Is LEA symbol better compared to Snellen chart for visual acuity assessment in preschool children?

Area of Science:

• Ophthalmology
• Pediatric Optometry
• Vision Science

Background:

• Accurate visual acuity (VA) measurement is crucial for early detection of vision impairments in preschool children.
• Traditional charts like the Snellen E test may present challenges for very young children due to their design.
• Alternative charts, such as the LEA symbol chart, are designed for improved recognition by preschool-aged individuals.

Purpose of the Study:

• To compare the visual acuity measurements obtained using the LEA symbol chart versus the Snellen E test chart.
• To assess the agreement between these two visual acuity testing methods in preschool children aged 3-5 years.

Main Methods:

• Fifty emmetropic preschool children (3-5 years old) without ocular abnormalities were included.
• Visual acuity was tested monocularly using both Snellen E and LEA symbol charts following a pseudo-randomized protocol.
• Interclass correlation coefficient (ICC) was used to assess agreement, and Mann-Whitney U test compared the results.

Main Results:

• The Interclass correlation coefficient (ICC) indicated only fair agreement between the LEA symbol chart and Snellen E chart (ICC=0.256 for right eye, 0.213 for left eye).
• A statistically significant difference (p < 0.000) was found when comparing visual acuity scores obtained from the two charts.
• The LEA symbol chart yielded significantly higher visual acuity scores compared to the Snellen E chart.

Conclusions:

• The LEA symbol chart demonstrates fair agreement with the Snellen E chart for visual acuity assessment in preschool children.
• Clinicians should be aware that the LEA symbol chart tends to report higher visual acuity scores than the Snellen E chart.
• The LEA symbol chart may offer a more sensitive measure for visual acuity in this age group.