The LEA Vision Test System is a series of pediatric vision tests designed specifically for children who do not know how to read the letters of the alphabet that are typically used in eye charts. There are numerous variants of the LEA test which can be used to assess the visual capabilities of near vision and distance vision, as well as several other aspects of occupational health, such as contrast sensitivity, visual field, color vision, visual adaptation, motion perception, and ocular function and accommodation (eye). [1]
The first version of the LEA test was developed in 1976 by Finnish pediatric ophthalmologist Lea Hyvärinen, MD, PhD. Dr. Hyvärinen completed her thesis on fluorescein angiography and helped start the first clinical laboratory in that area while serving as a fellow at the Wilmer Eye Institute of Johns Hopkins Hospital in 1967. During her time with the Wilmer Institute, she became interested in vision rehabilitation and assessment and has been working in that field since the 1970s, training rehabilitation teams, designing new visual assessment devices, and teaching. The first test within the LEA Vision Test System that Dr. Hyvarinen created was the classic LEA Symbols Test followed shortly by the LEA Numbers Test which was used in comparison studies within the field of occupational medicine. [2]
Among the array of visual assessment picture tests that exist, the LEA symbols tests are the only tests that have been calibrated against the standardized Landolt C vision test symbol. The Landolt C is an optotype that is used throughout most of the world as the standardized symbol for measuring visual acuity. It is identical to the "C" that is used in the traditional Snellen chart.[ citation needed ]
In addition to this, the LEA symbols test has been experimentally verified to be both a valid and reliable measure of visual acuity. As is desirable of a good vision test, each of the four optotypes used in the symbols test has been proven to measure visual acuity similarly and blur equally as well, supporting the test's internal consistency. [3]
A study published in Acta Ophthalmologica Scandinavica in 2006 [4] showed that the Lea Symbols 15-line folding distance chart is clinically useful in detecting deficiencies in visual acuity in preschool children. The study, which compared visual acuity diagnoses from Lea symbols tests to those obtained via ophthalmological examination, revealed that the Lea symbols chart provided an accurate and sufficient assessment in 95.9% of the 149 preschool-age children tested. This suggests that Lea tests can be used confidently as an alternative to more costly and time-consuming pediatric tests of visual acuity.
The unique design of the LEA tests and their special optotypes allow for pediatric low vision to be diagnosed in children at much younger ages than standard vision tests allow. This is especially important in young children who possess other physical disabilities or mental disabilities and are entitled to receive early special education benefits. More than half of children who suffer from low vision also have other impairments or disabilities. Most of the LEA tests can also be used on children with significant brain damage and serve as one of the few methods that can accurately assess visual actuiy in these situations. [5]
The LEA Vision Test System currently contains over 40 different tests which target the assessment of many aspects of vision and communication deficiencies in both children and adults. [6]
The oldest and most basic form of the LEA test is simply referred to as the "LEA Symbols Test". This test consists of four optotypes (test symbols): the outlines of an apple, a pentagon, a square, and a circle. Because these four symbols can be named and easily identified as everyday, concrete objects ("apple", "house", "window", and "ring"), they can be recognized at an earlier age than abstract letters or numbers can be. This enables preschool children to be tested for visual acuity long before they become familiar with the letter and numbers used in other standard vision charts.[ citation needed ]
The LEA Symbols Test is often used in the form of the three-dimensional (3-D) LEA Puzzle. This puzzle incorporates color along with the four standard optotypes to allow for measurement of visual acuity in children as young as fourteen months of age. [7]
The "LEA Numbers Test" was the second of the LEA tests that was developed and can be used to test the visual acuity of older children and even adults. This test has a layout similar to a typical Snellen chart, with lines of numbers decreasing in size towards the bottom of the page. Like the optotypes of the LEA Symbols Test, these numbers are also calibrated against the Landolt C and blur equally.
This test allows for the assessment of grating acuity, especially in children who possess severe or multiple visual deficiencies. The "LEA Gratings Test" has also been shown to be successful in vision testing of children with brain damage and is the only test that can reveal their limited capacity for the processing of large numbers of parallel lines. [8]
Visual information that is presented in low contrast settings is very important to the process of visual communication. It is especially vital to assess a child's contrast sensitivity at a young age in order to determine the distance and accuracy with the child can distinguish facial features. A very popular test designed specifically for this reason is the "Hiding Heidi Low Contrast Face Pictures" test (which the LEA Vision Test System produces a version of.) This test uses a series of cards depicting cartoon faces of different contrast levels. The contrast sensitivity assessment obtained from this test is very important in educational settings because children with contrast deficiencies have extreme difficulty receiving visual cues from body language or facial expressions and often can't read the blackboard or projector. [9]
Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to fully process input from one eye and over time favors the other eye. It results in decreased vision in an eye that typically appears normal in other respects. Amblyopia is the most common cause of decreased vision in a single eye among children and younger adults.
