Similarities and differences between behavioral and electrophysiological visual acuity thresholds in healthy infants during the second half of the first year of life

Abstract

Purpose

Behavioral and electrophysiological methods for visual acuity estimation typically correlate well in children and adult populations, but this relationship remains unclear in infants, particularly during the second half of the first year of life. It has been suggested that the agreement between both methods mostly relies on age and/or subjective acuity factors. The present study aimed at comparing acuity thresholds obtained with both approaches in a sample of healthy infants in a relatively narrow age range, that is 6–10 months old.

Methods

Acuity thresholds were assessed in 61 healthy infants aged between 6 and 10 months using the Teller acuity cards (TAC) and sweep visual evoked potentials (sVEP). The TAC stimuli (stationary vertical gratings displayed on laminated cards) ranged from 0.31 to 38 cycles per degree (cpd). The TAC acuity threshold was estimated according to the highest spatial frequency scored by the experimenter as seen by the infant. The sVEP stimuli (high-contrast vertical gratings counter-phased at 12 reversals/s) ranged from 13.5 to 1 cpd. sVEP were recorded at Oz and acuity threshold was estimated using regression linear fitting.

Results

Considering the entire sample, sVEP acuity thresholds (8.97 ± 2.52 cpd) were significantly better than TAC scores (5.58 ± 2.95 cpd), although the difference was within 1 octave for 64% of the infants. Neither Pearson nor intra-class correlations between the two methods were significant (0.18 and 0.03, respectively). While age at assessment was not related to any dependent variable (TAC, sVEP, sVEP–TAC difference score), subjective (behavioral) acuity was found to underlie the difference between the two methods. The difference between sVEP and TAC scores decreased as a function of subjective acuity, and at the highest subjective acuity level (>10 cpd), TAC acuity slightly exceeded sVEP acuity.

Conclusions

The superiority of sVEP acuity often reported in the literature was evident in our infant sample when subjective acuity (TAC) was low or moderate, but not when it was high (>10 cpd). The relationship between the two estimation methods was not dependent on age, but on subjective acuity.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. 1.

    Fantz RL (1958) Pattern vision in young infants. Psychol Rec 8:43–47

    Google Scholar 

  2. 2.

    Dobson V, Teller DY (1978) Visual acuity in human infants: a review and comparison of behavioral and electrophysiological studies. Vis Res 18(11):1469–1483

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Dobson V (1994) Visual acuity testing by preferential looking techniques. The eye in infancy. Mosby, St-Louis

    Google Scholar 

  4. 4.

    McDonald M, Dobson V, Sebris L, Baitch L, Varner D, Teller DY (1985) The acuity card procedure: a rapid test of infant acuity. Invest Ophthalmol Vis Sci 26:1158–1162

    CAS  PubMed  Google Scholar 

  5. 5.

    Courage ML, Adams RJ (1990) Visual acuity assessment from birth to three years using the acuity card procedure: cross-sectional and longitudinal samples. Optom Vis Sci 67(9):713–718

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Salomao SR, Ventura DF (1995) Large sample population age norms for visual acuities obtained with Vistech-Teller acuity cards. Invest Ophthalmol 36(3):657–670

    CAS  Google Scholar 

  7. 7.

    Hall HL, Courage ML, Adams RJ (2000) The predictive utility of the Teller acuity cards for assessing visual outcome in children with preterm birth and associated perinatal risks. Vis Res 40:2067–2076

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Teller DY, McDonald M, Preston K, Sebris L, Dobson V (1986) Assessment of visual acuity in infants and children: the acuity card procedure. Dev Med Child Neurol 28:779–789

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Tyler CW, Apkarian P, Levi D, Nakayama K (1979) Rapid assessment of visual function: an electric sweep technique for the pattern evoked potential. Invest Ophthalmol Vis Sci 18:703–713

    CAS  PubMed  Google Scholar 

  10. 10.

    Regan D (1973) Rapid objective refraction using evoked brain potentials. Invest Ophthalmol 12:669–679

    CAS  PubMed  Google Scholar 

  11. 11.

    Regan D (1980) Speedy evoked potential method for assessing vision in normal and amblyopic eyes: pros and cons. Vis Res 20:265–269

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Norcia AM, Tyler CW (1985) Infant VEP acuity measurements: analysis of individual differences and measurement error. Electroencephalogr Clin Neurophysiol 61(5):359–369

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Costa MF, Salomao SR, Berezovsky A (2004) Relationship between vision and motor impairment in children with spastic cerebral palsy: new evidence from electrophysiology. Behav Brain Res 149:145–150

    PubMed  Article  Google Scholar 

  14. 14.

