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Updated: Jul 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
Comparison of Eye Tracking and Teller Acuity Cards for Visual Acuity Assessment in Pediatric Cortical/Cerebral Visual
Melinda Y Chang1, Mark S Borchert1
1From The Vision Center at the Children's Hospital Los Angeles (M.Y.C., M.S.B.), Los Angeles, California, USA; Roski Eye Center, University of Southern California (M.Y.C., M.S.B.), Los Angeles, California, USA.
Insights
Eye tracking offers more reliable visual acuity assessment in children with cerebral visual impairment (CVI) compared to Teller acuity cards. This objective method shows stronger correlation with visual behavior assessments.
Area of Science:
- Ophthalmology
- Neuroscience
- Pediatrics
Background:
- Cerebral visual impairment (CVI) significantly impacts visual development in children.
- Accurate assessment of visual acuity is crucial for effective intervention in pediatric CVI.
- Traditional methods like Teller acuity cards (TAC) may have limitations in reliability for this population.
Purpose of the Study:
- To compare the reliability and validity of eye tracking versus TAC for visual acuity measurement in children with CVI.
- To evaluate the correlation of these methods with established visual behavior assessments.
Main Methods:
- A reliability and validity study involving 41 children diagnosed with CVI.
- Visual acuity was measured using eye tracking and TAC by masked examiners at baseline and 1 month.
- Visual behavior was assessed using the Visual Behavior Scale (VBS) by pediatric neuro-ophthalmologists.
Main Results:
- Eye tracking demonstrated excellent test-retest reliability (ICC = 0.81) for visual acuity.
- TAC showed only fair test-retest reliability (ICC = 0.42) in the pediatric CVI cohort.
- Eye tracking grating acuity strongly correlated with VBS scores (r = 0.72), surpassing TAC's correlation (r = 0.50).
Conclusions:
- Eye tracking provides a more reliable and valid measure of visual acuity in children with CVI compared to TAC.
- Objective eye tracking may offer superior accuracy over subjective human assessment for visual function in CVI.
- Further research is recommended to establish optimal longitudinal assessment methods for visual function in CVI.
Purpose:
To compare eye tracking and Teller acuity cards (TAC) for assessment of visual acuity in children with cortical, or cerebral, visual impairment (CVI).
Design:
Reliability and validity study.
Methods:
We recruited 41 children with CVI from a single academic pediatric neuro-ophthalmology clinic. All children performed eye tracking to measure visual acuity, and 26 children completed TAC assessment by a masked examiner. Additionally, 2 pediatric neuro-ophthalmologists graded visual behavior using the 6-level Visual Behavior Scale (VBS). Eye tracking and TAC were performed at baseline and at 1 month. Test-retest reliability of eye tracking and TAC were assessed using the intraclass correlation coefficient (ICC). Eye tracking and TAC visual acuities were correlated with one another and VBS scores using the Spearman correlation coefficient.
Results:
Test-retest reliability was excellent for eye tracking measurement of visual acuity (ICC = 0.81, P < .0001). For pediatric CVI, TAC test-retest reliability was fair (ICC = 0.42, P = .04). There was a moderate correlation between eye tracking and TAC (r = 0.43, P = .03) and between TAC and VBS score (r = 0.50, P = .009), and a strong correlation between eye tracking grating acuity and VBS score (r = 0.72, P < .0001).
Conclusions:
In our cohort of children with CVI, grating acuity measured by eye tracking demonstrated higher test-retest reliability and stronger correlation with pediatric neuro-ophthalmologic assessment of visual behavior than Teller acuity. Objective determination of gaze direction by an eye tracking camera may be more accurate than human assessment in this population. Future research is needed to determine the optimal methods of longitudinal assessment of visual function and functional vision in children with CVI.
