Comparison of the HOTV and Lea Symbols Charts for Preschool Vision Screening

Abstract

Purpose; Two preliterate acuity charts, the Lea Symbol chart and the HOTV chart, were compared prospectively in an established preschool vision screening program. The charts were compared by measuring time required to test, reliability coefficients, and the percentage of children testable with each chart. Methods and Materials: Seven hundred and seventyseven 3- to 5-year-old children were randomized to four screening sequences that determined the order of chart use. Each child was screened on two occasions within 6 weeks. Testing was performed at 10 feet, and optotypes were not isolated for testing. Results: Mean test time was significantly less for older children, but was not related to the chart used. Reliability coefficients were similar for the Lea Symbols and the HOTV charts. The percentage of children testable by each chart improved with increased age of the child. More 3 year olds were testable with the Lea Symbols chart compared to the HOTV chart (92% versus 85%, P=.05). Conclusions: Vision screening with either chart was more rapid and more frequently achieved with 4- and 5year-old children compared with the 3 year olds. For the population as a whole, each chart gave similar results. Among the 3 year olds, however, testability rates were better for the Lea Symbols chart. The Lea Symbols chart is an acceptable option for preschool vision screening, and may be more efficacious than the HOTV chart for screening 3-year-old children.

Effect of simulated refractive error on adult visual acuity for paediatric tests

“…Adult VA measurement generally involves a letter naming (recognition acuity) chart and many well validated charts exist for this purpose . Recognition acuity can also be measured in children from approximately 3 years of age using naming or matching tasks provided by charts such as the Lea Symbols test . However, recognition acuity measurement is challenging in children younger than 3 years of age and alternative techniques are necessary.…”

Home-based screening tools for amblyopia: a systematic review protocol

“…In addition, up to 60% of primary care providers do not perform vision screening on preschool-aged children, and others perform screening inconsistently. 16 Significant barriers to traditional vision screening include cost, limited access to healthcare and a limited number of qualified screeners available. 17 Hence, a variety of methodologies for vision screening have been trialled, including the use of home-based amblyopia screening tools, to help overcome these barriers to vision screening.…”

“…15 Many screening programmes have been unsuccessful, with an estimation of less than 25% of preschool-aged children being screened through a government or private programme in the USA. 16 Strengths and limitations of this study…”

Discrimination of paediatric acuity test optotypes by 6‐year‐old children

“…[7][8][9][10][11][12][13][14][15][16][17] The literature describing the development of these paediatric visual acuity tests has, therefore, been careful to include comparisons of acuity estimates recorded across different optotype designs. 18,[19][20][21][22][23][24][25][26][27][28][29] Differences in spatial frequency content and optotype design, combined with other factors such as crowding, attention span and cognitive capacity result in the need for careful calibration and validation of all paediatric tests. 6,[30][31][32] The acuity testing guidelines developed by the Committee on Vision 3 also noted that the discriminability of optotypes within a chart is an important factor in reliable and repeatable testing.…”