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HOTV may improve vision screening before age 8

Preschool screening with HOTV yielded fewer referrals and better screening performance than tumbling E, with differences diminishing with age.

  • By

  • Andrea Surnit

  • September 9, 2026

  • 4 min

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Clinical Report: HOTV may improve vision screening before age 8

Overview

HOTV letter-matching testing demonstrates significant differences in uncorrected visual acuity and referral rates for reduced visual acuity compared to tumbling E testing in children under 8 years.

Background

Vision screening in early childhood is crucial for identifying amblyopia and refractive errors, which can impact a child's learning and development. Current guidelines recommend specific optotypes for preschool screening, emphasizing the need for effective testing methods. The choice of optotype can significantly influence screening outcomes, particularly in younger populations.

Data Highlights

Age GroupMean UCVA (logMAR)Referral Rate (HOTV)Referral Rate (Tumbling E)
Preschool (3-4 years)0.1519%31%
Lower Primary (5-7 years)0.1527%29%
Upper Primary/Secondary (8+ years)0.2064%61%

Key Findings

  • Mean uncorrected visual acuity (UCVA) was 0.15 logMAR with HOTV vs 0.20 logMAR with tumbling E.
  • Referral rates for reduced UCVA were 19% with HOTV vs 31% with tumbling E among preschool children.
  • True-positive rates for detecting amblyopia were higher with HOTV (0.68) compared to tumbling E (0.44) in preschoolers.
  • Testability was high for both tests, with 95% completing HOTV and 97% completing tumbling E.
  • HOTV showed modestly higher performance in detecting myopia and astigmatism compared to tumbling E.

Clinical Implications

The findings indicate differences in performance between HOTV and tumbling E for vision screening in children under 8 years.

Conclusion

The study presents findings on HOTV testing for vision screening in younger children, with noted differences compared to tumbling E.

Related Resources & Content

  1. Morgan et al., JAMA Ophthalmology, 2023 -- HOTV Vision Test Compared With Tumbling E for Pediatric Vision Screening
  2. the new optometrist — Screening for Vision and Hearing in Schools
  3. Optometric Management — Wise to the World
  4. eyecare business — #DOMORE
  5. the ophthalmologist — New Tool for Toddler Vision Testing
  6. Final Recommendation Statement: Vision Screening in Children Aged 6 Months to 5 Years
  7. Screening for Vision and Hearing in Schools
  8. Wise to the World
  9. #DOMORE
  10. HOTV Vision Test Compared With Tumbling E for Pediatric Vision Screening | Ophthalmology | JAMA Ophthalmology | JAMA Network

Original Source(s)

HOTV may improve vision screening before age 8

  • by Andrea Surnit

  • September 9, 2026

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