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Comparison of optotypes of Amsterdam Picture Chart with those of Tumbling-E, LEA Symbols, ETDRS, and Landolt-C in non-amblyopic and amblyopic patients

  • Pediatrics
  • Published:
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Abstract

Purpose

To compare optotypes of the Amsterdam Picture Chart (APK) with those of Landolt-C (LC), Tumbling-E (TE), ETDRS and LEA symbols (LEA), to assess their reliability in measuring visual acuity (VA).

Methods

We recruited healthy controls with equal VA and amblyopes with ≥2 LogMAR lines interocular difference. New logarithmic charts were developed with LC, TE, ETDRS, LEA, and APK with identical size and spacing (four optotypes) between optotypes. Charts were randomly presented at 5 m under DIN EN ISO 8596 and 8597 conditions. VA was measured with LC (LC-VA), TE, ETDRS, LEA, and APK, using six out of ten optotypes answered correctly as threshold.

Results

In 100 controls aged 17–31, LC-VA was −0.207 ± SD 0.089 LogMAR. Visual acuity measured with TE differed from LC-VA by 0.021 (positive value meaning less recognizable), with ETDRS 0.012, with Lea 0.054, and with APK 0.117. In 46 amblyopic eyes with LC-VA <0.5 LogMAR, the difference was for TE 0.017, for ETDRS 0.017, for LEA 0.089, and for APK 0.213. In 13 amblyopic eyes with LC-VA ≥0.5 LogMAR, the difference was for TE 0.122, ETDRS 0.047, LEA 0.057, and APK 0.019. APK optotypes had a lower percentage of passed subjects at each LogMAR line compared to Landolt-C. The 11 APK optotypes had different thresholds.

Conclusions

Small APK optotypes were recognized worse than all other optotypes, probably because of their thinner lines. Large APK optotypes were recognized relatively well, possibly reflecting recognition acuity. Differences between the thresholds of the 11 APK optotypes reduced its sensitivity further.

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References

  1. Gutter M, Limpens D, Moed JL, de Graaf MEL (1999) Handleiding praktische vaardigheden orthoptie, 2nd edn. Luiten, Barendrecht, pp 199–201

    Google Scholar 

  2. Van Velzen-Mol HWM, Blankespoor MN, Wagenaar-Fischer MM, van Leerdam FJM (2003) De standaard ‘Opsporing visuele stoornissen 0–19 jaar‘ van de jeugdgezondheidszorg. Neth J Med 147:2012–2017

    Google Scholar 

  3. Hyvärinen L, Näsänen R, Laurinen P (1980) New visual acuity test for preschool children. Acta Ophthalmol 58:507–511

    Article  Google Scholar 

  4. Gräf MH, Becker R (1999) Determining visual acuity with LH symbols and Landolt rings. Klin Monatsbl Augenheilkd 215(2):86–90

    Article  PubMed  Google Scholar 

  5. Gräf MH, Becker R, Kaufmann H (2000) LEA symbols: visual acuity assessment and detection of amblyopia. Arch Ophthalmol 238:53–58

    Google Scholar 

  6. Rassow B, Wang Y (1999) Correlation of letter optotypes with Landholt ring for different degrees of visual acuity. Klin Monatsbl Augenheilkd 215:119–126

    Article  CAS  PubMed  Google Scholar 

  7. Becker B, Hübsch S, Gräf MH, Kaufmann H (2002) Examination of young children with LEA symbols. Br J Ophthalmol 86(5):513–516

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Becker R, Teichler G, Gräf M (2011) Comparison of visual acuity measured using Landolt-C and ETDRS charts in healthy subjects and patients with various eye diseases. Klin Monatsbl Augenheilkd 228(10):864–867

    Article  CAS  PubMed  Google Scholar 

  9. Lai YH, Wang HZ, Hsu HT (2011) Development of visual acuity in preschool children as measured with Landolt C and Tumbling E charts. J AAPOS 15:251–255

    Article  PubMed  Google Scholar 

  10. Wesemann W, Schiefer U, Bach M (2010) Neue DIN-Normen zur Sehschärfebestimmung. Ophthalmologe 107:821–826

    Article  CAS  PubMed  Google Scholar 

  11. Wittich W, Overbury O, Kapusta MA, Watanabe DH (2006) Difference between recognition and resolution acuity in patients undergoing macular hole surgery. Invest Ophthalmol Vis Sci 47:3690–3694

    Article  PubMed  Google Scholar 

  12. Candy TR, Mishoulam SR, Nosofsky RM, Dobson V (2011) Adult discrimination performance for pediatric acuity test optotypes. Invest Ophthalmol Vis Sci 52(7):4307–4313

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Erasmus Medical Center, Dr. Molewaterplein 50-60, 3015 GE, Rotterdam, The Netherlands

    Ö. Engin, D. D. G. Despriet, H. M. van der Meulen-Schot & H. J. Simonsz

  2. University of Applied Sciences, Utrecht, The Netherlands

    A. Romers & X. Slot

  3. Rotterdam Eye Hospital, Rotterdam, The Netherlands

    M. Tjon Fo Sang

  4. Department of Ophthalmology, University Eye Clinic, Frankfurt, Germany

    M. Fronius

  5. Department of Psychometrics, Vrij Universiteit, Amsterdam, Holland

    H. Kelderman

Authors
  1. Ö. Engin
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  2. D. D. G. Despriet
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  3. H. M. van der Meulen-Schot
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  4. A. Romers
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  7. M. Fronius
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  8. H. Kelderman
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  9. H. J. Simonsz
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Correspondence to Ö. Engin.

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Engin, Ö., Despriet, D.D.G., van der Meulen-Schot, H.M. et al. Comparison of optotypes of Amsterdam Picture Chart with those of Tumbling-E, LEA Symbols, ETDRS, and Landolt-C in non-amblyopic and amblyopic patients. Graefes Arch Clin Exp Ophthalmol 252, 2013–2020 (2014). https://doi.org/10.1007/s00417-014-2763-7

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  • DOI: https://doi.org/10.1007/s00417-014-2763-7

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