本研究得到了首都健康改善与研究基金（编号：2018-2Z-4076）和北京大学第一医院SEED研究基金（2019SF31）的支持。

此处描述的方案已获得北京大学第一医院伦理委员会（PKUFH 2018-223）的批准。这些程序遵循《赫尔辛基宣言》关于涉及人类受试者的研究的原则。描述了研究形式，并获得了参与者父母的知情同意。
1. 设备的准备
注意：AACP 组件安装在光线较暗的测试室中。房间里的窗帘被拉开，以避免阳光的干扰。显示系统、记录系统和分析系统是 AACP 的三个组成部分（图 1）。
<ol><li>设置一个显示系统，一个 28 英寸液晶显示器（62.208 cm x 34.992 cm 屏幕，3840 像素 x 2160 像素，0.162 mm/像素，30 Hz 帧速率）。将显示显示器放在可以抬起的桌子上。通过 8 位查找表线性化屏幕亮度。将黑色、中灰色和白色的亮度分别设置为 1 cd/m 2、200 cd/m 2 和 400 cd/m2。</li>
	<li>在屏幕的两侧放置两个侧板，以减少对被测试儿童的干扰。</li>
	<li>设置一个录制系统，一个分辨率为 1080 像素/30 fps 的高清专业网络摄像头。 注意：网络摄像头记录测试人员行为的图像序列，每个图像序列以 1280 像素 x 720 像素裁剪。在自动敏锐度测试期间，每 200 毫秒获取一个带时间戳的网络摄像头图像以进行同步。</li>
	<li>将显示监视器和网络摄像头连接到计算机，即分析系统。确保网络摄像头位于屏幕正下方的中心，并且可以根据需要进行调整。 注：显示器和网络摄像头要么与计算机（便携式计算机或台式电脑）集成，要么是随后连接到计算机的独立设备。</li>
	<li>在计算机上安装AACP程序软件，用于显示刺激和分析眼球运动。AACP程序软件（中国国家发明专利，第201910865074.4号和第201510919621.4号）包括激励显示模块、视觉测试模块和测试结果处理模块。</li>
	<li>将视觉刺激设置为具有不同周期/度 （cpd） 空间频率和 1.00 对比度的 12 cm x 12 cm 方波光栅。确保刺激随机显示在屏幕左侧或右侧的中心，并且屏幕的其余部分显示类似于 TACII 的亮度匹配灰色区域。 注意：在55厘米的检测距离（与TACII一致）处，刺激与印刷的TACII卡（16张卡，1/2倍频程）上的刺激大致相同（由于像素大小限制）。</li>
