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TOPLINE
In young children, the HOTV letter-matching vision test was associated with slightly better measurements of uncorrected visual acuity (UCVA) and was linked to fewer referrals for reduced vision than the tumbling E test.
METHODOLOGY
- Researchers conducted a cross-sectional study to compare HOTV letter-matching and tumbling E tests for UCVA outcomes in children.
- They included 995 Chinese children aged 3 to 15 years from kindergartens and schools between September and December 2024. Children aged approximately 3 to younger than 6 years were considered preschoolers.
- Each child completed both HOTV and tumbling E tests in a random order with a 30-minute rest between tests.
- Researchers assessed mean UCVA using logMAR, a numeric scale wherein lower numbers indicate better sight.
- Additional assessments included referral rates for reduced vision, testability, screening accuracy for amblyopia and refractive errors, and time to complete each test.
TAKEAWAY
- Mean UCVA was 0.15 logMAR with HOTV and 0.20 logMAR with tumbling E, with a difference of -0.05 logMAR (P < .001).
- The difference in UCVA scores decreased with age, from a full line in children aged 3 to younger than 4 years, to one letter or less by age 8 years or older.
- Among preschoolers, fewer children were identified with reduced UCVA using HOTV than the tumbling E test (mean difference, -12.6%; P < .001), and HOTV more accurately identified children who truly had an eye condition (true-positive rate, 0.68 vs 0.44).
- Testability was 95.1% for HOTV and 96.5% for tumbling E, with no significant difference. Among preschoolers without prior testing, HOTV took 6.2 seconds longer for instruction (P < .001).
IN PRACTICE
"[The authors] have provided a robust analysis comparing the HOTV test to the tumbling E test, concluding that the HOTV test is superior in multiple measures and therefore recommend its use in screening," Anna R. O'Connor, PhD, wrote in an invited commentary accompanying the journal article.
SOURCE
The study was led by Haotian Wu, MD, of Shanghai Eye Hospital in Shanghai, China. It was published online on August 27 in JAMA Ophthalmology.
LIMITATIONS
Children took both tests on the same day and may have become tired between tests. The tumbling E test may not be suitable for young children.
DISCLOSURES
The study received support from the National Natural Science Foundation of China and Shanghai Science and Technology Innovation Action Plan. One author reported receiving personal fees from Eyerising International. Another author reported receiving grants from one of the funding agencies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
