title: Effect of adult strabismus on ratings of official U.S. Army photographs.
abstract: OBJECTIVE
  To determine if strabismus affects the ratings of official U.S. Army photographs.
  
  
  METHODS
  Photographs of seven women and seven men officers (subjects) were digitally altered to give the impression of strabismus. Four photographs of each subject were obtained: two in an orthotropic state; one in a left exotropic state; and one in a left esotropic state. The photographs were presented randomly to a panel of 38 raters. Masked to the study design, the raters rated every photograph on a 1 to 10 Likert scale. The results were grouped according to eye alignment: two orthotropic groups, one exotropic group, and one esotropic group. Comparisons of the mean ratings were made between each eye alignment group and based on the subject's gender.
  
  
  RESULTS
  The mean rating for each orthotropic group was 5.4 and 5.5 Likert scale units with a SD of 0.8 and 0.9, respectively (group 1 and group 2). The mean rating for the exotropic group was 5.4 Likert scale units with a SD of 0.7. The mean rating for the esotropic group was 5.1 Likert scale units with a SD of 0.8. Significantly lower ratings were obtained for the esotropic group compared with the orthotropic group (p=0.028). Women received significantly lower ratings regardless of eye alignment (p=0.044).
  
  
  CONCLUSIONS
  This study indicates that the presence of esotropia negatively affects the rating of an official U.S. Army photograph; furthermore, female gender negatively affects ratings.
authors.affiliation: Brooke Army Medical Center, San Antonio, Texas, USA.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Goff
authors.forename: Abraham W
authors.initials: AW
authors.lastname: Suhr
authors.forename: John A
authors.initials: JA
authors.lastname: Ward
authors.forename: Janis K
authors.initials: JK
authors.lastname: Croley
authors.forename: Mary A
authors.initials: MA
authors.lastname: O'Hara
mesh_terms: D000328:Adult; D002322:Career Mobility; D004948:Esotropia / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel; D010781:Photography; D011287:Prejudice; D012737:Sex Factors