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Examination of young children with Lea symbols
1Department of Strabology and Neuroophthalmology, University of Giessen, Giessen, Germany. ralph-becker@web.de
Insights
Lea symbols are effective for assessing visual acuity in young children. While cooperation impacts results, interocular differences in visual acuity typically remain within one line when measurements are possible.
Area of Science:
- Ophthalmology
- Pediatrics
- Vision Science
Background:
- Establishing normal visual acuity values and interocular differences is crucial for pediatric eye care.
- Lea symbols offer a potential tool for visual acuity assessment in young children.
Purpose of the Study:
- To determine normal visual acuity values and interocular differences using Lea symbols in neurologically and ophthalmologically normal children.
- To evaluate the efficacy of Lea symbols compared to Landolt C for visual acuity testing in early childhood.
Main Methods:
- Visual acuity was measured using Lea symbols (LS) in 385 children aged 21-93 months during routine pediatric check-ups.
- A subset of 90 children underwent re-examination in a hospital setting, comparing LS with Landolt C (LC) acuity.
- Children with strabismus, ametropia, or organic eye disease were excluded from the study.
Main Results:
- Lea symbol acuity was successfully measured in both eyes of 54% of children in the practice, with success rates increasing significantly with age (76% for >36 months, 95% for >48 months).
- In the hospital setting, LS and LC were measurable in 77% and 48% of children, respectively, with cooperation improving with age.
- Interocular differences in visual acuity were typically one line or less in 80% of children in the practice and 90% in the hospital using Lea symbols.
Conclusions:
- Lea symbols are a valuable tool for visual acuity assessment in early childhood.
- Cooperation levels significantly influence the variability of visual acuity measurements in young children.
- When monocular measurements are feasible, the interocular difference in visual acuity generally does not exceed one line.
Aims:
In order to establish normal values and interocular differences of visual acuity, Lea symbols were applied to neurologically and ophthalmologically normal children.
Methods:
385 children (21-93 months old) were examined, within a routine check up in an urban paediatric practice where Lea symbol acuity (LS) was measured. Of these children, 90 were re-examined in hospital comparing Lea symbol acuity (LS) and Landolt C acuity (LC). Strabismus, ametropia, and any organic eye disease were excluded.
Results:
In the paediatric practice, LS could be measured on both eyes in 54% of the children. In the age group above 36 and 48 months the success rate was 76% and 95%, respectively. Acuity in the paediatric practice ranged from 0.1 to 2.0 (median 1.25) in the whole group. Interocular acuity difference was one line or less in 80%. In the hospital, LS and LC could be measured on both eyes of 77% and 48% of the 90 children, respectively. Cooperation increased with age. LS in the hospital ranged from 0.32 to 2.0 (median 1.0) and LC from 0.16 to 1.25 (median 0.8). Interocular difference of LS acuity was one line or less in 90%.
Conclusion:
Lea symbols were found to be useful for visual acuity assessment in early childhood. Significant variability of visual acuity in this age group is caused by cooperation. When monocular measurements are possible on both eyes, however, the intraindividual interocular difference of visual acuity usually does not exceed one line.