This document discusses various methods for assessing visual acuity in children of different ages. It begins by defining visual acuity and the standard test used in older children and adults, the Snellen chart. Preferential looking tests are commonly used in infants based on their ability to distinguish patterns. Other tests mentioned include Teller cards, visual evoked potentials, optokinetic nystagmus, and Catford drum tests. Approaches such as ball retrieval, toy and coin tests are used in toddlers. Allen's picture cards, Sheridan letters, and HOTV tests target preschoolers, while Snellen, LogMAR, Tumbling E, and Landolt C tests are standard for older children. Challenges in

1. ASSESMENT OF VISUAL
ACUITY IN CHILDREN
Intern:- Kavita Choudhary
Moderator :- Kunal Kishor

2. Definition
It is defined as the resolving power of the eye or
ability to see two separate objects.
It is determined by the smallest retinal image which
can be appreciated at a certain distance.
The VA test measures the smallest letters that
patient can read on a standardized chart at a
distance of 6m / 20 feets

3. Principal
The two distinct points can only be
recognizable as separate when they
subtend an angle of 1minute of an arc
at the nodal point of the eye

4. Normal visual Developments
AGE
At birth 6/120
4 months 6/60
6 months 6/36
1 year 6/18
2 years 6/6

5. Expected visual acuity levels
Age (months) OKN FPL VEP
1 20/300 20/400 20/300
6 20/60 20/150 20/20
12 20/40 20/100 20/20
36 20/20 20/20 20/20

6. Vision Tests in InfantsVision Tests in Infants

7. CSM method
C : Central
S : Steady
M : Maintenance

8. 2.Preferential Looking Test
Most Commonly used Test
Based upon turning of the head or eyes towards the
pattern rather than a uniform [homogenous] field.
Alternating Black and White Stripes are present
Stripe width progressively narrows which is then
randomly shown next to plain test object
Children with better vision are able to see finer
grating and turn towards it

10. Drawbacks of Preferential Looking Tests
Test near vision not distance vision

11. 3.Teller Acuity Cards
Modified form of Preferential
Looking Test
- Simpler & rapid testing
- Contains 17 cards
- 12.5 x 12.5 cm patches of square wave grating
- Gratings contrast: 82% - 84%
- Proper illumination: 10 candelas/m²

12. Drawbacks
Measures near visual acuity and not distance
Measures resolution acuity

13. 4.Visual Evoked Potential
VEP is the measure of change of electrical activity
of the visual cortex in response to patterned
stimulus
Checkered board or square wave grating
Abnormal VEP may indicate a problem with the
visual information reaching the cortex
VEP is very sensitive to optical blurring, can thus be
used as a method of refraction in very young patient

14. VEP
VEP is useful in the determination of problems
such as amblyopia, cortical blindness, and visual
impairment

15. 5.Opto kinetic nystagmus
Commonly used Test in Neonates
Test object moves in one direction
Based on observation of Pendular Eye
movements
Slow following phase & rapid recovery
phase.
Good correlation with subjective acuity.

16. Drawbacks of Optokinetic Nystagmus
Overestimates the visual acuity as the target is
moving

17. 6.Catford Drum test
Based on observation of Pendular Eye movements
Testing distance is 60 cm
It comprises of white cylinder marked with black
dots of increasing size corresponding to visual
acuities
The drum is masked by a screen except for a
rectangular aperture which exposes a single spot
Spot is made to oscillate horizontally and stimulates
eye movement

18. Draw backs
Overestimate vision as
target is moving and
test is conducted at
short working distance
Unreliable for
Amblyopia Screening

19. Testing Of Uniocular Amblyopia In
Infants
Occluding Amblyopic eye child does not resist.
while occluding the normal eye, child resists
the occlusion.

20. Vision test in 1-2 years

21. 1.Worth's ivory ball test:
Commonly Used
Based on Quality of Fixation
Ivory balls ranging from 0.5" to 1.5" ,
rolled on floor at a distance of about 3
metres.
Child is asked to retrieve each ball
Rough estimate of visual acuity is made
from the size of smallest ball which the
child can see

22. 2.Boeck Candy Test
Child picks up only those candy beads which
he can see easily
Beads of different sizes are shown to child and
is expected to pick them up
This gives approximate estimation of visual
acuity

23. 3.Screening Test for Young Children
and Retards [STYCAR]
Based on Pursuit Eye movements
Ten Balls rolled across a well illuminating
contrasting floor 3m away from child
Pursuit Eye movements indicate that they are
seen

24. Vision Test in 2-3 years

25. 1.Cardiff Acuity Test
Principle: vanishing optotype
Target - pictures, of the same overall size, drawn in decreasing
widths of white space
Acuity is determined by the narrowest white band for which the
target is visible to the child
Child naturally prefers to look at a target figure rather than the
blank end of the stimulus.

27. 2.Miniature Toy Test
Was previously used for
Handicapped children and low
Intellegence patient
Component of STYCAR Test
2 sets of Miniature object are used
One set is with Examiner standing at
10ft and child is asked to pickup
similar objects from his own set

28. 3.Coin Test
Coins of different sizes are shown to child and is
Child picks up only those coins which he can see
easily
expected to pick them up

29. 4.LEA Symbol test
Used in children age between 2-
Good for amblyopic patient to avoid crowding
phenomenon.

30. Vision test in 3-5 years

31. 1.Allen’s Picture Cards
It is recorded same as Snellens Acuity test
Instead of letters child identifies picture at a
distance of 6m.

32. 2.Sheridan letter test
It uses 5 letters HOTV & X
A&U are added in 7 letter set
Examiner shows cards having
small range of letters at 3m
Child points at one of the card
identical to the examiner card

33. 3.Lippmans HOTV test
Simpler version of Sheridan's test using only 4
letters HOTV.
Test distance 3 meter

34. Vision Test in 5-6 Years and above

35. 1.Snellens Visual Acuity Test
Most commonly used
Smallest Object which can be resolved by the eye
substends the same visual angle at the nodal point
of the eye i.e 5 min of arc
The test employs a chart with rows of letters with
diminishing size

36. Each row is accorded a number
indicating the distance in meters at
which a person with normal visual
acuity should correctly identify the
letters
Testing distance is 6m

37. 2.LogMAR Visual Acuity Charts
Based on Minimum Angle of
Resolution
More Precise than Snellen Test
Have regular progression in the
size and spacing of the letters
from one line to next
Same number of letters on
every line

38. 3.Tumbling E Test
Based on Minimum Separable distance
Task is to identify the direction in which
the limb of E points
Identification of the last line gives visual
acuity

39. 4.Landolt’s Broken Ring Chart
Most Commonly used
Based on Minimum Separable
distance.
The rings are constructed on the same basis as
that of Snellens
Child is instructed to indicate by the motion of the
hand at which point each one is broken
Interpretation of the last line identified by the
child determines visual acuity

40. Conclusion
Despite the development of methods appropriate to
different ages, measuring acuity remains difficult in
infants.
In addition, many techniques require special
equipment and conditions, making them unsuitable
for some settings

41. Cont………..
Whichever method is used to measure a child’s
vision, it is important to assess vision corrected for
any refractive errors, and to assess the eyes
separately as well as together whenever possible

42. Thank You