The Teller Acuity Cards Are Effective in Detecting Amblyopia

Abstract

Purpose Detection of amblyopia in infants and toddlers is difficult because the current clinical standard for this age group, fixation preference, is inaccurate. Although grating acuity represents an alternative, studies of preschoolers and schoolchildren report that it is not equivalent to the gold standard optotype acuity. Here, we examine whether the Teller Acuity Cards (TAC) can detect amblyopia effectively by testing children old enough (7.8 ± 3.6 years) to complete optotype acuity testing. Methods Grating acuity was assessed monocularly in 45 patients with unilateral amblyopia, 44 patients at risk for amblyopia, and 37 children with no known vision disorders. Each child’s grating acuity was classified as normal/abnormal based on age-appropriate norms. These classifications were compared with formal amblyopia diagnoses. Results Grating acuity was finer than optotype acuity among amblyopic eyes (medians: 0.28 vs. 0.40 logMAR, respectively, p < 0.0001) but not among fellow eyes (medians: 0.03 vs. 0.10 logMAR, respectively, p = 0.36). The optotype acuity-grating acuity discrepancy among amblyopic eyes was larger for cases of severe amblyopia than for moderate amblyopia (means: 0.64 vs. 0.18 logMAR, respectively, p = 0.0001). Nevertheless, most cases of amblyopia were detected successfully by the TAC, yielding a sensitivity of 80%. Furthermore, grating acuity was relatively sensitive to all amblyopia subtypes (69 to 89%) and levels of severity (79 to 83%). Conclusions Although grating acuity is finer than optotype acuity in amblyopic eyes, most children with amblyopia were identified correctly suggesting that grating acuity is an effective clinical alternative for detecting amblyopia.

Validation of the Waterloo Differential Visual Acuity Test (WatDAT) and Comparison With Existing Pediatric Tests of Visual Acuity

“…Our analysis showed that, although the specificity of the CAT and TAC was high (1.00), sensitivity was extremely poor at 0.46 and 0.65, respectively. This finding is unlike that from the report of an earlier study in children by Drover et al, 22 where TAC was successful in detecting amblyopia, yielding a sensitivity of 0.80. However, Kushner et al 6 agreed that TAC had low sensitivity for detecting reduced vision in children and adults; sensitivity ranged from 0.24 to 0.58 for participants with different levels of VA. Geer et al 23 reported a sensitivity for the CAT of 0.42 for detecting amblyopia and Howard et al 8 found a sensitivity of 0.56 with a cut-off of 0.0 logMAR.…”

Validation of the Waterloo Differential Visual Acuity Test (WatDAT) and Comparison With Existing Pediatric Tests of Visual Acuity

“…Our analysis showed that, although the specificity of the CAT and TAC was high (1.00), sensitivity was extremely poor at 0.46 and 0.65, respectively. This finding is unlike that from the report of an earlier study in children by Drover et al, 22 where TAC was successful in detecting amblyopia, yielding a sensitivity of 0.80. However, Kushner et al 6 agreed that TAC had low sensitivity for detecting reduced vision in children and adults; sensitivity ranged from 0.24 to 0.58 for participants with different levels of VA. Geer et al 23 reported a sensitivity for the CAT of 0.42 for detecting amblyopia and Howard et al 8 found a sensitivity of 0.56 with a cut-off of 0.0 logMAR.…”

Quantifying Nystagmus in Infants and Young Children: Relation between Foveation and Visual Acuity Deficit

“…The absolute test-retest differences did not correlate with the patients' age (r ϭ 0.1, P ϭ 0.9) or with the individual mean NOFF over the two visits (r ϭ 0.06, P ϭ 0.7). The test-retest variability in the subgroup of 20 (40%) patients whose eye movement recordings were calibrated using the group-averaged gain factor was not significantly different from the test-retest variability in the remaining 30 (60%) patients whose recordings were calibrated individually (F (19,29) ϭ 0.67, P ϭ 0.2).…”

Pediatric spectacle prescription

“…In managing a preverbal child, fixation preference and preferential looking cards are appropriate methods for assessing amblyopia; it is not necessary to wait for a child's visual response because the condition may lead to dense amblyopia. [ 29 30 31 ] Prescribing glasses and considering amblyopia treatment was chosen by 19.4% and 80.6% in Groups A and B, respectively. Amblyopia is a preventable consequence of anisometropia if treated properly in a timely fashion during the critical period of visual development and thus knowledge of how to approach this issue is detrimental to avoid permanent vision loss of the affected eye.…”

