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The Amblyopia Treatment Study Visual Acuity Testing Protocol
Arch Ophthalmol. 2001;119:1345-1353.
Objective To evaluate the reliability of a new visual acuity testing protocol for children using isolated surrounded HOTV optotypes.
Methods After initial pilot testing and modification, the protocol was evaluated using the Baylor-Video Acuity Tester (BVAT) to present isolated surrounded HOTV optotypes. At 6 sites, the protocol was evaluated for testability in 178 children aged 2 to 7 years and for reliability in a subset of 88 children. Twenty-eight percent of the 178 children were classified as having amblyopia.
Results Using the modified protocol, testability ranged from 24% in 2-year-olds to 96% in 5- to 7-year-olds. Test-retest reliability was high (r = 0.82), with 93% of retest scores within 0.1 logMAR unit of the initial test score. The 95% confidence interval for an acuity score was calculated to be the score ±0.125 logMAR unit. For a change between 2 acuity scores, the 95% confidence interval was the difference ±0.18 logMAR unit.
Conclusions The visual acuity protocol had a high level of testability in 3- to 7-year-olds and excellent test-retest reliability. The protocol has been incorporated into the multicenter Amblyopia Treatment Study and has wide potential application for standardizing visual acuity testing in children.
Jonathan M. Holmes, BM, BCh;
Roy W. Beck, MD, PhD;
Michael X. Repka, MD;
David A. Leske, BS;
Raymond T. Kraker, MSPH;
R. Clifford Blair, PhD;
Pamela S. Moke, MSPH;
Eileen E. Birch, PhD;
Richard A. Saunders, MD;
Richard W. Hertle, MD;
Graham E. Quinn, MD;
Kurt A. Simons, PhD;
Joseph M. Miller, MD;
for the Pediatric Eye Disease Investigator Group
From the Department of Ophthalmology, Mayo Clinic, Rochester, Minn (Dr Holmes and Mr Leske); the Jaeb Center for Health Research, Tampa, Fla (Drs Beck and Blair, Mr Kraker, and Ms Moke); the Wilmer Eye Institute, Johns Hopkins University, Baltimore, Md (Drs Repka and Simons); the Retina Foundation of the Southwest, Dallas, Tex (Dr Birch); the Department of Ophthalmology, Medical University of South Carolina, Storm Eye Institute, Charleston (Dr Saunders); the National Eye Institute, Bethesda, Md (Dr Hertle); the Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pa (Dr Quinn); and the Department of Ophthalmology, University of Arizona, Tucson (Dr Miller).
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