Use of Log-scaled Crowded Visual Acuity Charts in Clinical Studies Regarding Amblyopia

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2019 Jan 25

PMID 30675642

Authors

Asimina Mataftsi

Nikolaos Kappos

Paraskevi Riga

Stamatia Kokkali

Paraskevi Malamaki

Periklis Brazitikos

Anna-Bettina Haidich

Affiliations

Soon will be listed here.

Abstract

Purpose: Log-scaled crowded charts using standardized testing protocol are essential for precise and reproducible visual acuity (VA) testing regarding amblyopia. Despite common acceptance of these standards, current VA testing clinical practice shows considerable diversity. The purpose of this retrospective literature review was to investigate the methodology of VA measurement and reporting in pediatric ophthalmology literature regarding amblyopia.

Methods: We searched PubMed for clinical trials regarding amblyopia, published from January 1994 to July 2016. Primary outcomes included VA measurement methodology, namely use of (a) log-scaled chart, (b) crowded chart, and (c) specified testing protocol. The study design, publication year, and the journal's impact factor were analyzed in relation to the primary outcomes.

Results: Out of the 165 initial reports, 150 were included. VA was measured with a log-scaled chart in 65%, with a crowded chart in 57%, and with a specified protocol in 51% of studies. All three criteria were met in 43% of studies and in multivariable logistic model, they were associated with more recent publication year (odds ratio [OR] = 1.11, 95% confidence interval [95%CI] = 1.03-1.20) and were more likely to be present in higher impact factor journals (OR = 1.42, 95%CI = 1.17-1.72) or randomized controlled trials (OR = 3.09, 95%CI = 1.44-6.59).

Conclusions: In the last two decades, more than half of clinical trials addressing amblyopia have not followed the recommended methodology for optimal visual acuity assessment. Thus, their measurements may have been contaminated with noise, and their respective results and conclusions may include errors. Adhering to optimal, standardized methodology is key to progress in both clinical and research grounds.

References

Rydberg A, ERICSON B, Lennerstrand G, Jacobson L, Lindstedt E . Assessment of visual acuity in children aged 1 1/2-6 years, with normal and subnormal vision. Strabismus. 1999; 7(1):1-24. DOI: 10.1076/stra.7.1.1.656. View

McGraw P, Winn B, Gray L, Elliott D . Improving the reliability of visual acuity measures in young children. Ophthalmic Physiol Opt. 2000; 20(3):173-84. View

Hartmann E, Dobson V, Hainline L, Quinn G, Ruttum M, Schmidt P . Preschool vision screening: summary of a task force report. Ophthalmology. 2001; 108(3):479-86. DOI: 10.1016/s0161-6420(00)00588-1. View

Holmes J, Beck R, Repka M, Leske D, Kraker R, Blair R . The amblyopia treatment study visual acuity testing protocol. Arch Ophthalmol. 2001; 119(9):1345-53. DOI: 10.1001/archopht.119.9.1345. View

Holladay J . Visual acuity measurements. J Cataract Refract Surg. 2004; 30(2):287-90. DOI: 10.1016/j.jcrs.2004.01.014. View

Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M . Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis Sci. 2006; 47(3):1236-40. DOI: 10.1167/iovs.05-0981. View

Elliott M, Firth A . The logMAR Kay picture test and the logMAR acuity test: a comparative study. Eye (Lond). 2007; 23(1):85-8. DOI: 10.1038/sj.eye.6702990. View

Williams M, Moutray T, Jackson A . Uniformity of visual acuity measures in published studies. Invest Ophthalmol Vis Sci. 2008; 49(10):4321-7. DOI: 10.1167/iovs.07-0511. View

Birch E, Strauber S, Beck R, Holmes J . Comparison of the amblyopia treatment study HOTV and the electronic-early treatment of diabetic retinopathy study visual acuity protocols in amblyopic children aged 5 to 11 years. J AAPOS. 2008; 13(1):75-8. PMC: 2721221. DOI: 10.1016/j.jaapos.2008.07.007. View

10.

Koklanis K, Le T, Georgievski Z . The base-to-base induced-tropia prism test for detection of amblyopia: a pilot study. J AAPOS. 2010; 14(6):484-7. DOI: 10.1016/j.jaapos.2010.08.015. View

11.

Li R, Ngo C, Nguyen J, Levi D . Video-game play induces plasticity in the visual system of adults with amblyopia. PLoS Biol. 2011; 9(8):e1001135. PMC: 3166159. DOI: 10.1371/journal.pbio.1001135. View

12.

Bailey I, Lovie-Kitchin J . Visual acuity testing. From the laboratory to the clinic. Vision Res. 2013; 90:2-9. DOI: 10.1016/j.visres.2013.05.004. View

13.

Paudel P, Ramson P, Naduvilath T, Wilson D, Phuong H, Ho S . Prevalence of vision impairment and refractive error in school children in Ba Ria - Vung Tau province, Vietnam. Clin Exp Ophthalmol. 2013; 42(3):217-26. PMC: 4291105. DOI: 10.1111/ceo.12273. View

14.

Blackhurst D, Maguire M . Reproducibility of refraction and visual acuity measurement under a standard protocol. The Macular Photocoagulation Study Group. Retina. 1989; 9(3):163-9. View

15.

Repka M, Kraker R, Dean T, Beck R, Siatkowski R, Holmes J . A randomized trial of levodopa as treatment for residual amblyopia in older children. Ophthalmology. 2015; 122(5):874-81. PMC: 4414716. DOI: 10.1016/j.ophtha.2015.01.002. View

16.

Lovie-Kitchin J . Is it time to confine Snellen charts to the annals of history?. Ophthalmic Physiol Opt. 2015; 35(6):631-6. DOI: 10.1111/opo.12252. View

17.

Elliott D . The good (logMAR), the bad (Snellen) and the ugly (BCVA, number of letters read) of visual acuity measurement. Ophthalmic Physiol Opt. 2016; 36(4):355-8. DOI: 10.1111/opo.12310. View

18.

Tsou B, Bressler N . Visual Acuity Reporting in Clinical Research Publications. JAMA Ophthalmol. 2017; 135(6):651-653. PMC: 5847078. DOI: 10.1001/jamaophthalmol.2017.0932. View

19.

Lovie-Kitchin J . Validity and reliability of visual acuity measurements. Ophthalmic Physiol Opt. 1988; 8(4):363-70. DOI: 10.1111/j.1475-1313.1988.tb01170.x. View

20.

Fern K, Manny R, Davis J, Gibson R . Contour interaction in the preschool child. Am J Optom Physiol Opt. 1986; 63(5):313-8. DOI: 10.1097/00006324-198605000-00002. View