The amblyopia treatment study visual acuity testing protocol

Jonathan M. Holmes, Roy W. Beck, Michael X. Repka, David A. Leske, Raymond T. Kraker, R. Clifford Blair, Pamela S. Moke, Eileen E. Birch, Richard A. Saunders, Richard W. Hertle, Graham E. Quinn, Kurt A. Simons, Joseph M. Miller

Research output: Contribution to journalArticlepeer-review

228 Scopus citations


Objective: To evaluate the reliability of a new visual acuity testing protocol for children using isolated surrounded HOTV optotypes. Methods: After initial pilot testing and modification, the protocol was evaluated using the Baylor-Video Acuity Tester (BVAT) to present isolated surrounded HOTV optotypes. At 6 sites, the protocol was evaluated for testability in 178 children aged 2 to 7 years and for reliability in a subset of 88 children. Twenty-eight percent of the 178 children were classified as having amblyopia. Results: Using the modified protocol, testability ranged from 24% in 2-year-olds to 96% in 5- to 7-year-olds. Test-retest reliability was high (r=0.82), with 93% of retest scores within 0.1 logMAR unit of the initial test score. The 95% confidence interval for an acuity score was calculated to be the score ±0.125 logMAR unit. For a change between 2 acuity scores, the 95% confidence interval was the difference ±0.18 logMAR unit. Conclusions: The visual acuity protocol had a high level of testability in 3- to 7-year-olds and excellent test-retest reliability. The protocol has been incorporated into the multicenter Amblyopia Treatment Study and has wide potential application for standardizing visual acuity testing in children.

Original languageEnglish (US)
Pages (from-to)1345-1353
Number of pages9
JournalArchives of ophthalmology
Issue number9
StatePublished - 2001

ASJC Scopus subject areas

  • Ophthalmology


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