检查者经验和技术对交替遮盖试验的影响。
Effect of examiner experience and technique on the alternate cover test.
作者信息
Anderson Heather A, Manny Ruth E, Cotter Susan A, Mitchell G Lynn, Irani Jasmine A
机构信息
*OD, PhD, FAAO †OD, MS, FAAO ‡MAS, FAAO §BS University of Houston College of Optometry, Houston, Texas (HAA, REM), Southern California College of Optometry, Fullerton, California (SAC, JAI), and The Ohio State University College of Optometry, Columbus, Ohio (GLM).
出版信息
Optom Vis Sci. 2010 Mar;87(3):168-75. doi: 10.1097/OPX.0b013e3181d1d954.
PURPOSE
To compare the repeatability of the alternate cover test between experienced and inexperienced examiners and the effects of dissociation time and examiner bias.
METHODS
Two sites each had an experienced examiner train 10 subjects (inexperienced examiners) to perform short and long dissociation time alternate cover test protocols at near. Each site conducted testing sessions with an examiner triad (experienced examiner and two inexperienced examiners) who were masked to each other's results. Each triad performed the alternate cover test on 24 patients using both dissociation protocols. In an attempt to introduce bias, each of the paired inexperienced examiners was given a different graph of phoria distribution for the general population. Analysis techniques that adjust for correlations introduced when multiple measurements are obtained on the same patient were used to investigate the effect of examiner and dissociation time on each outcome.
RESULTS
The range of measured deviations spanned 27.5 prism diopters (Δ) base-in to 17.5Δ base-out. The absolute mean difference between experienced and inexperienced examiners was 2.28 ± 2.4Δ and at least 60% of differences were ≤2Δ. Larger deviations were measured with the long dissociation protocol for both experienced and inexperienced examiners (mean difference range = 1.17 to 2.14Δ, p < 0.0001). The percentage of measured small deviations (2Δ base-out to 2Δ base-in) did not differ between inexperienced examiners biased with the narrow vs. wide theoretical distributions (p = 0.41). The magnitude and direction of the deviation had no effect on the size of the differences obtained with different examiners or dissociation times.
CONCLUSIONS
Although inexperienced examiners differed significantly from experienced examiners, most differences were <2Δ suggesting good reliability of inexperienced examiners' measurements. Examiner bias did not have a substantial effect on inexperienced examiner measurements; however, increased dissociation resulted in larger measured deviations for all examiners.
目的
比较经验丰富和缺乏经验的检查者交替遮盖试验的可重复性，以及分离时间和检查者偏差的影响。
方法
两个研究地点分别由一名经验丰富的检查者培训10名受试者（缺乏经验的检查者），使其在近距离执行短分离时间和长分离时间的交替遮盖试验方案。每个研究地点由一个检查者三人组（经验丰富的检查者和两名缺乏经验的检查者）进行测试，他们对彼此的结果不知情。每个三人组使用两种分离方案对24名患者进行交替遮盖试验。为了引入偏差，给每对缺乏经验的检查者提供了不同的一般人群隐斜分布图表。采用调整同一患者多次测量时引入的相关性的分析技术，来研究检查者和分离时间对每个结果的影响。
结果
测量偏差范围从27.5棱镜度（Δ）底向内到17.5Δ底向外。经验丰富和缺乏经验的检查者之间的绝对平均差异为2.28±2.4Δ，至少60%的差异≤2Δ。对于经验丰富和缺乏经验的检查者，长分离方案测量的偏差更大（平均差异范围 = 1.17至2.14Δ，p<0.0001）。在理论分布窄与宽的情况下，受偏差影响的缺乏经验的检查者之间，测量到的小偏差（2Δ底向外至2Δ底向内）百分比没有差异（p = 0.41）。偏差的大小和方向对不同检查者或分离时间获得的差异大小没有影响。
结论
尽管缺乏经验的检查者与经验丰富的检查者存在显著差异，但大多数差异<2Δ，表明缺乏经验的检查者测量的可靠性良好。检查者偏差对缺乏经验的检查者测量没有实质性影响；然而，分离时间增加导致所有检查者测量的偏差更大。
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