Friedman David S, Katz Joanne, Repka Michael X, Giordano Lydia, Ibironke Josephine, Hawse Patricia, Tielsch James M
Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21210, USA.
Ophthalmology. 2008 Oct;115(10):1796-9. doi: 10.1016/j.ophtha.2008.04.001. Epub 2008 Jun 5.
To compare the results of fixation preference testing and standardized visual acuity testing in white and black children aged 30 through 71 months.
Cross-sectional study.
The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children aged 6 through 71 months in Baltimore, Maryland, United States. A total 1714 children 30 through 71 months of age were eligible for inclusion in this report, with 1435 (83.7%) testable by both fixation preference and Amblyopia Treatment Study (ATS) visual acuity testing protocol.
The vision of all children 30 through 71 months of age was tested using both the ATS visual acuity testing protocol (using single HOTV symbols with surround bars) and fixation preference testing (FPT).
The ability of fixation preference testing to identify children with clinically important interocular differences (IOD) in visual acuity (i.e., two or more logarithm of minimum angle of resolution units of difference or more).
Fifty-three children had 2 or more lines of IOD in visual acuity. Seven of them were graded as having momentary or no fixation (sensitivity = 13.2%; 95% confidence interval [CI], 5.3-27.2]), whereas 45 were graded as normal by FPT. In all 7 of the cases of poor FPT, the better-seeing eye was preferred. Low sensitivity and high specificity for detecting an IOD of 2 lines or more with FPT were seen for both white (33.3% sensitivity; 95% CI, 9.5-57.2; 99.6% specificity; 95% CI, 98.7-100) and black (6.5% sensitivity; 95% CI, 0.6, 23.2; 99.3% specificity; 95% CI, 98.3-99.8) children. When assessing FPT performance for 3 or more lines of IOD, only 5 of the 20 children (sensitivity, 25%; 95% CI, 6.0-44.0) had FPT grades of momentary or no fixation.
Fixation preference testing, when used as part of a population-based research project, does not identify accurately preschool children with 2 lines or more of IOD in presenting visual acuity. The clinical value of this test is poor and its use for diagnosis and monitoring interventions should be reconsidered.
比较30至71个月大的白种和黑种儿童的注视偏好测试结果与标准化视力测试结果。
横断面研究。
巴尔的摩小儿眼病研究是一项基于人群的对美国马里兰州巴尔的摩市6至71个月大儿童视力障碍患病率的评估。共有1714名30至71个月大的儿童符合纳入本报告的条件，其中1435名（83.7%）可通过注视偏好和弱视治疗研究（ATS）视力测试方案进行测试。
使用ATS视力测试方案（使用带有周边条的单个HOTV符号）和注视偏好测试（FPT）对所有30至71个月大儿童的视力进行测试。
注视偏好测试识别视力方面存在具有临床意义的双眼差异（IOD）（即相差两个或更多最小分辨角对数单位或更多）儿童的能力。
53名儿童的视力存在2行或更多行的IOD。其中7名被评定为有瞬间或无注视（敏感性=13.2%；95%置信区间[CI]，5.3 - 27.2），而45名通过FPT评定为正常。在所有7例FPT结果不佳的病例中，较好眼被优先选择。对于检测2行或更多行的IOD，白种儿童（敏感性33.3%；95% CI，9.5 - 57.2；特异性99.6%；95% CI，98.7 - 100）和黑种儿童（敏感性6.5%；95% CI，0.6，23.2；特异性99.3%；95% CI，98.3 - 99.8）的FPT均表现出低敏感性和高特异性。当评估3行或更多行IOD的FPT表现时，20名儿童中只有5名（敏感性，25%；95% CI，6.0 - 44.0）的FPT评定为瞬间或无注视。
当作为基于人群的研究项目的一部分使用时，注视偏好测试不能准确识别视力呈现2行或更多行IOD的学龄前儿童。该测试的临床价值较差，应重新考虑其在诊断和监测干预中的应用。
