How do innovative occluding glasses compare with handheld spoon shaped occluders in children's visual acuity test? A diagnostic agreement study

Abstract: Objective To explore how a novel set of occluding glasses compare with handheld spoon shaped occluders in young children in terms of visual acuity test results, and how children felt about the two tools . Setting Outpatient clinic of the ophthalmology department in a university teaching hospital in Wuhan, China. Participants 210 children aged 3-9 yeas visiting the clinic for VAT from June 1 through July 30,2024 were conveniently selected as participants, among whom, 10 were excluded as their parents did not sign the informed consent paper. Study design This diagnostic agreement study compared two types of eye occluders using a cross-over design. The 200 children were divided into two equal batches: the first batch (case no.1-100) received VAT using handheld spoon-shaped eye occluders followed by occluding glasses, while the second batch (case no.101-200) received the interventions in the reverse order. Outcome measures Paired VAT scores generated from the study were compared with the Bland-Altman analysis. All children were asked of their acceptance regarding the two eye-covering tools upon completion of the 2nd VAT. Results The VAT score measured with occluding glasses were closely comparable with those measured with the handheld spoon-shaped eye occluders, with interclass correlation coefficient ( ICC ) of 0.989 and 0.989 for left eyes and right eyes, respectively(P<0.001). The mean difference of VAT score measured by the 2 tools was 0.007 for right eyes versus 0.005 for left eyes, and the 95% limits of agreement (LoA) ranged from -0.07 to 0.08 for right eyes versus 0.07 to 0.08 for left eyes ,with 0.5 % versus 1 % of the measurements outside the 95% LoA. 61%(122/200) of the children preferred the appearance of the occluding glasses and considered it "more attractive than the handheld one". However, respectively 90.0% and 93.0% of the children favored the hand-held occluder in terms of convenience and comfort. Conclusions The VAT measurements obtained with the two types of eye occluders showed excellent agreement, justifying the use of the occluding glasses as a promising tool for VAT in young children. Yet, refinement of the novel product is needed to enhance convenience and comfort. Key words myopia, visual acuity test, eye occluders, young children