Stereoacuity test as a screening tool for amblyopia and binocular vision in children 6-12 years of age
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Abstract
Background
Stereoacuity is essential for depth perception and daily activities, complementing visual acuity. Assessing stereoacuity in children is vital for detecting binocular vision disorders and amblyopia. This study aimed to compare the Toegepast Natuurwetenschappelijk Onderzoek (TNO) test and the Titmus Fly test in school-based vision screening for children aged 6-12 years.
Methods
A cross-sectional study was conducted in social service settings with 122 elementary school children aged 6-12 years. Examinations included visual acuity, refraction, Ishihara color vision, and stereoacuity using both the TNO and Titmus Fly tests. Statistical comparisons were made using the Wilcoxon Signed-Ranks Test, and stereoacuity differences based on demographic factors and visual acuity were assessed using the Mann-Whitney U Test. The level of agreement between the two tests was determined using Bland-Altman analyses.
Results
Visual acuity significantly influenced stereoacuity results in the Titmus Fly test (p=0.001), with children having abnormal visual acuity performing worse. Approximately 68% of children reported that the Titmus Fly test was easier to perform. The mean difference between TNO and Titmus Fly measurements was 79.52 ± 63.75 (95% CI = 68.14–90.90; p=0.001), demonstrating a consistent bias between the two tests.
Conclusion
The Titmus Fly test is easier for children (6–12 years) to perform, but it tends to overestimate stereoacuity values compared to the TNO test, making the two methods non-interchangeable and not reliable. Stereoacuity assessment remains essential in school-based vision screening for evaluating binocular vision and amblyopia, especially in children with refractive errors.
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References
Skalicky SE. Binocular single vision and stereopsis. In: Skalicky SE, editor. Ocular and visual physiology. Singapore: Springer; 2016. p. 355–66.
American Academy of Ophthalmology. Sensory physiology and pathology. In: Khan AO, Chang TCP, El-Dairi MA, et al., editors. Basic and clinical science course. San Francisco: American Academy of Ophthalmology; 2023. p. 45–54.
Birch EE, O’Connor AR. Binocular vision. In: Lyons CJ, Lambert SR, editors. Taylor and Hoyt’s pediatric ophthalmology and strabismus. London: Elsevier; 2023. p. 830–7.
Potluri R, Akella S, Mallidi R, et al. Study on stereoacuity and associated factors in school children aged 7 to 14 years. Indian J Ophthalmol 2022;70:233-7. doi: 10.4103/ijo.IJO_1572_21.
Duelund N, Nisted I, Jørgensen ME, et al. Vision screening and refraction of Greenlandic schoolchildren. Acta Ophthalmol 2024:00:1-9. doi: 10.1111/aos.16740.
Bonfanti S, Gargantini A, Esposito G, Facchin A, Maffioletti M, Maffioletti S. Evaluation of stereoacuity with a digital mobile application. Graefes Arch Clin Exp Ophthalmol 2021;259:2843–8. doi: 10.1007/s00417-021-05195-z.
World Health Organization. Blindness and visual impairment. Geneva: World Health Organization; 2023.
Yekta A, Hooshmand E, Saatchi M, et al. Global prevalence and causes of visual impairment and blindness in children: a systematic review and meta-analysis. J Curr Ophthalmol 2022;34:1–15. doi: 10.4103/joco.joco_135_21.
Cho HC, Ro HL, Lee H. Convergent evaluation of visual function and stereoacuity function after surgery for intermittent exotropia. J Korea Convergence Society 2022;13:147–54. Korean. doi: 10.15207/JKCS.2022.13.04.147.
Deepa BMS, Valarmathi A, Benita S. Assessment of stereo acuity levels using random dot stereo acuity chart in college students. J Family Med Prim Care 2019;8:3850–3. doi: 10.4103%2Fjfmpc.jfmpc_755_19.
Zhao L, Wu H. The difference in stereoacuity testing: contour-based and random dot-based graphs at far and near distances. Ann Transl Med 2019;7:193. doi: 10.21037/atm.2019.03.62.
Murthy GVS. Concepts of community ophthalmology (Public health for eye care). In: Vashist P, Gupta N, Senjam SS, Gupta V, editors. Textbook of community ophthalmology. 1st ed. London: Taylor and Francis Group; 2024. p. 1–11.
Iyengar RS, Krautmann M, Kotha S, et al. Cost-effectiveness analysis of a regional program for identifying and treating children with correctable refractive error in Indonesia. Ophthalmic Epidemiol 2024;31:325–32. doi: 10.1080/09286586.2023.2266831.
Basrowi RW, Darusman KR, Wilar Y, et al. Key dimensions of refractive errors screening at school in Indonesia: a primary educator’s perspective. Natl J Community Med 2024;15:314–9. doi: 10.55489/njcm.150420243679.
Sun Y, Fu J, Chen W, et al. Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study. Graefes Arch Clin Exp Ophthalmol 2022;260:599–608. doi: 10.1007/s00417-021-05390-y.
Arnoldi K, Frenkel A. Modification of the Titmus fly test to improve accuracy. Am Orthopt J 2014;64:64–70. doi: 10.3368/aoj.64.1.64.
Kiran A, Rashid F, Siddique M, et al. Comparison of the efficacy of TNO and Titmus Fly in myopic anisometropes. Pak J Med Health Sci 2022;16:321–3. doi: 10.53350/pjmhs22166321.
Baskaran AA, Ramalingam E, Britto T, et al. Validity of TNO cards as a screening test for defects of binocularity in children. TNOA J Ophthalmic Sci Res 2023;61:172–6. doi: 10.4103/tjosr. tjosr_75_22.
Dikkaya F, Erdur SK. Evaluation of stereopsis in children with corrected anisometropia according to the type, severity and presence of amblyopia. Erciyes Med J 2022;44:387–91. doi: 10.14744/etd.2022.07742.
Karabela Y, Salman IA. Evaluation of stereoacuity and binocular functions in patients with anisometropic amblyopia through Titmus, TNO, and Synoptophore. Haydarpasa Numune Med J 2022;62:346–52. doi: 10.14744/hnhj.2022.33716.
Wong BM, Fung SSM, Velez FG, et al. Evaluation of 3D tablet-based stereoacuity test ASTEROID in children with normal and abnormal visual acuity. J AAPOS 2024;28:103930. doi: 10.1016/j.jaapos.2024.103930.