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Interobserver reliability of the Teller Acuity Card procedure in pediatric patients
Insights
Teller Acuity Card testing shows reliable grating acuity estimates in children with visual or neurologic abnormalities. Despite longer testing times in this group, the accuracy of visual acuity measurements remains consistent compared to healthy children.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Neuroscience
Background:
- Assessing visual acuity in infants and children with ocular or neurologic conditions is crucial for timely intervention.
- Teller Acuity Card (TAC) testing is a common method for estimating grating acuity in young children.
- Understanding the reliability of TAC in atypical pediatric populations is essential for clinical practice.
Purpose of the Study:
- To compare interobserver agreement for Teller Acuity Card (TAC) grating acuity estimates.
- To evaluate TAC reliability between children with ocular/neurologic abnormalities and healthy preterm children.
Main Methods:
- 57 children (3-38 months) with suspected visual impairment (clinical group) and 57 age-matched healthy preterm children (control group) were recruited.
- Two independent observers assessed each child's grating acuity using TAC, with monocular and binocular testing.
- Interobserver agreement was assessed for grating acuity and interocular acuity difference.
Main Results:
- High interobserver agreement (≥1 octave) was observed in both groups: 91% (monocular) and 96% (binocular) for clinical, and 95% (monocular) and 96% (binocular) for control.
- Interobserver agreement for interocular acuity difference was 88% in both clinical and control groups.
- Testing time was significantly longer in the clinical group, indicating greater testing difficulty.
Conclusions:
- Teller Acuity Card testing demonstrates consistent reliability for estimating grating acuity in children with ocular or neurologic abnormalities.
- The findings support the use of TAC by experienced testers in both healthy and atypical pediatric populations.
- While children with abnormalities may require more time, TAC provides dependable visual acuity data.
Purpose:
To compare interobserver agreement for Teller Acuity Card estimates of grating acuity between children with ocular or neurologic abnormalities, or both, and age-matched healthy preterm children.
Methods:
Subjects were 57 children, 3 to 38 months of age, who were referred for visual assessment because of diagnosed or suspected visual impairment (clinical group), and 57 healthy preterm children with no known visual or neurologic abnormalities (control group), each of whom was matched to a clinical subject, based on corrected age at the time of testing, and type of testing (monocular or binocular). Each child's grating acuity was tested by two independent observers.
Results:
Interobserver agreement of 1 octave or better was found in 91% of the monocular and 96% of the binocular clinical test-retest comparisons and in 95% of the monocular and 96% of the binocular control comparisons. For estimates of interocular acuity difference, interobserver agreement of 1 octave or better was found in 88% of clinical subjects and 88% of control subjects. Average test time was significantly longer in the clinical group (4.1 minutes [SD = 1.9] for monocular and 3.6 minutes [SD = 1.9] for binocular tests) than in the control group (2.5 minutes [SD = 0.9] for monocular and 2.4 minutes [SD = 0.6] for binocular tests), suggesting that children in the clinical group were more difficult to test.
Conclusions:
Teller Acuity Card testing conducted by experienced testers is as reliable in children with mild to severe ocular or neurologic abnormalities as it is in healthy children, even though children with abnormalities may be more difficult to test.