Development of visual acuity in preschool children as measured with Landolt C and Tumbling E charts

Lai, Yu‐Hung; Wang, Hwei-Zu; Hsu, Hsin‐Tien

doi:10.1016/j.jaapos.2011.03.010

Cited by 27 publications

(28 citation statements)

References 20 publications

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“…Any eye with presenting visual acuity < 0.3 logMAR or 6/12 with the E chart was considered to be reduced vision . The E chart was chosen as it is the most common visual acuity chart used for this age group in developing countries …”

Section: Methodsmentioning

confidence: 99%

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Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers

Thomas

Rajashekar

Kamath

et al. 2020

Clinical and Experimental Optometry

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Background Preschool vision screenings are considered to be cost‐effective methods to identify children with vision disorders. The children of this age group are poor at communicating their symptoms and hence screening is mandated. This study is aimed at estimating the diagnostic accuracy and agreement of Lea, HOTV and E visual acuity charts for detecting significant refractive errors. Methods A cross‐sectional study was conducted, in which monocular unaided vision assessment of each study participant was performed with Lea, HOTV and E charts. Stereo acuity was measured with the Randot Preschool Test and a comprehensive eye examination including dilatation was performed. Significant refractive error was defined as hyperopia > 3.25 D, myopia > 2.00 D, astigmatism > 1.50 D, anisometropia if interocular difference > 1.00 D for hyperopia, > 3.00 D for myopia or > 1.50 D for astigmatism. Sensitivity, specificity, positive and negative predictive values were estimated. Bland–Altmann plots were generated to help identify the level of agreement between the vision charts. Results A total of 256 eyes were analysed. Lea, HOTV and E had sensitivities of 87.8 per cent, 90.2 per cent and 90.2 per cent, respectively. Specificity and positive predictive values were better for HOTV (77.3 per cent, 65.5 per cent) and Lea (75 per cent, 62.6 per cent), compared to E chart (69.8 per cent, 58.7 per cent). Negative predictive values for Lea, HOTV and E charts were 92.8 per cent, 93.8 per cent and 93.8 per cent, respectively. Bland–Altmann analysis showed good agreement between Lea and HOTV, Lea and E, and HOTV and E visual acuity charts. The acuity difference was least between Lea and HOTV charts (0.1 logMAR). Eighty‐five (33.2 per cent) eyes had significant refractive errors. Eighty (94.1 per cent) eyes were astigmatic. Conclusion The diagnostic accuracy of the visual acuity charts was high for the identification of significant refractive errors in preschool children. There was very good agreement between the visual acuity charts.

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Section: Methodsmentioning

confidence: 99%

“…HOTV has been reported to be the most commonly used chart in the USA . Adhikari et al recommended HOTV while Lai et al stressed high testability of directional optotypes like Landolt C or Tumbling E for developing countries, where English was not the native language. Cyert et al found the HOTV chart to be 0.25 logMAR better than the Lea chart.…”

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confidence: 99%

Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers

Thomas

Rajashekar

Kamath

et al. 2020

Clinical and Experimental Optometry

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“…Een alternatief voor de APK zou de Lea-Hyverine kaart (die ook gebruikt wordt in België) kunnen zijn [8,9]. Deze kaart wordt in Nederland nu al gebruikt bij kinderen met een verstandelijke beperking [10].…”

Section: Discussieunclassified

Het oogonderzoek in de jeugdgezondheidszorg op de leeftijd van 3 jaar: ruimte voor verbetering

Iyer¹,

Samkar

Vlasblom³

et al. 2017

Tijdschr Jeugdgezondheidsz

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“…Charts such as Lea symbols, HOTV, landolt C, and tumbling E are commonly used to measure vision. [234]…”

Section: Introductionmentioning

confidence: 99%

“…[6] In addition to the letter acuity chart, the Bailey-Lovie tumbling E chart is also available for acuity measurement. Though many studies have been published on visual acuity measurements with tumbling E chart,[478] the comparison of this chart constructed based on logMAR principle has not been previously reported. Previous studies have used the Snellen E chart which has a number of well documented limitations.…”

Section: Introductionmentioning

confidence: 99%

Comparison of visual acuity results in preschool children with lea symbols and bailey-lovie e chart

Sanker

Dhirani

Bhakat

2013

Middle East Afr J Ophthalmol

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Purpose:To compare visual acuity with two visual acuity charts in preschool children.Materials and Methods:Visual acuity measurement with Lea symbols and Bailey-Lovie tumbling E chart was performed on children between 3 and 6 years of age. Visual acuity data from the two charts were analyzed with Bland-Altman plot to determine the limits of agreement. The Wilcoxon signed test was performed in children aged 3-4 years and in children aged 5-6 years separately to evaluate the influence of age. The inter-eye difference between the two charts were further analyzed with the paired t-test. A p value > 0.05 was considered statistically significant.Results:A total of 47 children were enrolled for the study. The average logarithm of the Minimum Angle of Resolution (LogMAR) monocular visual acuity with Lea symbols (0.17 ± 0.13) was better than the Bailey-Lovie tumbling E chart (0.22 ± 0.14). The mean difference between Bailey-Lovie tumbling E chart and Lea symbol chart was 0.05 ± 0.12 in logMAR units. A second analysis eliminating outliers showed the same result but lower differences (n = 43, 0.05 ± 0.05 logMAR units). Visual acuity results between the two charts in children aged 3-4 years showed a significant difference (p = 0.000), but not for children aged 5-6 years (p = 0.059). Inter-eye differences between the two charts was not statistically significant (p = 0.77).Conclusion:Bailey-Lovie tumbling E chart is comparable to the Lea symbols chart in pre-school children. But preference should be given to Lea symbols for children aged 3-4 years as the symbols are more familiar than a directional test for this age group.

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Development of visual acuity in preschool children as measured with Landolt C and Tumbling E charts

Cited by 27 publications

References 20 publications

Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers

Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers

Het oogonderzoek in de jeugdgezondheidszorg op de leeftijd van 3 jaar: ruimte voor verbetering

Comparison of visual acuity results in preschool children with lea symbols and bailey-lovie e chart

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