Stereoacuity norms for school-age children using the Frisby stereotest

Baseline Accommodation and Binocular Vision Measures in Malay Schoolchildren Enrolled in the Myopia Control Study Using Spectacle Lenses in Kuala Lumpur

Myopia control lenses have been shown to modify visual function; however, it is arguable if these changes are short-term or long-term. We investigated the changes in accommodative behaviour and binocular vision functions of Malay myopic children who participated in a myopia control trial utilising spectacle lenses (n = 40). This article presents baseline accommodation and binocular vision measurements. The mean (± SD) age, spherical equivalent measured by cycloplegic autorefraction, and axial length (AL) for the right eyes were 10.00 ± 1.47 years, -3.02 ± 1.20 D, and 24.42 ± 0.93 mm, respectively. All participants had good distance and near visual acuities with high-contrast charts (100%), which were significantly better than low-contrast charts (10%) (p < 0.001). The mean (± SD) accommodative lag at baseline was 1.14 ± 0.35 D, while monocular and binocular accommodative amplitudes were 15.35 ± 2.07 D and 16.82 ± 2.27 D, respectively. Malay schoolchildren in this study were more esophoric at near compared to distance, with an accommodative-convergence over accommodation (AC/A) ratio of 5.64 ± 0.66 ∆/D. A higher degree of myopia was found to be associated with a longer AL (r = -0.49, p < 0.05) and higher esophoria at near (r = -0.46, p < 0.05). These baseline measures are consistent with data from other studies showing that myopic children have a high accommodative lag, an elevated AC/A ratio, a longer AL, and are more esophoric at near. The measures reported herein will serve as a basis for examining changes that occur within 12 months of wearing myopia control spectacle lenses.

A comparative study of stereopsis measurements: analyzing natural conditions versus dichoptic presentation using smartphones and ultraviolet printer technology

Background

Accurate differentiation between stereopsis assessments in the natural and dichoptic presentation states has proven challenging with commercial stereopsis measurement tools. This study proposes a novel method to delineate these differences more precisely.

Methods

We instituted two stereopsis test systems predicated on a pair of 4K smartphones and a modified Frisby Near Stereotest (FNS) version. Stereoacuity was evaluated both in the natural environment state (via the modified FNS) and the dichoptic state (via smartphones). Thirty subjects aged 20 to 28 years participated in the study with the best-corrected visual acuity (VA) of each eye no less than 0 logMAR and stereoauity of no worse than 40″. Varying degrees of monocular VA loss were induced using the fogging method, while this study does not explore conditions where the VA of both eyes is worse than 0 logMAR.

Results

When the VA difference between the two eyes did not exceed 0.2 logMAR, the modified FNS produced lower stereoacuity values compared to the 4K smartphones (Wilcoxon signed-rank test: difference = 0 logMAR, Z = -3.879, P < 0.001; difference = 0.1 logMAR, Z = -3.478, P = 0.001; difference = 0.2 logMAR, Z = -3.977, P < 0.001). Conversely, no significant differences were observed when the binocular vision difference exceeded 0.2 logMAR (difference = 0.3 logMAR, Z = -1.880, P = 0.060; difference = 0.4 logMAR, Z = -1.784, P = 0.074; difference = 0.5 logMAR, Z = -1.812, P = 0.070).

Conclusion

The findings suggest that stereoacuity values measurements taken in the natural environment state surpass those derived from the dichoptic presentation. However, the observed difference diminishes as stereopsis decreases, corresponding to an increase in induced anisometropia.

Two Disparity Channels in Human Visual Cortex With Different Contrast and Blur Sensitivity

Purpose

Our goal is to describe the contrast and blur sensitivity of multiple horizontal disparity subsystems and to relate them to the contrast and spatial sensitivities of their monocular inputs.

