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Updated: Jan 10, 2026
Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
A Novel Eye Tracking-Based Gamified Assessment of Contrast Sensitivity Function in Children: Prospective Development
Yunsi He1, Yijing Zhuang1, Lei Feng1
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie South Road, Guangzhou, 510060, China, 86 020 8733 0351.
Background:
Reliable assessment of visual function in young children remains a challenge. Contrast sensitivity function (CSF) is a sensitive and fundamental index of visual performance, yet existing pediatric CSF assessments lack objectivity and adaptability. To bridge this methodological gap, we developed a novel eye tracking-based gamified contrast sensitivity function (ETGCSF) tool that integrates gaze-based detection with interactive gameplay to objectively quantify CSF in an engaging and child-centered manner.
Objective:
This study aimed to (1) establish the feasibility and test-retest reliability of the ETGCSF tool in preschool-aged children and (2) evaluate whether optimization using adaptive algorithms and enhanced gamification elements could improve test efficiency while maintaining reliability.
Methods:
This was a prospective study with 2 sequential cohorts. A total of 80 Chinese children aged 3 to 6 years were pragmatically recruited from Zhongshan Ophthalmic Center between May 2021 and July 2023. On the basis of timing of data collection, 35% (28/80) of the children were included in experiment 1 (mean age 5.24, SD 0.15 years), and 65% (52/80) were included in experiment 2 (mean age 4.76, SD 0.11 years). Children completed 2 runs of ETGCSF test. Experiment 1 used the baseline ETGCSF protocol, and experiment 2 used the optimized protocol. Primary outcomes were test-retest reliability of the area under the log contrast sensitivity function curve (AULCSF) and CSF acuity, reported as intraclass correlation coefficients (ICCs) with 95% CIs.
Results:
In experiment 1, the ETGCSF tool showed strong reliability, with ICCs of 0.890 (95% CI 0.741-0.951) for AULCSF and 0.890 (95% CI 0.763-0.949) for CSF acuity. The median test duration was 482 (IQR 451-569) seconds. In experiment 2, the optimized ETGCSF reduced median test duration to 241 (IQR 189-296) seconds (P<.001) while maintaining comparable reliability. AULCSF estimates varied by 0.03 log units across 2 runs (95% CI -0.51 to 0.57; t51=0.749; P=.46), with an ICC of 0.851 (95% CI 0.740-0.914; P<.001) that was not significantly different from that of experiment 1 (z=0.660; P=.51). Similarly, CSF acuity estimates varied by 0.004 log units (95% CI -0.33 to 0.32; t51=0.192; P=.85), with an ICC of 0.832 (95% CI 0.708-0.904; P<.001), also comparable to that of experiment 1 (z=-0.925; P=.36).
Conclusions:
This study introduces a paradigm shift in pediatric visual assessment by leveraging objective eye tracking and gamified engagement to transform contrast sensitivity testing into a scalable, child-friendly process. The ETGCSF tool demonstrated strong reliability and markedly improved efficiency in assessing CSF in preschool children aged 3 to 6 years. These findings support ETGCSF as a promising tool for real-world clinical practice, and its modular design holds potential for future adaptations ranging from streamlined rapid screening in very young children to full CSF profiling for research.
