Major Article
Screening merits of the Lang II, Frisby, Randot, Titmus, and TNO stereo tests,☆☆,

https://doi.org/10.1067/mpa.2001.118669Get rights and content

Abstract

Purpose: Previous works show a pronounced disagreement on the reliability of stereo tests as screening tools for amblyopia and strabismus. This study's aim was to compare the ability of the Lang II, Frisby, Randot, Titmus, and TNO stereo tests to detect amblyopia and strabismus with visual acuity testing and cover testing. Methods: A total of 1035 school children aged 12 to 13 years were examined in a field study in Monterrey, Mexico. In addition to the 5 stereo tests, the examination included visual acuity, cover testing, refraction (skiascopy), and inspection of the red reflex and posterior pole. Results: Sensitivity ranged from 17% to 47% (Frisby-Titmus-Lang II-Randot-TNO, in order of occurrence). Of the 60 subjects with strabismus and/or amblyopia, only 8 subjects were identified by all 5 stereo tests. A considerable number of subjects (25), the majority of whom were amblyopic (23 subjects), were not identified by any of the tests. All stereo tests showed higher sensitivities for strabismus than for amblyopia. Conclusion: None of the 5 stereo tests studied is suitable for screening for amblyopia or strabismus. The results of both ocularly normal subjects and subjects with strabismus and/or amblyopia are variable, and there is no way of separating normal response from abnormal response. (J AAPOS 2001;5:316-22)

Section snippets

Subjects and methods

The field study was performed in the metropolitan area of Monterrey, Mexico. One school each in 4 of the 5 metropolitan communities was visited. A total of 1035 children (454 boys and 581 girls) born in Mexico in 1986 were examined. The participation rate was 78%. Participation was voluntary and informed consent was obtained from all parents and participating children. A short questionnaire was added to the permission form to gather information about subjects' previous contacts with eye

Results

In the studied population, 24 children had manifest strabismus. Of the children with strabismus, 14 had subnormal visual acuity (<20/20) in one or both eyes. The types of strabismus can be seen in detail in Table one. There were no consecutive exotropias.

Amblyopia was found in 50 children. A total of 60 children had amblyopia and/or strabismus.

Subnormal stereoacuity was found in 2.2% to 10.4% of the total population across the 5 stereo tests used (Lang II-Frisby-TNO-Randot-Titmus, in order of

Discussion

Previous works on the screening qualities of stereo tests have shown disparate results. The stereo tests have been developed over a period of time, with the Titmus stereo fly being the oldest test and the Lang II being the latest contribution. There is some agreement that tests based on the random-dot technique (eg, the TNO and Lang tests) are superior to tests such as the Titmus and Randot stereo testing real stereopsis generated from truly binocular interaction.3, 11 The Randot stereo test is

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    This study was supported by the Swedish Medical Research Council (grant No. 02226), the Wilhelm and Martina Lundgren Science Foundation, the Sunnerdahl Foundation for the Handicapped, the Margit Thysielius Foundation, the Mayflower Charity foundation for Children, the KMA Foundation, the DBV Foundation, and the Ahrnberg Foundation.

    ☆☆

    This study was conducted at the Department of Ophthalmology, Universidad Autónoma de Nuevo León, Monterrey, Mexico.

    Reprint requests: Josefin Ohlsson, MD, Department of Ophthalmology, SU/Mölndal, SE 431 80 Mölndal, Sweden (E-mail: [email protected]).

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