    Costa MF, Ventura DF (2012) Visual impairment in children with spastic cerebral palsy measured by psychophysical and electrophysiological grating acuity tests. Dev Neurorehabil 15(6):414–424

    PubMed  Article  Google Scholar 

  15. 15.

    Good WV (2001) Development of a quantitative method to measure vision in children with chronic cortical visual impairment. Trans Am Ophthalmol Soc 99:253–269

    CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Norcia AM, Tyler CW (1985) Spatial frequency sweep VEP: visual acuity during the first year of life. Vis Res 25(10):1399–1408

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Almoqbel F, Leat SJ, Irving E (2008) The technique, validity and clinical use of the sweep VEP. Ophthal Physiol Opt 28:393–403

    Article  Google Scholar 

  18. 18.

    Riddell PM, Ladenheim B, Mast J, Catalano T, Nobile R, Hainline L (1997) Comparison of measures of visual acuity in infants: Teller acuity cards and sweep visual evoked potentials. Optom Vis Sci 74(9):702–707

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Mackie RT, McCulloch DL (1995) Assessment of visual acuity in multiply handicapped children. Br J Ophthalmol 79(3):290–296

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Atkinson J, Braddick O (2013) Inferences about infant’s visual brain mechanisms. Vis Neurosci 30(5–6):185–195

    PubMed  Article  Google Scholar 

  21. 21.

    Zemon V, Hartmann EE, Gordon J, Prunte-Glowazki A (1997) An electrophysiological technique for assessment of the development of spatial vision. Optom Vis Sci 74(9):708–716

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Ohn Y-H, Katsumi O, Matsui Y, Tetsuka H, Hirose T (1991) Snellen visual acuity versus pattern reversal visual evoked response acuity in clinical applications. Ophtalmic Res 26:240–252

    Article  Google Scholar 

  23. 23.

    Katsumi O, Arai M, Wajima R, Denno S, Hirose T (1995) Spatial frequency sweep pattern reversal VER acuity vs Snellen visual acuity: effect of optical defocus. Vis Res 36:903–909

    Article  Google Scholar 

  24. 24.

    Sokol S, Moskowitz A, McCormack G, Augliere R (1988) Infant grating acuity is temporally tuned. Vis Res 28(12):1357–1366

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Katsumi O, Arai M, Wajima R, Denno S, Hirose T (1996) Spatial frequency sweep pattern reversal VER acuity vs Snellen visual acuity: effect of optical defocus. Vis Res 36(6):903–909

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Prager TC, Zou YL, Jensen CL, Fraley JK, Anderson RE, Heird WC (1999) Evaluation of methods for assessing visual function of infants. J AAPOS 3(5):275–282

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Watson T, Orel-Bixler D, Haegerstrom-Portnoy G (2009) VEP vernier, VEP grating, and behavioral grating acuity in patients with cortical visual impairment. Optom Vis Sci 86(6):774–780. doi:10.1097/OPX.0b013e3181a59d2a

    PubMed  Article  Google Scholar 

  28. 28.

    Gottlob I, Fendick MG, Guo S, Zubcov AA, Odom JV, Reinecke RD (1990) Visual acuity measurements by swept spatial frequency visual-evoked-cortical potentials (VECPs): clinical application in children with various visual disorders. J Pediatr Ophthalmol Strabismus 27(1):40–47

    CAS  PubMed  Google Scholar 

  29. 29.

    Arai M, Katsumi O, Paranhos FR, Lopes De Faria JM, Hirose T (1997) Comparison of Snellen acuity and objective assessment using the spatial frequency sweep PVER. Graefe’s Arch Clin Exp Ophthalmol 235(7):442–447

    CAS  Article  Google Scholar 

  30. 30.

    Westall CA, Ainsworth JR, Buncic JR (2000) Which ocular and neurologic conditions cause disparate results in visual acuity scores recorded with visually evoked potential and teller acuity cards? J AAPOS 4(5):295–301. doi:10.1067/mpa.2000.107898

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Katsumi O, Denno S, Arai M, De Lopes Faria J, Hirose T (1997) Comparison of preferential looking acuity and pattern reversal visual evoked response acuity in pediatric patients. Graefe’s Arch Clin Exp Ophtalmol 235:684–690

    CAS  Article  Google Scholar 

  32. 32.

