Non-Instrumented DVA: Assessment of Performance and Clinical Feasibility in Children Ages 2 Through 13 Years

Background/Objectives: Vestibular disorders can have functional consequences for children, including balance and gross motor delays, academic difficulties and behavioral manifestations; however, they are frequently undiagnosed in children. The purposes of this study were to evaluate the feasibility and clinical utility of performing a non-instrumented dynamic visual acuity (DVA) test as a primary screening tool for children and to examine typical performance on this non-instrumented DVA test in a large sample of children ages 2 through 13 years. Methods: A clinical DVA test was administered to a convenience sample of 208 children aged 2-13 years. Static visual acuity was assessed using a standard Snellen or LEA eye chart, depending on the child's ability to read letters. Dynamic visual acuity was then measured while the examiner manually rotated the child's head at 2 Hz (240 bpm). DVA was calculated as the number of lines of visual acuity lost with head movement. Results: All children aged 4 years and older and 67% of 3-year-olds successfully completed DVA testing. Most 2-year-olds and 33% of 3-year-olds were unable to complete DVA testing. Although the number of visual acuity lines lost with rotational head oscillations at 2 Hz varied between age groups, Kruskal-Wallis test indicated no significant difference in DVA scores between age groups (K = 12.721, DF = 9, P = 0.176). Ninety percent of children who were able to perform DVA testing lost two or fewer lines of visual acuity with head rotations consistent with adult norms. Conclusions: This method of DVA testing is an easily accessible and promising clinically feasible screening tool for identifying children with vestibular dysfunction. The authors recommend widespread vestibular screening of children to facilitate rapid referral for diagnosis and treatment of children with vestibular dysfunction.