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.

To compare the effectiveness of HOTV letter-matching testing versus tumbling E testing for vision screening in children under 8 years old.

Study Design: Cross-sectional observational study conducted in Shanghai, China, involving 995 children aged 3 to 15 years who completed both HOTV and tumbling E tests.
Testing Methodology: Participants underwent comprehensive ophthalmic examinations and completed both tests in randomized order with a 30-minute rest period.

Mean uncorrected visual acuity (UCVA) was better with HOTV (0.15 logMAR) than with tumbling E (0.20 logMAR).
The greatest difference in UCVA was observed in children aged 3 to younger than 4 years, reaching 1 logMAR line.
Referral rates for reduced UCVA were lower with HOTV (19%) compared to tumbling E (31%) among preschool children.
True-positive rates for amblyopia screening were higher with HOTV (0.68) than with tumbling E (0.44) in preschool children.
HOTV showed modestly higher performance for detecting myopia and astigmatism.

Both tests were administered on the same day, which may have introduced a fatigue effect.
Performance was poorer when either test was administered second, limiting direct comparisons.