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(Investigative Ophthalmology and Visual Science. 2003;44:3294-3300.)
© 2003 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.02-1199

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Repeatability of ETDRS Visual Acuity in Children

Ruth E. Manny,1 Mohamed Hussein,2 Jane Gwiazda,3 and Wendy Marsh-Tootle4 and the COMET Study Group5

1From the College of Optometry, University of Houston, Houston, Texas; the 2Department of Preventive Medicine, University Hospital and Medical Center, Stony Brook, New York; the 3New England College of Optometry, Boston, Massachusetts; and the 4School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama.

PURPOSE. To evaluate repeatability of the best corrected log minimum angle of resolution (MAR) Early-Treatment Diabetic Retinopathy Study (ETDRS) acuity in a group of 6- to 11-year old children with myopia.

METHODS. Best corrected monocular visual acuity (VA) of a subset of children (n = 86) enrolled in the Correction of Myopia Evaluation Trial (COMET; mean spherical equivalent refractive error -2.35 D with no more than 1.25 D astigmatism) was measured at baseline and 1 month later with ETDRS logMAR charts. Children started with logMAR 0.4 (6/15 or 20/50) and read each letter on all subsequent lines until they missed all letters in 1 line.

RESULTS. At baseline, the mean best corrected logMAR VA was 0.003 ± 0.076 (6/6 or 20/20 ± 3.8 letters) in the right eye and 0.008 ± 0.059 (6/6 or 20/20 ± 2.95 letters) in the left eye. The signed difference between VA measured at baseline and that measured at 1 month was not significantly different from zero in either eye. Repeatability was not associated with age, but a small, statistically significant association with gender was detected in the left eye, with boys approximately 2 letters more variable than girls. The {kappa} statistic (agreement within 1 line) was good to excellent.

CONCLUSIONS. Based on the 95% limits of agreement, the criterion for a statistically significant change in VA is no more than ±0.15 logMAR (or ±8 letters). This value is similar to those reported for adults and indicates that logMAR VA provides a repeatable measure of acuity in children.





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