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Repeatability intraexaminer and agreement in amplitude of accommodation measurements

  • B. AntonaEmail author
  • F. Barra
  • A. Barrio
  • E. Gonzalez
  • I. Sanchez
Pediatrics

Abstract

Background

Clinical measurement of the amplitude of accommodation (AA) provides an indication of maximum accommodative ability. To determine whether there has been a significant change in the AA, it is important to have a good idea of the repeatability of the measurement method used. The aim of the present study was to compare AA measurements made using three different subjective clinical methods: the push-up, push-down, and minus lens techniques. These methods differ in terms of the apparent size of the target, the end point used, or the components of the accommodation response stimulated. Our working hypothesis was that these methods are likely to show different degrees of repeatability such that they should not be used interchangeably.

Methods

The AA of the right eye was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18 to 32). The repeatability of the tests and agreement between them was estimated by the Bland and Altman method. We determined the mean difference (MD) and the 95% limits of agreement for the repeatability study (COR) and for the agreement study (COA).

Results

The COR for the push-up, push-down, and minus lens techniques were ±4.76, ±4.00, and ±2.52D, respectively. Higher values of AA were obtained using the push-up procedure compared to the push-down and minus lens methods. The push-down method also yielded a larger mean AA than the negative-lens method. MD between the three methods were high in clinical terms, always over 1.75D, and the COA differed substantially by at least ±4.50D. The highest agreement interval was observed when we compared AA measurements made using minus lenses and the push-up method (±5.65D).

Conclusions

The minus lens method exhibited the best repeatability, least MD (−0.08D) and the smallest COR. Agreement between the three techniques was poor.

Keywords

Accommodation amplitude Repeatability Agreement 

Notes

Acknowledgements

This study was supported by grant PR1/07-14909 from the Universidad Complutense de Madrid.

References

  1. 1.
    Rosenfield M, Gilmartin B (1990) Effect of target proximity on the open-loop accommodative response. Optom Vis Sci 67:74–79PubMedCrossRefGoogle Scholar
  2. 2.
    Hokoda SC (1985) General binocular dysfunctions in an urban optometry clinic. J Am Optom Assoc 56:560–562PubMedGoogle Scholar
  3. 3.
    Rosenfield M (1997) Accommodation. In: Zadnik K (ed) The ocular examination; measurements and findings. WB Saunders, PhiladelphiaGoogle Scholar
  4. 4.
    Wick B, Hall P (1987) Relation among accommodative facility, lag, and amplitude in elementary school children. Am J Optom Physiol Opt 64:593–598PubMedGoogle Scholar
  5. 5.
    Goss D (1992) Clinical accommodation testing. Curr Opin Ophthalmol 3:78–82. doi: 10.1097/00055735-199202000-00011 PubMedCrossRefGoogle Scholar
  6. 6.
    Woehrle MB, Peters RJ, Frantz KA (1997) Accommodative amplitude determination: can we substitute the pull-away for the push-up method? J Optom Vis Dev 28:246–249Google Scholar
  7. 7.
    Brozek J, Simonson E, Bushard WJ, Peterson JH (1948) Effects of practice and the consistency of repeated measurements of accommodation and vergence. Am J Ophthalmol 31:191–198PubMedGoogle Scholar
  8. 8.
    Rosenfield M, Cohen AS (1996) Repeatability of clinical measurements of the amplitude of accommodation. Ophthalmic Physiol Opt 16:247–249. doi: 10.1016/0275-5408(95)00093-3 PubMedCrossRefGoogle Scholar
  9. 9.
    Chen AH, O’Leary DJ (1998) Validity and repeatability of the modified push-up method for measuring the amplitude of accommodation. Clin Exp Optom 81:63–71CrossRefGoogle Scholar
  10. 10.
    Rouse MW, Borsting E, Deland PN (2002) Reliability of binocular vision measurements used in the classification of convergence insufficiency. Optom Vis Sci 79:254–264. doi: 10.1097/00006324-200204000-00012 PubMedCrossRefGoogle Scholar
  11. 11.
    Scheiman M, Wick B (2002) Clinical management of binocular vision. Heterophoric accommodative and eye movement disorders. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  12. 12.
    Carlson NB, Kurtz D (2004) Clinical procedures for ocular examination. McGraw Hill, New YorkGoogle Scholar
  13. 13.
    Bland J, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1–8476:307–310Google Scholar
  14. 14.
    Zadnik K, Mutti DO, Adams AJ (1992) The repeatability of measurement of the ocular components. Invest Ophthalmol Vis Sci 33:2325–2333PubMedGoogle Scholar
  15. 15.
    Argimon JM, Jimenez J (2004) Métodos de investigación clínica y epidemiológica. Harcourt, MadridGoogle Scholar
  16. 16.
    Reeves BC, Hill AR, Aspinall PA (1987) The clinical significance of change. Ophthalmic Physiol Opt 7:441–446PubMedCrossRefGoogle Scholar
  17. 17.
    Atchison DA, Capper EJ, McCabe KL (1994) Critical subjective measurement of amplitude of accommodation. Optom Vis Sci 71:699–706. doi: 10.1097/00006324-199411000-00005 PubMedCrossRefGoogle Scholar
  18. 18.
    Ostrin LA, Glasser A (2004) Accommodation measurements in a prepresbyopic and presbyopic population. J Cataract Refract Surg 30:1435–1444. doi: 10.1016/j.jcrs.2003.12.045 PubMedCrossRefGoogle Scholar
  19. 19.
    Rambo VC, Sangal SP (1960) A study of the accommodation of the people of India. With further notes on the development of presbyopia at different ages in different peoples. Am J Ophthalmol 49:993–1004PubMedGoogle Scholar
  20. 20.
    Kragha IKOK (1989) Measurement of amplitude of accommodation. Ophthalmic Physiol Opt 9:342–343. doi: 10.1111/j.1475-1313.1989.tb00925.x PubMedCrossRefGoogle Scholar
  21. 21.
    Wold JE, Hu A, Chen S, Glasser A (2003) Subjective and objective measurement of human accommodative amplitude. J Cataract Refract Surg 29:1878–1888. doi: 10.1016/S0886-3350(03)00667-9 PubMedCrossRefGoogle Scholar
  22. 22.
    Fitch RC (1971) Procedural effects on the manifest human amplitude of accommodation. Am J Optom Arch Am Acad Optom 48:918–926PubMedGoogle Scholar
  23. 23.
    Hokoda SC, Ciuffreda KJ (1982) Measurement of accommodative amplitude in amblyopia. Ophthalmic Physiol Opt 2:205–212PubMedGoogle Scholar
  24. 24.
    Rosenfield M, Cohen AS (1995) Push-up amplitude of accommodation and target size. Ophthalmic Physiol Opt 15:231–232 letter. doi: 10.1016/0275-5408(95)90576-N PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • B. Antona
    • 1
    • 2
    Email author
  • F. Barra
    • 1
  • A. Barrio
    • 1
  • E. Gonzalez
    • 1
  • I. Sanchez
    • 1
  1. 1.Departamento de Optica II (Optometria y Vision)Universidad ComplutenseMadridSpain
  2. 2.Escuela Universitaria de Óptica, Universidad Complutense de MadridMadridSpain

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