</ol>2. 眼动追踪校准
<ol><li>获得家长的知情同意，并向他们描述研究形式。</li>
	<li>将孩子放置在距离显示器 55 厘米的地方。让孩子独自坐在椅子上，或者最好坐在父母的腿上。如果孩子独自坐着，让父母坐在孩子旁边。</li>
	<li>调整升降台的位置并将其与显示器一起放置。垂直于孩子的眼睛排列屏幕。</li>
	<li>调整网络摄像头的位置，以确保孩子的脸在录制系统中可见，并避免捕获孩子以外的人脸。</li>
	<li>在开始手术之前，通知孩子他们将观看屏幕。指示家长在孩子不注意时提示孩子看屏幕。测试期间不需要具体说明。</li>
	<li>打开 AACP 程序软件。在软件中输入孩子的信息（姓名、性别、年龄）。</li>
	<li>单击 “开始” 按钮。软件启动校准程序。图形交换格式（GIF）图像（2.0736 cm x 2.0736 cm，128 x 128像素）出现在屏幕中央的白色背景下（图2）。图像和背景音乐同时出现。这种刺激至少呈现3秒。分析系统同时确定儿童的视线是否注视在图像上。如果在此演示过程中 1 分钟内没有可用的凝视数据，屏幕将显示另一个卡通 GIF 图像。当在此区域内检测到注视坐标时，测试过程无需测试人员的操作即可启动并自动运行。</li>
</ol>3. 测试程序
<ol><li>呈现初始光栅。光栅的空间频率范围为0.33-30.0 cpd，步长为1/2倍频程。根据孩子的年龄确定初始光栅，如TACII测试。</li>
	<li>呈现初始光栅 1，000 毫秒，这是试验的长度。然后，显示 200 毫秒的空白屏幕。再次呈现相同的刺激，然后再次出现空白屏幕。呈现相同空间频率设置的光栅三次。</li>
	<li>在执行程序期间，让网络摄像头记录孩子的面部照片。该软件使用这些图片来分析他们的观看行为。视力测试程序根据 表1 中所述的标准检查眼动反应，以确定是否看到了刺激（图3）。</li>
	<li>让测试结果处理程序呈现后续激励，按照图4所示的协议11。</li>
	<li>每三次试验后，展示一张GIF图像（带背景音乐）作为视觉奖励，以保持孩子的兴趣。如果在 GIF 图像演示后 1 分钟内没有可用的凝视数据（例如，如果孩子转过身或闭上眼睛），请停止测试。此测试不输出任何结果。</li>
	<li>执行步骤3.4和3.5后，分析软件程序输出的子级光栅敏锐度结果。</li>
</ol>