Methods

Steady-state visual evoked potential (SSVEP) amplitudes were recorded in response to dynamic random dot stereograms (DRDSs) alternating at 2 Hz between zero disparity and varying magnitudes of crossed disparity for disparity plane and disparity grating stimuli. Half-image contrasts ranged between 2.5% and 80% and over a range of Gaussian blurs from 1.4 to 12 arcmin. Separate experiments measured contrast and blur sensitivity for the monocular half-images.

Results

The first and second harmonics disparity responses were maximal for disparity gratings and for the disparity plane condition, respectively. The first harmonic of the disparity grating response was more affected by both contrast and blur than was the second harmonic of the disparity plane response, which had higher contrast sensitivity than the first harmonic.

Conclusions

The corrugation frequency, contrast, and blur tuning of the first harmonic suggest that it reflects activity of neurons tuned to higher luminance spatial frequencies that are selective for relative disparity, whereas the second harmonic reflects the activity of neurons sensitive to absolute disparity that are driven by low monocular spatial frequencies.

Translational Relevance

SSVEPs to DRDSs provide two objective neural measures of disparity processing, the first harmonic-whose stimulus preferences are similar to those of behavioral stereoacuity-and the second harmonic that represents an independent disparity-specific but not necessarily stereoscopic mechanism.

Measures and variability with age of low contrast acuity and near stereoacuity in children

CLINICAL RELEVANCE

Low contrast acuity (LCA) and near stereoacuity (NS) testing are integral to the comprehensive assessment of sensory visual function in children. However, routine ophthalmological evaluations seldom take these measures into consideration. Additionally, there is limited literature regarding the normative values of these parameters in children.

BACKGROUND

This study investigated LCA and NS measures and their variability in children with normal visual acuity. The aim was to provide a benchmark for distinguishing normal measures from abnormal ones.

METHODS

A prospective observational study was conducted in primary and secondary schools across North India. The participants numbered 240 children, aged between 3 and 15 years. They were split into 12 smaller groups of 20 participants in each age group. Only participants with normal monocular uncorrected visual acuity, no refractive error, normal birth history, and no systemic ailments, were recruited. All the participants underwent a complete ophthalmic examination and non-cycloplegic retinoscopy. LCA was measured, using the low contrast Lea number chart at three metres. NS was measured using the Randot® stereo test at 40 cm.

RESULTS

The percentages of males and females, were found to be 55%, and 45%, respectively (p = 0.093). The mean NS was found to be 38.7 ± 11.5 arcsecs in the 3-9-year age group, and 26.7 ± 5.6 arcsecs in the 9-15-year age group (p-value <0.001). The mean NS showed an increasing trend up to 9 years of age. The mean LCA was 64.4 ± 20.1 in the age group of 3-8 years, and 76.38 ± 11.39 in the age group of 8-15 years (p-value <0.001). Considerable variability was noted in the LCA in the younger age group (p-value = 0.000).

CONCLUSIONS

LCA and NS mature gradually during childhood. LCA stabilises after the age of 8, while NS stabilises after the age of 9.

Differences in stereoacuity between crossed and uncrossed disparities reduce with practice

INTRODUCTION

Stereoacuity, like many forms of hyperacuity, improves with practice. We investigated the effects of repeated measurements over multiple visits on stereoacuity using two commonly utilised clinical stereotests, for both crossed and uncrossed disparity stimuli.

METHODS

Participants were adults with normal binocular vision (n = 17) aged between 18 and 50 years. Stereoacuity was measured using the Randot and TNO stereotests on five separate occasions over a six week period. We utilised both crossed and uncrossed stimuli to separately evaluate stereoacuity in both disparity directions. A subset of the subject group also completed a further five visits over an additional six week period. Threshold stereoacuity was determined by the lowest disparity level at which the subjects could correctly identify both the position and disparity direction (crossed or uncrossed) of the stimulus. Data were analysed by repeated measures analysis of variance.

