Age-related distribution and developmental characteristics of optokinetic nystagmus-based visual acuity in normal children aged 18-72 months

HUANG Dan; WANG Lihua; CHEN Xinhua; LI Jingyu; LI Manli; SUN Penghua; AN Dexiang; ZHONG Aimei; ZHANG Peibin; YUAN Songtao; Multi-center Pediatric OKN Screening Collaboration of the Chinese Preventive Medicine Association

doi:10.11852/zgetbjzz2026-0006

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Chinese Journal of Child Health Care ›› 2026, Vol. 34 ›› Issue (10) : 1087-1092. DOI: 10.11852/zgetbjzz2026-0006

Early-life Prevention of Chronic Disease

Age-related distribution and developmental characteristics of optokinetic nystagmus-based visual acuity in normal children aged 18-72 months

HUANG Dan¹, WANG Lihua², CHEN Xinhua³, LI Jingyu⁴, LI Manli⁵, SUN Penghua⁶, AN Dexiang⁷, ZHONG Aimei⁸, ZHANG Peibin¹, YUAN Songtao¹, Multi-center Pediatric OKN Screening Collaboration of the Chinese Preventive Medicine Association

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Abstract

Objective To characterize the age-specific distribution and developmental pattern of optokinetic nystagmus (OKN)-based visual acuity in children aged 18-72 months using multicenter data. Methods This multicenter cross-sectional study recruited 3 118 children aged 18-72 months from eight participating centers between 2024 and 2025, including 50.8% boys and 49.2% girls. Only children without identified amblyopia risk factors were included. All participants underwent comprehensive ophthalmic examinations, including automated OKN-based visual-acuity testing. Children were stratified into 10 age groups at 6-month intervals. Interocular differences in OKN-based visual acuity were assessed using the paired Wilcoxon signed-rank test, and monotonic age trends were evaluated using Spearman rank correlation. Results OKN-based visual acuity increased significantly with age (Spearman's ρ=0.888, P<0.001). The 5th and 50th percentile values at 18 months were 4.3 and 4.4, respectively, and increased to 4.6 and 4.9 at 72 months. Piecewise linear regression identified an age-related change point at 36 months. The slope was 0.110 per 6 months before the change point and approximately 0.015 per 6 months thereafter. The piecewise model provided a significantly better fit than the single linear model (ΔAIC=514.0, F=560.6, P<2.2×10^-16). Conclusions OKN-based visual acuity exhibited a two-phase age-related pattern. Values increase rapidly between 18 and 36 months—by approximately one visual-acuity line per 6-month increase in age—and then showed a slower increase or approaches a plateau. These findings provide an empirical basis for establishing age-specific reference values and interpreting OKN-based visual acuity in children aged 18-72 months.

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visual acuity / optokinetic nystagmus / development / percentile / children

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HUANG Dan, WANG Lihua, CHEN Xinhua, LI Jingyu, LI Manli, SUN Penghua, AN Dexiang, ZHONG Aimei, ZHANG Peibin, YUAN Songtao, Multi-center Pediatric OKN Screening Collaboration of the Chinese Preventive Medicine Association. Age-related distribution and developmental characteristics of optokinetic nystagmus-based visual acuity in normal children aged 18-72 months[J]. Chinese Journal of Child Health Care. 2026, 34(10): 1087-1092 https://doi.org/10.11852/zgetbjzz2026-0006

