (vanishing optotypes), crowded linear Lea Symbols (picture-optotype recognition task) and the Early Treatment of Diabetic Retinopathy Study (ETDRS) letter chart. RESULTS The Cardiff Acuity Test over-estimated VA compared with the Lea Symbols and ETDRS charts in both focused and defocused conditions. The mean difference between the Cardiff Acuity Test and the ETDRS chart was 0.31 logMAR (95% limits of agreement (LOA) 0.10-0.52 logMAR) in focused conditions and 0.64 logMAR (95% LOA 0.25-1.05 logMAR) with 3D of spherical defocus. Defocus degraded VA on all charts, however there was a significant chart-by-defocus interaction whereby the Cardiff Acuity Test was more resistant to the effects of both spherical (P < 0.0001) and cylindrical (P < 0.001) optical defocus than the recognition acuity tasks at all defocus levels. CONCLUSION Although the Cardiff Acuity Test provides an easy method for VA measurement in infants and toddlers, there is a considerable overestimation of VA compared with recognition acuity tasks particularly in the presence of defocus. A simple correction factor (of for example three lines overestimate) cannot be applied to Cardiff acuity measures as there is increasing over-estimation of VA with increasing defocus. Infants with significant refractive error may fall within normal visual acuity ranges for the Cardiff Acuity Test.
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Affiliation(s)
- Nabin Paudel
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Robert J Jacobs
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rebecca Sloan
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sarah Denny
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kimberley Shea
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Nicola Anstice
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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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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Anstice NS, Jacobs RJ, Simkin SK, Thomson M, Thompson B, Collins AV. Do picture-based charts overestimate visual acuity? Comparison of Kay Pictures, Lea Symbols, HOTV and Keeler logMAR charts with Sloan letters in adults and children. PLoS One 2017; 12:e0170839. [PMID: 28152076 PMCID: PMC5289485 DOI: 10.1371/journal.pone.0170839] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/11/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose Children may be tested with a variety of visual acuity (VA) charts during their ophthalmic care and differences between charts can complicate the interpretation of VA measurements. This study compared VA measurements across four pediatric charts with Sloan letters and identified chart design features that contributed to inter-chart differences in VA. Methods VA was determined for right eyes of 25 adults and 17 children (4–9 years of age) using Crowded Kay Pictures, Crowded linear Lea Symbols, Crowded Keeler logMAR, Crowded HOTV and Early Treatment of Diabetic Retinopathy Study (ETDRS) charts in focused and defocused (+1.00 DS optical blur) conditions. In a separate group of 25 adults, we compared the VA from individual Kay Picture optotypes with uncrowded Landolt C VA measurements. Results Crowded Kay Pictures generated significantly better VA measurements than all other charts in both adults and children (p < 0.001; 0.15 to 0.30 logMAR). No significant differences were found between other charts in adult participants; children achieved significantly poorer VA measurements on the ETDRS chart compared with pediatric acuity tests. All Kay Pictures optotypes produced better VA (p < 0.001), varying from -0.38 ± 0.13 logMAR (apple) to -0.57 ± 0.10 logMAR (duck), than the reference Landolt C task (mean VA -0.19 ± 0.08 logMAR). Conclusion Kay Pictures over-estimated VA in all participants. Variability between Kay Pictures optotypes suggests that shape cues aid in optotype determination. Other pediatric charts offer more comparable VA measures and should be used for children likely to progress to letter charts.
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Affiliation(s)
- Nicola S. Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Robert J. Jacobs
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Samantha K. Simkin
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Melissa Thomson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew V. Collins
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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