RESULTS

Stereoacuity for crossed and uncrossed stimuli improved significantly across the first five visits (F_1,21  = 4.24, p = 0.05). The main effect of disparity direction on stereoacuity was not significant (F₁  = 0.02, p = 0.91). However, a significant interaction between disparity direction and stereotest was identified (F₁  = 7.92, p = 0.01).

CONCLUSIONS

Stereoacuity measured with both the TNO and Randot stereotests improved significantly over the course of five repetitions. Although differences between crossed and uncrossed stereoacuity were evident, they depended on the stereotest used and reduced or disappeared after repeated measurements. A single measure of stereoacuity is inadequate for properly evaluating adult stereopsis clinically.

Percentile curves of stereacuity in a Spanish paediatric population

OBJECTIVE

The main objective of this study was to obtain percentile curves of stereoacuity in arc seconds for a Spanish population aged between three and twelve years of age.

MATERIALS AND METHODS

A descriptive, observational and transversal study was conducted, which included children aged between three and twelve years of age who did not present with any known ocular and/or systemic diseases. The convenience sampling method was used to select the sample from three schools and one hospital in the Community of Madrid. The Bueno-Matilla Vision Unit's random dot test was used to measure stereoacuity. A descriptive statistic was performed with the stereoacuity values that were obtained for the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles.

RESULTS

The stereoacuity values of 1300 children were analysed. In the 50th percentile curve, it was determined that stereoacuity values close to 40 sec/arc were present from four years of age, and at four years and nine months, stereoacuity values close to 28 sec/arc were already being observed within said percentile, with values that were similar to those expected in the adult population. A progressive increase was observed, reaching 19 sec/arc before six years of age, with this stereoacuity value becoming more established in children from seven years of age.

CONCLUSION

Although given the specific type of sampling that was performed it was not possible to generalise the results to the entire population, these percentile curves may aid paediatric professionals in their assessment of the development of this visual ability, which is indicative of the degree of development of binocular vision.

A longitudinal study of local stereoacuity and associated factors in schoolchildren: The Shahroud Schoolchildren Eye Cohort Study

CLINICAL RELEVANCE

Impaired stereoacuity is seen in some children without amblyopia, strabismus, and clinically significant refractive errors. Therefore, there are probably other factors affecting stereoacuity.

BACKGROUND

The aim of this work was to investigate the longitudinal changes of local stereoacuity and associated factors in schoolchildren.

METHODS

The present report is a part of the Shahroud Schoolchildren Eye Cohort Study. The target population was children aged 6 to 12 years in Shahroud, Iran. The second phase of the study was conducted in 2018 by re-inviting all participants in the first phase (2015). After an initial interview, study participants underwent optometric examination and ocular biometry. Stereoacuity was evaluated using Stereo Fly Test. Exclusion criteria were functional amblyopia, strabismus, significant refractive errors, probable ocular pathology/organic amblyopia in either of the two study phases, a history of intraocular surgery or ocular trauma, and incomplete data.

RESULTS

The data of 4666 children were analysed for this report, of which 53.7% were male. The mean age of the studied participants in the second phase was 12.37 ± 1.71 years. The mean stereoacuity was 42.31 (95% CI: 42.05 - 42.57) seconds of arc in the first phase, which reduced to 51.72 (95% CI: 50.79-52.65) seconds of arc in the second phase (P < 0.001). The prevalence of poor stereoacuity was 0.17% (95% CI: 0.06-0.29) in the first phase, which increased to 3.94% (95% CI: 3.34-4.54) in the second phase (P < 0.001). According to the multiple linear regression, older age in the first study phase (β = 0.011, P < 0.001), urban residence (β = -0.019, P = 0.006), increased spherical anisometropia (0.038, P = 0.013), and increased axial length (β = 0.062, P = 0.003) were significantly associated with reduction of stereoacuity (in log scale) after three years.

CONCLUSION

In addition to the known risk factors of amblyopia, strabismus, and significant refractive errors, other factors are also associated with stereoacuity changes in children.

Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study

PURPOSE

To explore the distribution of stereoacuity and to examine its determinants in school-age children in Tibetan plateau, Southwest China.

METHODS

This is the cross-sectional part of a school-based cohort study of 7-year-old children in Lhasa, Tibet Autonomous Region, Southwest China. Children in first year of primary school were invited to undergo a comprehensive examination, including height, weight, visual acuity, cycloplegic autorefraction (1% cyclopentolate), anterior segment, cover and uncover test, and stereoacuity (Titmus Stereo Test).

RESULTS

A total of 1833 eligible subjects were included, with a mean age of 6.82 ± 0.46 years. Mean stereoacuity was 1.78 ± 0.21 in log units (median: 60 arcsec). Children with stereoacuity equal to 40 arcsec and stereoacuity worse than 100 arcsec accounted for 29.24% and 8.18% of the cohort, respectively. Tibetan ethnicity (OR = 1.98; 95%CI, 1.30-3.03), astigmatism (OR = 1.65; 95%CI, 1.26-2.17), strabismus (OR = 2.92; 95%CI, 1.38-6.18), and amblyopia (OR = 3.77; 95%CI, 1.14-12.49) were risk factors for normal stereoacuity (= 40 arcsec). Shorter height, younger age, strabismus, and worse BCVA (P < 0.05 for all) were both related to lower stereoacuity in Spearman correlation analysis and associated with lower stereoacuity in multivariate regression analysis.

CONCLUSION

Stereoacuity maturation does not appear fully completed in 7-year-old children, while few children present stereoacuity worse than 100 arcsec (8.18%). Lower stereoacuity was associated with younger age, shorter height, strabismus, and lower best-corrected visual acuity.

Normative Values, Testability, and Validity for a New Preferential Looking Stereoacuity Test

Introduction: Age norms and testability for 3-5 year old children have been reported for the PASS III stereotest using a pointing response. We aimed to expand the normative data to children as young as 6 months, assess testability, and evaluate validity use of the PASS III as a preferential-looking test for younger children and children with special needs. Methods: 68 control children, 362 children with eye conditions, and 167 children with special needs were tested with the PASS III. Percent testable was calculated for children with and without special needs, normal tolerance limits were determined, and test validity was assessed. Results: In controls, mean PASS III stereoacuity improved from 371 arcsec at 12 months to 174 arcsec at 24 months, and 87 arcsec at 36 months. Testability in the 12, 24, and 36 months age groups were 81%, 87%, and 97% respectively and 92% for special needs children. Comparison to previously published norms and testing in a known nil stereoacuity cohort supported PASS III test validity. Compared to gold standard stereoacuity tests, accuracy of the PASS was 89%. Conclusion: Overall, preferential-looking tests using the PASS III provide a sensitive and specific measure of stereoacuity with high testability for young children and children with special needs.

The difference of distance stereoacuity measured with different separating methods

Background

The majority of tests to evaluate stereopsis should separate two eyes first. Whether different binocular separating manner may affect the test result of stereopsis is the main purpose of this study. Red-green anaglyphs, polarized light technology, active shutter 3D system, and auto-stereoscopic technique were chosen to evaluate distance stereoacuity.

Methods

Red-green anaglyphs test system was established with an ASUS laptop with the aid of TNO Stereotest glasses. Active shutter 3D system was set up with the same ASUS laptop with the aid of NVidia 3D Vision 2 Wireless Glasses Kit. The polarized 3D system adopted the AOC display. A Samsung naked-eye 3D laptop was used to set up an auto-stereoscopic system. Thirty subjects were recruited. Distance stereoacuity was measured with those computer systems.

