ArticlePloS one2017
Do picture-based charts overestimate visual acuity? Comparison of Kay Pictures, Lea Symbols, HOTV and Keeler logMAR charts with Sloan letters in adults and children.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 35 citations in OpenAlex.
- Visual Acuity: Comparison of ETDRS Charts Using Latin Letters, Tumbling E, or Landolt C Optotypes.Investigative ophthalmology & visual science · 2026Article
- Vision screening of Greenlandic children evaluating efficacy, coverage and future directions.Acta ophthalmologica · 2026Article
- Investigation of the Visual Acuity Test Success Rate of a New Child-Friendly Minimum-Separable Chart for 2- and 3-Year-Old Children.Vision (Basel, Switzerland) · 2025Article
- Vision screening in older adults who attend hospital following a fall: a scoping review.BMC geriatrics · 2025Article
- The Waterloo Differential Acuity Test (WatDAT)-Testability and normative data.Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) · 2025Article
- Recommended practices for vision screening in pre-school-age children: A 2025 update.Optometry and vision science : official publication of the American Academy of Optometry · 2025Review
- Elevated Visual Crowding in CRB1-Associated Retinopathies: Understanding Functional Visual Deficits Using Child-Friendly Computerized Testing.Investigative ophthalmology & visual science · 2025Article
- The importance of assessing vision in falls management: A narrative review.Optometry and vision science : official publication of the American Academy of Optometry · 2025Review
- Developing a Novel Pediatric Eye Chart Assessing Visual Acuity by Minimum Separable Threshold.Children (Basel, Switzerland) · 2024Article
- Validation of the Waterloo Differential Visual Acuity Test (WatDAT) and Comparison With Existing Pediatric Tests of Visual Acuity.Translational vision science & technology · 2023Article
- Discrimination of paediatric acuity test optotypes by 6-year-old children.Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) · 2023Article
- Acuity Comparison Methods via Timed Test-Retest Precision of Matching-Card e-ETDRS Compared to PDI Check in Treated Amblyopes and Superb Normals.Clinical optometry · 2023Article
- Preliminary clinical validation of a new picture-based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters.Eye (London, England) · 2022Article
- The Effect of Test Method on Visual Acuity in School Children Aged 4-5.The British and Irish orthoptic journal · 2022Article
- Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population.American journal of ophthalmology · 2021Article
- Grouping Effects on Foveal Spatial Interactions in Children.Investigative ophthalmology & visual science · 2020Article
- Article
- Measurement of visual acuity with a digital eye chart: optotypes, presentation modalities and repeatability.Journal of optometryArticle
- Differential visual acuity - A new approach to measuring visual acuity.Journal of optometryArticle
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeChildren may be tested with a variety of visual acuity (VA) charts during their ophthalmic care and differences between charts can complicate the interpretation of VA measurements. This study compared VA measurements across four pediatric charts with Sloan letters and identified chart design features that contributed to inter-chart differences in VA.
methodsVA was determined for right eyes of 25 adults and 17 children (4-9 years of age) using Crowded Kay Pictures, Crowded linear Lea Symbols, Crowded Keeler logMAR, Crowded HOTV and Early Treatment of Diabetic Retinopathy Study (ETDRS) charts in focused and defocused (+1.00 DS optical blur) conditions. In a separate group of 25 adults, we compared the VA from individual Kay Picture optotypes with uncrowded Landolt C VA measurements.
resultsCrowded Kay Pictures generated significantly better VA measurements than all other charts in both adults and children (p < 0.001; 0.15 to 0.30 logMAR). No significant differences were found between other charts in adult participants; children achieved significantly poorer VA measurements on the ETDRS chart compared with pediatric acuity tests. All Kay Pictures optotypes produced better VA (p < 0.001), varying from -0.38 ± 0.13 logMAR (apple) to -0.57 ± 0.10 logMAR (duck), than the reference Landolt C task (mean VA -0.19 ± 0.08 logMAR).
conclusionKay Pictures over-estimated VA in all participants. Variability between Kay Pictures optotypes suggests that shape cues aid in optotype determination. Other pediatric charts offer more comparable VA measures and should be used for children likely to progress to letter charts.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.