References

[1] 李长菲, 刘桂香, 黄启坤, 等. 视动性眼球震颤法在儿童视力检查中的应用分析[J]. 中国眼耳鼻喉科杂志, 2022, 22(5): 469-473.
Li CF, Liu GX, Huang QK, et al. Application analysis of optokinetic nystagmus method in visual acuity examination in children[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2022, 22(5): 469-473. (in Chinese)
[2] Turuwhenua J, LinTun Z, Norouzifard M, et al. OKN-Fast: Objective visual acuity threshold measurement using the optokinetic response[C]. IEEE EMBC, 2023, 2023: 1-4.
[3] 宋钰, 马玉娜, 刘桂香, 等. 运用视动性眼球震颤法检测视力的可行性研究[J]. 中国斜视与小儿眼科杂志, 2020, 28(1): 23,25, 28-29.
Song Y, Ma YN, Liu GX, et al. Feasibility study of visual acuity measurement using optokinetic nystagmus[J]. Chinese Journal of Strabismus and Pediatric Ophthalmology, 2020, 28(1): 23,25, 28-29. (in Chinese)
[4] Min X, Rehman FU, Jing W, et al. Preliminary study on the computer-based optokinetic nystagmus analyzer to detect the visual acuity of preschool children[J].Indian J Ophthalmol, 2024, 72(Suppl 2): 162-166.
[5] Turuwhenua J, LinTun Z, Norouzifard M, et al. Automated visual acuity estimation by optokinetic nystagmus using a stepped sweep stimulus[J].Ophthalmic Physiol Opt, 2024, 44(7): 1500-1512.
[6] Zhu B, Yang M, Liu X, et al. Assessing pediatric visual acuity with a computerized optokinetic nystagmus analyzer[J].Clinics (Sao Paulo), 2025, 80: 100671.
[7] 国家卫生健康委办公厅.关于印发0~6岁儿童眼保健及视力检查服务规范(试行)的通知[EB/OL]. 中华人民共和国国家卫生健康委员会公报, 2021(6): 8-37.
[8] Wester ST, Rizzo JF, Balkwill MD, et al. Optokinetic nystagmus as a measure of visual function in severely visually impaired patients[J].Invest Ophthalmol Vis Sci, 2007, 48(10): 4542-4548.
[9] Gurnani B, Kaur K, Chaudhary S, et al. Nystagmus in clinical practice: From diagnosis to treatment-a comprehensive review[J].Clin Ophthalmol, 2025, 19: 1617-1657.
[10] Han S, Han E, Hyon J, et al. Measurement of distance objective visual acuity with the computerized optokinetic nystagmus test in patients with ocular diseases[J].Graefes Arch Clin Exp Ophthalmol, 2011, 249: 1379-1385.
[11] Lim M, Soul JS, Hansen RM, et al. Development of visual acuity in children with cerebral visual impairment[J].Arch Ophthalmol, 2005, 123(9): 1215-1220.
[12] Neijzen CM, de Wit FM, Hettinga YM, et al. Reference values for the Teller Acuity Cards Ⅱ (TAC Ⅱ) in infants and preverbal children, a meta-analysis[J].Acta Ophthalmol, 2025, 103(4): 479-485.
[13] Doustkouhi SM, Turnbull PRK, Dakin SC. The effect of refractive error on optokinetic nystagmus[J].Sci Rep, 2020, 10(1): 20062.
[14] Mayer DL, Beiser AS, Warner AF, et al. Monocular acuity norms for the Teller Acuity Cards between ages one month and four years[J].Invest Ophthalmol Vis Sci, 1995, 36(3): 671-685.
[15] 中华医学会眼科学分会斜视与小儿眼科学组, 中国医师协会眼科医师分会斜视与小儿眼科学组. 中国儿童弱视防治专家共识(2021年)[J]. 中华眼科杂志, 2021, 57(5): 336-340.
Strabismus and Pediatric Ophthalmology Group, Chinese Ophthalmological Society, Chinese Medical Association, et al. Expert consensus on prevention and treatment of amblyopia in children (2021)[J]. Chinese Journal of Ophthalmology, 2021, 57(5): 336-340. (in Chinese)
[16] 李玲, 张红. 儿童青少年眼健康管理研究进展[J]. 中国儿童保健杂志, 2022, 30(4): 413-416.
Li L, Zhang H. Research progress on eye health management in children and adolescents[J]. Chin J Child Health Care, 2022, 30(4): 413-416. (in Chinese)
[17] 崔丽红, 姚聪. 儿童视力障碍的诊断与检查判定[J]. 中国实用儿科杂志, 2018, 33(4): 265-267.
Cui LH, Yao C. Diagnosis and examination criteria for visual impairment in children[J]. Chin J Prac Pediatr, 2018, 33(4): 265-267. (in Chinese)
[18] Lewis TL, Maurer D, Chung JY, et al. The development of symmetrical OKN in infants: Quantification based on OKN acuity for nasalward versus temporalward motion[J].Vision Res, 2000, 40(4): 445-453.
[19] Valmaggia C, Rütsche A, Baumann A, et al. Age related change of optokinetic nystagmus in healthy subjects: A study from infancy to senescence[J].Br J Ophthalmol, 2004, 88(12): 1577-1581.
[20] 黄丹, 杨翎, 王荔, 等. 视动性眼球震颤法在18月~4岁儿童视力检测中的应用研究[J]. 中国斜视与小儿眼科杂志, 2023, 31(4): 37-40, 68.
Huang D, Yang L, Wang L, et al. Application of optokinetic nystagmus method in visual acuity assessment among children aged 18 months to 4 years[J]. Chinese Journal of Strabismus and Pediatric Ophthalmology, 2023, 31(4): 37-40, 68. (in Chinese)