Results

The auto-stereoscopic system was failed to measure distance stereopsis. A significant difference was found among red-green anaglyphs, polarized 3D system, and active shutter 3D system (Friedman Test, Chi-square =48.713, P<0.001). No significant difference was found between the polarized 3D system and an active shutter 3D system (Z=-1.134, P=0.257). The stereoacuity of the red-green glasses test was significantly worse than those of the other two test systems (versus shutter 3D test, Z=-4.553, P<0.001; versus polarized 3D test, Z=-4.618, P<0.001).

Conclusions

Different separating methods may affect the test result of distance stereopsis.

Screening for Stereopsis of Children Using an Autostereoscopic Smartphone

Background

The advantage of using an autostereoscopic smartphone is that it can achieve 3D effects without the need for glasses. The purpose of this study was to evaluate whether this technology could be utilized to detect stereoacuity.

Methods

An autostereoscopic smartphone was used to imitate Lang stereotest I & II, Pass Test 3, Dinosaur Stereoacuity Test, and the Random Dot Stereo Acuity Test to screen the stereopsis of children from 3–6 years old.

Results

No significant difference was found between each pair of groups (autostereoscopic smartphone vs. Lang stereotest I, Lang stereotest II, Pass Test 3, Dinosaur Stereoacuity Test, and Random Dot Stereo Acuity Test, respectively; Wilcoxon signed-rank test, P value all >0.05). All of the weighted kappa were higher than 0.84. Therefore, all of the comparisons between measurements showed a high level of agreement.

Conclusions

The autostereoscopic smartphone is an effective tool when used for the screening of deficiency in stereopsis.

Effect of chromatic contrast on stereoacuity measurement with computer-aided three-dimensional technology

Background

Various measurement tools are utilized to detect the stereopsis threshold in the clinic, but seldom of these involves chromatic information. Incorporating colorful elements into computer-aided, three-dimensional (3D) evaluation systems could help the tests appear more vivid and attractive. The aim of this study was to clarify the effect of different chromatic pair stereo targets on the stereoacuity result.

Methods

A total of 17 subjects with visual acuity in each eye of at least 0 logarithmic minimum angle of resolution (logMAR) and a stereoacuity of at least 32 second of arc (arcsec) were recruited. A 3D laptop with liquid crystal shutter glasses was used for evaluating stereoacuity. Thirteen pages were set including seven maximum color contrast pages and six isoluminant color contrast pages.

Results

In maximum color contrast pair, no significant difference was found among all seven experiments [six test groups and one reference group, one-way analysis of variance (ANOVA) test, F=0.995, P=0.493]. There was also no significant difference among the isoluminant color contrast pairs (six test groups, one-way ANOVA test, F=0.873, P=0.644). Paired t-test was used for comparing the data between the same hue series in the maximum color contrast pair vs. the isoluminant color contrast pair, and significant differences were found in all six pairs (P<0.001).

Conclusions

Adding chromatic factors to the stereo test is practical to evaluate stereopsis.

Stereopsis: are we assessing it in enough depth?

The assessment of stereoacuity is an integral part of the ophthalmic assessment, with the responses used to inform clinical management decisions. Stereoacuity impacts on many aspects of life, but there are discrepancies reported where people without measurable stereoacuity report appreciating 3-D vision. This could be due, in part, to the presentation of the stimuli. A literature review was undertaken to evaluate current assessment techniques, how they relate to patient outcomes, identify the limitations of current tests and discuss how they could be improved. Recent evidence has been collated on currently available tests, used commonly within vision clinics, with normative data provided allowing responses to the tests to be interpreted. The relevance of the results is evaluated in relation to a range of outcomes, where a reduced level of stereopsis has a negative impact on the ability of an individual to perform many tasks, and can lead to an increase in difficulty interacting in the world. Current tests are limited in the aspects of stereoacuity they assess and their ability to precisely measure stereopsis. The world is not static, yet clinical tests are limited to measuring static stereoacuity, even though higher grades of depth perception can be identified in the presence of changing depth. Presentation methods of stereoacuity tests have remained similar over time, with a limited number of disparity levels assessed. New assessment methods are becoming available that include automated staircase testing to present multiple levels of disparity using digital technology. Current clinical tests are limited in their presentation, and are poor at detecting/measuring stereoacuity in those with limited stereopsis. Given the relevance of the stereoacuity measurement to management choices and functional outcomes, new testing methods would be beneficial to fully assess stereoacuity, both static and dynamic.

