Visual acuity assessment of preschool children in the inner city area in Jakarta

  • Dian Estu Yulia Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • Yulinda Arty Laksmita Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • Julie Dewi Barliana Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • Laura Agnestasia Djunaedi Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • Lia Amanda Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • Hartono Gunardi Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Keywords: visual acuity assessment, preschool children, Lea Symbols, Tumbling-E chart

Abstract

Background Visual acuity (VA) assessment is an important ocular examination to identify children with vision problems. Such early identification allows for early intervention to prevent childhood blindness.

Objective To describe and compare visual acuity measurements in preschool children using two different visual acuity charts.

Methods This cross-sectional study in children aged 36-60 months was done in a low-income area in the Central Jakarta District as a collaboration between Department of Ophthalmology and Department of Child Health, Universitas Indonesia Medical
School/Dr. Cipto Mangunkusumo Hospital, Jakarta. All children underwent visual acuity examinations using Lea symbols and Tumbling E charts. The VA results from two charts were analyzed with Bland-Altman plot for limits of agreement. Statistical analyses were performed to determine the differences between vision charts.

Results A total of 113 children enrolled, but only 38 children completed the examinations. The mean age of subjects was 50.5 (SD 6.4) months. Overall, subjects’ mean VA was 0.29 (SD 0.18) for Lea symbols and 0.37 (SD 0.14) for Tumbling E. The mean difference of VA between Lea symbols and Tumbling E was 0.07 (SD 0.22) logMAR units, with upper and lower limits of agreement at 0.36 and 0.51, respectively. There was no statistical difference in VA score using Lea symbols and Tumbling-E based on gender and age.

Conclusion Most preschool children in our study have normal visual acuity. Lea symbols and Tumbling E chart are comparable and can be used to efficiently measure VA in preschool children.

References

1. Anstice NS, Thompson B. The measurement of visual acuity in children: an evidence-based update. Clin Exp Optom. 2014;97:3–11. DOI:10.1111/cxo.12086.
2. Inal A, Ocak OB, Aygit ED, Yilmaz I, Inal B, Taskapili M, et al. Comparison of visual acuity measurements via three different methods in preschool children: Lea symbols, crowded Lea symbols, Snellen E chart. Int Ophthalmol. 2018;38:1385–91. DOI:10.1007/s10792-017-0596-1.
3. Paul CM, Sathyan S. Comparison of the efficacy of Lea Symbol chart and Sheridan Gardiner chart for preschool vision screening. Indian J Ophthalmol. 2018;66:924–8. DOI:10.4103/ijo.IJO_1078_17.
4. Engin O, Despriet DDG, van der Meulen-Schot HM, Romers A, Slot X, Sang MTF, et al. Comparison of optotypes of Amsterdam Picture Chart with those of Tumbling-E, LEA symbols, ETDRS, and Landolt-C in non-amblyopic and amblyopic patients. Graefes Arch Clin Exp Ophthalmol. 2014;252:2013–20. DOI:10.1007/s00417-014-2763-7.
5. Wright K, Spiegel P. Pediatric opthalmology and strabismus. 3rd ed. St. Louis: Mosby; 2012.
6. Bell AL, Rodes ME, Kellar LC. Childhood eye examination. Am Fam Physician. 2013;88:241–8.
7. Pan Y, et al. Visual Acuity Norms in Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study. Optom Vis Sci. 2009 June ; 86(6): 607–61. DOI:10.1097/OPX.0b013e3181a76e55
8. Bailey IL, Lovie-Kitchin JE. Visual acuity testing. From the laboratory to the clinic. Vision Res. 2013;90:2–9. DOI:10.1016/j.visres.2013.05.004.
9. 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. DOI:10.1097/01.opx.0000144746.80718.67.
10. Vivekanand U, Gonsalves S, Bhat SS. Is LEA symbol better compared to Snellen chart for visual acuity assessment in preschool children? Rom J Ophthalmol. 2019;63:35–7.
11. Dobson V, Maguire M, Orel-Bixler D, Quinn G, Ying GS. Visual acuity results in school-aged children and adults: Lea Symbols chart versus Bailey-Lovie chart. Optom Vis Sci. 2003;80:650–4. DOI:10.1097/00006324-200309000-00010.
12. Becker R, Hübsch S, Gräf MH, Kaufmann H. Examination of young children with Lea symbols. Br J Ophthalmol. 2002;86:513–6. DOI:10.1136/bjo.86.5.513.
13. Moganeswari D, Thomas J, Srinivasan K, Jacob GP. Test re-test reliability and validity of different visual acuity and stereoacuity charts used in preschool children. J Clin Diagn Res. 2015;9:NC01-5. DOI:10.7860/JCDR/2015/14407.6747.
14. Sanker N, Dhirani S, Bhakat P. Comparison of visual acuity results in preschool children with lea symbols and Bailey-Lovie E chart. Middle East Afr J Ophthalmol. 2013;20:345–8. DOI:10.4103/0974-9233.120020.
15. Thomas B, Umapathy E, Iputo J. Effects of nutritional deficiency on visual acuity. J Biol Sci. 2008;8:1246-50. DOI:10.3923/jbs.2008.1246.1250.
Published
2021-11-23
How to Cite
1.
Yulia D, Laksmita Y, Barliana J, Djunaedi L, Amanda L, Gunardi H. Visual acuity assessment of preschool children in the inner city area in Jakarta. PI [Internet]. 23Nov.2021 [cited 26Apr.2024];62(1):1-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2555
Section
Developmental Behavioral & Community Pediatrics
Received 2020-12-04
Accepted 2021-11-23
Published 2021-11-23