Design Limitations Research Articles

Refractive changes associated with oculoplastic surgeries: A scoping review.

To carry out a comprehensive critical review of the peer-reviewed literature on the refractive changes associated with oculoplastic surgeries. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) statement recommendations. Following specific inclusion and exclusion criteria, 20 articles were selected for the current scoping review. Each of them was analyzed carefully and their risk of bias was assessed with the Quality Assessment Tool for case Series Studies from the National Heart, Lung and Blood Institute. Data of 1428 eyes from 1051 patients were analyzed. All studies were case series. Regarding the oculoplastic pathologies, five articles focused on dermatochalasis, four on chalazion, five on ptosis and six on congenital ptosis. Most articles did not report changes in the spherical equivalent (SE), astigmatism changes of less than 0.5 diopters (D), changes in astigmatism axis of less than 11 degrees and changes in uncorrected distance visual acuity (UDVA) of less than 0.06 logMAR. Out of the 20 articles reviewed, 6 achieved a risk of bias score between 6 and 8, representing a low level of evidence and highlighting the limitations in the study design. Based on the findings of this study, there is no evidence to suggest clinically significant refractive changes following oculoplastic surgeries. The most notable changes may occur after surgery for severe ptosis; however, further research is needed to confirm this observation.

Clinical effectiveness of regenerative periodontal surgery and orthodontic tooth movement with clear aligners in stage IV periodontitis: a case series.

To evaluate the clinical effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) with clear aligners in stage IV (type 2) periodontitis. Ten patients with a total of 103 intra-bony defects were analyzed after regenerative surgery using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by OT with clear aligners. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1) and at final splinting (T2) after orthodontic tooth movement. Mean rBL gain was significant with 2.13 mm (±1.64 mm) after 1 year (T1) and 3.02 mm (±2.00mm) at final splinting (T2). Mean PPD was significantly reduced from 5.40 mm (±1.80 mm)at baseline to 3.78 mm (±1.73 mm) at T1 and remained stable with 3.73 mm (±1.70 mm)at T2. Pocket closure (PPD< 4mm) was accomplished in 76% of all defects. Tooth loss amounted to 2.9%. Within the limitations of the retrospective study design, the findings suggest that the interdisciplinary treatment of periodontitis stage IV by regenerative periodontal surgery and consecutive OT with clear aligners can lead to favorable results.

Lithium Niobate Electro-Optic Modulation Device without an Overlay Layer Based on Bound States in the Continuum

Electro-optic modulation devices are essential components in the field of integrated optical chips. High-speed, low-loss electro-optic modulation devices represent a key focus for future developments in integrated optical chip technology, and they have seen significant advancements in both commercial and laboratory settings in recent years. Current electro-optic modulation devices typically employ architectures based on thin-film lithium niobate (TFLN), traveling-wave electrodes, and impedance-matching layers, which still suffer from transmission losses and overall design limitations. In this paper, we demonstrate a lithium niobate electro-optic modulation device based on bound states in the continuum, featuring a non-overlay structure. This device exhibits a transmission loss of approximately 1.3 dB/cm, a modulation bandwidth of up to 9.2 GHz, and a minimum half-wave voltage of only 3.3 V.

Factors impacting clinical data and documentation quality in Australian aged care and disability services: a user-centred perspective

BackgroundResearch has highlighted a need to improve the quality of clinical documentation and data within aged care and disability services in Australia to support improved regulatory reporting and ensure quality and safety of services. However, the specific causes of data quality issues within aged care and disability services and solutions for optimisation are not well understood.ObjectivesThis study explored aged care and disability workforce (referred to as ‘data-users’) experiences and perceived root causes of clinical data quality issues at a large aged care and disability services provider in Western Australia, to inform optimisation solutions.MethodsA purposive sample of n = 135 aged care and disability staff (including community-based and residential-based) in clinical, care, administrative and/or management roles participated in semi-structured interviews and web-based surveys. Data were analysed using an inductive thematic analysis method, where themes and subthemes were derived.ResultsEight overarching causes of data and documentation quality issues were identified: (1) staff-related challenges, (2) education and training, (3) external barriers, (4) operational guidelines and procedures, (5) organisational practices and culture, (6) technological infrastructure, (7) systems design limitations, and (8) systems configuration-related challenges.ConclusionThe quality of clinical data and documentation within aged care and disability services is influenced by a complex interplay of internal and external factors. Coordinated and collaborative effort is required between service providers and the wider sector to identify behavioural and technical optimisation solutions to support safe and high-quality care and improved regulatory reporting.

