Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters

Emma McVeigh; Siobhán Ludden; Sahra Mohamed; Nilpa Shah; Pádraig Mulholland; Annegret Dahlmann-Noor

doi:10.1038/s41433-021-01840-3

Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters

Emma McVeigh, Siobhán Ludden, Sahra Mohamed, Nilpa Shah, Pádraig Mulholland, Annegret Dahlmann-Noor

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Abstract

Background/aims: Amblyopia is the most common visual deficit in children and accurate visual acuity (VA) assessment is essential for diagnosis. While ETDRS high-contrast logMAR VA is the reference standard test for adults, less agreement exists for pre-literate children. A new picture optotype acuity test (The Auckland Optotypes [TAO]) has shown favourable comparison to letter acuity charts but has not yet been evaluated in children with amblyopia. This study aimed to compare VA obtained using TAO to crowded logMAR letters in children age 5–8 years with amblyopia. Methods: Children with amblyopia (n = 54 [20.37% strabismic, 18.52% anisometropic, 61.11% mixed], mean age 78.30 ± 11.72 months) were recruited from paediatric ophthalmology/orthoptic clinics at Moorfields Eye Hospital NHS Foundation Trust, London, and Cambridge Community Services NHS Trust, Bedford. Best-corrected VA was measured in both the amblyopic eye (AE) and fellow eye (FE) using TAO and a crowded letter acuity chart. Bland–Altman analysis was used to measure 95% limits of agreement (LoA) for VA measures captured (AE, FE and interocular difference [IOD]). Results: Good agreement between TAO and letter VA measurement was observed (mean bias: AE –0.01, FE 0.01, IOD –0.02). For AE measures 95% LoA were from –0.25 to 0.24 logMAR, this being similar for FE (–0.24 to 0.25) and IOD measures (–0.30 to 0.27). Conclusion: TAO and letters elicited similar VA in children with amblyopia. TAO could be a useful picture-based chart for paediatric vision assessment.

Original language	English
Pages (from-to)	1-5
Number of pages	5
Journal	EYE
Early online date	6 Jan 2022
DOIs	https://doi.org/10.1038/s41433-021-01840-3
Publication status	Published online - 6 Jan 2022

Bibliographical note

Funding Information:
Supported in part by an in-practice research grant from the College of Optometrists (EMMcV), a research award grant from the British Isles Paediatric Ophthalmology and Strabismus Association (BIPOSA) (SML) and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (AD-N, PJM, NS). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

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title = "Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters",

abstract = "Background/aims: Amblyopia is the most common visual deficit in children and accurate visual acuity (VA) assessment is essential for diagnosis. While ETDRS high-contrast logMAR VA is the reference standard test for adults, less agreement exists for pre-literate children. A new picture optotype acuity test (The Auckland Optotypes [TAO]) has shown favourable comparison to letter acuity charts but has not yet been evaluated in children with amblyopia. This study aimed to compare VA obtained using TAO to crowded logMAR letters in children age 5–8 years with amblyopia. Methods: Children with amblyopia (n = 54 [20.37% strabismic, 18.52% anisometropic, 61.11% mixed], mean age 78.30 ± 11.72 months) were recruited from paediatric ophthalmology/orthoptic clinics at Moorfields Eye Hospital NHS Foundation Trust, London, and Cambridge Community Services NHS Trust, Bedford. Best-corrected VA was measured in both the amblyopic eye (AE) and fellow eye (FE) using TAO and a crowded letter acuity chart. Bland–Altman analysis was used to measure 95% limits of agreement (LoA) for VA measures captured (AE, FE and interocular difference [IOD]). Results: Good agreement between TAO and letter VA measurement was observed (mean bias: AE –0.01, FE 0.01, IOD –0.02). For AE measures 95% LoA were from –0.25 to 0.24 logMAR, this being similar for FE (–0.24 to 0.25) and IOD measures (–0.30 to 0.27). Conclusion: TAO and letters elicited similar VA in children with amblyopia. TAO could be a useful picture-based chart for paediatric vision assessment.",

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T1 - Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters

AU - McVeigh, Emma

AU - Ludden, Siobhán

AU - Mohamed, Sahra

AU - Shah, Nilpa

AU - Mulholland, Pádraig

AU - Dahlmann-Noor, Annegret

N1 - Funding Information: Supported in part by an in-practice research grant from the College of Optometrists (EMMcV), a research award grant from the British Isles Paediatric Ophthalmology and Strabismus Association (BIPOSA) (SML) and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (AD-N, PJM, NS). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Publisher Copyright: © 2021, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

PY - 2022/1/6

Y1 - 2022/1/6

N2 - Background/aims: Amblyopia is the most common visual deficit in children and accurate visual acuity (VA) assessment is essential for diagnosis. While ETDRS high-contrast logMAR VA is the reference standard test for adults, less agreement exists for pre-literate children. A new picture optotype acuity test (The Auckland Optotypes [TAO]) has shown favourable comparison to letter acuity charts but has not yet been evaluated in children with amblyopia. This study aimed to compare VA obtained using TAO to crowded logMAR letters in children age 5–8 years with amblyopia. Methods: Children with amblyopia (n = 54 [20.37% strabismic, 18.52% anisometropic, 61.11% mixed], mean age 78.30 ± 11.72 months) were recruited from paediatric ophthalmology/orthoptic clinics at Moorfields Eye Hospital NHS Foundation Trust, London, and Cambridge Community Services NHS Trust, Bedford. Best-corrected VA was measured in both the amblyopic eye (AE) and fellow eye (FE) using TAO and a crowded letter acuity chart. Bland–Altman analysis was used to measure 95% limits of agreement (LoA) for VA measures captured (AE, FE and interocular difference [IOD]). Results: Good agreement between TAO and letter VA measurement was observed (mean bias: AE –0.01, FE 0.01, IOD –0.02). For AE measures 95% LoA were from –0.25 to 0.24 logMAR, this being similar for FE (–0.24 to 0.25) and IOD measures (–0.30 to 0.27). Conclusion: TAO and letters elicited similar VA in children with amblyopia. TAO could be a useful picture-based chart for paediatric vision assessment.

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Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters

Abstract

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