Symbol Discrimination Speed in Children With Visual Impairments

We measured visual acuity and visual discrimination speed simultaneously in children with visual impairments to determine whether they are slower than children with normal vision.

Five- to twelve-year-old children with visual impairments due to ocular dysfunction (VIo; n = 30) or cerebral visual impairment (CVI; n = 17) performed a speed-acuity test in which they indicated the orientation of Landolt-C symbols as quickly and accurately as possible. The reaction times for symbols ranging between -0.3 and 1.2 logMAR relative to acuity threshold were compared with normative data. To test whether children were already slow in merely detecting symbols, we also compared their reaction times on a simple visual detection task (VDT) to normative data. An auditory detection task (ADT) was used to probe for other, more general deficits.

Of the children with visual impairments, 88% had abnormally long reaction times in the speed-acuity test. This deficit was partly explained by their reduced acuity, but 40% still needed more time to discriminate acuity-matched optotypes. Children responded late in the VDT too, especially those with CVI, but this impairment could not fully account for their slow symbol discrimination. In children with CVI, reaction times in the ADT were affected as much as those in the VDT, suggesting more general sensorimotor problems in CVI.

The speed-acuity test offers additional insight in visual impairment. Children with VIo and CVI are abnormally slow in discerning foveal details. Magnification of materials is often insufficient to compensate for this deficit, partly because stimulus detection is already hampered.