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Analysis of the application of computerized optokinetic nystagmus analyzer in vision examination
Meixia Jiang1, Yunyun Sun1, Jie Hong1
1Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, China.
Objective:
To investigate the practicability, accuracy, and consistency of the computerized optokinetic nystagmus (OKN) analyzer for visual acuity (VA) measurement.
Method:
Cross-sectional consistency evaluation study. A total of 219 subjects (13.48 ± 12.89 years, 115 males, 104 females) underwent bilateral VA testing using a computerized OKN analyzer and a traditional OKN drum. Additionally, 104 subjects (12.58 ± 12.05 years, 54 males, 50 females) were tested bilaterally with the computerized OKN analyzer and a standard logarithmic E chart (random order), including 80 myopic eyes (spherical equivalent [SE] ≤ -0.5 D) and 63 hyperopic eyes (SE ≥ + 0.5 D); VA was recorded in logMAR. Concordance rates between the OKN analyzer and OKN drum were calculated. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to assess the consistency between the OKN analyzer and a standard logarithmic E chart. Subjects completing the lightbox test were stratified by age (3-4 years, 5 years, 6 years, 7-18 years, 18-58 years), refractive error, and VA range to compare inter-method correlations.
Results:
Compared with the OKN drum, the computerized OKN analyzer achieved a concordance rate of 74.00% (right eye) and 77.08% (left eye), indicating good agreement. For VA measurements, mean VA (logMAR) of the right eye was 0.24 ± 0.29 (OKN analyzer) vs. 0.24 ± 0.28 (lightbox); left eye was 0.25 ± 0.28 vs. 0.24 ± 0.29. ICC values were 0.92 (right eye) and 0.88 (left eye, both P < 0.001), confirming significant consistency. Bland-Altman analysis showed 95% limits of agreement of -0.228 to 0.233 (right eye) and - 0.266 to 0.293 (left eye). Inter-method consistency improved with age (highest in ≥ 18 years) and was stronger in myopic vs. hyperopic eyes. Notably, correlation weakened as VA improved, with the highest concordance in the 0.1-0.5 decimal VA.
Conclusion:
The computerized OKN analyzer exhibits favorable reliability and practicability for VA testing in patients aged ≥ 6 years across different refractive errors, with accuracy that appears sufficient for screening and general clinical estimation of VA. However, in very young children (3-4 years) and in eyes with normal VA, agreement with chart‑based VA is limited, and further validation is required.
