title: Diagnosis of eccentric fixation using a calibrated ophthalmoscope: defining clinically significant limits.
abstract: Visuscopy and other ophthalmoscopic methods are widely applied in the assessment of fixation behaviour in amblyopia, although the reliability and inter-examiner variability of this test has not been established. Typically eccentric fixation is diagnosed solely on the basis of retinal position, but this fails to address the accompanying sensorimotor adaptations. A double-blind (masked) trial of a paediatric population was undertaken (n = 30, age range 3 years 9 months to 11 years, mean 5.6 +/- 1.5 years), involving three examiners applying a detailed protocol. The criteria for eccentric fixation were established from the non-amblyopic eyes. The most reliable criterion for the diagnosis of fixation was established from the results of the study. No single parameter proved 100% reliable, and amplitude showed greatest inconsistencies. It is recommended that a consensus of at least three parameters from position, zero retinomotor point, principal visual direction and percent foveation is required to diagnose the fixation status reliably.
authors.affiliation: Department of Vision Sciences, Glasgow Caledonian University, UK. m.cleary@gcal.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Cleary
authors.forename: C M
authors.initials: CM
authors.lastname: Thompson
mesh_terms: D000550:Amblyopia / Q000175:diagnosis* / Q000503:physiopathology; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology; D006801:Humans; D008297:Male; D015588:Observer Variation; D019721:Ophthalmoscopes; D009887:Ophthalmoscopy / Q000379:methods*; D011237:Predictive Value of Tests; D012016:Reference Values; D018709:Statistics, Nonparametric