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Related Experiment Videos

Preschool Worth 4-Shape test: testability, reliability, and validity.

Sarah E Morale1, Brett G Jeffrey, Sherry L Fawcett

  • 1Retina Foundation of the SW, Dallas, Texas 75231, USA.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|August 20, 2002
PubMed
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The new Worth 4-Shape test is more effective for assessing binocular fusion in young children than the standard Worth 4-Dot. It demonstrates higher testability and comparable accuracy, making it a valid tool for pediatric vision screening.

Area of Science:

  • Ophthalmology
  • Pediatric Optometry
  • Vision Science

Background:

  • The Worth 4-Dot test is a standard tool for assessing binocular fusion.
  • Its application is limited in young children due to usability challenges.

Purpose of the Study:

  • To evaluate the testability, reliability, and validity of a modified Worth 4-Dot test, termed the Worth 4-Shape.
  • The modification involved replacing circles with shapes while keeping the color configuration identical.

Main Methods:

  • 131 patients (123 normal) aged 2-8 years and 4 older patients with visual acuity ≥20/40 were tested.
  • The Worth 4-Shape and Worth 4-Dot tests were administered at 35 cm and 3m for test-retest reliability.
  • Gold standard criteria included medical history, bifoveal fixation, and stereoacuity.

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Main Results:

  • Worth 4-Shape showed significantly higher testability than Worth 4-Dot in children under 4 years (95.9% vs 79.5% at 35cm; 79.5% vs 55.1% at 3m).
  • Comparable test-retest concordance was observed for both tests (P >.3).
  • Sensitivity and specificity were high and comparable: Worth 4-Shape (92%, 97%) vs. Worth 4-Dot (90%, 94%).

Conclusions:

  • The Worth 4-Shape test exhibits superior success rates compared to the Worth 4-Dot, particularly in children under 4 years.
  • It offers equivalent diagnostic accuracy and high test-retest reliability.
  • The Worth 4-Shape is a valid and effective alternative for assessing binocular fusion in young children.