Validation of the Waterloo Differential Visual Acuity Test (WatDAT) and Comparison With Existing Pediatric Tests of Visual Acuity

“…Our analysis showed that, although the specificity of the CAT and TAC was high (1.00), sensitivity was extremely poor at 0.46 and 0.65, respectively. This finding is unlike that from the report of an earlier study in children by Drover et al, 22 where TAC was successful in detecting amblyopia, yielding a sensitivity of 0.80. However, Kushner et al 6 agreed that TAC had low sensitivity for detecting reduced vision in children and adults; sensitivity ranged from 0.24 to 0.58 for participants with different levels of VA. Geer et al 23 reported a sensitivity for the CAT of 0.42 for detecting amblyopia and Howard et al 8 found a sensitivity of 0.56 with a cut-off of 0.0 logMAR.…”

Quantifying Nystagmus in Infants and Young Children: Relation between Foveation and Visual Acuity Deficit

“…The absolute test-retest differences did not correlate with the patients' age (r ϭ 0.1, P ϭ 0.9) or with the individual mean NOFF over the two visits (r ϭ 0.06, P ϭ 0.7). The test-retest variability in the subgroup of 20 (40%) patients whose eye movement recordings were calibrated using the group-averaged gain factor was not significantly different from the test-retest variability in the remaining 30 (60%) patients whose recordings were calibrated individually (F (19,29) ϭ 0.67, P ϭ 0.2).…”

Pediatric spectacle prescription

“…In managing a preverbal child, fixation preference and preferential looking cards are appropriate methods for assessing amblyopia; it is not necessary to wait for a child's visual response because the condition may lead to dense amblyopia. [ 29 30 31 ] Prescribing glasses and considering amblyopia treatment was chosen by 19.4% and 80.6% in Groups A and B, respectively. Amblyopia is a preventable consequence of anisometropia if treated properly in a timely fashion during the critical period of visual development and thus knowledge of how to approach this issue is detrimental to avoid permanent vision loss of the affected eye.…”

Validation of the Waterloo Differential Visual Acuity Test (WatDAT) and Comparison With Existing Pediatric Tests of Visual Acuity

“…Our analysis showed that, although the specificity of the CAT and TAC was high (1.00), sensitivity was extremely poor at 0.46 and 0.65, respectively. This finding is unlike that from the report of an earlier study in children by Drover et al, 22 where TAC was successful in detecting amblyopia, yielding a sensitivity of 0.80. However, Kushner et al 6 agreed that TAC had low sensitivity for detecting reduced vision in children and adults; sensitivity ranged from 0.24 to 0.58 for participants with different levels of VA. Geer et al 23 reported a sensitivity for the CAT of 0.42 for detecting amblyopia and Howard et al 8 found a sensitivity of 0.56 with a cut-off of 0.0 logMAR.…”

Quantifying Nystagmus in Infants and Young Children: Relation between Foveation and Visual Acuity Deficit

“…The absolute test-retest differences did not correlate with the patients' age (r ϭ 0.1, P ϭ 0.9) or with the individual mean NOFF over the two visits (r ϭ 0.06, P ϭ 0.7). The test-retest variability in the subgroup of 20 (40%) patients whose eye movement recordings were calibrated using the group-averaged gain factor was not significantly different from the test-retest variability in the remaining 30 (60%) patients whose recordings were calibrated individually (F (19,29) ϭ 0.67, P ϭ 0.2).…”

Pediatric spectacle prescription

“…In managing a preverbal child, fixation preference and preferential looking cards are appropriate methods for assessing amblyopia; it is not necessary to wait for a child's visual response because the condition may lead to dense amblyopia. [ 29 30 31 ] Prescribing glasses and considering amblyopia treatment was chosen by 19.4% and 80.6% in Groups A and B, respectively. Amblyopia is a preventable consequence of anisometropia if treated properly in a timely fashion during the critical period of visual development and thus knowledge of how to approach this issue is detrimental to avoid permanent vision loss of the affected eye.…”