Department of Ophthalmology, School of Medicine, Pusan National University, 1-10 Ami-dong Seo-gu, Busan, 49241, South Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
BMC Ophthalmol. 2021 Nov 30;21(1):413. doi: 10.1186/s12886-021-02187-9.
Assessing visual function in infants is usually challenging. Fix-and-Follow is a simple and popular method for assessing early development of visual perception in infants, currently however, there is no formal reproducible method for grading the capacity of fix-and-follow. This study was to develop and validate a new fix-and-follow grading system for assessing visual function development in preverbal children.
In this cross-sectional study, the fix-and-follow grades was evaluated in 21 consecutive preverbal children. Fixation was categorised as grade 1 if there was no response to the target and grade 2 if there was a response but only for < 3 s. Grades of 3 and 4 were assigned based capacities to (1) fix on a moving target for ≥3 s, and (2) shift fixation from one target to another. If only one of these two criteria was met, grade 3 was assigned. If both were met, grade 4 was assigned. Following was evaluated using smooth pursuit movement, where grade 1 indicated no movement, grade 2 partial movement, and grade 3 complete movement. Two ophthalmologists independently applied the grading method in all patients. Then one of two examiners repeated the examinations to investigate the intra-observer agreement of the grading system.
Intra-observer agreement was excellent (Kappa coefficient = 0.823) and inter-observer agreement was good (Kappa coefficient = 0.625). All patients who exhibited abnormal ocular movement had score discrepancy between a new fix-and-following grading examination.
The new fix-and-follow grading scale can be applied easily in preverbal children in an office setting, and it proved reliable and reproducible.
评估婴儿的视觉功能通常具有挑战性。固视跟随是一种用于评估婴儿早期视觉感知发育的简单而流行的方法，但目前尚无正式的可重复方法来分级固视跟随的能力。本研究旨在开发和验证一种新的固视跟随分级系统，用于评估言语前儿童的视觉功能发育。
在这项横断面研究中，对 21 例连续的言语前儿童进行了固视跟随分级评估。如果对目标没有反应，则将固视归类为 1 级；如果有反应，但持续时间<3 秒，则归类为 2 级。根据以下两种能力中的一种，将等级 3 和 4 分配：（1）能够固定在移动目标上≥3 秒；（2）将注视从一个目标转移到另一个目标。如果只满足这两个标准中的一个，则分配 3 级；如果都满足，则分配 4 级。随后评估平滑追踪运动，如果没有运动，则为 1 级；部分运动，则为 2 级；完全运动，则为 3 级。两位眼科医生独立地对所有患者应用分级方法。然后，其中一位检查者重复检查，以调查分级系统的观察者内一致性。
观察者内一致性极好（Kappa 系数=0.823），观察者间一致性良好（Kappa 系数=0.625）。所有表现出异常眼球运动的患者在新的固视跟随分级检查中都存在评分差异。
新的固视跟随分级量表可在言语前儿童的办公室环境中轻松应用，且证明具有可靠性和可重复性。
