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Visual acuity testability in African-American and Hispanic children: the multi-ethnic pediatric eye disease study
Susan A Cotter1, Kristina Tarczy-Hornoch, Ying Wang
1Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Insights
The Amblyopia Treatment Study (ATS) HOTV visual acuity protocol is effective for testing preschool children, especially those over 36 months. This method aids in diagnosing and managing amblyopia in minority children.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Amblyopia, or
- lazy eye,
- is a leading cause of vision loss in children.
- Early detection and treatment are crucial for effective management.
- Standardized visual acuity testing protocols are essential for accurate diagnosis.
Purpose of the Study:
- To compare age- and gender-specific testability rates for the Amblyopia Treatment Study (ATS) HOTV visual acuity testing protocol.
- To evaluate the effectiveness of the electronic visual acuity (EVA) tester in African-American and Hispanic preschool children.
- To determine the feasibility of using the ATS HOTV protocol in diverse pediatric populations.
Main Methods:
- A population-based, cross-sectional study was conducted.
- Presenting monocular distance visual acuity was measured using the ATS HOTV protocol in African-American and Hispanic children aged 30-72 months.
- Testability rates were calculated and compared across age, gender, and ethnicity groups using Chi-square analyses and the Cochran trend test.
Main Results:
- Overall testability was 84%, with slight variations between African-American (83%) and Hispanic (85%) children.
- Older children (61-72 months) had a 100% testability rate, compared to 39% for younger children (30-36 months).
- Girls (86%) were slightly more likely to be testable than boys (82%), with no significant ethnicity-related differences after age stratification.
Conclusions:
- The ATS HOTV protocol on the EVA tester is a feasible method for assessing visual acuity in most African-American and Hispanic preschool children.
- The protocol is particularly effective for children older than 36 months.
- This testing method can be integrated into the diagnosis and management of amblyopia and other visual impairments in minority preschool populations.
Purpose:
To compare the age- and gender-specific testability rates for the Amblyopia Treatment Study (ATS) HOTV visual acuity testing protocol using the electronic visual acuity (EVA) tester in African-American and Hispanic preschool children.
Design:
Population-based, cross-sectional study.
Methods:
Measurement of presenting monocular distance visual acuity using the ATS HOTV protocol was attempted in all African-American and Hispanic children aged 30 to 72 months from the population-based Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). Children able to be tested monocularly in both eyes were considered able. Age-, gender-, and ethnicity-specific testability rates were calculated. Comparisons of testability among different groups were performed using Chi-square analyses and the Cochran trend test.
Results:
Testing was attempted on 3,126 children (1,471 African-American, 1,655 Hispanic; 50% female). Overall, 84% (83% African-American, 85% Hispanic; 86% female, 82% male) were testable. Older children were more likely to complete testing successfully than younger children (P < .0001). Age-specific testability in children 30 to 36 months of age, 37 to 48 months of age, 49 to 60 months of age, and 61 to 72 months of age was 39%, 84%, 98%, and 100%, respectively. After stratifying by age, there were no ethnicity-related differences in children testable (P = .12). Girls (86%) were slightly more likely to be testable than boys (82%; P > .003).
Conclusions:
Monocular threshold visual acuity testing using the ATS HOTV protocol on the EVA tester (Jaeb Center for Health Research, Tampa, Florida, USA) can be completed by most African-American and Hispanic preschool children, particularly those older than 36 months of age. This protocol therefore may be used in minority preschool children as an integral part of the diagnosis and management of amblyopia and other forms of visual impairment.