Cross-angled versus flat-trim bristle tuft configurations in manual toothbrushes: A systematic review.

This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients. PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate. Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group. Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.

ESF-YOLO: an accurate and universal object detector based on neural networks

As an excellent single-stage object detector based on neural networks, YOLOv5 has found extensive applications in the industrial domain; however, it still exhibits certain design limitations. To address these issues, this paper proposes Efficient Scale Fusion YOLO (ESF-YOLO). Firstly, the Multi-Sampling Conv Module (MSCM) is designed, which enhances the backbone network’s learning capability for low-level features through multi-scale receptive fields and cross-scale feature fusion. Secondly, to tackle occlusion issues, a new Block-wise Channel Attention Module (BCAM) is designed, assigning greater weights to channels corresponding to critical information. Next, a lightweight Decoupled Head (LD-Head) is devised. Additionally, the loss function is redesigned to address asynchrony between labels and confidences, alleviating the imbalance between positive and negative samples during the neural network training. Finally, an adaptive scale factor for Intersection over Union (IoU) calculation is innovatively proposed, adjusting bounding box sizes adaptively to accommodate targets of different sizes in the dataset. Experimental results on the SODA10M and CBIA8K datasets demonstrate that ESF-YOLO increases Average Precision at 0.50 IoU (AP50) by 3.93 and 2.24%, Average Precision at 0.75 IoU (AP75) by 4.77 and 4.85%, and mean Average Precision (mAP) by 4 and 5.39%, respectively, validating the model’s broad applicability.

Electromagnetic Energy Harvester Targeting Wearable and Biomedical Applications.

This work presents a miniaturized electromagnetic energy harvester (EMEH) based on two coils moving in a head-to-head permanent magnet tower. The two coils are separated by a set distance so that the applied force moves the EMEH from one equilibrium position to another. In this configuration, the harvester produces energy in two different working modes: when a force is applied to the moving part or when an external random acceleration is applied to the whole system. A custom test bench has been designed to characterize the behavior of this energy harvester under a variety of conditions encountered in wearable applications. Notably, at 10 Hz and 1.32 g RMS acceleration, our inertial EMEH demonstrates its capability to sustain a consistent output power of 1696 μW within a total volume of 22.39 cm3, showcasing its efficiency in environments with erratic stimuli typical of wearable and biomedical applications. The presented EMEH is compared with reported inertial EMEH structures to extract its design limitations as well as future improvements, situating the present work in a comprehensive state-of-the-art and defining a generic performance target for biomedical and wearable applications.

The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study

This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence.

Jute/PP composites for covering honeycomb panels: Designability and mechanical behaviors

An approach involving low energy consumption was used to transform jute/polypropylene prepregs into a sustainable sandwich structure for automotive application. Fiber orientation and stacking sequence were modified to investigate their influence on the physical-mechanical properties of the prepregs as well as cyclic flexural properties, compression fatigue behaviors and 3D microstructure of honeycomb sandwich panels. The mechanical properties of the face sheets were comparable with GF-SMC; but since they are derived from natural fiber they present a more sustainable and renewable alternative to GF-SMC. Stacking sequence and fiber orientation were found remarkably factors for the limitation of structure and performance design. The honeycomb panels occurred fatigue failures under the compression cyclic loading for 131–547 times. The flexural and shear buckling modes correlated with each other and all the materials failed in a combination of face wrinkling, partial crushing and debonding. It was found that the prepregs could provide more possibilities for optimum structural design of honeycomb sandwich panels, benefiting for the applications in the automotive lightweight field.

