Abstract
BackgroundThe inclusion for rehabilitation of visually impaired children is partly based on the measurement of near vision, but guidelines for near visual acuity assessment are currently lacking. The twofold purpose of this systematic review was to: (i) provide an overview of the impact of the chart design on near visual acuity measured, and (ii) determine the method of choice for near vision assessments in children of different developmental ages.MethodsA literature search was conducted by using the following electronic databases: PubMed, Cochrane Library, and EMBASE. The last search was run on March 26th 2016. Additional studies were identified by contacting experts and searching for relevant articles in reference lists of included studies. Search terms were: vision test(s), vision assessment(s), visual acuity, chart(s) and near.ResultsFor children aged 0–3 years the golden standard is still the preferential looking procedure. Norms are available for this procedure for 6–36 month old children. For 4–7 year olds, we recommend using the LEA symbols, because these symbols have been properly validated and can be used in preliterate children. Responses can be verbal or by matching the target symbol. In children aged 8–13 years, the recommended method is the ETDRS letter chart, because letter acuity is more predictive for functional vision and reading than symbol acuity. In 8–13 year olds, letter acuity is 0.1–0.2 logMAR poorer than symbol acuity.ConclusionsChart design, viewing distance, and threshold choice have a serious impact on near visual acuity measurements. Near visual acuity measured with symbols is lower than near visual acuity measured with gratings, and near visual acuity measured with letters is lower than near visual acuity measured with symbols. Viewing distance, chart used, and letter spacing should be adapted to the child’s development and reported in order to allow comparisons between measurements.
Highlights
The inclusion for rehabilitation of visually impaired children is partly based on the measurement of near vision, but guidelines for near visual acuity assessment are currently lacking
Near visual acuity measurements are an important part of general vision assessment
Studies that reported near visual acuity outcome measures were included if they met four inclusion criteria: (1) a cross-sectional or observational design was used, (2) the study included 0–13 year old children with normal development and normal vision, and/or 0–13 year old children with normal development and low vision, (3) the study included children without mental impairments, and (4) the study was published in an English peer-reviewed journal
Summary
The inclusion for rehabilitation of visually impaired children is partly based on the measurement of near vision, but guidelines for near visual acuity assessment are currently lacking. The twofold purpose of this systematic review was to: (i) provide an overview of the impact of the chart design on near visual acuity measured, and (ii) determine the method of choice for near vision assessments in children of different developmental ages. The measurement of near visual acuity in children is not yet part of the routine ophthalmological examination. It is time consuming and requires special skills because children are eager to shorten the Huurneman and Boonstra BMC Ophthalmology (2016) 16:215 based on the developmental level of the child. This systematic review will provide guidelines for near visual acuity measurements for 0-3 year old children with normal visual acuity and low vision
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