title: Repeatability intraexaminer and agreement in amplitude of accommodation measurements.
abstract: BACKGROUND
  Clinical measurement of the amplitude of accommodation (AA) provides an indication of maximum accommodative ability. To determine whether there has been a significant change in the AA, it is important to have a good idea of the repeatability of the measurement method used. The aim of the present study was to compare AA measurements made using three different subjective clinical methods: the push-up, push-down, and minus lens techniques. These methods differ in terms of the apparent size of the target, the end point used, or the components of the accommodation response stimulated. Our working hypothesis was that these methods are likely to show different degrees of repeatability such that they should not be used interchangeably.
  
  
  METHODS
  The AA of the right eye was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18 to 32). The repeatability of the tests and agreement between them was estimated by the Bland and Altman method. We determined the mean difference (MD) and the 95% limits of agreement for the repeatability study (COR) and for the agreement study (COA).
  
  
  RESULTS
  The COR for the push-up, push-down, and minus lens techniques were +/-4.76, +/-4.00, and +/-2.52D, respectively. Higher values of AA were obtained using the push-up procedure compared to the push-down and minus lens methods. The push-down method also yielded a larger mean AA than the negative-lens method. MD between the three methods were high in clinical terms, always over 1.75D, and the COA differed substantially by at least +/-4.50D. The highest agreement interval was observed when we compared AA measurements made using minus lenses and the push-up method (+/-5.65D).
  
  
  CONCLUSIONS
  The minus lens method exhibited the best repeatability, least MD (-0.08D) and the smallest COR. Agreement between the three techniques was poor.
authors.affiliation: Departamento de Optica II (Optometria y Vision), Universidad Complutense, Madrid, Spain. bantona@opt.ucm.es
authors.forename: B
authors.initials: B
authors.lastname: Antona
authors.forename: F
authors.initials: F
authors.lastname: Barra
authors.forename: A
authors.initials: A
authors.lastname: Barrio
authors.forename: E
authors.initials: E
authors.lastname: Gonzalez
authors.forename: I
authors.initials: I
authors.lastname: Sanchez
mesh_terms: D000065:Accommodation, Ocular; D000293:Adolescent; D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015588:Observer Variation; D009907:Optometry / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D055815:Young Adult
references.citation: Lancet. 1986 Feb 8;1(8476):307-10
references.pmid: 2868172
references.citation: Curr Opin Ophthalmol. 1992 Feb;3(1):78-82
references.pmid: 10149307
references.citation: J Cataract Refract Surg. 2004 Jul;30(7):1435-44
references.pmid: 15210220
references.citation: Am J Ophthalmol. 1960 May;49:993-1004
references.pmid: 14436025
references.citation: Ophthalmic Physiol Opt. 1995 May;15(3):231-2
references.pmid: 7659424
references.citation: J Am Optom Assoc. 1985 Jul;56(7):560-2
references.pmid: 4020010
references.citation: Optom Vis Sci. 2002 Apr;79(4):254-64
references.pmid: 11999151
references.citation: J Cataract Refract Surg. 2003 Oct;29(10):1878-88
references.pmid: 14604706
references.citation: Ophthalmic Physiol Opt. 1996 May;16(3):247-9
references.pmid: 8977892
references.citation: Ophthalmic Physiol Opt. 1987;7(4):441-6
references.pmid: 3502657
references.citation: Optom Vis Sci. 1994 Nov;71(11):699-706
references.pmid: 7885674
references.citation: Ophthalmic Physiol Opt. 1989 Jul;9(3):342-3
references.pmid: 2622684
references.citation: Am J Optom Physiol Opt. 1987 Aug;64(8):593-8
references.pmid: 3661669
references.citation: Am J Optom Arch Am Acad Optom. 1971 Nov;48(11):918-26
references.pmid: 5289813
references.citation: Ophthalmic Physiol Opt. 1982;2(3):205-12
references.pmid: 7177646
references.citation: Am J Ophthalmol. 1948 Feb;31(2):191-8
references.pmid: 18905674
references.citation: Invest Ophthalmol Vis Sci. 1992 Jun;33(7):2325-33
references.pmid: 1607244
references.citation: Optom Vis Sci. 1990 Feb;67(2):74-9
references.pmid: 2336258