Lea symbols:: visual acuity assessment and detection of amblyopia

Objective: Lea symbols can be used for measuring visual acuity in childhood. Therefore, these symbols might be useful for early detection of amblyopia. We evaluated whether the visual acuity determined with Lea symbols (LS) corresponds to the visual acuity determined with the Landolt-C (LC). Patients and methods: In 55 strabismic amblyopic volunteers aged 5-59 years, the monocular visual acuity of both eyes was determined using LC and LS. For comparison, the right eye of 20 healthy volunteers was examined. Single optotypes (LC, LS) were used in 55 amblyopes and crowded optotypes (LC17.2, LC2.6, CLS) in 40 amblyopes. The luminance of the test charts was 180-200 cd/m(2), with a contrast >85%. The refraction of the subjects was corrected beforehand. Results: In the 40 amblyopic eyes tested under each condition, LS exceeded CLS and LC by about 1 line (dB), LC17.2 by 2 lines and LC2.6 by 3 lines (mean values +/- SD: LS 0.62+/-1.8 dB, CLS 0.46+/-1.7 dB, LC 0.5+/-2.0 dB, LC17.2, 0.41+/-2.3 dB, LC2.6 0.29+/-2.3 dB). The non-amblyopic fellow eyes and healthy eyes showed smaller differences (fellow eyes LS 1.32+/-1.1 dB, CLS 1.17+/-1.1 dB, LC 1.15+/-0.9 dB, LC17.2 1.05+/-0.9 dB, LC2.6 0.93+/-1.1 dB; healthy eyes LS 1.74+/-0.9 dB, CLS 1.58+/-0.8 dB, LC 1.48+/-0.6 dB, LC17.2 1.41+/-0.7 dB, LC2.6 1.32+/-1.1 dB). In the amblyopic eyes, the reduction of LC was more distinct than the reduction of LS. Fifty-two amblyopes had an amblyopia >1 dB of LC, LC17.2 and LC2.6, while 50 had an interocular acuity difference >1 dB CLS. Conclusions: Using Lea symbols, a recognition acuity can be determined and amblyopia can reliably be detected. Due to their design, the Lea symbols are particularly suitable and recommendable for application in young children. However a slight systematic difference between LS and LC has to be considered.