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Updated: Aug 20, 2026
An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
A new visual evoked potential system for vision screening in infants and young children
John W Simon1, John B Siegfried, Monte D Mills
1Department of Ophthalmology/Lions Eye Institute, Albany Medical College, NY 12208, USA. SimonJ@mail.amc.edu
Insights
A new visual evoked potential (VEP) system shows promise for infant vision screening. This child-friendly test effectively detects amblyopia (lazy eye) in young children, aiding early intervention.
Area of Science:
- Ophthalmology
- Pediatric Vision Science
- Medical Technology
Background:
- Amblyopia affects 3-5% of children, necessitating early detection through vision screening.
- Current screening methods for amblyopia have limitations, highlighting the need for improved tools.
Purpose of the Study:
- To assess a new, child-friendly visual evoked potential (VEP) system for screening amblyopia in young children.
- To compare the efficacy of the ENFANT II VEP system against standard ophthalmologic examinations.
Main Methods:
- 122 children aged 6 months to 5 years were evaluated using the ENFANT II VEP system.
- Results were compared masked to standard ophthalmologic examinations, defining amblyopia based on visual acuity or clinical treatment decisions.
Main Results:
- The ENFANT II VEP test was completed by 94% of children in an average of 10 minutes.
- The system demonstrated high sensitivity (0.973) and negative predictive value (0.984) for detecting amblyopia.
Conclusions:
- The ENFANT II VEP system offers user-friendly features like easy electrode placement and rapid, engaging stimuli.
- This VEP system shows significant potential as a screening tool for amblyopia and other visual impairments in pediatric populations.
Introduction:
With a prevalence of 3-5%, amblyopia represents a major public health problem. Effective treatment depends on early detection, and a broad consensus of professional opinion supports vision screening of infants and young children. No single method of screening has been demonstrated to be superior in detecting amblyopia and all methods have significant limitations.
Methods:
We assessed a new, "child-friendly" visual evoked potential (VEP) system (ENFANTtrade mark II, Diopsys Corp., Metuchen, NJ) for use in screening. We studied 122 children, aged 6 months to 5 years, comparing test results in a masked fashion to results of standard ophthalmologic examinations. A statistical program analyzed VEP differences between fellow eyes to determine a "pass" or "fail" for each child. For verbal patients, clinical amblyopia was defined as an interocular difference of two or more lines in best-corrected visual acuity. For preverbal patients, clinical amblyopia was defined by the clinician's decision to treat with occlusion or atropine penalization. Preverbal children with significant refractive errors or structural eye pathology were also considered clinically abnormal.
Results:
The test was completed by 94% of the study group, each child requiring an average of 10 minutes to complete testing of both eyes. The sensitivity was 0.973, the specificity 0.808, the positive predictive value 0.706, and the negative predictive value 0.984.
Conclusion:
With its easy electrode placement and rapid, attractive stimulus, the new system overcomes technical difficulties which were associated with older VEP techniques. The test shows promise as a screening tool for detecting amblyopia and other visual deficits in young children.
