Hamm Lisa M, Anstice Nicola S, Black Joanna M, Dakin Steven C
School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.
New Zealand National Eye Centre, Auckland, New Zealand.
Ophthalmic Physiol Opt. 2018 Nov;38(6):596-608. doi: 10.1111/opo.12590.
Sloan letters displayed by the Electronic Visual Acuity (EVA) system are the gold standard for recognition acuity measurement in research settings. However, letters are not always appropriate for children. The Auckland Optotypes (TAO) are a new, open-access set of 10 pictograms available in regular and vanishing formats. We sought to assess feasibility of using both formats of TAO for measuring visual acuity (VA) in children using a Bayesian adaptive staircase, in a community setting.
We tested 121 children (5-12 years old) with both formats of TAO, a handheld flipchart vision screener (Parr vision test), as well as the gold standard EVA. We measured feasibility of the three comparison tests in three ways. First, using limits of agreement (LoA) with EVA, second, calculating area under the receiver operating characteristic curve (AUC), and finally, investigating trial-by-trial responses.
Agreement between tests was within test-retest reliability of EVA measures (LoA = ±0.14, LoA = ±0.15, LoA = ±0.16 logMAR). TAO tests were highly effective at identifying children with vision impairment (AUC = 0.96, AUC = 0.95), whereas Parr was less effective (AUC = 0.82). In 5-6 year old children there was an enhanced advantage of TAO (AUC = 0.97, AUC = 0.98) over Parr (AUC = 0.75). Although each child completed 16 trials, approximately 10 trials were sufficient to achieve excellent LoA, and six trials sufficient for accurate screening.
Threshold VA assessment and vision screening are feasible using both vanishing and regular formats of TAO.
电子视力（EVA）系统显示的斯隆字母是研究环境中识别视力测量的金标准。然而，字母并不总是适合儿童。奥克兰视标（TAO）是一组新的、可公开获取的10个象形图，有常规和消失两种形式。我们试图评估在社区环境中，使用贝叶斯自适应阶梯法，将两种形式的TAO用于测量儿童视力（VA）的可行性。
我们用两种形式的TAO、手持式翻转视力筛查仪（帕尔视力测试）以及金标准EVA对121名儿童（5 - 12岁）进行了测试。我们从三个方面测量了这三种比较测试的可行性。第一，使用与EVA的一致性界限（LoA）；第二，计算受试者工作特征曲线下的面积（AUC）；最后，研究逐次试验的反应。
测试之间的一致性在EVA测量的重测可靠性范围内（LoA = ±0.14，LoA = ±0.15，LoA = ±0.16 logMAR）。TAO测试在识别视力障碍儿童方面非常有效（AUC = 0.96，AUC = 0.95），而帕尔测试效果较差（AUC = 0.82）。在5 - 6岁儿童中，TAO（AUC = 0.97，AUC = 0.98）比帕尔测试（AUC = 0.75）有更大优势。虽然每个儿童完成了16次试验，但大约10次试验足以实现良好的LoA，6次试验足以进行准确筛查。
使用消失和常规形式的TAO进行阈值VA评估和视力筛查是可行的。
