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Assessment of near visual acuity in 0-13 year olds with normal and low vision: a systematic review
Bianca Huurneman1,2, F Nienke Boonstra3,4
1Department Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. B.Huurneman@donders.ru.nl.
Insights
Choosing the right vision test for children is crucial. This review recommends specific near visual acuity tests based on age, from preferential looking for infants to ETDRS charts for older children.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Developmental Pediatrics
Background:
- Near vision assessment is vital for visually impaired children's rehabilitation.
- Current guidelines for near visual acuity assessment in children are insufficient.
Purpose of the Study:
- To review the impact of chart design on measured near visual acuity.
- To identify optimal near vision assessment methods for different pediatric age groups.
Main Methods:
- Systematic literature search of PubMed, Cochrane Library, and EMBASE databases.
- Included studies identified through expert contact and reference list searches.
- Keywords: vision test, vision assessment, visual acuity, chart, near.
Main Results:
- Preferential looking is the standard for 0-3 years; norms exist for 6-36 months.
- LEA symbols recommended for 4-7 years (preliterate, matching responses).
- ETDRS letter charts recommended for 8-13 years (predictive of reading, symbol acuity is lower).
Conclusions:
- Chart design, viewing distance, and threshold choice significantly affect near visual acuity.
- Symbol acuity is lower than grating acuity; letter acuity is lower than symbol acuity.
- Adapt test parameters to child's development for accurate, comparable measurements.
Background:
The inclusion for rehabilitation of visually impaired children is partly based on the measurement of near vision, but guidelines for near visual acuity assessment are currently lacking. The twofold purpose of this systematic review was to: (i) provide an overview of the impact of the chart design on near visual acuity measured, and (ii) determine the method of choice for near vision assessments in children of different developmental ages.
Methods:
A literature search was conducted by using the following electronic databases: PubMed, Cochrane Library, and EMBASE. The last search was run on March 26th 2016. Additional studies were identified by contacting experts and searching for relevant articles in reference lists of included studies. Search terms were: vision test(s), vision assessment(s), visual acuity, chart(s) and near.
Results:
For children aged 0-3 years the golden standard is still the preferential looking procedure. Norms are available for this procedure for 6-36 month old children. For 4-7 year olds, we recommend using the LEA symbols, because these symbols have been properly validated and can be used in preliterate children. Responses can be verbal or by matching the target symbol. In children aged 8-13 years, the recommended method is the ETDRS letter chart, because letter acuity is more predictive for functional vision and reading than symbol acuity. In 8-13 year olds, letter acuity is 0.1-0.2 logMAR poorer than symbol acuity.
Conclusions:
Chart design, viewing distance, and threshold choice have a serious impact on near visual acuity measurements. Near visual acuity measured with symbols is lower than near visual acuity measured with gratings, and near visual acuity measured with letters is lower than near visual acuity measured with symbols. Viewing distance, chart used, and letter spacing should be adapted to the child's development and reported in order to allow comparisons between measurements.
