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Updated: Oct 17, 2025
Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Age norms for grating acuity and contrast sensitivity in children using eye tracking technology
E Esteban-Ibañez1, T Pérez-Roche2,3, E Prieto1,4
1Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain.
Insights
A new digital device using eye tracking technology accurately assesses visual acuity and contrast sensitivity in children. This objective method is reliable for evaluating visual development from infancy.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Biomedical Engineering
Background:
- Visual acuity is the primary method for assessing children's vision, but contrast sensitivity offers complementary data often overlooked in clinical practice.
- Digital devices offer advantages for evaluating visual function, enabling earlier and more comprehensive assessments of visual development.
- Eye tracking technology integrated with digital devices provides objective, rapid, and examiner-independent measurement of visual function in children.
Purpose of the Study:
- To establish age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking.
- To validate a grating acuity test (DIVE VA) against established methods in pediatric populations.
Main Methods:
- Healthy children aged 6 months to 7 years underwent assessment of grating visual acuity (VA) and contrast sensitivity (CS) using the DIVE (Device for an Integral Visual Examination) with eye tracking.
- A preferential gaze paradigm was employed to gather data for age-normative values.
- The DIVE VA test was validated by comparing its results with the LEA grating test (LGT) in children aged 6 months to 4 years.
Main Results:
- Both visual acuity and contrast sensitivity values demonstrated an increase with age, particularly within the first two years of life.
- Validation of the DIVE VA test showed good agreement with the LGT, especially in children under one year of age.
- The DIVE device proved to be an objective and reliable tool for assessing visual function parameters in children.
Conclusions:
- The DIVE device, incorporating eye tracking, offers an automatic, objective, and reliable method for assessing visual function in children.
- The digital approach enhances the evaluation of visual development, even in infants.
- The DIVE device shows strong agreement with traditional visual acuity tests, particularly in early childhood.
Key Messages:
Visual acuity is the most used method to assess visual function in children. Contrast sensitivity complements the information provided for visual acuity, but it is not commonly used in clinical practice. Digital devices are increasingly used as a method to evaluate visual function, due to multiple advantages. Testing with these devices can improve the evaluation of visual development in children from a few months of age. Visual acuity and contrast sensitivity tests, using eye tracking technology, are able to measure visual function in children across a wide range of ages, objectively, quickly and without need of an experienced examiner.
Purpose:
To report age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking technology and to validate the grating acuity test.
Methods:
In the first project of the study, we examined healthy children aged between 6 months and 7 years with normal ophthalmological assessment. Grating visual acuity (VA) and contrast sensitivity (CS) were assessed using a preferential gaze paradigm with a DIVE (Device for an Integral Visual Examination) assisted with eye tracking technology to provide age norms. For the validation project, we compared LEA grating test (LGT) with DIVE VA in a group of children aged between 6 months and 4 years with normal and abnormal visual development.
Results:
Fifty-seven children (2.86 ± 1.55 years) were examined with DIVE VA test and 44 successfully completed DIVE CS test (3.06 ± 1.41 years). Both, VA and CS values increased with age, mainly along the first two years of life. Sixty-nine patients (1.34 ± 0.61 years) were included in the DIVE VA test validation. The mean difference between LGT and DIVE VA was - 1.05 ± 4.54 cpd with 95% limits of agreement (LoA) of - 9.95-7.84 cpd. Agreement between the two tests was higher in children younger than 1 year with a mean difference of - 0.19 ± 4.02 cpd.
Conclusions:
DIVE is an automatic, objective and reliable tool to assess several visual function parameters in children, and it has good agreement with classical VA tests, especially for the first stage of life.
