Is LEA symbol better compared to Snellen chart for visual acuity assessment in preschool children?

To compare visual acuity using the LEA symbol chart with Snellen E test chart in preschool children of age 3-5 years. : 50 emmetropic children aged 3 to 5 years. Strabismus, amblyopia, ametropia, and any organic eye disease. A pseudo randomized protocol was used to test visual acuity (VA) in each subject monocularly on both eyes using Snellen E chart and LEA symbol chart. Visual acuity for both charts was scored as smallest optotype size which the child correctly identified 3 of maximum 4 optotypes. The strength of agreement on VA between two charts was tested using Interclass correlation coefficient (ICC). A Mann-Whitney U test was applied to compare both the groups. Boys: Girls = 26:24 with a mean age and standard deviation of 4.12 + 0.79 years. ICC between Snellen's and LEA symbol chart was 0.256 and 0.213 for right and left eye respectively. Analysis of the two samples using Mann-Whitney test showed a significant difference between the two charts (p value <0.000). LEA symbol test showed only a fair agreement with Snellen E charts for visual acuity measurements. Visual acuity measurement with LEA symbol chart showed significantly higher scores as compared to Snellen's chart.