Longitudinal Assessment of Monocular Grating Acuity: Predictive Value of Estimates in Infancy

Clinical usefulness of the teller acuity cards test in preliterate children and its correlation with optotype test: A retrospective study

This study evaluated the reproducibility of the Teller Acuity Cards (TAC) test, its correlation with the optotype test, and its usefulness for detecting amblyopia in preliterate children. We retrospectively reviewed the medical records of 64 children who had undergone the TAC test more than once and were later followed up with the optotype test. The mean corrected visual acuities (logMAR) of the first and last TAC tests were 0.86 (mean 19.9 months) and 0.69 (27.7 months), respectively. The first optotype acuity was 0.18 (33.7 months). The first TAC acuity result was positively correlated with the age of the child, but it was not statistically significant (r = −0.077, p > 0.05). The first and last TAC test acuities were significantly correlated (r = 0.382, p < 0.01). There was a significant but small correlation between the final TAC and the first optotype acuities (r = 0.193, p < 0.05). Interocular differences in visual acuity were significantly correlated between the last TAC and first optotype tests (r = 0.395, p < 0.05). TAC acuity might be a valid predictor of optotype acuity later on although it was underestimated compared to that in the optotype test. The TAC test can be used to detect unilateral amblyopia in preliterate children.

Correlation of monocular grating acuity at age 12 months with recognition acuity at age 4.5 years: findings from the Infant Aphakia Treatment Study

PURPOSE

To determine whether grating acuity at age 12 months can be used to predict recognition acuity at age 4.5 years in children treated for unilateral congenital cataract enrolled in the Infant Aphakia Treatment Study (IATS).

METHODS

Traveling testers assessed monocular grating acuity at 12 months of age (Teller Acuity Card Test [TACT]) and recognition acuity at 4.5 years of age (Amblyopia Treatment Study Electronic Visual Acuity Testing, HOTV) in children treated for visually significant monocular cataract in the IATS. Spearman rank correlation was used to evaluate the relationship between visual acuities at the two ages in the treated eyes.

RESULTS

Visual acuity data at both ages were available for 109 of 114 children (96%). Grating acuity at 12 months of age and recognition acuity at 4.5 years of age were significantly correlated for the treated eyes (r_spearman = 0.45; P = 0.001). At age 4.5 years, 67% of the subjects who had grating acuity at 12 months of age within the 95% predictive limits in their treated eye demonstrated recognition acuity better than 20/200. Similarly, at age 4.5 years 67% of the subjects who had grating acuity at age 12 months below the 95% predictive limits in their treated eye demonstrated recognition acuity of 20/200 or worse.

CONCLUSIONS

A single grating acuity assessment at age 12 months predicts recognition acuity in a child treated for unilateral congenital cataract in only two-thirds of cases. Clinicians should consider other factors, such as patching compliance and age at surgery, when using an early grating acuity assessment to modify treatment.

Accuracy of the contrast sensitivity card test for infants: retest variability and prediction of spatial resolution

PURPOSE

We assessed the retest variability of a new contrast sensitivity (CS) card procedure and its ability to predict spatial resolution.

METHODS

Twenty-four 3-month-olds were tested twice with the CS cards and once with the Teller acuity cards (TAC) within a single session.

RESULTS

Coefficient of repeatability (COR) analysis revealed that retest variability of the new cards is superior to that of an earlier prototype at low to mid spatial frequencies. Furthermore, retest variability is comparable to that of infant visual evoked potential studies and the Vistech 6500, a chart commonly used to measure CS in adults. Finally, estimates of visual acuity based on the CS cards were consistent with those provided by the TAC (although CS-based estimates were generally lower overall).

CONCLUSIONS

Given its reliability and accuracy, the new CS card procedure has good potential as a clinical tool for assessing spatial vision in infants and toddlers.

The predictive utility of the Teller acuity cards for assessing visual outcome in children with preterm birth and associated perinatal risks

We assessed binocular grating visual acuity with the Teller acuity cards (TAC) in 3-36-month-olds at risk for visual disorders. After 3-8 years, each child was assessed with the TAC and with a battery of tests of spatial and non-spatial vision. The initial TAC score: (1) was uncorrelated with any of the later measures; (2) had low positive, but high negative predictive value for the later tests; (3) had low sensitivity, but high specificity for identifying children with and without visual disorders, respectively. We concluded that early TAC grating acuity predicts visual outcome, but perhaps only for children with initially normal grating acuity.

Retest variability of human infant contrast sensitivity: how many tests are sufficient?

Retest variability of a new infant contrast sensitivity (CS) card procedure was assessed by binocular measurement of a group of 20 6-month-olds twice within a 1-week period. Coefficient of reliability analyses showed that within-subject variability between tests was only slightly less than variation across subjects, which suggests that results from a single test are a poor predictor of an infant's "true" visual functioning. To determine how many tests are needed to estimate when infant CS stabilizes to within an acceptable (0.15 log unit) criterion, a second experiment was conducted in which a small group of subjects was tested repeatedly over a 2-week period. The results showed that averaging performance on 2 to 3 tests was required before an accurate estimate of the subject's performance could be obtained. Our results suggest that caution should be taken in the interpretation of a single measurement of infant visual functioning.

Long-term reliability and predictive validity of the Teller Acuity Card procedure

The predictive characteristics of the Teller Acuity Card (TAC) procedure were examined in 129 children treated in a neonatal intensive care unit for preterm birth or perinatal complications. Monocular TAC grating acuity at 4, 8, 11, 17, 24, 30, and 36 months was compared with TAC grating acuity (reliability) and HOTV recognition acuity (predictive validity) at 48 months. Most reliability coefficients were significant, with r's ranging from 0.13 at 17 months to 0.59 at 36 months. Predictive validity measurements were of similar magnitude, with r's ranging from 0.22 at 4 months to 0.61 at 36 months. Normal TAC scores at earlier ages were predictive of normal TAC and HOTV acuity at 48 months in 73-95% of eyes. TAC scores below the normal range were less predictive, with 39-80% of eyes continuing to show below-normal acuity at 48 months.