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Fixation preference test: reliability for the detection of amblyopia in patients with strabismus and interexaminer agreement

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Abstract

Purpose

The purpose of this study was to analyze the reliability of the fixation preference test (FPT) in the detection of amblyopia, and to determine interexaminer agreement.

Methods

Eighty patients whose visual acuity could be tested objectively and had a horizontal misalignment of more than 10 prism diopters were enrolled. The best corrected visual acuity (BCVA) and orthoptic findings were all recorded. Non-preferred eye in primary position and fixation preference grade were assessed independently by two masked experienced examiners. The primary outcome measures were reliability of FPT in terms of its correlation with BCVA and interexaminer agreement.

Results

There was no significant correlation between fixation preference grades and interocular visual acuity difference as well as the type and amount of deviation, the presence of fusion, stereopsis, anisometropia, and previous strabismus surgery for none of the examiners (p > 0.05 for all). Sensitivity was 52.0% for examiner 1 and 54.0% for examiner 2 while specificity was 50.0 and 46.7%, respectively. Interexaminer agreement was 76.7% (p < 0.001) for all patients.

Conclusions

FPT is widely used in children particularly when the visual acuity cannot be determined in an objective manner. The test may not be accurate and reliable in the detection of amblyopia and also in predicting the visual acuity difference between both eyes, even though it was found to show a high degree of agreement between examiners. In conclusion, it should be kept in mind that the reliability of FPT may be limited and the results should be interpreted with caution and be supported by other tests.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey

    Kadriye Erkan Turan, Hande Taylan Sekeroglu & Ali Sefik Sanac

  2. Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Sevilay Karahan

Authors
  1. Kadriye Erkan Turan
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  2. Hande Taylan Sekeroglu
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  3. Sevilay Karahan
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  4. Ali Sefik Sanac
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Corresponding author

Correspondence to Kadriye Erkan Turan.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Patients were recruited upon approval of the institutional review board/ ethics 21 committee. The authors adhered to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Erkan Turan, K., Taylan Sekeroglu, H., Karahan, S. et al. Fixation preference test: reliability for the detection of amblyopia in patients with strabismus and interexaminer agreement. Int Ophthalmol 37, 1305–1310 (2017). https://doi.org/10.1007/s10792-016-0403-4

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  • DOI: https://doi.org/10.1007/s10792-016-0403-4

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