婴幼儿视力的自动评估

<ol>
	<li>Teller, D. Y., McDonald, M. A., Preston, K., Sebris, S. L., Dobson, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+visual+acuity+in+infants+and+children:+the+acuity+card+procedure.">Assessment of visual acuity in infants and children: the acuity card procedure.</a> Developmental Medicine and Child Neurology. 28 (6), 779-789 (1986).</li><li>Teller, D. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+forced-choice+preferential+looking+procedure:+a+psychophysical+technique+for+use+with+human+infants.">The forced-choice preferential looking procedure: a psychophysical technique for use with human infants.</a> Infant Behavior and Development. 2, 135-153 (1979).</li><li>Preston, K. L., McDonald, M., Sebris, S. L., Dobson, V., Teller, D. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+acuity+card+procedure+for+assessment+of+infants+with+ocular+disorders.">Validation of the acuity card procedure for assessment of infants with ocular disorders.</a> Ophthalmology. 94 (6), 644-653 (1987).</li><li>Mohn, G., vanHof-van Duin, J., Fetter, W. P., de Groot, L., Hage, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acuity+assessment+of+non-verbal+infants+and+children:+clinical+experience+with+the+acuity+card+procedure.">Acuity assessment of non-verbal infants and children: clinical experience with the acuity card procedure.</a> Developmental Medicine and Child Neurology. 30 (2), 232-244 (1988).</li><li>Cavallini, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+acuity+in+the+first+two+years+of+life+in+healthy+term+newborns:+an+experience+with+the+teller+acuity+cards.">Visual acuity in the first two years of life in healthy term newborns: an experience with the teller acuity cards.</a> Functional Neurology. 17 (2), 87-92 (2002).</li><li>Clifford, C. E., Haynes, B. M., Dobson, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Are+norms+based+on+the+original+teller+acuity+cards+appropriate+for+use+with+the+new+teller+acuity+cards+II.">Are norms based on the original teller acuity cards appropriate for use with the new teller acuity cards II.</a> Journal of American Association for Pediatric Ophthalmology and Strabismus. 9 (5), 475-479 (2005).</li><li>Jones, P. R., Kalwarowsky, S., Atkinson, J., Braddick, O. J., Nardini, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automated+measurement+of+resolution+acuity+in+infants+using+remote+eye-tracking.">Automated measurement of resolution acuity in infants using remote eye-tracking.</a> Investigative Ophthalmology &amp; Visual Science. 55 (12), 8102-8110 (2014).</li><li>Hathibelagal, A. R., Leat, S. J., Irving, E. L., Nandakumar, K., Eizenman, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+infant+visual+acuity+with+gaze+tracker+monitored+visual+fixation.">Measuring infant visual acuity with gaze tracker monitored visual fixation.</a> Optometry and Vision Science. 92 (7), 823-833 (2015).</li><li>Barsingerhorn, A. D., Boonstra, F. N., Goossens, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Saccade+latencies+during+a+preferential+looking+task+and+objective+scoring+of+grating+acuity+in+children+with+and+without+visual+impairments.">Saccade latencies during a preferential looking task and objective scoring of grating acuity in children with and without visual impairments.</a> Acta Ophthalmologica. 97 (6), 616-625 (2019).</li><li>Vrabi&#269;, N., Juro&#353;, B., Tekav&#269;i&#269; Pompe, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automated+visual+acuity+evaluation+based+on+preferential+looking+technique+and+controlled+with+remote+eye+tracking.">Automated visual acuity evaluation based on preferential looking technique and controlled with remote eye tracking.</a> Ophthalmic Research. 64 (3), 389-397 (2021).</li><li>Wen, J., Yang, B., Li, X., Cui, J., Wang, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automated+assessment+of+grating+acuity+in+infants+and+toddlers+using+an+eye-tracking+system.">Automated assessment of grating acuity in infants and toddlers using an eye-tracking system.</a> Journal of Vision. 22 (12), 8 (2022).</li><li>Leone, J. F., Mitchell, P., Kifley, A., Rose, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normative+visual+acuity+in+infants+and+preschool-aged+children+in+Sydney.">Normative visual acuity in infants and preschool-aged children in Sydney.</a> Acta Ophthalmologica. 92 (7), e521-e529 (2014).</li><li>Clifford-Donaldson, C. E., Haynes, B. M., Dobson, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teller+Acuity+Card+norms+with+and+without+use+of+a+testing+stage.">Teller Acuity Card norms with and without use of a testing stage.</a> Journal of AAPOS. 10 (6), 547-551 (2006).</li><li>Robinson, J., Moseley, M., Fielder, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grating+acuity+cards-spurious+resolution+and+the+edge+artifact.">Grating acuity cards-spurious resolution and the edge artifact.</a> Clinical Vision Sciences. 3 (4), 285-288 (1988).</li></ol>

