Detection of amblyopia in infants and toddlers is difficult because the current clinical standard for this age group, fixation preference, is inaccurate. Although grating acuity represents an alternative, studies of preschoolers and schoolchildren report that it is not equivalent to the gold standard optotype acuity. Here, we examine whether the Teller Acuity Cards (TAC) can detect amblyopia effectively by testing children old enough (7.8 ± 3.6 years) to complete optotype acuity testing.
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Each issue we will take a look at some of the most frequently asked questions that we receive and feature a Q & A below!
Q: What is the best way to prep a non-verbal or preliterate patient for optotype recognition?
A: It is important to set up the testing area ahead of time. The area should be well lit and arranged to assure as little distraction as possible. If you are in an open space use movable barriers to hide visual distractions when possible. Before beginning explain to the child what you are going to do and why, (a contest to see what each eye can see) then ask the child to name the symbols on the sample 5 symbol chart (response key). If they can’t think of a name, suggest: star, circle or ball; square or box; house or arrow; apple or heart. Be sure they are consistent in a name so you know that they can recognize the target correctly. When the symbols get smaller they may change to a smaller version of the name such as “ant house” or “berry”, etc. Asking them to match what the symbol looks like will confirm their answer. For a child who is hesitant to talk or name the symbols, ask them to match the symbol on the large square chart to the correct symbol on the separate individual symbol card (flash card) by pointing to the one that looks the same. It is easier to start with the largest symbols and then move to smaller ones. It is best to have fun with it!!