Related Experiment Video
Updated: Jun 28, 2026
Stereoacuity Improvement using Random-Dot Video Games
Published on: January 14, 2020
Fixation preference and visual acuity testing in a population-based cohort of preschool children with amblyopia risk
Susan A Cotter1, Kristina Tarczy-Hornoch, Erin Song
1Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033-9224, USA.
Insights
Fixation preference (FP) testing is unreliable for detecting amblyopia in young children with risk factors. This study found poor sensitivity, suggesting clinicians should not use FP as a substitute for visual acuity (VA) testing.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Diagnostic Test Evaluation
Background:
- Amblyopia risk factors like anisometropia and strabismus are common in preschool children.
- Accurate early detection of amblyopia is crucial for effective treatment and visual development.
Purpose of the Study:
- To compare the clinical assessment of fixation preference (FP) with visual acuity (VA) in identifying amblyopia.
- To evaluate the diagnostic accuracy of FP testing in a population-based sample of preschool children.
Main Methods:
- A population-based study evaluated 243 children aged 30-72 months with amblyopia risk factors.
- Fixation preference testing was performed before visual acuity measurement.
- Sensitivity and specificity of FP for predicting unilateral amblyopia were determined.
Main Results:
- FP testing showed low sensitivity (20%) for amblyopia in children with anisometropia.
- Among strabismic children, FP sensitivity was 69%, varying by age.
- Specificity for FP testing was generally high but varied between groups.
Conclusions:
- Fixation preference testing demonstrates poor accuracy in identifying amblyopia in preschool children with risk factors.
- Clinicians should exercise caution when using FP as a surrogate for interocular visual acuity differences in young children.
Purpose:
To compare the clinical assessment of fixation preference (FP) to visual acuity (VA) in a population-based sample of preschool children with amblyopia risk factors.
Design:
Evaluation of diagnostic test in a population-based study.
Participants:
243 children with anisometropia and/or strabismus, aged 30 to 72 months, living in Los Angeles County, CA [corrected]
Methods:
Before measuring VA, FP testing was performed at near and usually without correction, using the binocular fixation pattern in children with strabismus >10 prism diopters (Delta), or the induced tropia test for children with strabismus
Main Outcome Measure:
Grade of FP.
Results:
Sensitivity of FP testing for amblyopia among children with anisometropia was 20% (9/44) and specificity was 94% (102/109). Among strabismic children, sensitivity was 69% (9/13; worse in children 30-47 than 48-72 months old) and specificity was 79% (70/89), with similar findings for esotropia and exotropia.
Conclusion:
The ability of FP testing to correctly identify amblyopia in preschool children with amblyopia risk factors is poor. Clinicians should be wary of using FP as a surrogate measure of interocular difference in VA in young children.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