Visual acuity (VA) commonly refers to the clarity of vision, but technically rates an examinee's ability to recognize small details with precision. Visual acuity is dependent on optical and neural factors, i.e. (1) the sharpness of the retinal image within the eye, (2) the health and functioning of the retina, and (3) the sensitivity of the interpretative faculty of the brain. The most commonly referred visual acuity is the far acuity, which describes the examinee's ability to recognize small details at a far distance, and is relevant to people with myopia; However, for people with hyperopia, the near acuity is used instead to describe the examinee's ability to recognize small details at a near distance.
A Snellen chart is an eye chart that can be used to measure visual acuity. Snellen charts are named after the Dutch ophthalmologist Herman Snellen, who developed the chart in 1862. Many ophthalmologists and vision scientists now use an improved chart known as the LogMAR chart.
An eye chart, or optotype, is a chart used to measure visual acuity. Eye charts are often used by health care professionals, such as optometrists, physicians or nurses, to screen persons for vision impairment. Ophthalmologists, physicians who specialize in the eye, also use eye charts to monitor the visual acuity of their patients in response to various therapies such as medications or surgery.
An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.
Pediatric ophthalmology is a sub-speciality of ophthalmology concerned with eye diseases, visual development, and vision care in children.
Herman Snellen was a Dutch ophthalmologist who introduced the Snellen chart to study visual acuity (1862). He took over directorship of the Netherlands Hospital for Eye Patients, after Franciscus Donders.
The Landolt C, also known as a Landolt ring, Landolt broken ring, or Japanese vision test, is an optotype: a standardized symbol used for testing vision. It was developed by the Swiss-born ophthalmologist Edmund Landolt.
Infant vision concerns the development of visual ability in human infants from birth through the first years of life. The aspects of human vision which develop following birth include visual acuity, tracking, color perception, depth perception, and object recognition.
Contrast is the difference in luminance or colour that makes an object distinguishable. In visual perception of the real world, contrast is determined by the difference in the colour and brightness of the object and other objects within the same field of view. The human visual system is more sensitive to contrast than absolute luminance; we can perceive the world similarly regardless of the huge changes in illumination over the day or from place to place. The maximum contrast of an image is the contrast ratio or dynamic range.
Emmetropia is the state of vision in which a faraway object at infinity is in sharp focus with the eye lens in a neutral or relaxed state. That condition of the normal eye is achieved when the refractive power of the cornea and eye lens and the axial length of the eye balance out, which focuses rays exactly on the retina, resulting in perfectly sharp distance vision. A human eye in a state of emmetropia requires no corrective lenses for distance; the vision scores well on a visual acuity test.
An E chart, also known as a tumbling E chart, is an ophthalmological chart used to measure a patient's visual acuity.
Sloan letters, designed by Louise Sloan in 1959, are a set of optotypes used to test visual acuity generally used in Snellen charts and logMAR charts.
Low vision is both a subspeciality and a condition. Optometrists, Opticians and Ophthalmologists after their training may undergo further training in Low vision assessment and management. There are various classifications for low vision, this varies from country to country and even from state to state. It must however be noted that the work of a low vision specialist is very important as they aid individuals with reduced vision even in the presence of conventional lenses to be able to make use of their residual vision. People benefitting from low vision assessment must be motivated to make use of the residual vision and must again be willing to use the various aids that would be prescribed.
A logMAR chart is a chart consisting of rows of letters that is used by ophthalmologists, orthoptists, optometrists, and vision scientists to estimate visual acuity. The chart was developed at the National Vision Research Institute of Australia in 1976, and is designed to enable a more accurate estimate of acuity than do other charts. For this reason, the LogMAR chart is recommended, particularly in a research setting.
Stereoscopic acuity, also stereoacuity, is the smallest detectable depth difference that can be seen in binocular vision.
Cyclotropia is a form of strabismus in which, compared to the correct positioning of the eyes, there is a torsion of one eye about the eye's visual axis. Consequently, the visual fields of the two eyes appear tilted relative to each other. The corresponding latent condition – a condition in which torsion occurs only in the absence of appropriate visual stimuli – is called cyclophoria.
Vernier acuity is a type of visual acuity – more precisely of hyperacuity – that measures the ability to discern a disalignment among two line segments or gratings. A subject's vernier acuity is the smallest visible offset between the stimuli that can be detected. Because the disalignments are often much smaller than the diameter and spacing of retinal receptors, vernier acuity requires neural processing and "pooling" to detect it. Because vernier acuity exceeds acuity by far, the phenomenon has been termed hyperacuity. Vernier acuity develops rapidly during infancy and continues to slowly develop throughout childhood. At approximately three to twelve months old, it surpasses grating acuity in foveal vision in humans. However, vernier acuity decreases more quickly than grating acuity in peripheral vision. Vernier acuity was first explained by Ewald Hering in 1899, based on earlier data by Alfred Volkmann in 1863 and results by Ernst Anton Wülfing in 1892.
Childhood cataract is cataract that occurs at birth or in childhood. It may be congenital or acquired.
The Jaeger chart is an eye chart used in testing near vision acuity. It is a card on which paragraphs of text are printed, with the text sizes increasing from 0.37 mm to 2.5 mm. This card is to be held by a patient at a fixed distance from the eye dependent on the J size being read. The smallest print that the patient can read determines their visual acuity. The original 1867 chart had a text containing seven paragraphs and a corresponding seven-point scale.