Recognition acuity in children measured using The Auckland Optotypes.

Area of Science:

• Ophthalmology
• Pediatric Vision
• Optometry

Background:

• Electronic Visual Acuity (EVA) systems using Sloan letters are standard for research visual acuity (VA) measurement.
• Traditional letter optotypes may not be suitable for young children.
• The Auckland Optotypes (TAO) offer a new, open-access set of pictograms in regular and vanishing formats.

Purpose of the Study:

• To assess the feasibility of using both regular and vanishing formats of TAO for measuring VA in children.
• To evaluate TAO's effectiveness in a community setting using a Bayesian adaptive staircase.
• To compare TAO's performance against the gold standard EVA and a handheld screener.

Main Methods:

• 121 children aged 5-12 years were tested with TAO (regular and vanishing), Parr vision test, and EVA.
• Feasibility was measured using limits of agreement (LoA) with EVA, area under the receiver operating characteristic curve (AUC), and trial-by-trial responses.
• Bayesian adaptive staircase was employed for VA measurement.

Main Results:

• TAO demonstrated good agreement with EVA (LoA ±0.14-0.15 logMAR), comparable to test-retest reliability.
• TAO tests were highly effective in identifying vision impairment (AUC 0.95-0.96), outperforming the Parr test (AUC 0.82).
• Fewer trials (approx. 6-10) were sufficient for accurate screening and good agreement.

Conclusions:

• Both regular and vanishing formats of TAO are feasible for threshold VA assessment in children.
• TAO provides a viable and effective tool for vision screening in pediatric populations.
• The pictographic nature of TAO may enhance its suitability for young children.