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Comparative Study
. 2010 Feb;87(2):87-95.
doi: 10.1097/OPX.0b013e3181c750b1.

Effect of age using Lea Symbols or HOTV for preschool vision screening

Vision in Preschoolers (VIP) Study Group
Collaborators
Comparative Study

Effect of age using Lea Symbols or HOTV for preschool vision screening

Vision in Preschoolers (VIP) Study Group. Optom Vis Sci. 2010 Feb.

Abstract

Purpose: To compare the effectiveness of the Lea Symbols and the HOTV distance visual acuity tests, presented monocularly in linear, crowded formats at 3 m, as vision screening tests to identify 3- to 5-year-old children in need of eye care.

Methods: Subjects were 1,142 3- to 5-year-old Head Start children who completed a comprehensive eye examination, used to determine if the child had one or more targeted conditions: amblyopia, strabismus, significant refractive error, or unexplained reduced visual acuity. Each child was tested on both tests by masked examiners, with test order determined randomly. The optotype sizes administered were age-based according to the child's age at school entry on September 1. Children of age 3 were tested with 10/100, 10/32, 10/25, and 10/20 optotypes whereas those who were 4 were tested with 10/100, 10/25, 10/20, and 10/16 optotypes.

Results: Most children (>95%) completed both tests, with no statistically significant differences. Pass/fail cut-offs were set to yield specificities as close as possible to 90%. The largest sensitivity differences observed were in the 3-year-old group (mean age, 45.3 months), where the sensitivity for detection of > or =1 targeted conditions was 61% for the Lea Symbols and was 46% for the HOTV letters (difference 15%, 95% confidence interval: -0.01 to 0.30) and the sensitivity for detection of group 1 conditions was 83% for the Lea Symbols and 57% for the HOTV letters (difference 26%, 95% confidence interval: -0.01 to 0.49). However, neither these differences nor any of the other age group sensitivity differences were statistically significant. For the 3-year-old children, the pass/fail criterion was one line larger for the HOTV letters than for the Lea Symbols.

Conclusions: Most children completed both tests. Although the 3-year-old children achieved better acuity scores with the Lea Symbols test, there were no statistically significant differences in sensitivity between tests for any age group.

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Figures

Figure 1
Figure 1
Photograph of 10/32 line from one page of one flip book from the Lea Symbols test (A) and the HOTV test (B). Reprinted from The Vision in Preschoolers Study Group. Preschool visual acuity screening with HOTV and Lea Symbols: Testability and between-test agreement. Optom Vis Sci 2004;81:678-83.
Figure 1
Figure 1
Photograph of 10/32 line from one page of one flip book from the Lea Symbols test (A) and the HOTV test (B). Reprinted from The Vision in Preschoolers Study Group. Preschool visual acuity screening with HOTV and Lea Symbols: Testability and between-test agreement. Optom Vis Sci 2004;81:678-83.
Figure 2
Figure 2
The ROC curves for the Lea Symbols and HOTV Test for all VIP Study targeted conditions for each of the four age-specific groups of children. (A) Age 3; (B) Age 4 younger; (C) Age 4 older; and (D) Age 5
Figure 3
Figure 3
The ROC curves for the Lea Symbols and HOTV Test for VIP Group 1 conditions for each of the four age-specific groups of children. (A) Age 3; (B) Age 4 younger; (C) Age 4 older; and (D) Age 5
See this image and copyright information in PMC

References

    1. Hartmann EE, Dobson V, Hainline L, Marsh-Tootle W, Quinn GE, Ruttum MS, Schmidt PP, Simons K. Preschool vision screening: summary of a Task Force report. Behalf of the Maternal and Child Health Bureau and the National Eye Institute Task Force on Vision Screening in the Preschool Child. Pediatrics. 2000;106:1105–16. - PubMed
    1. Hered RW, Murphy S, Clancy M. Comparison of the HOTV and Lea Symbols charts for preschool vision screening. J Ophthalmic Nurs Technol. 1997;16:68–73. - PubMed
    1. Schmidt P, Maguire M, Dobson V, Quinn G, Ciner E, Cyert L, Kulp MT, Moore B, Orel-Bixler D, Redford M, Ying GS, the Vision in Preschoolers Study Group Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study. Ophthalmology. 2004;111:637–50. - PubMed
    1. The Vision in Preschoolers Study Group Preschool visual acuity screening with HOTV and Lea symbols: testability and between-test agreement. Optom Vis Sci. 2004;81:678–83. - PubMed
    1. The Vision in Preschoolers (VIP) Study Group Development and implementation of a preschool vision screening program in a mobile setting. NHSA Dialog. 2005;8:16–24.

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