Regulating Artificial Intelligence: A Study in the Comparison between South Asia and Other Countries

Any regulation, law, or legal order enforced by the lawful authority of a territory to maintain, control, and regulate the characteristics, development, and public interaction of an artificial entity developed in a digital manner can be called AI legislation. The paper presents a comparative analysis of the regulatory landscape for artificial intelligence in the South Asian countries in relation to other selective countries and organizations globally, in light of the challenges encountered in regulating AI in the region. Furthermore, the study demonstrates that South Asian nations have experienced a significant and persistent legal disparity in comparison to other global regions, which has been both involuntary and inequitable. The paper presents an argument for the regulation of artificial intelligence and offers suggestions for South Asian countries to effectively regulate AI despite challenges related to its design and economic limitations.

Current Gaps in the Control of Cardiovascular Disease in Vietnam: A Systematic Review of Vietnamese-based Studies

Cardiovascular disease (CVD) is the leading cause of death among all non-communicable diseases (NCDs) in Vietnam. The objectives of the present study were to analyse contemporary gaps in CVD control studies, which were published in Vietnam between 2013 and 2017. A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Research articles written in English or Vietnamese, published between 2013 and 2017, and focused on the four main WHO themes of CVD control were identified. Among 11,385 Vietnamese-based CVD studies published during this period, only 119 studies (1.0%) were relevant to public health CVD control outcomes, and only 17 of 20 CVD indicators were addressed in these studies. Most studies were published in Vietnamese journals (73.9%), focused on disease and intermediate risk factors (73.9%), were cross-sectional (84.8%) and hospital-based (54.6%). We observed a lack of studies, many of which suffered design and analysis limitations, focused on several WHO themes for effective CVD control. Future Vietnamese-based CVD control studies should focus on the WHO-recommended themes and health indicators in broader community settings to provide better data to inform effective public health policies to control CVD.

Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial.

Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701. DERR1-10.2196/53684.

Analyzing the impact of bicycle geometry and cargo loading on the rideability and safety of cargo bikes: An investigative study

IntroductionElectric cargo bikes have become popular for transporting goods and people due to their small size and strong carrying capacity. However, the way they perform, handle, and operate safely can be affected by the weight of the cargo, where it is placed on the bike, and the bike's design. MethodThis paper analyzes the rideability and safety of eight different cargo bikes representing three different design categories, Retrofitted, Long-john, and Long-tail bikes, also considering three different cargo loading locations. We quantitatively examined the rideability by computing the minimum speed for self-stability, the maximum possible acceleration and deceleration without losing wheel-ground contact, the handlebar torque for steady-state turning, and the force required to overcome obstacles. The effect of using powerful motorized wheels has also been discussed. ResultsLong-john cargo bikes are unstable for lightweight cargo loads, more sensitive to cargo loads, and therefore may not be suitable for riding in narrow, crowded spaces like footpaths. Moreover, retrofitted cargo bikes should only be used to carry lightweight cargo as a combination of heavy cargo load and a powerful rear wheel motor poses a potential risk of accidents. Long-tail cargo bikes are less affected by changes to the cargo load and are thus safer than retrofitted bikes. Their relatively compact length also makes for a smaller turning radius. ConclusionRideability and safe handling of the cargo bikes strongly depend on the bike design and load and loading position. Retrofitted bikes are not suitable for carrying heavy loads and any load at the front has an adverse effect on the overall rideability and safety. Practical applicationThe results highlight the benefits and limitations of different cargo bike designs and, therefore, could have implications for the cargo bike manufacturers, service providers, and policymakers.

90 Novel approach for childhood Sjögren’s Disease therapies: multistakeholder design of a series of N-of-1 trials

OBJECTIVES/GOALS: Childhood Sjögren’s disease (cSD) is a rare autoimmune disease. Despite the profound impact on children and their families, pediatric-specific clinical trials to inform therapeutic strategies in cSD are lacking. In 2022 we participated in the Trial Innovation Network (TIN) Design Lab with the purpose of designing a series of N-of-1 trials for cSD. METHODS/STUDY POPULATION: New medications have the potential to be safe/effective treatments for cSD but must be evaluated in randomized trials. To overcome limitations of traditional parallel-group designs given the rarity of cSD, we developed an N-of-1 trial approach. Our proposal was selected by the Tufts TIN Design Lab. The Design Lab multi-stakeholder process involved parents of and patients with cSD, pediatric and adult rheumatologists, and experts in clinical trial design and outcomes. We engaged all stakeholders in protocol development to maximize the impact of the proposed approach on clinical care, ensure a successful recruitment plan, and inform the choice of endpoints as there are no widely accepted cSD outcome measures to determine treatment efficacy. RESULTS/ANTICIPATED RESULTS: Using the Design Lab methodology, we clarified the N-of-1 study goals and engaged in an iterative process to develop a “briefing book” that ensured a sound premise for our study. We reviewed and accumulated published literature to support our focus on mucosal/glandular manifestations, identified potential interventions to be used in the N-of-1 trials, and enumerated possible outcomes, including outcomes important to patient/parents. This work culminated in a full-day Design Lab event that included multiple stakeholders who provided expertise from different perspectives on the full drug development pathway. Study design feedback focused on three specific areas. 1) Inclusion and exclusion criteria; 2) Identification of outcome measures; 3) Treatment and washout periods. DISCUSSION/SIGNIFICANCE: To address the critical need and move treatment of cSD forward, we are designing a prototype N-of-1 trial in children with rheumatic disease. We will continue to engage stakeholders by using a series of Delphi surveys and an in-person meeting to create composite outcome measures to test cSD therapies in personalized trials.

Phase structure-induced amplification of interfacial polarization loss for excellent electromagnetic wave absorption

The development of multicomponent dielectric composites has emerged as a predominant approach to achieving exceptional electromagnetic (EM) wave absorbers. However, elucidating the intrinsic characteristics and absorption mechanism for EM wave absorbers poses significant challenges due to the intertwined discussion of electromagnetic loss with dipole polarization loss, defects/interfacial polarization, and conductive loss, among others. To address this issue, manganese selenide (MnSe) nanocrystals with different phase structures are synthesized successfully by the thermal injection decomposition method, including star-shaped α-MnSe nanocrystals and tetrapod-shaped γ-MnSe nanocrystals, which were combined with rGO layers to form α-MnSe/rGO composites and γ-MnSe/rGO composites. Through controllable phase structure, tune the interfacial charge transfer and establish the link between interfacial polarization and EM wave absorption. Owing to the boosted interfacial polarization loss provided by the star-shaped α-MnSe nanocrystals and rGO layers, α-MnSe/rGO composites harvest an RLmin of −62.4 dB (2.7 mm) and a broad bandwidth of 7.52 GHz at 2.9 mm. This study successfully breaks through the limitations of conventional component design, establishing a robust correlation between phase structure/interfacial polarization and electromagnetic wave dissipation capability. These findings provide valuable insights for developing advanced materials with enhanced electromagnetic wave absorption properties.

OntoAgency: An agency-based ontology for tracing control, ownership and decision-making in smart buildings

This article proposes an agency-based design ontology (OntoAgency) to systematically trace the relationships between stakeholders who own, control, and decide upon the benefits and experiences provided by smart building services. The ontology associates ‘smartness’ to different building operation domains and assigns their functionalities to agents involved in the flow of data and decision making. It enables control paths to be traced back to specific people, machines, and companies behind smart operations – including those that appear to be ‘external’ to a smart building. Based on Actor-Network Theory (ANT), the ontology connects knowledge from the social sciences to technical knowledge from building design, construction, operation and controls. The need in developing this ontology originates from the limits of conventional design and engineering ontologies, particularly with respect to their unproblematic take on the interplay between different social and technical systems and their neglect to model the varied abilities of stakeholders to exert control over, and benefit from, the technical systems and operations. The proposed ontology addresses these gaps by offering a more realistic and versatile model of inter-agents relationships. It can also highlight points of consented and unconsented data leakage and associated security issues. This knowledge becomes critical for designing and managing increasingly more complex smart building systems.

Comparative analysis of energy saving effect of passive exoskeleton designs

Nowadays, exoskeletons have a wide range of application in many fields. Among various types of exoskeletons, passive exoskeletons have become a major development field in exoskeleton device due to their lightweight and simple structure characteristics. This study provides an analysis of an ankle passive exoskeleton and a full lower limb passive exoskeleton design on their respective energy-saving effect during walking. The two selected designs both represent common approaches within the fields of ankle and full lower limb exoskeleton. Through a comparative evaluation of the structures and energy-saving methods of the two designs, the study validates the effectiveness of both designs. Drawing from the characteristics of the designs and comparative analysis, the study discusses the performance and limitations of both designs and outlines potential improvement and applications of both designs. Base on the analysis and the findings, the study aims to contribute to further advancement of passive exoskeleton design and offers some suggestions for its development.

Roles and Effect of Digital Technology on Young Children’s STEM Education: A Scoping Review of Empirical Studies

Digital technology is increasingly used in STEM education for young children aged 0–8 years. An extensive literature search was conducted using seven databases to systematically investigate the effect of digital technology on young children’s STEM education. Twenty-two eligible articles published from 2010 to 2021 were identified. Results showed that robotics, programming, and multimedia were used to support young children’s STEM education. Digital technology plays different roles in the process of STEM education. Outcomes also showed that digital technology positively affected young children’s STEM education in terms of STEM knowledge or skill acquisition and learning engagement. This was regardless of gender but relevant to age and the learning condition. Participating children and teachers reported high acceptance and satisfaction with the included programs. However, many difficulties, challenges and criticisms were revealed by the extracted data, including how digital technology is used in young children’s STEM education, the nature of young children, the requirements placed upon educators, and different types of adult–child interactions. We also look at the limitations of the study design within included studies and provide recommendations accordingly.

High-efficiency high-numerical-aperture metalens designed by maximizing the efficiency limit

Theoretical bounds are commonly used to assess the limitations of photonic design. Here we introduce a more active way to use theoretical bounds, integrating them into part of the design process and identifying optimal system parameters that maximize the efficiency limit itself. As an example, we consider wide-field-of-view high-numerical-aperture metalenses, which can be used for high-resolution imaging in microscopy and endoscopy, but no existing design has achieved a high efficiency. By choosing aperture sizes to maximize an efficiency bound, setting the thickness according to a thickness bound, and then performing inverse design, we come up with high-numerical-aperture (NA=0.9) metalens designs with, to our knowledge, record-high 98% transmission efficiency and 92% Strehl ratio across all incident angles within a 60° field of view, reaching the maximized bound. This maximizing-efficiency-limit approach applies to any multi-channel system and can help a wide range of optical devices reach their highest possible performance.

Developing a Novel Pediatric Eye Chart Assessing Visual Acuity by Minimum Separable Threshold

The purpose of this study was to develop a new pediatric acuity chart that can assess the minimum separation threshold by incorporating the minimum separation threshold into the picture. To overcome the design limitations of the Landolt ring, two designs of highly versatile minimum separable thresholds that can be easily incorporated into a picture were created: a black, filled circle (the “Circle”) and a segment (the “Square”), both with the same break as in the Landolt ring. The three designs—the Landolt ring, Circle, and Square—were used to evaluate and compare the differences in the visual acuity of 21 healthy adults. No significant differences were observed between the results of the visual acuity tested with the Landolt ring, Circle, and Square (Landolt ring vs. Circle: p = 0.92, Landolt ring vs. Square: p = 0.31, Circle vs. Square: p = 0.40). The Bland–Altman analysis revealed no fixed errors between the Landolt ring and Circle and between the Landolt ring and Square (95% CI: −0.09–0.08, −0.09–0.12). Proportional errors were also not observed (p = 0.68, p = 0.41). The Landolt ring, Circle, and Square designs obtained equal results in visual acuity, thus achieving the successful development of a novel pediatric visual acuity chart using these designs.