title: Effect of age using Lea Symbols or HOTV for preschool vision screening.
abstract: OBJECTIVE
  To compare the effectiveness of the Lea Symbols and the HOTV distance visual acuity tests, presented monocularly in linear, crowded formats at 3 m, as vision screening tests to identify 3- to 5-year-old children in need of eye care.
  
  
  METHODS
  Subjects were 1,142 3- to 5-year-old Head Start children who completed a comprehensive eye examination, used to determine if the child had one or more targeted conditions: amblyopia, strabismus, significant refractive error, or unexplained reduced visual acuity. Each child was tested on both tests by masked examiners, with test order determined randomly. The optotype sizes administered were age-based according to the child's age at school entry on September 1. Children of age 3 were tested with 10/100, 10/32, 10/25, and 10/20 optotypes whereas those who were 4 were tested with 10/100, 10/25, 10/20, and 10/16 optotypes.
  
  
  RESULTS
  Most children (>95%) completed both tests, with no statistically significant differences. Pass/fail cut-offs were set to yield specificities as close as possible to 90%. The largest sensitivity differences observed were in the 3-year-old group (mean age, 45.3 months), where the sensitivity for detection of > or =1 targeted conditions was 61% for the Lea Symbols and was 46% for the HOTV letters (difference 15%, 95% confidence interval: -0.01 to 0.30) and the sensitivity for detection of group 1 conditions was 83% for the Lea Symbols and 57% for the HOTV letters (difference 26%, 95% confidence interval: -0.01 to 0.49). However, neither these differences nor any of the other age group sensitivity differences were statistically significant. For the 3-year-old children, the pass/fail criterion was one line larger for the HOTV letters than for the Lea Symbols.
  
  
  CONCLUSIONS
  Most children completed both tests. Although the 3-year-old children achieved better acuity scores with the Lea Symbols test, there were no statistically significant differences in sensitivity between tests for any age group.
mesh_terms: D000367:Age Factors; D000375:Aging; D002675:Child, Preschool; D004215:Distance Perception; D006801:Humans; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D015351:Vision Screening / Q000379:methods*; D014787:Vision Tests / Q000295:instrumentation* / Q000592:standards*; D014792:Visual Acuity