Normative pediatric visual acuity using single surrounded HOTV optotypes on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study protocol

Abstract

Purpose-To provide normative pediatric visual acuity data using HOTV optotypes presented on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study (ATS) protocol.Methods-Monocular testing was conducted on 384 healthy full-term children ranging from 3 to 10 years of age (mean, 5.4 years; SD = 1.8 years). A total of 373 children completed monocular testing of each eye. In addition, 23 adults (mean, 28.7 years; SD = 4.9 years) were tested for comparison. Both monocular visual acuity and interocular acuity differences were recorded.Results-Mean visual acuity improved by slightly more than one line (0.12 logMAR) from 3 years of age to adulthood, increasing from 0.08 logMAR to −0.04 logMAR (F 6,400 = 26.3, p < 2.0 × 10 −26 ). At all ages, mean interocular acuity difference was less than one line on a standard acuity chart (overall mean difference = 0.04 logMAR; SD = 0.06 logMAR).Conclusions-These results represent the first normative data reported for HOTV optotypes using the ATS protocol on the Electronic Visual Acuity Tester. These data may play an important role in clinical practice, screening, and clinical research.Accurate and reliable measurement of visual acuity in children is essential for the detection and management of pediatric eye disease. Visual acuity is also a desirable outcome measure for pediatric eye research. Yet, though the Early Treatment Diabetic Retinopathy Study (ETDRS) testing protocol is generally accepted as the gold standard of visual acuity measurement in adults, 1,2 there is no widely accepted, standardized visual acuity protocol for young children. To remedy this, the Pediatric Eye Disease Investigator Group (PEDIG) has recently developed the Electronic Visual Acuity (EVA) Tester, a computerized testing system that provides automated presentation of letter optotypes (HOTV or ETDRS). 3Corresponding author and address to which reprints should be sent: James R. Drover, PhD, Retina Foundation of the Southwest, 9900 N. Central Expressway, Suite 400, Dallas, TX, 75231, Telephone: (214) Fax: (214) 363-4538, e-mail: jdrover@retinafoundation.org. The study was conducted at The Retina Foundation of the SouthwestThe authors have no commercial interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The EVA testing system offers a number of features that make it particularly suitable for multiple-site, pediatric vision testing. Most importantly, it offers standardization of optotypes, luminance, and testing procedure across sites and requires limited tester training. 3,4 For pediatric use, it incorporates the Amblyopia Treatme...

Development of Visual Acuity and Contrast Sensitivity in Children

“…Atkinson and Braddick 12 , using Snellen acuity, found that crowded optotype acuity was 58% of that of adults at 5 years of age. Drover et al 24 , using crowded optotypes, found a difference between 7 year olds and 8-10 year olds, but did not comment on whether there was a difference between 8-10 year olds and adults. De Vries and Spekreisje 25 showed data that indicate that the trend line continues upward until the mid-teens, but there was no statistical analysis.…”

A new computer-based pediatric vision-screening test

“…However, based on current normative visual acuity data, 13 and as recommended in the current AAPOS screening guidelines, 9 the JVAS has been updated to feature a 20/50-sized optotype as the pass threshold for 3-year-olds. Similarly, current normative visual acuity data 13,14 indicate a pass threshold of 20/32 for 5-year-olds, whereas the version of the JVAS used in this study utilized 20/40 as the pass threshold for this age group. Bringing JVAS screening thresholds into line with gold standard failure criteria (Table 1) by lowering the JVAS pass threshold for 3-year-olds to 20/50 and raising the pass threshold for 5-year-olds to 20/32, should improve specificity and sensitivity of the JVAS, respectively.…”

“…Failure on the gold standard examination was based on updated American Association for Pediatric Ophthalmology and Strabismus Vision Screening Guidelines (Table 1), 4 with visual acuity failure based on the most recent normative pediatric visual acuity data as published by Pan and colleagues 13 for children aged 30-72 months and Drover and colleagues 14 for children aged ≥72 months (Table 1). In this way, our study evaluated the ability of the JVAS to detect reduced visual acuity, amblyopia, and amblyopia risk factors.…”

Visual rehabilitation of patients with oculocutaneous albinism Type I (OCA1): Results in 85 patents

“…The spectacles prescribed fully corrected myopia > 0.75 diopters, astigmatism > 1.50 diopters and anisometropia > 1.00 diopters and either fully corrected or symmetrically under-corrected (by up to 1.50 D) hyperopia of > +3.50 D (spherical equivalent). Spectacle-corrected distance visual acuity was measured at 3M in the patients' habitual head position using the amblyopia treatment study (ATS) HOTV protocol for patients < 7 years and the ATS ETDRS protocol for patients > 7 years of age at least every 4 (+1) weeks after spectacle wear until acuity remained at within 1 line from the prior visit [23]. The visit at which visual acuity remained stable became the baseline for all further measurements.…”