Mataftsi Asimina, Kappos Nikolaos, Riga Paraskevi, Kokkali Stamatia, Malamaki Paraskevi, Brazitikos Periklis, Haidich Anna-Bettina
IInd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki "Papageorpiou" Hospital, N.Efkarpia, 56429, Thessaloniki, Greece.
Naval Hospital of Athens, Athens, Greece.
Graefes Arch Clin Exp Ophthalmol. 2019 Mar;257(3):639-644. doi: 10.1007/s00417-018-04235-5. Epub 2019 Jan 24.
Log-scaled crowded charts using standardized testing protocol are essential for precise and reproducible visual acuity (VA) testing regarding amblyopia. Despite common acceptance of these standards, current VA testing clinical practice shows considerable diversity. The purpose of this retrospective literature review was to investigate the methodology of VA measurement and reporting in pediatric ophthalmology literature regarding amblyopia.
We searched PubMed for clinical trials regarding amblyopia, published from January 1994 to July 2016. Primary outcomes included VA measurement methodology, namely use of (a) log-scaled chart, (b) crowded chart, and (c) specified testing protocol. The study design, publication year, and the journal's impact factor were analyzed in relation to the primary outcomes.
Out of the 165 initial reports, 150 were included. VA was measured with a log-scaled chart in 65%, with a crowded chart in 57%, and with a specified protocol in 51% of studies. All three criteria were met in 43% of studies and in multivariable logistic model, they were associated with more recent publication year (odds ratio [OR] = 1.11, 95% confidence interval [95%CI] = 1.03-1.20) and were more likely to be present in higher impact factor journals (OR = 1.42, 95%CI = 1.17-1.72) or randomized controlled trials (OR = 3.09, 95%CI = 1.44-6.59).
In the last two decades, more than half of clinical trials addressing amblyopia have not followed the recommended methodology for optimal visual acuity assessment. Thus, their measurements may have been contaminated with noise, and their respective results and conclusions may include errors. Adhering to optimal, standardized methodology is key to progress in both clinical and research grounds.
使用标准化测试方案的对数标度拥挤视力表对于弱视的精确且可重复的视力（VA）测试至关重要。尽管这些标准已被普遍接受，但当前的VA测试临床实践仍存在很大差异。本回顾性文献综述的目的是调查儿科眼科文献中关于弱视的VA测量和报告方法。
我们在PubMed上搜索了1994年1月至2016年7月发表的关于弱视的临床试验。主要结果包括VA测量方法，即使用（a）对数标度视力表、（b）拥挤视力表和（c）指定的测试方案。分析了研究设计、发表年份和期刊影响因子与主要结果的关系。
在165份初始报告中，纳入了150份。65%的研究使用对数标度视力表测量VA，57%使用拥挤视力表，51%使用指定方案。43%的研究满足所有三个标准，在多变量逻辑模型中，它们与更近的发表年份相关（优势比[OR]=1.11，95%置信区间[95%CI]=1.03-1.20），并且更有可能出现在影响因子较高的期刊（OR=1.42，95%CI=1.17-1.72）或随机对照试验中（OR=3.09，95%CI=1.44-6.59）。
在过去二十年中，超过一半的关于弱视的临床试验未遵循推荐的最佳视力评估方法。因此，它们的测量可能受到噪声干扰，其各自的结果和结论可能存在误差。坚持最佳的标准化方法是临床和研究取得进展的关键。
