Screening for Amblyopia: a Comparison of Paediatric Letter Tests

Overview

Journal Br J Ophthalmol

Specialty Ophthalmology

Date 1997 Jun 1

PMID 9274410

Citations 21

Authors

A J Simmers

L S Gray

K Spowart

Affiliations

Soon will be listed here.

Abstract

Aims/background: The measurement of visual acuity is the most widely accepted indicator of amblyopia and is thought by some to be the only effective screening test. The aim of this study was to investigate the effectiveness of the traditional single optotype Sheridan-Gardiner test (SGT) in the measurement of visual acuity and the detection of amblyopia, compared with the log based linear format Glasgow acuity cards (GAC).

Methods: In the present study visual acuity was measured monocularly in 702 primary 1 schoolchildren using both acuity tests.

Results: A significant difference was found in the mean (SD) visual acuity measured with GAC (0.9 (0.08) modified logMAR) and SGT (1.13 (0.09) modified logMAR), df = 632, t = -59.08, p = 0.0001. The majority of children (89.3%) achieved visual acuities better than 6/6 in either eye when using the single optotype test. If the 95% confidence limits for a significant interocular difference in acuity are used as-criteria for the detection of unilateral amblyopia, GAC were found to be the most sensitive, correctly identifying 100%, while SGT identified 55% of the children with unilateral amblyopia.

Conclusion: The results of this study highlight several problems with both the test format and testing procedure in the present school screening system.

Citing Articles

Using a Computerised Staircase and Incremental Optotype Sizes to Improve Visual Acuity Assessment Accuracy.

OConnor A, King C, Milling A, Tidbury L Br Ir Orthopt J. 2022; 18(1):93-100.

PMID: 35938054 PMC: 9306677. DOI: 10.22599/bioj.271.

Visual acuity percentile curves in a Spanish paediatric population.

Navas-Navia B, Garcia-Montero L, Perez-Sanchez B, Villa-Collar C J Optom. 2021; 15(1):69-77.

PMID: 33640320 PMC: 8712613. DOI: 10.1016/j.optom.2021.01.001.

Visual Profile of Children who Passed or Failed the UK School Vision Screening Protocol.

McCullough S, Saunders K Br Ir Orthopt J. 2020; 15(1):36-46.

PMID: 32999973 PMC: 7510406. DOI: 10.22599/bioj.121.

Comparison of the efficacy of Lea Symbol chart and Sheridan Gardiner chart for preschool vision screening.

Paul C, Sathyan S Indian J Ophthalmol. 2018; 66(7):924-928.

PMID: 29941732 PMC: 6032748. DOI: 10.4103/ijo.IJO_1078_17.

The effect of adherence to spectacle wear on early developing literacy: a longitudinal study based in a large multiethnic city, Bradford, UK.

Bruce A, Kelly B, Chambers B, Barrett B, Bloj M, Bradbury J BMJ Open. 2018; 8(6):e021277.

PMID: 29895654 PMC: 6009541. DOI: 10.1136/bmjopen-2017-021277.

References

Pickert S, WACHS H . Stimulus and communication demands of visual acuity tests. Am J Optom Physiol Opt. 1980; 57(12):875-80. DOI: 10.1097/00006324-198012000-00001. View

Ingram R . The possibility of preventing amblyopia. Lancet. 1980; 1(8168 Pt 1):585-7. DOI: 10.1016/s0140-6736(80)91068-5. View

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

Harwerth R, Smith 3rd E, Duncan G, CRAWFORD M, von Noorden G . Multiple sensitive periods in the development of the primate visual system. Science. 1986; 232(4747):235-8. DOI: 10.1126/science.3952507. View

Fern K, Manny R . Visual acuity of the preschool child: a review. Am J Optom Physiol Opt. 1986; 63(5):319-45. DOI: 10.1097/00006324-198605000-00003. View

von Noorden G . A reassessment of infantile esotropia. XLIV Edward Jackson memorial lecture. Am J Ophthalmol. 1988; 105(1):1-10. DOI: 10.1016/0002-9394(88)90113-4. View

Atkinson J, Anker S, Evans C, Hall R . Visual acuity testing of young children with the Cambridge Crowding Cards at 3 and 6 m. Acta Ophthalmol (Copenh). 1988; 66(5):505-8. DOI: 10.1111/j.1755-3768.1988.tb04371.x. View

Fielder A . The management of squint. Arch Dis Child. 1989; 64(3):413-8. PMC: 1791939. DOI: 10.1136/adc.64.3.413. View

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

10.

Bailey I, Bullimore M, Raasch T, Taylor H . Clinical grading and the effects of scaling. Invest Ophthalmol Vis Sci. 1991; 32(2):422-32. View

11.

Harwerth R, Smith 3rd E, CRAWFORD M, von Noorden G . Behavioral studies of the sensitive periods of development of visual functions in monkeys. Behav Brain Res. 1990; 41(3):179-98. DOI: 10.1016/0166-4328(90)90107-p. View

12.

McGraw P, Winn B . Glasgow Acuity Cards: a new test for the measurement of letter acuity in children. Ophthalmic Physiol Opt. 1993; 13(4):400-4. DOI: 10.1111/j.1475-1313.1993.tb00499.x. View

13.

Williamson T, Andrews R, Dutton G, Murray G, Graham N . Assessment of an inner city visual screening programme for preschool children. Br J Ophthalmol. 1995; 79(12):1068-73. PMC: 505342. DOI: 10.1136/bjo.79.12.1068. View

14.

Stuart J, BURIAN H . A study of separation difficulty. Its relationship to visual acuity in normal and amblyopic eyes. Am J Ophthalmol. 1962; 53:471-7. View

15.

FLOM M, WEYMOUTH F, Kahneman D . VISUAL RESOLUTION AND CONTOUR INTERACTION. J Opt Soc Am. 1963; 53:1026-32. DOI: 10.1364/josa.53.001026. View

16.

Sheridan M . Vision screening of very young or handicapped children. Br Med J. 1960; 2(5196):453-6. PMC: 2097285. DOI: 10.1136/bmj.2.5196.453. View

17.

Hilton A, Stanley J . Pitfalls in testing children's vision by the Sheridan Gardiner single optotype method. Br J Ophthalmol. 1972; 56(2):135-9. PMC: 1208699. DOI: 10.1136/bjo.56.2.135. View

18.

YOUNGSON R . Anomaly in visual acuity testing in children. Br J Ophthalmol. 1975; 59(3):168-70. PMC: 1017375. DOI: 10.1136/bjo.59.3.168. View

19.

Bailey I, Lovie J . New design principles for visual acuity letter charts. Am J Optom Physiol Opt. 1976; 53(11):740-5. DOI: 10.1097/00006324-197611000-00006. View

20.

Friendly D . Preschool visual acuity screening tests. Trans Am Ophthalmol Soc. 1978; 76:383-480. PMC: 1311632. View