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Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Investigation of the Visual Acuity Test Success Rate of a New Child-Friendly Minimum-Separable Chart for 2- and
1Department of Rehabilitation, Orthoptics and Visual Science Course, School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan.
Insights
The new Child-Friendly Minimum-Separable (CFMS) chart significantly improves visual acuity testing cooperation in toddlers aged 2-3 years compared to the standard Landolt ring chart. This new chart is especially beneficial for younger children, enhancing early amblyopia detection.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Visual Science
Background:
- Early detection of amblyopia in toddlers is crucial for effective treatment.
- Conventional Landolt ring charts demonstrate low testability and cooperation rates in 2-3-year-old children.
- A novel Child-Friendly Minimum-Separable (CFMS) chart was developed to address these limitations.
Purpose of the Study:
- To evaluate the practicality of the CFMS chart for visual acuity testing in 2-3-year-old children.
- To compare cooperation rates between the CFMS chart and the standard Landolt ring chart in this age group.
Main Methods:
- A prospective pilot study involved 40 children (20 two-year-olds, 20 three-year-olds).
- Visual acuity was assessed using both Landolt ring and CFMS charts in a randomized order.
- Cooperation rates and visual acuity outcomes were analyzed for each chart type.
Main Results:
- The CFMS chart showed significantly higher cooperation rates: 75% in 2-year-olds vs. 15% for Landolt ring (p=0.0005).
- In 3-year-olds, cooperation was 90% with CFMS versus 60% with Landolt ring (p=0.031).
- Age positively correlated with cooperation for both charts, but more strongly for CFMS.
Conclusions:
- The CFMS chart offers a superior alternative to the Landolt ring for visual acuity testing in young children.
- Improved cooperation with the CFMS chart facilitates more reliable amblyopia screening in toddlers.
- The CFMS chart is particularly advantageous for testing 2-year-olds, enhancing early detection capabilities.
Abstract:
Background/Objectives: Early detection and timely treatment of amblyopia require reliable visual acuity testing in toddlers; however, conventional Landolt ring charts often show poor testability in 2-3-year-old children. Therefore, we aimed to verify the practicality of a new Child-Friendly Minimum-Separable (CFMS) chart for 2-3-year-old children by comparing cooperation rates with the standard Landolt ring visual acuity chart. Methods: A prospective pilot study was conducted on 20 children aged 2 years (30.6 ± 3.2 months) and 20 children aged 3 years (41.8 ± 3.9 months). Right-eye visual acuity was tested in random order using the Landolt ring (four options, 3/5 considered correct) and the CFMS chart (two options, 3/3 considered correct). Test cooperation rates and visual acuity were analyzed. Results: In the 2-year-olds, the cooperation rate was 15% and 75% for the Landolt ring and CFMS chart, respectively (p = 0.0005). Twelve children refused to cooperate with the Landolt ring but cooperated with the CFMS chart; the reverse did not occur. In the 3-year-olds, the cooperation rate was 60% and 90% for the Landolt ring and CFMS chart, respectively (p = 0.031); six children cooperated only with the CFMS chart. The odds ratio for cooperation per additional month of age was 1.34 (95% confidence interval [CI]: 1.12-1.59; p = 0.001) and 1.24 (95% CI: 1.03-1.50; p = 0.026) for the Landolt ring and CFMS chart, respectively. Conclusions: Compared to the Landolt ring, the CFMS chart significantly improves cooperation rates for visual acuity testing in 2-3-year-old children, especially among 2-year-olds.
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