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Is It a Boy or Girl? A New Visual Acuity Test
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Is It a Boy or Girl? A New Visual Acuity Test


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  • 1. Letter to the Editor Boy or girl? – a new visual acuity test screening tool Tomoya Handa, Ran Nakadate, Tomoko Hatayama, Tsukushi Yokota and Nobuyuki Shoji Department of Rehabilitation, Orthop- tics and Visual Science Course, School of Allied Health Sciences, Kitasato Uni- versity, Sagamihara, Japan doi: 10.1111/aos.12161 Editor, M aking young children under- stand the content of visual acu- ity tests is not easy. For example, it can be difficult to get them to understand the visual acuity test targets on the Landolt Ring chart or Snellen chart. Eye charts for children that use simple symbols as visual targets have been reported, but the need to understand the visual target itself has not changed (Kastenbaum et al. 1977; Woodhouse et al. 1992; Hered et al. 1997; Vision in Preschoolers Study Group 2010). For example, with the use of a picture visual target, they need to understand what the picture visual target itself is (horse, car, etc.). Development of a visual acuity test for screening that young children can understand and respond to in a short time and with lit- tle difficulty is needed. We have devel- oped and verified a new screening visual acuity test for children. The subjects are 308 eyes of 154 chil- dren (5, 6 years old) who underwent a trial in a preschool visual function examination in the city of Sagamihara (Kanagawa, Japan). Sagamihara con- ducts that an ophthalmological exami- nation is recommended for children with visual acuity test results of <0.7 (decimal visual acuity). In a bright room, a visual target was shown on a 32-inch TV monitor (TH-L32ET5, Pan- asonic Corporation, Kadoma, Osaka, Japan) and controlled by a PC using software made by the authors. Subjects sat at a test distance of 5.0 m, and their eyes were measured one at a time. The set-up for this screening visual acuity test is shown in Fig. 1A. The visual tar- get in this test is a hybrid image that is set to look like a boy with visual acuity of <0.7 (decimal visual acuity) and to look like a girl with visual acuity of ‡0.7 (decimal visual acuity). The visual target for this test is shown in Fig. 1B. The line thickness of the girl’s hair and ribbon is set at 2 mm for a visual angle of 0.0247° at a test distance of 5 m. The contrast of the lines for the hair and ribbon was set at 53% based on previous verification. Visual acuity test results with the Landolt C chart are also divided into two levels of ‡0.7 (decimal visual acuity), and <0.7 (deci- mal visual acuity), with the results of the present screening visual acuity test and the visual acuity test with a Lan- dolt C chart (uncorrected visual acuity) then compared. This study followed the tenets of the Declaration of Helsinki, and all subjects provided informed consent. The rate of agreement between the results with this screening visual acu- ity test and the visual acuity using a Landolt C chart was 72.1% (agree- ment in 222 of 308 subject eyes) when evaluated based on the two levels of visual acuity, ‡0.7 (decimal visual acu- ity) and <0.7 (decimal visual acuity). All the children were able to under- stand the test with a simple explana- tion, and the test could be carried out over a short time period of about 10– 20 seconds for each child. With the visual target in this screen- ing visual acuity test, children could easily understand the test when they were simply asked, ‘Do you see a boy?’ or ‘Do you see a girl?’. In addi- tion, with the use of a TV monitor to display the visual target, children nat- urally gaze at even a distant visual target. Based on these two advanta- ges, it is thought that this screening visual acuity test for children could be carried out over a short period of time without difficulty, so that this test may be widely applicable for use in the visual acuity tests of children. References Hered RW, Murphy S & Clancy M (1997): Comparison of the HOTV and Lea sym- bols charts for preschool vision screening. J Pediatr Ophthalmol Strabismus 37: 24–28. Kastenbaum SM, Kepford KL & Holmstrom ET (1977): Comparison of the STYCAR and Lighthouse acuity tests. Am J Optom Physiol Opt 54: 458–463. Vision in Preschoolers Study Group (2010): Effect of age using Lea symbols of HOTV for preschool vision screening. Optom Vis Sci 87: 87–95. Woodhouse JM, Adoh TO, Oduwaiye KA, Batchelor BG, Megji S, Unwin N & Jones N (1992): New acuity test for toddlers. Ophthalmic Physiol Opt 12: 249–251. Correspondence: Tomoya Handa, CO, PhD Department of Rehabilitation Orthoptics and Visual Science Course School of Allied Health Sciences Kitasato University 1-15-1 Kitasato, Minami-ku Sagamihara 252-0373 Japan Tel: + 81 42 778 9671 Fax: + 81 42 778 9684 Email: (A) (B) Fig. 1. (A) Setting for the screening visual acuity test. The visual target in this screening visual acuity test is displayed on a TV monitor at test distance of 5.0 m. The examiner covers one eye of the child being tested with an occluder and measures the unilateral visual acuity of the right eye followed by the left eye in that order. (B) The visual target for the screening visual acuity test. This visual target is a hybrid image, which looks like a girl if the ‘ribbon’ and ‘hair’ are recognized and looks like a boy if the ‘ribbon’ and ‘hair’ are not recognized. Acta Ophthalmologica 2013 1