Parent-administered visual acuity testing: is it reliable and can it improve office efficiency?

J AAPOS. 2004 Aug;8(4):332-7. doi: 10.1016/j.jaapos.2004.02.004.


Purpose: To evaluate the accuracy of a parent-administered visual acuity test, using the electronic visual acuity tester (EVA) (JAEB Center, Tampa, FL) and evaluate its use as a means to improve efficiency of office acuity testing.

Methods: This was a prospective experimental study. Part I: Sixty-four children had their visual acuity determined using the EVA, first by their parents and then by an ophthalmic technician. Acuity scores were compared. Part II: Forty-four other children were randomly assigned to one of 2 groups. Group A (parent-prescreen) children had their visual acuity determined first by the parents using the EVA. The visual acuity result in that child was then rechecked by the technician using the Reinforcement Phase and Phase 2 of the Amblyopia Treatment Study (ATS) visual acuity testing protocol. Group B (full ATS protocol) children had their acuity determined by the technician using the full ATS protocol. The number of optotypes presented by the technician in order to determine the acuity in each group was compared.

Results: Part I: Reliability of parent-determined visual acuity scores was high (r = 0.91 and 0.81 for right eyes (OD) and left eyes (OS), respectively), with 93% of right eye parent scores and 85% of left eye parent scores within 0.11 logarithm of minimal angle of resolution (logMAR) units (ie, within one line of vision) of the technician score. Part II: The parent prescreen group (Group A) required presentation of 66% fewer optotypes to the OD and 68% fewer optotypes to the OS than the full ATS protocol group (Group B) (OD: P = 5.4 x 10(-18); OS: P = 6.5 x 10(-18)).

Conclusions: Visual acuity testing results by parents using the EVA are reliable. Electronic visual acuity prescreening by parents reduces the number of optotype presentations required to be shown by the technician to accurately determine acuity. Use of a parent-assisted screening system in the waiting room may translate to increased office efficiency.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Caregivers
  • Child
  • Child, Preschool
  • Community Participation
  • Diagnosis, Computer-Assisted / methods*
  • Efficiency, Organizational*
  • Female
  • Humans
  • Male
  • Office Management
  • Parents*
  • Practice Management
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Vision Disorders / diagnosis*
  • Vision Tests / instrumentation
  • Vision Tests / methods*
  • Visual Acuity*