Departamento de Optica II (Optometria y Vision), Escuela Universitaria de Optica, Universidad Complutense de Madrid, C/ Arcos de Jalón s/n, 28037 Madrid, Spain.
Ophthalmic Physiol Opt. 2009 Nov;29(6):606-14. doi: 10.1111/j.1475-1313.2009.00679.x. Epub 2009 Aug 3.
Clinical measurement of the accommodative response (AR) identifies the focusing plane of a subject with respect to the accommodative target. To establish whether a significant change in AR has occurred, it is important to determine the repeatability of this measurement. This study had two aims: First, to determine the intraexaminer repeatability of AR measurements using four clinical methods: Nott retinoscopy, monocular estimate method (MEM) retinoscopy, binocular crossed cylinder test (BCC) and near autorefractometry. Second, to study the level of agreement between AR measurements obtained with the different methods.
The AR of the right eye at one accommodative demand of 2.50 D (40 cm) was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18-32 years). The intraexaminer repeatability of the tests, and agreement between them, were estimated by the Bland-Altman method. We determined mean differences (MD) and the 95% limits of agreement [coefficient of repeatability (COR) and coefficient of agreement (COA)].
Nott retinoscopy and BCC offered the best repeatability, showing the lowest MD and narrowest 95% interval of agreement (Nott: -0.10 +/- 0.66 D, BCC: -0.05 +/- 0.75 D). The 95% limits of agreement for the four techniques were similar (COA = +/- 0.92 to +/-1.00 D) yet clinically significant, according to the expected values of the AR. The two dynamic retinoscopy techniques (Nott and MEM) had a better agreement (COA = +/-0.64 D) although this COA must be interpreted in the context of the low MEM repeatability (COR = +/-0.98 D).
The best method of assessing AR was Nott retinoscopy. The BCC technique was also repeatable, and both are recommended as suitable methods for clinical use. Despite better agreement between MEM and Nott, agreement among the remaining methods was poor such that their interchangeable use in clinical practice is not recommended.
通过对调节反应（AR）的临床测量，可以确定被试者相对于调节目标的聚焦平面。为了确定 AR 是否发生了显著变化，重要的是要确定这种测量的可重复性。本研究有两个目的：第一，使用四种临床方法（Nott 视网膜检影、单眼估计法（MEM）视网膜检影、双眼交叉圆柱镜试验（BCC）和近距自动验光）确定 AR 测量的内部检查者重复性。其次，研究不同方法获得的 AR 测量值之间的一致性水平。
在 61 名视力正常的受试者中，右眼在一个 2.50 D（40 cm）的调节需求下，在两次不同的检查中进行测量，平均年龄为 19.7 岁（范围 18-32 岁）。通过 Bland-Altman 方法评估测试的内部检查者重复性以及它们之间的一致性。我们确定了平均差异（MD）和 95%一致性区间[可重复性系数（COR）和一致性系数（COA）]。
Nott 视网膜检影和 BCC 提供了最佳的可重复性，显示出最低的 MD 和最窄的 95%一致性区间（Nott：-0.10 +/- 0.66 D，BCC：-0.05 +/- 0.75 D）。根据 AR 的预期值，四种技术的 95%一致性区间相似（COA = +/- 0.92 至 +/-1.00 D），但具有临床意义。两种动态视网膜检影技术（Nott 和 MEM）具有更好的一致性（COA = +/-0.64 D），尽管 MEM 的可重复性较低（COR = +/-0.98 D），因此必须在该 COA 上下文中进行解释。
评估 AR 的最佳方法是 Nott 视网膜检影。BCC 技术也具有可重复性，两者都被推荐为临床使用的合适方法。尽管 MEM 和 Nott 之间的一致性更好，但其余方法之间的一致性较差，因此不建议在临床实践中互换使用。
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