Utility and Validity of the Handy Eye Chart^TM in Non-English Speaking Populations

Abstract

Purpose : The purpose of this study is to assess the utility of the Handy Eye Chart^TM in non-English speaking individuals. Visual acuity results, testing times, and chart preferences for adult participants undergoing vision screening using the Handy Eye Chart^TM were compared with results obtained using other established eye charts (Tumbling E or Early Treatment of Diabetic Retinopathy Study (ETDRS) charts) in two populations of participants for whom English is not the primary language.

Methods : Visual acuity of participants whose primary language was Spanish, and Amharic was tested with the Handy eye chart and an established eye chart at the Mexican Consulate in Atlanta, Georgia or the Menelik Ii Hospital in Addis Ababa, Ethiopia, respectively. We recorded the visual acuity and time required to compete testing with each chart, and the participants completed a short subjective survey indicating chart preference.

Results : There was a mean difference between the Handy Eye Chart^TM and the ETDRS chart of 0.08 in the Spanish-speaking group, equivalent to 4 letters acuity difference. There was a mean difference between the Handy Eye Chart^TM and the Tumbling E chart respectively of 0.003 and 0.06 in the Spanish-speaking and Amharic-speaking group. This is equivalent to less than 1 letter difference in the Spanish-speaking group, and 3 letters difference in the Amharic-speaking group. In all arms, the visual acuity obtained by the Handy Eye Chart^TM was consistently slightly worse than the established eye charts. Testing times were shown to be similar between the Handy Eye Chart^TM and established charts. In the Spanish-speaking group, the Handy Eye Chart^TM was a mean of 31 seconds slower than the ETDRS chart (p<0.0001). The Handy Eye Chart^TM was a mean of 4 seconds slower than the Tumbling E chart (p=0.65). In the Amharic-speaking population, the Handy Eye Chart^TM was a mean of 4 seconds faster than the Tumbling E chart (p=0.65). 20% of patients across all groups prefered the Handy Eye Chart^TM over the more familiar chart.

Conclusions : The Handy Eye Chart^TM is an efficient and valid test of visual acuity in non-English speaking adults. Although participants tended to prefer testing with familiar eye charts, the Handy Eye Chart^TM is a promising alternative for use in settings with a variety of language barriers.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.