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Updated: Jun 18, 2026

An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
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An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System

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The 'mirror test' for estimating visual acuity in infants.

Richard Bowman1, Daphne L McCulloch, Elizabeth Law

  • 1Royal Hospital for Sick Children, Yorkhill, Glasgow, UK. richardandruthbowman@gmail.com

The British Journal of Ophthalmology
|December 2, 2009
PubMed
Summary
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Infant fixation distance to their own reflection increases with age and correlates with visual acuity card tests. This simple method could aid in detecting visual impairments in infants.

Area of Science:

  • Ophthalmology
  • Developmental Pediatrics
  • Infant Vision Research

Background:

  • Assessing visual function in infants is crucial for early detection of potential impairments.
  • Traditional visual acuity testing in infants can be challenging and requires specialized equipment.

Purpose of the Study:

  • To investigate the relationship between the distance infants fixate on their own reflections and standard visual acuity card testing.
  • To explore the potential of using mirror fixation distance as a novel clinical test for infant visual function.

Main Methods:

  • 78 healthy infants under 9 months were observed fixating their reflections in a mirror.
  • The distance at which fixation was lost was recorded.
  • Binocular visual acuities were assessed using the Teller acuity card procedure.

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Main Results:

  • Mirror fixation distance showed a strong positive correlation with infant age (R²=0.73, p<0.0005) and Teller acuity (R²=0.69, p<0.0005).
  • Using logarithmic scales and logistic growth functions, correlations improved (log mirror distance vs log Teller acuity, R²=0.86; log mirror distance vs log age, R²=0.88).
  • Both age and Teller acuity independently predicted mirror fixation distance in multivariate analysis.

Conclusions:

  • Infant mirror fixation distance increases with age and correlates well with visual acuity card results.
  • The simplicity and portability of this method suggest its utility as an additional tool for screening infant visual function.
  • This technique offers a promising, non-invasive approach for assessing visual development in infants.