Guidelines recommend the HOTV matching-letter vision test for children aged 3 to 5 years for vision screening. However, the tumbling E test remains widely used globally despite requiring greater cognitive processing in younger children. A Chinese study compared the two tests for uncorrected visual acuity (UCVA) and assessed their performance for pediatric vision screening. The study included 995 children aged 3 to 15 years who underwent both vision tests, cycloplegic refraction, and comprehensive ophthalmic examinations.

Mean UCVA was 0.15 (20/25) with HOTV compared with 0.20 (20/32) with tumbling E. The difference between the tests was greater in younger children. It was about 1 logMAR line in children aged 3 to younger than 4 years and more than 3 letters in those younger than 8 years, but decreased to 1 letter or less in children aged 8 years and older. Among 183 preschool children,…