Vicente, Marvin Gaye Joson

OP1-1
Pediatric Optometry

PREFERENTIAL LOOKING

The Preferential Looking test is used to assess visual acuity in infants

and young children who are unable to identify pictures or letters. The child is
presented with two stimulus fields, one with stripes and the other with a
homogeneous gray area of the same average luminance as the striped field.
The location of the stripes is randomly alternated. Typically, infants and
children will look at the more interesting stripes (if they can detect them)
rather than at the blank field.

In the diagram, the baby is shown in an

infant seat; alternatively, the child may
sit on an adult's lap or be held over the
shoulder. A small peephole is centered
between the two fields. An observer
views the child through the peephole and
judges the location of the stripes based
on the child's head and eye movements.
If the child can see the stripes, he/she
will prefer to look at them. If the child
cannot see them, the striped field will
look the same as the blank gray field, and
the child will not show a preference. The smallest stripe width for which the
observer can consistently identify the location of the stripes is considered to
be the child's resolution threshold (visual acuity).

Reference: http://infantvision.org/diagnostic.htm#pl

Average time of assessment is approximately 3-8 minutes.

1. For < 6 months, test at 38 cm

2. For ≥ 6 months, test at 55 cm
3. Begin with largest grating to establish patient behavior/fixation patterns
4. Prior to each card presentation capture patient's attention
5. Begin testing with the manufacturer suggested "start card" based on age and
present in descending order in octave steps (every other card)
6. Briefly present each card at least 2x
7. View patient's response through the peephole
8. The examiner should not know in advance the location of the grating
9. When close to threshold present cards in half octave steps (1 card at a time)
and record the last line with 3/4 correct responses

Reference: http://www.scco.edu/ceonline/courseview.asp?selclassid=4&selID=24&selOrderID=3
In measuring of visual acuity in preverbal children subjective methods (Snellen’s
optotypes, Landolt C, Albini’s tumbling E test, Pigassou’s chart) are not suitable
because they require active participation by the child.

Reference: http://www.springerlink.com/content/k1u41g55453w85n2/

The patient doesn’t need to verbally communicate with the examiner or

necessarily understand the test.
Whilst resolution acuity tests are suitable for the very young or those with
whom communication is difficult, older children and those better able to communicate
should be tested with more complex visual acuity tests which assess ’recognition
acuity’