Related Experiment Video
Updated: May 23, 2026
An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Visual acuity testability and comparability in Australian preschool children: the Sydney Paediatric Eye Disease Study
J F Leone1, G A Gole, P Mitchell
1Discipline of Orthoptics, The University of Sydney, Lidcombe, NSW, Australia.
Insights
The Amblyopia Treatment Study (ATS) HOTV protocol demonstrated high testability for preschool children aged 3 and above. This vision screening method is recommended for its effectiveness in assessing visual acuity in young children.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Standardized vision screening protocols are crucial for early detection of visual impairments in preschool children.
- Assessing visual acuity (VA) in young children presents unique challenges due to developmental factors and cooperation levels.
Purpose of the Study:
- To evaluate the testability and comparability of three different vision tests for preschool children.
- To establish standardized protocols for vision screening in a population-based sample.
Main Methods:
- The study involved 1774 preschool children aged ≥24 months, assessing monocular distance visual acuity using the ATS HOTV protocol.
- For children aged ≥60 months (n=576), VA was also tested with logMAR retro-illuminated HOTV or ETDRS charts (CSV 1000).
Main Results:
- Testability increased significantly with age for all VA tests.
- The ATS HOTV protocol showed the highest testability (80%), particularly in children aged 3 years and above (≥80%).
- In children ≥60 months, HOTV (94%) was more testable than ETDRS (59%).
Conclusions:
- The ATS HOTV protocol is highly testable for children aged 3 years and older.
- The HOTV (CSV) chart is suitable for children over 5 years, with potential for younger children.
- Higher VA scores with ATS HOTV should be considered when comparing results across different tests.
Purpose:
To establish standardised protocols for vision screening, testability and comparability of three different vision tests were examined in a population-based, cross-sectional sample of preschool children (Sydney Paediatric Eye Disease Study).
Methods:
Measurement of presenting monocular distance visual acuity (VA) using the Amblyopia Treatment Study (ATS) HOTV protocol, was attempted by all (1774) children aged≥24 months. In addition, in children aged≥60 months (576), VA was also tested using the logMAR retro-illuminated HOTV or Early Treatment Diabetic Retinopathy Study (ETDRS) linear charts (CSV 1000). Children able to have both eyes tested monocularly were considered.
Results:
Testability significantly increased with age for all VA tests. The ATS HOTV with an overall testability of 80% (females: 82%, males: 78%) was the most testable of the VA tests (P<0.0001). In children aged <3 years testability was low (≤47%) rising to≥80% in children aged≥3. In children≥60 months, testability was higher for the HOTV (94%) than the ETDRS (59%) chart. In those that did two VA tests, mean difference of the ATS HOTV compared with the HOTV(CSV) was -0.1, and compared with ETDRS was -0.12 (P<0.0001).
Conclusions:
Children aged <3 years had poor VA testability, whereas those 3 years and above were highly testable using the ATS HOTV. The HOTV (CSV) retro-illuminated test was appropriate for children aged >5 years, and may be possible in younger children with early educational exposure. When comparing VA measures using these tests, the higher VA attained using the ATS HOTV, needs to be taken into account.
