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. 2022 Dec;36(12):2341-2345.
doi: 10.1038/s41433-021-01840-3. Epub 2022 Jan 6.

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 M McVeigh  1   2 , Siobhán M Ludden  1   3   4 , Sahra Mohamed  5 , Nilpa Shah  1   2 , Pádraig J Mulholland  1   2   6 , Annegret Dahlmann-Noor  7   8   9   10
Affiliations

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 M McVeigh et al. Eye (Lond). 2022 Dec.

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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Conflict of interest statement

PJM: Heidelberg Engineering & LKC Inc. (research support). NS: The Moorfields Acuity Chart (co-inventor) and COMPlog Clinical Vision Measurement Systems Ltd. (research support). AD-N: Santen Inc. (medical advisor).

Figures

Fig. 1
Fig. 1. The Auckland Optotypes.
An illustration of The Auckland Optotypes in both regular and vanishing forms.
Fig. 2
Fig. 2
a–c Bland–Altman LoA plots indicate good agreement between TAO and crowded logMAR letters for the amblyopic eye (a), fellow eye (b) and interocular difference measures (c). 95% confidence intervals surrounding the 95% LOA are represented by grey shading with different plot markers for each test site. d–f Equality plots comparing TAO and logMAR. Ordinary least-squares linear regression line is included (black) along with an equality line (grey).
Fig. 3
Fig. 3
Interaction plots examining the effect of a experimental site and chart form, b logMAR letter VA level in the amblyopic eye (amblyopia severity) and chart form, and c logMAR letter VA level in the amblyopic eye (amblyopia severity) with test site on IOD values.
See this image and copyright information in PMC

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