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.
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.
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.
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.
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Fantz RL (1958) Pattern vision in young infants. Psychol Rec 8:43–47
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
Dobson V (1994) Visual acuity testing by preferential looking techniques. The eye in infancy. Mosby, St-Louis
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
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
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
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
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
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
Regan D (1973) Rapid objective refraction using evoked brain potentials. Invest Ophthalmol 12:669–679
Regan D (1980) Speedy evoked potential method for assessing vision in normal and amblyopic eyes: pros and cons. Vis Res 20:265–269
Norcia AM, Tyler CW (1985) Infant VEP acuity measurements: analysis of individual differences and measurement error. Electroencephalogr Clin Neurophysiol 61(5):359–369
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
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
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
Norcia AM, Tyler CW (1985) Spatial frequency sweep VEP: visual acuity during the first year of life. Vis Res 25(10):1399–1408
Almoqbel F, Leat SJ, Irving E (2008) The technique, validity and clinical use of the sweep VEP. Ophthal Physiol Opt 28:393–403
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
Mackie RT, McCulloch DL (1995) Assessment of visual acuity in multiply handicapped children. Br J Ophthalmol 79(3):290–296
Atkinson J, Braddick O (2013) Inferences about infant’s visual brain mechanisms. Vis Neurosci 30(5–6):185–195
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
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
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
Sokol S, Moskowitz A, McCormack G, Augliere R (1988) Infant grating acuity is temporally tuned. Vis Res 28(12):1357–1366
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
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
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
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
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
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
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
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
Maurer D, Lewis TL (2001) Visual acuity: the role of visual input in inducing postnatal change. Clin Neurosci Res 1:239–247
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
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
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
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
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310
Altman DG, Bland JM (1983) Measurement in medicine: the analysis of method comparison studies. Statistician 32:307–317
Hamer RD, Norcia AM, Tyler CW, Hsu-Winges C (1989) The development of monocular and binocular VEP acuity. Vis Res 29(4):397–408
Norcia AM, Tyler CW, Hamer RD (1990) Development of contrast sensitivity in the human infant. Vis Res 30(10):1475–1486
Orel-Bixler D, Haegerstrom-Portnoy G, Hall A (1989) Visual assessment of the multiply handicapped patient. Optom Vis Sci 66(8):530–536
Salapatek P, Bechtold AG, Bushnell EW (1976) Infant visual acuity as a function of viewing distance. Child Dev 47(3):860–863
Campbell FW, Robson JG (1968) Application of Fourier analysis to the visibility of gratings. J Physiol 197:551–566
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
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
Ellemberg D, Lewis TL, Liu CH, Maurer D (1999) Development of spatial and temporal vision during childhood. Vis Res 39(14):2325–2333
Yuodelis C, Hendrickson A (1986) A qualitative and quantitative analysis of the human fovea during development. Vis Res 26(6):847–855
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
Ridder WH III, Rouse MW (2007) Predicting potential acuities in amblyopes. Doc Ophthalmol Adv Ophthalmol 114:135–145
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.
Health Canada provided financial support in the form of research funding. The sponsor had no role in the design or conduct of this research.
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.
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.
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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
- Visual acuity
- Teller acuity cards
- Sweep visual evoked potentials