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Published on: March 17, 2023
Validation of clinical tools to measure grating acuity and contrast sensitivity in children with cerebral visual
Rebecca Sumalini1, Ahalya Subramanian2, Miriam L Conway2
1Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India; Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India; Department of Optometry and Visual Science, School of Health & Medical Sciences, City St George's, University of London, London, United Kingdom.
Insights
Validated clinical tools for assessing visual function in children with cerebral visual impairment (CVI) are lacking. This study found Teller Acuity Cards-II (TAC-II) and Ohio Contrast Cards (OCC) offer better repeatability for grating acuity and contrast sensitivity, respectively.
Area of Science:
- Ophthalmology
- Pediatrics
- Clinical Assessment
Background:
- Cerebral visual impairment (CVI) affects visual function in children.
- Validated clinical tools for measuring visual function in children with CVI are scarce.
- Accurate assessment is crucial for timely intervention and management of CVI.
Purpose of the Study:
- To evaluate and compare the clinical utility of different visual function assessment tools in children with and without CVI.
- To assess the repeatability and testability of grating acuity (GA) and contrast sensitivity (CS) measurement tools.
- To guide the selection of appropriate clinical tools for CVI assessment.
Main Methods:
- Recruited children aged 6 months to 7 years with (n=111) and without CVI (n=50).
- Assessed GA using Teller Acuity Cards-II (TAC-II) and Peekaboo Vision app (PV app).
- Measured CS using Hiding Heidi low contrast face cards (HH cards) and Ohio Contrast Cards (OCC).
- Conducted retests within one month and analyzed intra-examiner repeatability.
Main Results:
- Both TAC-II and PV app showed significant differences in GA measurements between groups.
- HH cards and OCC also exhibited significant differences in CS measurements.
- TAC-II demonstrated better repeatability for GA than the PV app in children with CVI.
- OCC showed better repeatability for CS than HH cards in children with CVI.
- TAC-II and OCC exhibited comparable testability, testing time, and engagement scores.
Conclusions:
- Teller Acuity Cards-II (TAC-II) and Ohio Contrast Cards (OCC) are more repeatable for assessing grating acuity and contrast sensitivity, respectively, in children with CVI.
- Clinical tools for visual function assessment in CVI should not be used interchangeably.
- Clinicians must consider the repeatability indices of each test when interpreting results for children with CVI.
Abstract:
There is a lack of validated clinical tools to measure visual functions in children with cerebral visual impairment (CVI). This study addresses this gap. Children aged 6 months-7 years with and without CVI (CVI, n = 111, mean age: 3.0 ± 1.9 years; 70.2 % male and without CVI, n = 50, mean age: 3.4 ± 1.9 years; 38 % male) were recruited. Grating acuity (GA) was evaluated using Teller Acuity Cards-II (TAC-II) and the Peekaboo Vision app (PV app), and contrast sensitivity (CS) using Hiding Heidi low contrast face cards (HH cards) and Ohio Contrast Cards (OCC). Retests were conducted within one month. The mean difference between the PV app and TAC-II was significant (CVI: -0.25 ± 0.40 logMAR, 95 % LoA: -1.03 to 0.53 logMAR; controls: -0.14 ± 0.30 logMAR, 95 % LoA: -0.72 to 0.44 logMAR). The median difference between the HH cards and OCC was also significant (CVI: 0.00 logCS, IQR: 0.25 logCS, 95 % LoA: -0.43 to 0.67 logCS; controls: 0.25 logCS, IQR: 0.00 logCS, 95 % LoA: -0.01 to 0.56 logCS). Intra-examiner repeatability analysis in children with CVI (n = 21) and controls (n = 16) revealed that TAC-II (CR, CVI = 0.47, controls = 0.27) had better repeatability than the PV app (CR, CVI = 0.99, controls = 0.41), while OCC (CR, CVI = 0.45, controls = 0.19) had better repeatability than HH cards (CR, CVI = 0.90, controls = 0.60). TAC-II and OCC demonstrated better repeatability and comparable testability, testing time, and engagement scores for GA and CS tests respectively in children with CVI. Findings indicate that clinical tools should not be used interchangeably, and clinicians must carefully interpret results based on each test's repeatability indices.
