The Electronic Visual Acuity Tester: Testability in Preschool Children

ABSTRACT: Purpose. To evaluate the ability of preschool children to have their threshold visual acuity assessed using a standardized, computer‐based letter test. Methods. Participants were 1195 3.5‐ to 5‐year‐old children enrolled in the Vision in Preschoolers Study. Monocular visual acuity was assessed by licensed eye care professionals (optometrists and pediatric ophthalmologists experimented in the examination of children), using the Electronic Visual Acuity tester, which uses the letters H, O, T, and V with a crowded surround. Results. Overall, 99.1% of children passed the training that consisted of identifying the letters H, O, T, and V by naming or matching the letters at 60 cm. Among those who passed the training, 99.6% completed the binocular pretest at 3 m, and 97.6% of those passing the training and the pretest completed monocular threshold visual acuity testing of each eye with the Electronic Visual Acuity tester. Testability increased with age for training (p = 0.03), pretesting (p = 0.04), and acuity testing (p = 0.07). Overall, 93.3% of 3.5‐year‐olds, 96.7% of 4‐year‐olds, and 98.8% of 5‐year‐olds completed training, pretesting, and monocular threshold acuity testing of each eye using standard letter optotypes. Conclusion. Using the computer‐based Electronic Visual Acuity system, nearly all 3.5‐ to 5‐year‐old children can complete monocular acuity testing of each eye.