Clinical testing of contrast sensitivity in children: Age-related norms and validity

Purpose. The Hiding Heidi (HH) test and the LEA low-contrast symbols are two commercially available charts of contrast sensitivity (CS) for children. However, there are no published normal data and no indication of how CS measured by these charts relates to other measures of CS. In this study, normal age-related data for both tests are reported, and validity against the Pelli-Robson (PR) chart is measured. Methods. Eighty-eight normally sighted children were divided into four age groups: 1 to <2.5 years, 2.5 to <4 years, 4 to <6 years, and 6 to <8 years. An adult group with normal vision and with low vision also took part. CS was measured with the HH test, the LEA symbols at 1 m and 28 cm, and the PR chart, as the child's ability permitted. Because there were obvious differences between the contrast levels of the PR chart and the nominal contrast for the children's charts, each contrast level for the children's tests was recalibrated. Results. The HH test and the LEA symbols at 28 cm and 1 m all showed a floor effect; that is, most children of all ages correctly responded to the lowest contrast. The median CS for the LEA symbols at 28 cm and 1 m was 2.22 log CS, which was 1.65 when recalibrated. There was a significant difference of PR CS between the 6- to <8-year-olds and adults (p < 0.001). Of the children's charts, the LEA symbols at 28 cm, once recalibrated for contrast, had the best agreement with the PR chart. Conclusion. The LEA and HH charts cannot measure a true contrast threshold for children with normal vision because of the floor effect. The LEA symbols at 28 cm gave the most useful information, once recalibrated for contrast, and may be useful to predict performance of children with low vision, when CS is likely to be compromised.