June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Associations Between Distance Visual Acuity and Cycloplegic Refractive Error in Children Aged 5 to 9 Years
Author Affiliations & Notes
  • Jennifer X Haensel
    Spencer Center for Vision Research at Byers Eye Institute, Stanford University School of Medicine, California, United States
  • Lisa Jordan
    College of Optometry, The Ohio State University, Ohio, United States
  • Angela Chen
    Marshall B Ketchum University, California, United States
  • Susan A Cotter
    Marshall B Ketchum University, California, United States
  • Ingryd Lorenzana FCOVD FAAO
    Advanced Vision Center, Illinois, United States
  • Silvia Han
    Marshall B Ketchum University, California, United States
  • Amy E Aldrich
    Snowy Range Vision Center, Wyoming, United States
  • Aparna Raghuram
    Boston Children's Hospital, Massachusetts, United States
    Harvard Medical School, Massachusetts, United States
  • Kristine Huang
    Marshall B Ketchum University, California, United States
  • Vivian Manh
    Seattle Children's Hospital, Seattle, Washington, United States
  • Reena Patel
    Marshall B Ketchum University, California, United States
  • Dashaini V Retnasothie
    Marshall B Ketchum University, California, United States
  • Tawna L Roberts
    Spencer Center for Vision Research at Byers Eye Institute, Stanford University School of Medicine, California, United States
  • Footnotes
    Commercial Relationships   Jennifer Haensel None; Lisa Jordan None; Angela Chen None; Susan Cotter None; Ingryd Lorenzana FCOVD FAAO None; Silvia Han None; Amy Aldrich None; Aparna Raghuram None; Kristine Huang None; Vivian Manh None; Reena Patel None; Dashaini Retnasothie None; Tawna Roberts None
  • Footnotes
    Support  Stanford Maternal and Child Health Research Institute (JXH), American Academy of Optometry Clinical Research Award (TLR)
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1425 – F0383. doi:
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      Jennifer X Haensel, Lisa Jordan, Angela Chen, Susan A Cotter, Ingryd Lorenzana FCOVD FAAO, Silvia Han, Amy E Aldrich, Aparna Raghuram, Kristine Huang, Vivian Manh, Reena Patel, Dashaini V Retnasothie, Tawna L Roberts; Associations Between Distance Visual Acuity and Cycloplegic Refractive Error in Children Aged 5 to 9 Years. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1425 – F0383.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Distance visual acuity (VA) testing is commonly performed in children to screen for significant refractive error; however, the diagnostic value of distance VA remains unclear. We examined associations between VA and different types of cycloplegic refractive error in children.

Methods : Unaided distance VA (logMAR) was assessed monocularly in 234 children using single-surround ATS-HOTV (5-6 years) or eETDRS (7-9 years) protocols. Better-eye VA was used for analyses. Cycloplegic refractive error was determined using the Grand Seiko WR-5100K autorefractor. Refractive error was classified as emmetropia (EMM; -0.75D< sphere (sph) <+0.75D & cylinder (cyl) <0.75D), simple myopia (SM; sph≤-0.75D & cyl<0.75D), simple hyperopia (SH; sph≥+0.75D & cyl<0.75D), compound myopic/hyperopic astigmatism (CMA/CHA; both meridians myopic/hyperopic & cyl≥0.75D), simple myopic/hyperopic astigmatism (SMA/SHA; one myopic/hyperopic & one emmetropic meridian), or mixed astigmatism (MA; one hyperopic & one myopic meridian). Receiver operating characteristic (ROC) analysis was conducted to identify optimal logMAR VA thresholds for the detection of each refractive error type (if N>10) using the Youden Index.

Results : VA ranged from -0.3 to 1.2 logMAR (median=0.0, IQR=0.3), SE from -3.15D to +10.45D (mean=+1.00D, SD=1.79D), and astigmatism from 0.03D to 4.24D (mean=0.75D, SD=0.75D). Refractive error distribution was SH (N=90), EMM (N=52), SHA (N=27), CHA (N=26), SM (N=16), SMA (N=13), CMA (N=7), and MA (N=3). Analyses found low optimal logMAR VA thresholds across refractive error types (SM=0.15, SMA=0.05, SH=-0.25, SHA=-0.05, CHA=0.05), with high sensitivity (SM=94%, SMA=85%, SH=100%, SHA=85%, CHA=81%) but low specificity (SMA=63%, SH=1%, SHA=39%, CHA=66%) except for SM (79%). Analyses were repeated with clinically significant hyperopia (sph≥+2.00D; SH: N=13, CHA: N=13), also yielding low optimal thresholds (SH=-0.25, CHA=0.05), high sensitivity (SH=100%, CHA=92%), and low specificity (SH=2%, CHA=55%). ROC analysis on any clinically significant refractive error type showed a low optimal logMAR threshold (0.05) with 78% sensitivity and 87% specificity.

Conclusions : Distance VA had poor diagnostic value in the detection of clinically significant refractive error in children 5 to 9 years of age. Optimal logMAR VA thresholds based on the Youden Index were not informative in discriminating refractive error type.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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