Preschool Visual Acuity Screening with HOTV and Lea Symbols: Testability and Between‐Test Agreement

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  • VGVision in Preschoolers Study Group
    Vision in Preschoolers Study Group
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Abstract
Purpose.: To compare the performance of 3‐ to 5‐year‐old children on visual acuity screening with HOTV letters vs. Lea symbols as optotypes. Methods.: Subjects included 1253 Head Start children who were aged either 3 or 4 years on September 1 of the school year of testing. The sample over‐represented children who had not passed a Head Start screening. Binocular pretesting at 1 m demonstrated the child's ability to identify the optotypes verbally or by matching optotypes on a lap card. Acuity was tested monocularly at 3 m using crowded single lines of optotypes. Lines tested were based on age at the beginning of the school year (September 1) with 3‐year‐old children tested with lines 10/100, 10/32, 10/25, and 10/20 and 4‐year‐old children tested with 10/100, 10/25, 10/20, and 10/16. Results.: Overall, 99% of children were able to complete the binocular pretest for each test successfully, and there was no difference between the tests (p = 0.83). Children's ability to complete the pretest increased slightly with age. HOTV test scores were slightly worse than Lea symbols test scores (p = 0.047), primarily because more children were unable to pass the monocular 10/100 card for the HOTV test than for the Lea symbols test (2.6% vs. 1.3%). The percentage of identical results on HOTV vs. Lea overall was 67.3% and increased significantly with age. When the results were different, 3‐year‐old children, but not 4‐ and 5‐year‐old children, tended to have worse results on the HOTV letter test. Conclusions.: The vision of nearly all 3‐ to 5‐year‐old children can be screened using either HOTV letters or Lea symbols. HOTV letters may be slightly more difficult than Lea symbols for 3‐ to 5‐year‐old children, with the largest difference between acuity results on the two tests occurring in 3‐year‐old children.
Funding Information
  • National Eye Institute
  • National Institutes of Health
  • U.S. Department of Health and Human Services (EY12644 (PS))
  • U.S. Department of Health and Human Services (EY12545 (EC))
  • U.S. Department of Health and Human Services (EY12550 (LC))
  • U.S. Department of Health and Human Services (EY12534 (BM))
  • U.S. Department of Health and Human Services (EY12647 (DOB))
  • U.S. Department of Health and Human Services (EY12648 (PS, MTK))
  • U.S. Department of Health and Human Services (EY12547 (MM))

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