验光误差测量中的测试者间一致性。
Intertester agreement in refractive error measurements.
作者信息
Huang Jiayan, Maguire Maureen G, Ciner Elise, Kulp Marjean T, Quinn Graham E, Orel-Bixler Deborah, Cyert Lynn A, Moore Bruce, Ying Gui-Shuang
机构信息
*MS †PhD ‡OD §OD, MS ∥MD, MSCE **OD, PhD Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (JH, MGM, G-SY); Salus University, Elkins Park, Pennsylvania (EC); College of Optometry, Ohio State University, Columbus, Ohio (MTK); The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ); School of Optometry, University of California, Berkeley, Berkeley, California (DO-B); College of Optometry, Northeastern State University, Tahlequah, Oklahoma (LAC); and New England College of Optometry, Boston, Massachusetts (BM).
出版信息
Optom Vis Sci. 2013 Oct;90(10):1128-37. doi: 10.1097/OPX.0000000000000025.
PURPOSE
To determine the intertester agreement of refractive error measurements between lay and nurse screeners using the Retinomax Autorefractor and the SureSight Vision Screener.
METHODS
Trained lay and nurse screeners measured refractive error in 1452 preschoolers (3 to 5 years old) using the Retinomax and the SureSight in a random order for screeners and instruments. Intertester agreement between lay and nurse screeners was assessed for sphere, cylinder, and spherical equivalent (SE) using the mean difference and the 95% limits of agreement. The mean intertester difference (lay minus nurse) was compared between groups defined based on the child's age, cycloplegic refractive error, and the reading's confidence number using analysis of variance. The limits of agreement were compared between groups using the Brown-Forsythe test. Intereye correlation was accounted for in all analyses.
RESULTS
The mean intertester differences (95% limits of agreement) were -0.04 (-1.63, 1.54) diopter (D) sphere, 0.00 (-0.52, 0.51) D cylinder, and -0.04 (1.65, 1.56) D SE for the Retinomax and 0.05 (-1.48, 1.58) D sphere, 0.01 (-0.58, 0.60) D cylinder, and 0.06 (-1.45, 1.57) D SE for the SureSight. For either instrument, the mean intertester differences in sphere and SE did not differ by the child's age, cycloplegic refractive error, or the reading's confidence number. However, for both instruments, the limits of agreement were wider when eyes had significant refractive error or the reading's confidence number was below the manufacturer's recommended value.
CONCLUSIONS
Among Head Start preschool children, trained lay and nurse screeners agree well in measuring refractive error using the Retinomax or the SureSight. Both instruments had similar intertester agreement in refractive error measurements independent of the child's age. Significant refractive error and a reading with low confidence number were associated with worse intertester agreement.
目的
使用视网膜自动验光仪（Retinomax）和SureSight视力筛查仪，确定非专业筛查人员与护士筛查人员之间屈光不正测量结果的测试者间一致性。
方法
经过培训的非专业筛查人员和护士筛查人员，对1452名学龄前儿童（3至5岁）使用Retinomax和SureSight以随机顺序进行筛查人员和仪器的屈光不正测量。使用平均差值和95%一致性界限评估非专业筛查人员与护士筛查人员之间在球镜、柱镜和等效球镜（SE）方面的测试者间一致性。使用方差分析比较基于儿童年龄、睫状肌麻痹屈光不正以及读数置信度定义的组间测试者平均差值（非专业筛查人员减去护士筛查人员）。使用Brown-Forsythe检验比较组间一致性界限。所有分析均考虑了双眼相关性。
结果
对于Retinomax，测试者平均差值（95%一致性界限）为球镜-0.04（-1.63，1.54）屈光度（D）、柱镜0.00（-0.52，0.51）D、SE -0.04（1.65，1.56）D；对于SureSight，球镜为0.05（-1.48，1.58）D、柱镜0.01（-0.58，0.60）D、SE 0.06（-1.45，1.57）D。对于任何一种仪器，球镜和SE的测试者平均差值在不同年龄、睫状肌麻痹屈光不正或读数置信度的儿童组间无差异。然而，对于两种仪器，当眼睛存在显著屈光不正或读数置信度低于制造商推荐值时，一致性界限更宽。
结论
在“启智计划”学龄前儿童中，经过培训的非专业筛查人员和护士筛查人员使用Retinomax或SureSight测量屈光不正时一致性良好。两种仪器在屈光不正测量方面的测试者间一致性相似，与儿童年龄无关。显著的屈光不正和低置信度读数与较差的测试者间一致性相关。
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