作者进行了以下披露：BK.Y.，XQ.L.，JS.C.和L.W.：中国国家发明专利“连续视频帧中人脸检测和瞳孔定位的方法和系统”（CN201910865074.4）;XQ.L.、BK.Y.、JS.C.和L.W.：中国国家发明专利“视觉自动测试系统”（第201510919621.4号）。

基于眼动追踪方法的几项研究7，8，9，10表明该方法在评估语言交流困难的婴幼儿方面具有价值。然而，以前研究的参与者人数相对较少。只有30名12个月以下的婴儿通过Jones等人开发的ACTIVE程序进行了测试7。由Vrabic等人开发的AVAT程序10对35名婴幼儿进行了类似的测?...

婴儿期是视觉发育的关键时期。生命早期出现的视觉问题会对孩子的发育产生重大影响。能够对婴儿进行定量视觉评估很重要，这有助于发现早期视力问题。然而，由于婴儿的认知发育或表达能力不足以识别视力表符号，如字母或图形，因此很难测量他们的视力。目前婴儿视力评估的黄金标准是基于优先视力测试2的视力卡程序1。但是，由于这种方法需要有经验的测试人员通过观察孩子的眼球运动来判断视力3，4，5，6，因此受到测试人员经验的限制4，5。因此，敏锐卡程序，如柜员敏锐卡（TAC）5，6，仍然是一种主观方法。因此，需要一种可以定量测量婴幼儿视力的方法，该方法无需口头交流即可使用，并且不受需要经验丰富的测试人员的限制。
远程眼动仪的发明和使用使自动敏锐度测量系统得以开发。在以前的研究中，眼动追踪方法已被用作儿童视觉功能评估的工具7，8，9，10。远程眼动仪可用于凝视跟踪，可以替代测试人员对儿童眼球运动的观察。ACTIVE程序7和AVAT程序10是使用远程眼动仪进行的全自动视力测试;他们在健康婴幼儿中产生了与基勒敏锐度卡测试相当的视力结果。与最近的其他研究相反，我们使用网络摄像头而不是远程眼动仪来捕捉孩子的目光。我们发明了一种基于计算机视觉的眼动数据自动获取方法。该程序将眼动获取方法与优先看技术相结合，以评估儿童的视觉功能。
本文旨在提出一种新型的自动化方法，该方法可以评估幼儿的视力，称为自动敏锐度卡程序（AACP）。该程序对尚未获得足够沟通技巧的婴幼儿特别有用。关键方面是可以量化视觉反应以产生婴幼儿的光栅敏锐度。光栅敏锐度测量能够检测视觉病理，并在后续医疗管理中发挥重要作用。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>AACP procedure software</td>
			<td>In-house</td>
			<td>In-house</td>
			<td>The AACP procedure software (China National Invention Patents, No. 201910865074.4 and No. 201510919621.4) comprises a stimulus displaying module, a vision testing module, and a testing result processing module.</td>
		</tr>
		<tr>
			<td>Computer processor</td>
			<td>Intel Corporation, Santa Clara, CA, USA&#160;</td>
			<td>Intel CORE i7-6500U processor</td>
			<td>Analysis system</td>
		</tr>
		<tr>
			<td>Display monitor</td>
			<td>InnoLux Co., Ltd., China</td>
			<td>InnoLux M280DGJ-L30&#160;</td>
			<td>Display system</td>
		</tr>
		<tr>
			<td>Webcam</td>
			<td>Logitech International S.A., Lausanne, Switzerland&#160;</td>
			<td>Logitech C920 high-definition pro webcam</td>
			<td>Recording system</td>
		</tr>
	</tbody>
</table>

an automated method for assessing visual acuity in infants and toddlers using an eye-tracking system

视力测量是在婴儿期和儿童期进行的一项重要视觉功能测试。然而，由于婴儿沟通能力的不足，很难准确测量他们的视力。本文提出了一种评估儿童（5-36个月大）视力的新型自动化方法。这种方法，即自动敏锐卡程序（AACP），使用网络摄像头进行眼动追踪，并自动识别儿童的观看行为。当被测儿童观看高分辨率数字显示屏上显示的视觉刺激时，进行双选优先外观测试。当被测试的孩子观看刺激时，他们的面部图片会被网络摄像头记录下来。这些图片被设置的计算机程序用来分析他们的观看行为。通过这个程序，测量孩子对不同刺激的眼动反应，并在没有交流的情况下评估他们的视力。通过将结果与柜员敏锐度卡（TAC）获得的光栅敏锐度进行比较，AACP性能被认为与TAC相当。

