PURPOSE: To compare the clinical assessment of fixation preference (FP) to visual acuity (VA) in a population-based sample of preschool children with amblyopia risk factors. DESIGN: Evaluation of diagnostic test in a population-based study. PARTICIPANTS: 243 children with anisometropia and/or strabismus, aged 30 to 72 months, living in Los Angeles County, CA [corrected] METHODS: Before measuring VA, FP testing was performed at near and usually without correction, using the binocular fixation pattern in children with strabismus >10 prism diopters (Delta), or the induced tropia test for children with strabismus <or=10Delta or without strabismus. We determined the sensitivity and specificity of FP testing for predicting unilateral amblyopia, defined by optotype VA, among children with amblyopia risk factors. MAIN OUTCOME MEASURE: Grade of FP. RESULTS: Sensitivity of FP testing for amblyopia among children with anisometropia was 20% (9/44) and specificity was 94% (102/109). Among strabismic children, sensitivity was 69% (9/13; worse in children 30-47 than 48-72 months old) and specificity was 79% (70/89), with similar findings for esotropia and exotropia. CONCLUSION: The ability of FP testing to correctly identify amblyopia in preschool children with amblyopia risk factors is poor. Clinicians should be wary of using FP as a surrogate measure of interocular difference in VA in young children. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
PURPOSE: To compare the clinical assessment of fixation preference (FP) to visual acuity (VA) in a population-based sample of preschool children with amblyopia risk factors. DESIGN: Evaluation of diagnostic test in a population-based study. PARTICIPANTS: 243 children with anisometropia and/or strabismus, aged 30 to 72 months, living in Los Angeles County, CA [corrected] METHODS: Before measuring VA, FP testing was performed at near and usually without correction, using the binocular fixation pattern in children with strabismus >10 prism diopters (Delta), or the induced tropia test for children with strabismus <or=10Delta or without strabismus. We determined the sensitivity and specificity of FP testing for predicting unilateral amblyopia, defined by optotype VA, among children with amblyopia risk factors. MAIN OUTCOME MEASURE: Grade of FP. RESULTS: Sensitivity of FP testing for amblyopia among children with anisometropia was 20% (9/44) and specificity was 94% (102/109). Among strabismic children, sensitivity was 69% (9/13; worse in children 30-47 than 48-72 months old) and specificity was 79% (70/89), with similar findings for esotropia and exotropia. CONCLUSION: The ability of FP testing to correctly identify amblyopia in preschool children with amblyopia risk factors is poor. Clinicians should be wary of using FP as a surrogate measure of interocular difference in VA in young children. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
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