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

Anstice, Nicola; Jacobs, Robert J.; Simkin, Samantha; Thomson, Melissa; Thompson, Benjamin; Collins, Andrew

doi:10.1371/journal.pone.0170839

Cited by 23 publications

(31 citation statements)

References 48 publications

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“…There are multiple methods of checking visual acuity in children in clinic: Lea symbols, Kay pictures, HOTV, Snellen letter s, Sloan letters, Early Treatment of Diabetic Retinopathy Study (ETDRS), tumbling “E”; all with and without crowding bars. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Lea symbols, HOTV, and letter acuity have been recommended for use in children. 8 , 11 Visual Acuity is also mass-tested in vision screening programs with the goal of detecting children with visual impairment as recommended by the American Academy of Pediatrics and the American Association for Pediatric Ophthalmology and Strabismus.…”

Section: Introductionmentioning

confidence: 99%

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Silverstein

Williams

Brown

et al. 2021

American Journal of Ophthalmology

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: Purpose With the recent rise of teleophthalmology due to coronavirus disease, we are in need of accurate and reliable methods of checking visual acuity remotely. We compare the visual acuity as measured by the GoCheck Kids application, HOTV with the amblyopia treatment study (ATS), and our clinic protocol. Design This is a prospective, comparison of visual acuity assessment methods. Methods Established patients (aged 3-18) in the practice of a single pediatric ophthalmologist were eligible. Visual acuity was measured by: 1) GoCheck Kids mobile application (by patient’s family member), 2) HOTV-ATS (by study personnel), and 3) regular clinic protocol (by ophthalmic technician). To assess agreement between measures of acuity, intraclass correlations with 95% confidence intervals were computed. Results Fifty-three children participated. The mean difference between GoCheck Kids and HOTV-ATS acuities (0.094) was significantly different (p<0.001); the intraclass correlation (ICC) was 0.55 (95% CI: 0.40, 0.68). The mean difference between GoCheck Kids and chart acuities (0.010) was not significantly different (p=0.319); ICC: 0.59 (95% CI: 0.45, 0.71). The mean difference between HOTV-ATS and chart acuities (0.084) was significantly different (p<0.001); ICC: 0.66 (95% CI: 0.53, 0.76). The percent of eyes with visual acuity as measured by GoCheck Kids that was within 1 line of the HOTV-ATS and chart acuity was 65.3% and 86.7%, respectively. Conclusions GoCheck Kids as checked by a family member provides a modest correlation of visual acuity compared to the chart screen and a fair correlation of visual acuity compared to HOTV-Amblyopia Treatment Study protocol, though a vast majority are within 1 line.

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Section: Introductionmentioning

confidence: 99%

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Silverstein

Williams

Brown

et al. 2021

American Journal of Ophthalmology

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“…These attributes make it difficult to maintain consistency in the placement and size of crowding elements (Cyert, 2010;Lalor, Formankiewicz, & Waugh, 2016), which is a significant disadvantage given the importance of assessing vulnerability to crowding in amblyopia (Stuart & Burian, 1962;Levi & Klein, 1985;Levi, Hariharan, & Klein, 2002;Greenwood et al, 2012). Finally, acuity levels elicited by individual optotypes in these larger groups are variable (Amsterdam Picture [Engin et al, 2014]; Kay pictures [Lalor et al, 2016]; for overall summaries, see Candy, Mishoulam, Nosofsky, & Dobson, 2011;Anstice & Thompson, 2014;Anstice et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity

et al. 2018

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When measuring recognition acuity in a research setting, the most widely used symbols are the Early Treatment of Diabetic Retinopathy Study (ETDRS) set of 10 Sloan letters. However, the symbols are not appropriate for patients unfamiliar with letters, and acuity for individual letters is variable. Alternative pictogram sets are available, but are generally comprised of fewer items. We set out to develop an open-access set of 10 pictograms that would elicit more consistent estimates of acuity across items than the ETDRS letters from visually normal adults. We measured monocular acuity for individual uncrowded optotypes within a newly designed set (The Auckland Optotype [TAO]), the ETDRS set, and Landolt Cs. Eleven visually normal adults were assessed on regular and vanishing formats of each set. Inter-optotype reliability and ability to detect subtle differences between participants were assessed using intraclass correlations (ICC) and fractional rank precision (FRP). The TAO vanishing set showed the strongest performance (ICC = 0.97, FRP = 0.90), followed by the other vanishing sets (Sloan ICC = 0.88, FRP = 0.74; Landolt ICC = 0.86, FRP = 0.80). Within the regular format, TAO again outperformed the existing sets (TAO ICC = 0.77, FRP = 0.75; Sloan ICC = 0.65, FRP = 0.64; Landolt ICC = 0.48, FRP = 0.63). For adults with normal visual acuity, the new optotypes (in both regular and vanishing formats) are more equally legible and sensitive to subtle individual differences than their Sloan counterparts. As this set does not require observers to be able to name Roman letters, and is freely available to use and modify, it may have wide application for measurement of acuity.

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“…Since the authors have used different eye-chart layouts, the crowding effect had a crucial role and interacted with different layouts and optotypes. 29 …”

Section: Discussionmentioning

confidence: 99%

“…Different eye charts, with different flankers or spacing (crowding), could give different results. 3 , 29 , 30 , 31 The difference in VA due to the presence of flankers could only be tested directly by comparing several modalities of presentation. Moreover, in order to test stability as a function of time, the repeatability of the measurement should be analysed.…”

Section: Methodsmentioning

confidence: 99%

Measurement of visual acuity with a digital eye chart: optotypes, presentation modalities and repeatability

Dall’Orto

Facchin

Bellatorre

et al. 2021

Journal of Optometry

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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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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

Cited by 23 publications

References 48 publications

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity

Measurement of visual acuity with a digital eye chart: optotypes, presentation modalities and repeatability

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