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Impact of Children's Postural Variation on Viewing Distance and Estimated Visual Acuity
Lisa M Hamm1,2, Kishan Mistry1, Joanna M Black1,2
1School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.
Insights
Children frequently move during visual acuity tests, potentially overestimating results. Real-time distance tracking can improve accuracy for near and intermediate vision assessments in children.
Area of Science:
- Ophthalmology
- Pediatric Vision
- Human Factors in Testing
Background:
- Accurate visual acuity measurement requires fixed viewing distances.
- Chin rests are often impractical for pediatric vision screening.
- Children's movement during testing can impact results.
Purpose of the Study:
- Quantify children's movement during near and intermediate visual acuity tests.
- Assess the impact of movement on acuity measurements.
- Investigate the feasibility of real-time distance correction.
Main Methods:
- Thirty-three 7-year-old children participated in tablet-based acuity tests.
- A trained lay screener administered tests in the child's home.
- Tablet webcam tracked children's position during testing for distance estimation.
Main Results:
- At 40 cm, 18% of trials showed movement affecting acuity, leading to overestimations in 16% of tests.
- At 150 cm, initial positioning was less accurate, but movement had less impact.
- Overall, 8% of 150 cm tests overestimated acuity by more than 0.1 logMAR.
Conclusions:
- Children exhibit significant movement during near and intermediate visual acuity assessments.
- Real-time distance monitoring using camera-enabled devices is feasible.
- Correcting for movement can enhance the accuracy of visual acuity measures in children.
Purpose:
Reliable estimation of visual acuity requires that observers maintain a constant distance from the target, but use of chin rests is not always feasible. Our aim was to quantify children's movement during community testing and its impact on near (40 cm) and intermediate (150 cm) acuity measures.
Methods:
Thirty-three 7-year-old children performed several acuity tests run on a tablet computer, administered in the child's home by a trained lay screener. The tablet webcam was used to derive a continuous estimate of the child's position during testing. We estimated acuity using both the recommended viewing distance and using trial-by-trial estimates of the child's physical distance from the screen.
Results:
Although initial positioning in the 40-cm viewing distance condition was accurate, on 18% of trials children moved sufficiently to support a 0.1 logMAR improvement in acuity, leading 16% of staircases to overestimate acuity by more than one line. Initial positioning for the 150-cm condition was less accurate, but the longer viewing distance minimized the impact of children's movement on the visual angle of the target. Overall, at 150 cm 8% of staircases were overestimated by more than 0.1 logMAR.
Conclusions:
Children move substantially during intermediate and near acuity tests despite assessors encouraging maintenance of the correct viewing distance.
Translational Relevance:
Real-time estimates of the child's physical distance from the target are possible when assessments are conducted on camera-enabled devices. Correction for movement will likely lead to more accurate measures of near and intermediate visual acuity.