Normative Monocular Visual Acuity for Early Treatment Diabetic Retinopathy Study Charts in Emmetropic Children 5 to 12 Years of Age

Objective: To provide normative data for children tested with Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Design: Cross-sectional study. Participants: A total of 252 Native American (Tohono O'odham) children aged 5 to 12 years. On the basis of cycloplegic refraction conducted on the day of testing, all were emmetropic (myopia ≤0.25 diopter [D] spherical equivalent, hyperopia ≤1.00 D spherical equivalent, and astigmatism ≤0.50 D in both eyes). Methods: Monocular visual acuity was tested at 4 m, using 1 ETDRS chart for the right eye (RE) and another for the left eye (LE). Main Outcome Measures: Visual acuity was scored as the total number of letters correctly identified, by naming or matching to letters on a lap card, and as the smallest letter size for which the child identified 3 of 5 letters correctly. Results: Visual acuity results did not differ for the RE versus the LE, so data are reported for the RE only. Mean visual acuity for 5-year-olds (0.16 logarithm of the minimum angle of resolution [logMAR] [20/29]) was significantly worse than for 8-, 9-, 10-, 11-, and 12-year-olds (0.05 logMAR [20/22] or better at each age). The lower 95% prediction limit for determining whether a child has visual acuity within the normal range was 0.38 (20/48) for 5-year-olds and 0.30 (20/40) for 6- to 12-year-olds, which was reduced to 0.32 (20/42) for 5-year-olds and 0.21 (20/32) for 6- to 12-year-olds when recalculated with outlying data points removed. Mean interocular acuity difference did not vary by age, averaging less than 1 logMAR line at each age, with a lower 95% prediction limit of 0.17 log unit (1.7 logMAR lines) across all ages. Conclusions: For monocular visual acuity based on ETDRS charts to be in the normal range, it must be better than 20/50 for 5-year-olds and better than 20/40 for 6- to 12-year-olds. Normal interocular acuity difference includes values of less than 2 logMAR lines. Normative ETDRS visual acuity values are not as good as norms reported for adults, suggesting that a child's visual acuity results should be compared with norms based on data from children, not with adult norms. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.