Vision in children with autism spectrum disorder: a critical review

Autism spectrum disorder (ASD) is a common neurodevelopmental condition with approximately 1-2 per cent prevalence in the population. The condition has lifelong effects for the individual and family, and early intervention and management helps maximise quality of life and outcomes. Many studies of vision in ASD have attempted to link the behavioural and sensory deficits in ASD with underlying visual processing. From this work, it is clear that individuals with ASD 'see' and process the world differently, but there remain gaps in our understanding. This review will summarise our current knowledge of key aspects of visual functions and the optometric profile of ASD. This includes findings regarding visual acuity and contrast sensitivity, refractive error, eye movements, binocular vision, near visual functions and retinal structure in ASD. From this, a pattern of knowledge emerges for children with ASD: we should expect normal visual acuity; there will likely be atypical eye movements and susceptibility for subtle visuo-motor deficits, there is an increased prevalence of strabismus; an increased likelihood of astigmatism and possibly other refractive errors; attention, crowding and task complexity will likely be problematic; and retinal structure and function may be compromised. Bringing this together, these findings highlight that further work is necessary, not only to understand how higher-level functions link to behaviours, but also to ensure there is a sound understanding of the building-blocks of vision to fully grasp the profile of visual processing as a whole in ASD. This review will give a translational viewpoint for clinicians, and underline the benefits of comprehensive vision care in ASD.

Stereoacuity measurement using a phoropter combined with two 4K smartphones

PURPOSE

To evaluate stereoacuity using a combination of a phoropter and two 4K smartphones.

METHODS

A stereopsis measurement system was established using a phoropter (Topcon VT-10) and two Sony 4K smartphones (Sony Xperia Z5 Premium Dual E6883). A total of 154 subjects (69 children and 85 adults) were enrolled for evaluation using this system and subsequent comparison with the Fly Stereo Acuity test.

RESULTS

There was a high level of agreement between the two methods using Bland-Altman statistical analysis (children group, 95 per cent limits of agreement ±0.14 log arcseconds [arcsec]; adult group, 95 per cent limits of agreement ±0.13 log arcsec).

CONCLUSION

The closely spaced pixels of a 4K smartphone display enable measurement of stereoacuity at a relatively short distance. The flexibility and versatility of the mobile test system are likely to be useful in clinical practice.

Overestimation of stereo thresholds by the TNO stereotest is not due to global stereopsis

PURPOSE

It has been repeatedly shown that the TNO stereotest overestimates stereo threshold compared to other clinical stereotests. In the current study, we test whether this overestimation can be attributed to a distinction between 'global' (or 'cyclopean') and 'local' (feature or contour-based) stereopsis.

METHODS

We compared stereo thresholds of a global (TNO) and a local clinical stereotest (Randot Circles). In addition, a global and a local psychophysical stereotest were added to the design. One hundred and forty-nine children between 4 and 16 years old were included in the study.

RESULTS

Stereo threshold estimates with TNO were a factor of two higher than with any of the other stereotests. No significant differences were found between the other tests. Bland-Altman analyses also indicated low agreement between TNO and the other stereotests, especially for higher stereo threshold estimates. Simulations indicated that the TNO test protocol and test disparities can account for part of this effect.

DISCUSSION

The results indicate that the global - local distinction is an unlikely explanation for the overestimated thresholds of TNO. Test protocol and disparities are one contributing factor. Potential additional factors include the nature of the task (TNO requires depth discrimination rather than detection) and the use of anaglyph red/green 3D glasses rather than polarizing filters, which may reduce binocular fusion.

