Comparison of Patti Pics and Lea Symbols Optotypes in Children and Adults

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Although a great variety of pediatric tests of visual acuity exist, few have been compared directly within the same patients or have been evaluated directly against an adult gold standard.


Right eyes from 80 3- to 5-year-old preschoolers were tested at 3 m with the two current pediatric optotype tests—the Patti Pics and the Lea Symbols (Mass VAT versions)—that best adhere to the international standard for early eye and vision screening. For comparison, right eyes from 52 adults were tested under the same conditions with both pediatric tests and with a gold standard Mass VAT Sloan letter test.


Compared with the Patti Pics, both children and adults showed relatively better and finer levels of visual acuity with Lea Symbols (0.07–0.11 logMAR better). Compared with Sloan letters, adults’ acuity was also 0.09 logMAR better with the Lea Symbols but was virtually identical and also showed good statistical agreement with Patti Pics acuity.


Although both pediatric tests show excellent testability, our data suggest that acuity values obtained with the Patti Pics optotypes are more consistent with those obtained with a gold standard visual acuity test used for older children and adults.

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