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Updated: Aug 15, 2026
An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Intraobserver reliability of the Teller Acuity Card procedure in infants with perinatal complications
1Section on Child and Family Research, National Institute of Child Health and Human Development, Bethesda, MD, USA.
Insights
The Teller Acuity Card (TAC) procedure reliably measures grating acuity in infants with neonatal intensive care unit (NICU) histories. Repeat testing is advised if tester confidence in visual acuity results is low.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Neonatology
Background:
- Infant visual acuity assessment is crucial for early detection of developmental abnormalities.
- The Teller Acuity Card (TAC) procedure is a common method for estimating grating acuity in infants.
- Evaluating the reliability of visual assessment tools in high-risk infant populations is essential.
Purpose of the Study:
- To assess the intraobserver test-retest reliability of the Teller Acuity Card (TAC) procedure.
- To evaluate the TAC procedure's reliability in infants with a history of neonatal intensive care unit (NICU) treatment.
- To determine factors influencing the reliability of TAC measurements in this population.
Main Methods:
- Seventy-nine infants treated in the NICU were included in the study.
- Monocular testing was performed at corrected ages between 2.5 and 18.5 months.
- Testers were masked to grating location and spatial frequency to minimize bias.
Main Results:
- 91% of intraobserver test-retest scores varied by no more than one octave.
- 68% of scores differed by 0.5 octave or less, indicating good reliability.
- Reliability was consistent across risk levels but affected by low tester confidence ratings.
Conclusions:
- The Teller Acuity Card (TAC) procedure demonstrates reliable intraobserver test-retest results in NICU-treated infants.
- The findings support the use of TAC for visual acuity assessment in this population.
- Repeating test sessions is recommended when tester confidence in the validity of results is low.
Purpose:
Intraobserver test-retest reliability of the Teller Acuity Card (TAC) procedure for estimating grating acuity was assessed in 79 infants who had been treated in a neonatal intensive care unit for preterm birth and/or other perinatal complications.
Methods:
Subjects were tested monocularly at one or more of four different age intervals that ranged between 2.5 and 18.5 mo corrected age. Testers were masked to the location and spatial frequency of the grating on each card.
Results:
Of the intraobserver test-retest scores, 91% differed by no more than one octave and 68% differed by no more than 0.5 octave. Intraobserver agreement was similar to that reported previously for healthy, preterm infants. Reliability was uniform between infants of differing levels of risk for abnormal visual development but bore effects of low tester ratings of confidence.
Conclusions:
The results demonstrate the reliability of the TAC procedure but suggest that test sessions should be repeated when tester confidence in validity of results is low.
