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Updated: Oct 9, 2025
Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Web-based visual acuity testing for children
Eileen E Birch1, Lindsey A Hudgins2, Reed M Jost2
1Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
A new web-based system for at-home pediatric visual acuity testing shows excellent agreement with in-office eye exams. This approach can help maintain continuous vision care for children, especially when travel is difficult.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Digital Health
Background:
- Accurate visual acuity testing is crucial for early detection and management of pediatric vision disorders.
- Traditional in-office testing can present logistical challenges for families, potentially leading to delayed or missed appointments.
- Web-based technologies offer a promising avenue for remote health monitoring and patient engagement.
Purpose of the Study:
- To evaluate a novel web-based system for conducting pediatric visual acuity tests at home.
- To compare the results obtained from the at-home system with standard in-office visual acuity assessments.
Main Methods:
- Sixty-five children aged 3-12 years, with and without visual deficits, participated in the study.
- Monocular visual acuity was assessed in-office using the ATS-HOTV (ages 3-6) or E-ETDRS (ages 7-12) protocols.
- Families received a link to a web-based version of the same tests for at-home administration; equivalence was analyzed using linear mixed models.
Main Results:
- For the ATS-HOTV protocol, the mean difference between in-office and at-home results was 0.01 log MAR (95% CI, -0.06 to 0.09).
- For the E-ETDRS protocol, the mean difference was 0.04 log MAR (95% CI, -0.06 to 0.14).
- These findings indicate excellent concordance between at-home and in-office visual acuity measurements.
Conclusions:
- The developed web-based system for at-home pediatric visual acuity testing demonstrates high concordance with in-office testing.
- At-home testing can be a valuable tool to ensure continuity of care, particularly for families facing travel burdens.
- This technology may help prevent discontinuation or delays in essential vision care for children.
Purpose:
To evaluate a newly developed, web-based system for at-home pediatric visual acuity testing and to compare results with standard in-office visual acuity test results.
Methods:
Children aged 3-12 years with and without visual deficits were enrolled (N = 65; 130 eyes). Monocular visual acuity was tested in-office using the ATS-HOTV (ages 3-6) or E-ETDRS (ages 7-12) protocol. Each child's family was emailed a link to a web-based version of the same visual acuity test for at-home testing. Equivalence was evaluated by using a linear mixed model to estimate the mean difference between in-office and at-home visual acuity test results and the corresponding two-sided 95% confidence interval.
Results:
For children tested with the ATS-HOTV protocol, the mean difference between in-office and at-home visual acuity test results was 0.01 log MAR (95% CI, -0.06 to 0.09). For children tested with the E-ETDRS protocol, the mean difference was 0.04 log MAR (95% CI, -0.06 to 0.14).
Conclusions:
At-home, web-based ATS-HOTV and E-ETDRS visual acuity test results had excellent concordance with in-office visual acuity testing. If the burden of travel is significant, at-home testing of children's visual acuity may provide the information needed to continue care when it might otherwise be discontinued or delayed.
