Evaluation of the Aniseikonia Inspector Version 3 in School-Aged Children

Purpose It has been suggested that children perceptually adapt to changes in retinal image size in the presence of anisometropia and therefore do not display clinically significant aniseikonia. However, given that early methods of eikonometry were not child-friendly, the prevalence of this condition in children is poorly understood. Retinal image size differences may be relevant in the discussion of amblyogenesis. The computer-based Aniseikonia Inspector Version 3 (AI3) uses a simple, forced-choice method and includes calibration for heterophoria. The present study is designed to evaluate AI3 by measuring background and induced aniseikonia in children aged 5 to 13 years. Methods All subjects were present for a standard-of-care eye examination and had at least 20/40 best-corrected visual acuity and no history of strabismus or amblyopia. Trials of AI3 were performed in the vertical direction only, using the 12-point test, and two trials were recorded. Each subject was randomized to have a 4% size lens added to either the right eye or the left eye. Two trials were performed in this manner, followed by two more trials with the size lens over the alternate eye. Results Eighteen children were enrolled; three subjects were not able to complete testing because of lack of attention or understanding. Results from each condition (background aniseikonia, induced aniseikonia OD, and induced aniseikonia OS) were averaged for each patient. With the 4% size lens over the OD, mean aniseikonia measured -3.83%. With the 4% size lens over the OS, mean aniseikonia measured 4.29%. Conclusions Most children were able to complete aniseikonia testing with AI3. Background aniseikonia was clinically insignificant (0.59%), and induced aniseikonia measurements were close to expected values using a 4% size lens. Aniseikonia Inspector Version 3 appears to be a useful means for measuring aniseikonia in a normal pediatric population. Further study in children with anisometropia is needed.