Evaluating stereoacuity with 3D shutter glasses technology

Background

To determine the stereoacuity threshold with a 3D laptop equipped with 3D shutter glasses, and to evaluate the effect of different shape and size of test symbols and different type of disparities to stereoacuity.

Methods

Thirty subjects with a visual acuity in each eye of at least 0 logMAR and a stereoacuity of at least 32 arcsec (as assessed in Fly Stereo Acuity Test) were recruited. Three target symbols—tumbling "E", tumbling "C", and "□"—were displayed, each with six different sizes representing a visual acuity ranging from 0.5 to 0 logMAR when tested at 4.1 m, and with both crossed and uncrossed disparities. Two test systems were designed - fixed distance of 4.1 m and one for variable distance. The former has disparities ranging from 10 to 1000 arcsec. Each subject completed 36 trials to investigate the effect of different symbol sizes and shapes, and disparity types on stereoacuity. In the variable distance system, each subject was tested 12 times for the same purposes, both proximally and distally (the point where the 3D effect just appears and where it just disappears respectively), and the mean value was calculated from the mean proximal and distal distances.

Results

No significant difference was found among the groups in the fixed distance test system (Kruskal-Wallis test; Chi-square = 29.844, P = 0.715). Similarly, no significant difference was found in the variable distance system (Kruskal-Wallis test; proximal: Chi-square = 5.687, P = 0.338; distal: Chi-square = 5.898, P = 0.316; mean: Chi-square = 6.152, P = 0.292).

Conclusions

Evaluating stereoacuity using this measurement system was convenient and effective. Changes in target shape and size and disparity types had no significant effect on stereoacuity. It would be helpful to choose optimal targets according to different purposes using computer-assisted 3D measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-016-0223-3) contains supplementary material, which is available to authorized users.

Distance stereotesting using vision test charts for intermittent exotropia

Purpose

To assess the role of distance stereoacuity using the System Chart SC-1600 Pola (SC) to evaluate intermittent exotropia (IXT).

Methods

Stereoacuity testing was performed in 28 children with IXT and 25 age-matched control subjects using the SC test, the distance Randot stereotest for distance, and the Titmus stereotest for near stereoacuity. Ocular alignment control was defined using the revised Newcastle Control Score (NCS). The correlations between the stereotests and NCS were evaluated using Spearman’s correlation test.

Results

Distance stereoacuity was better in both groups when using the SC test than when using the distance Randot stereotest (median: patients with IXT, 90 arcsec and 400 arcsec; control, 60 arcsec and 100 arcsec; P<0.001 for both comparisons). The two test scores were not correlated in either group (IXT: r_s=−0.003, P=0.99; control: r_s=0.37, P=0.07). A positive correlation was found between the distance NCS and SC test scores (r_s=0.49, P=0.004) and the total NCS and SC test scores (r_s=0.49, P=0.004). However, no correlation was observed between any NCS and the distance Randot stereotest or Titmus stereotest scores.

Conclusion

Stereoacuity, as measured by the SC test, may be an objective measure of IXT control.

Stereopsis results at 4.5 years of age in the infant aphakia treatment study

PURPOSE

To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used.

DESIGN

Randomized prospective clinical trial.

METHODS

The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1-7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using 3 different tests: (1) Frisby; (2) Randot Preschool; and (3) Titmus Fly.

RESULTS

Twenty-eight patients (25%) had a positive response to at least 1 of the stereopsis tests. There was no statistically significant difference in stereopsis between the 2 treatment groups: Frisby (contact lens, 6 [11%]; IOL, 7 [13%]; P = .99), Randot (contact lens, 3 [6%]; IOL, 1 [2%]; P = .62), or Titmus (contact lens, 8 [15%]; IOL, 13 [23%]; P = .34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 vs 2.4 months; P = .002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs 20/252; P = .0003).

CONCLUSION

The type of optical correction did not influence stereopsis outcomes. However, 2 other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis.