ATS HOTV Visual Acuity Testability in African–American & Hispanic Preschool Children: The Multi–Ethnic Pediatric Eye Disease Study

Abstract

Purpose: : To evaluate the ability of African–American and Hispanic preschool children to complete the Amblyopia Treatment Study (ATS) HOTV Visual Acuity Testing Protocol using the Electronic Visual Acuity Tester (ATS e–HOTV).

Methods: : Measurement of presenting monocular distance visual acuity was attempted in a sample of African–American and Hispanic children aged 30–72 months from the population–based Multi–Ethnic Pediatric Eye Disease Study (MEPEDS). The ATS e–HOTV visual acuity protocol was performed. Children able to be tested in both right and left eyes were considered "able" and those not able to be tested in both eyes were considered "unable." Children unable to perform testing on the day of their initial examination were sent home with a training card to return for a retest on another day. Age–, gender– and ethnicity–specific testability rates were calculated. Comparisons of testability among different groups were performed using chi–square analyses and the trend test.

Results: : ATS e–HOTV testing was attempted on 1742 children (764 African–American, 978 Hispanic; 869 female, 873 male). Overall, 87% (87% African–American, 88% Hispanic; 85% male, 90% female) were testable. Age–specific testability was 46%, 88%, 98%, and 100% in children 30–36 months, 37–48 months, 49–60 months, and 61–72 months of age, respectively. After stratifying by age, there were no gender– or ethnicity–related differences in the proportion of children who were testable (p >0.26, p >0.15, respectively). Older children were more likely to successfully complete testing than younger children (p<0.0001). Testability rates increased from 35% at age 30 months to 90% or greater at 42 months. Of those retested because they were unable to initially complete the protocol, 62% were successful on retesting.

Conclusions: : The majority of children aged 30 months and older can sucessfully complete monocular visual acuity testing using the ATS e–HOTV visual acuity protocol. Testability rates rise steeply in children aged 30–42 months and then plateau. Males and females and children of African–American and Hispanic descent are equally likely to be testable.

Keywords: visual acuity • clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical (human) or epidemiologic studies: prevalence/incidence