    Sokol S, Moskowitz A, McCormack G (1992) Infant VEP and preferential looking acuity measured with phase alternating gratings. Invest Ophthalmol Vis Sci 33(11):3156–3161

    CAS  PubMed  Google Scholar 

  33. 33.

    Maurer D, Lewis TL (2001) Visual acuity: the role of visual input in inducing postnatal change. Clin Neurosci Res 1:239–247

    Article  Google Scholar 

  34. 34.

    Odom JV, Bach M, Brigell M, Holder GE, McCulloch D, Mizota A, Tormene AP (2016) ISCEV standard for clinical visual evoked potentials: (2016 update). Doc Ophthalmol Adv Ophthalmol 133:1–9

    Article  Google Scholar 

  35. 35.

    Greenstein VC, Seliger S, Zemon V, Ritch R (1998) Visual evoked potential assessment of the effects of glaucoma on visual subsystems. Vis Res 38(12):1901–1911

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    McDonald M, Ankrum C, Preston K, Sebris SL, Dobson V (1986) Monocular and binocular acuity estimation in 18- to 36-month-olds: acuity card results. Am J Optom Physiol Opt 63(3):181–186

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Leone JF, Mitchell P, Kifley A, Rose KA (2014) Normative visual acuity in infants and preschool-aged children in Sydney. Acta Ophthalmol 92(7):e521–e529. doi:10.1111/aos.12366

    PubMed  Article  Google Scholar 

  38. 38.

    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Altman DG, Bland JM (1983) Measurement in medicine: the analysis of method comparison studies. Statistician 32:307–317

    Article  Google Scholar 

  41. 41.

    Hamer RD, Norcia AM, Tyler CW, Hsu-Winges C (1989) The development of monocular and binocular VEP acuity. Vis Res 29(4):397–408

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Norcia AM, Tyler CW, Hamer RD (1990) Development of contrast sensitivity in the human infant. Vis Res 30(10):1475–1486

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Orel-Bixler D, Haegerstrom-Portnoy G, Hall A (1989) Visual assessment of the multiply handicapped patient. Optom Vis Sci 66(8):530–536

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Salapatek P, Bechtold AG, Bushnell EW (1976) Infant visual acuity as a function of viewing distance. Child Dev 47(3):860–863

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Campbell FW, Robson JG (1968) Application of Fourier analysis to the visibility of gratings. J Physiol 197:551–566

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  46. 46.

    Yadav NK, Almoqbel F, Head L, Irving EL, Leat SJ (2009) Threshold determination in sweep VEP and the effects of criterion. Doc Ophthalmol Adv Ophthalmol 119(2):109–121. doi:10.1007/s10633-009-9177-6

    Article  Google Scholar 

  47. 47.

    Ridder WH III (2004) Methods of visual acuity determination with the spatial frequency sweep visual evoked potential. Doc Ophthalmol Adv Ophthalmol 109(3):239–247

    Article  Google Scholar 

  48. 48.

    Ellemberg D, Lewis TL, Liu CH, Maurer D (1999) Development of spatial and temporal vision during childhood. Vis Res 39(14):2325–2333

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Yuodelis C, Hendrickson A (1986) A qualitative and quantitative analysis of the human fovea during development. Vis Res 26(6):847–855

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    Ridder WH III, McCulloch D, Herbert AM (1998) Stimulus duration, neural adaptation, and sweep visual evoked potential acuity estimates. Invest Ophthalmol Vis Sci 39(13):2759–2768

    PubMed  Google Scholar 

  51. 51.

    Ridder WH III, Rouse MW (2007) Predicting potential acuities in amblyopes. Doc Ophthalmol Adv Ophthalmol 114:135–145

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank all families for their participation in this study and Mathieu Simard for his very helpful assistance in data collection and analysis. This research was funded by Health Canada. C. Polevoy was supported by the Canadian Institute of Health Research (CIHR) Doctoral Research Award.

Funding

Health Canada provided financial support in the form of research funding. The sponsor had no role in the design or conduct of this research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dave Saint-Amour.

Ethics declarations

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Statement on Human Rights

The study was performed in accordance with Universal Declaration of Human Rights.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Polevoy, C., Muckle, G., Séguin, J.R. et al. Similarities and differences between behavioral and electrophysiological visual acuity thresholds in healthy infants during the second half of the first year of life. Doc Ophthalmol 134, 99–110 (2017). https://doi.org/10.1007/s10633-017-9576-z

Download citation

Keywords

  • Visual acuity
  • Teller acuity cards
  • Sweep visual evoked potentials
  • Infant