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Test Re-Test Reliability and Validity of Different Visual Acuity and Stereoacuity Charts Used in Preschool Children
Diana Moganeswari1, Jyothi Thomas2, Krithica Srinivasan3
1Post Graduate Student, School of Allied Health Sciences SOAHS, Manipal University , Manipal, India .
Insights
The HOTV chart demonstrates excellent test-retest reliability for preschool vision screening. The Lea chart is a viable alternative, while Frisby and Titmus charts are less reliable for diagnosing visual acuity issues in young children.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Preschool vision screenings are crucial for early detection of visual impairments in children.
- Effective vision tests must be age-appropriate, testable, repeatable, and valid for accurate results.
Purpose of the Study:
- To compare the test-retest reliability, sensitivity, and specificity of various visual acuity and stereo acuity charts in preschool children.
- Evaluate the performance of HOTV, Lea, E-chart, Frisby, and Titmus charts.
Main Methods:
- Assessed monocular visual acuity and stereo acuity in 90 preschool children (36-71 months) using HOTV, Lea, E-chart, Frisby, and Titmus charts.
- Measurements were repeated one week later to assess test-retest reliability.
- Included comprehensive eye examinations for all participants.
Main Results:
- HOTV chart showed the highest test-retest reliability (ICC 0.99), considered the gold standard.
- Lea chart (ICC 0.96) and E-chart (ICC 0.92) also demonstrated good reliability.
- Frisby and Titmus charts had perfect reliability (ICC 1.0) but lower sensitivity and specificity for diagnostic accuracy.
Conclusions:
- The HOTV chart is recommended as the gold standard for preschool vision screening in semi-urban settings.
- The Lea chart is a suitable alternative when the HOTV chart is unavailable.
- Frisby and Titmus charts are useful for screening but have limitations in diagnostic precision.
Background:
Preschool vision screenings are cost effective ways to detect children with vision impairments. The use of any vision tests in children must be age appropriate, testable, repeatable and valid.
Aim:
To compare the test re-test reliability, sensitivity and specificity of different visual acuity and stereo acuity charts used in preschool children.
Materials And Methods:
Monocular visual acuity of 90 subjects (180 eyes) of age 36 to 71 months was assessed with HOTV, Lea and E-chart in a preschool located in a semi urban area, Manipal, Karnataka. After the vision assessment, stereo acuity was recorded using Frisby and Titmus stereo charts followed by comprehensive eye examination. Repeated measurements of visual acuity and stereo acuity were done one week after the initial assessment.
Results:
Mean age of children was 53± 10 months with equal gender distribution. Intra class correlation (ICC) of Lea, HOTV, E-chart, Frisby and Titmus charts were 0.96, 0.99, 0.92, 1.0 and 1.0 respectively. The area under receiver operating curve (ROC) for Lea and E-chart was 0.892 and 0.776. HOTV was considered as the gold standard as it showed the least difference on repeated measurements. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of E-chart was 99, 15, 45, 94 and 21.8 percent, and Lea was 93, 56, 59 and 92 percent. The sensitivity, specificity, PPV and NPV of Frisby was 75, 27, 9, 92 percent were as of Titmus was 75, 13, 8 and 85 percent respectively.
Conclusion:
HOTV chart can be used as the gold standard for measuring visual acuity of pre-schoolers in a semi urban area. Lea chart can be used in the absence of HOTV chart. Frisby and Titmus charts are good screening tools, but with poor diagnostic criteria.