The infantile period is a critical period for visual development. Visual problems that arise early in life can have a significant impact on a child&#39;s development. It is important to be able to perform a quantitative visual assessment in infants, which can help detect early vision problems. However, because infants are not cognitively developed or expressive enough to recognize visual acuity chart symbols, such as letters or graphs, measuring their visual acuity is difficult. The current gold standard for infant vision assessment is the acuity card procedure1 based on the preferential looking test2. However, because this method requires experienced testers to judge visual acuity by observing the child&#39;s eye movements3,4,5,6, it is limited by the experience of the testers4,5. Therefore, acuity card procedures, such as Teller Acuity Cards (TACs)5,6, remain a subjective method. Thus, there is a need for a method that can quantitatively measure visual acuity in infants and young children, that can be used without the need for verbal communication and that is not limited by requiring experienced testers.
The invention and use of the remote eye tracker enabled an automated acuity measuring system to be developed. In previous studies, eye-tracking methods have been used as a tool for visual function evaluation in children7,8,9,10. A remote eye tracker can be used for gaze tracking and is a substitute for a tester&#39;s observation of a child&#39;s eye movements. The ACTIVE procedure7 and AVAT procedure10 are fully automated visual acuity tests with a remote eye tracker; they have yielded comparable visual acuity results to the Keeler Acuity Cards test in healthy infants and young children. As opposed to other recent studies, we used a webcam instead of a remote eye tracker to capture the child&#39;s gaze. We invented an eye movement data automatic acquisition method based on computer vision. The procedure combined the eye movement acquisition method with the preferential looking technique in assessing visual function in children.
This paper aims to present a novel automated method, which can evaluate visual acuity in young children, called the automated acuity card procedure (AACP). This procedure is particularly useful for infants and younger children who have not yet acquired sufficient communication skills. The key aspect is that visual responses can be quantitated to yield grating acuity in infants and young children. Grating acuity measurement enables the detection of visual pathologies and plays an important role in subsequent medical management.

作者聚焦：一种使用眼动追踪系统评估婴幼儿视力的自动化方法  

一种使用眼动追踪系统评估婴幼儿视力的自动化方法

This novel automated method called the Automated Acuity Card Procedure, or AACP, can evaluate visual acuity in young children. The procedure is useful for infancy and the younger children who have not yet acquired sufficient communication skills. The AACP procedure uses a webcam instead of a remote eye-tracker.A two-choice preferential-looking test automatically recognizes the child's watching behaviors. When the child watch the visual stimuli on a digital display screen, cartoon images are presented in the center of the screen as visual rewards during the testing procedure. It reduces the misstatement of the procedure caused by the infant's eye gets shifting to the side In the future, by changing the types of visual stimulation, the AACP may be used to evaluate other visual information processing functions early in children's development.

AACP应用于一组11：155正常发育的婴幼儿（5至36个月，基于胎龄）。在先前发表的一项研究中，将AACP获得的光栅敏锐度结果与TACII获得的结果进行了比较。通过这两个程序获得的结果显著相关（r153 = 0.83， p < 0.001）。只有10.32%（155个中的16个）的儿童结果相差超过一个八度。其中，8名儿童年龄为5-7个月。在这16名儿童中，有3名儿童的视力结果通过AACP获得，比TACII获?...

Watch this Scientific Journal Video about An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System at JoVE.com

在本文中，我们提出了一种通过使用眼动追踪系统评估婴幼儿视力的新型自动化方法。

Visual acuity measurement is an important visual function test to perform in infancy and childhood. However, accurate visual acuity measurement in infants ...

这种称为自动敏锐卡程序（AACP）的新型自动化方法可以评估幼儿的视力。该程序对尚未获得足够沟通技巧的婴儿和年幼儿童很有用。AACP程序使用网络摄像头而不是远程眼动仪。双选优先外观测试会自动识别孩子的观看行为。当孩子在数字显示屏上观看视觉刺激时，卡通图像在测试过程中作为视觉奖励呈现在屏幕中央。它减少了由于婴儿的眼睛移向侧面而导致的程序的错误陈述 在未来，通过改变视觉刺激的类型，AACP可用于评估儿童发育早期的其他视觉信息处理功能。

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Behavior

An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System

1.7K 次观看.  Peking University. 这种称为自动敏锐卡程序（AACP）的新型自动化方法可以评估幼儿的视力。该程序对尚未获得足够沟通技巧的婴儿和年幼儿童很有用。AACP程序使用网络摄像头而不是远程眼动仪。双选优先外观测试会自动识别孩子的观看行为。当孩子在数字显示屏上观看视觉刺激时，卡通图像在测试过程中作为视觉奖励呈现在屏幕中央。它减少了由于婴儿的眼睛移向侧面而导致的程序的?...