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M.K. Powers, Y. Morita; Visual Skills: Remote vs. on Site Assessment . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4594.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine whether remote visual skills assessment via an internet–based psychophysical program yields similar results to in–person screening at school. Methods: 41 students in grades 1 through 8 currently attending a private school in Wisconsin were selected for visual skills screening by their teachers on the basis of their responses to a symptom checklist and/or poor reading performance. Each student was evaluated both remotely (by MP, in California, via internet data only) and in person by an experienced school vision therapist (JW, on site, in Wisconsin). MP had no information about the students except their responses to 3 daily sessions of a 20–minute psychophysical assessment of accommodative facility, saccadic tracking, and relative vergence skills. JW observed each child while they interacted with the computer during the internet assessment, and subsequently performed a battery of standard hands–on optometric tests (e.g., Brock String, near point of convergence, Van Orden Star). MP and JW made separate determinations of which students should receive visual skills training due to deficient performance. The internet data were scored completely objectively, while the on–site data were scored according to the vision therapists' standard clinical criteria. Results: Across all grade levels, 25 (61%) of the students were referred for visual skills training following screening via internet, and 33 (80%) were referred for visual skills training following screening via the on–site battery of tests. Both methods recommended all students in grades 1–3 for visual skills training. At higher grades, the on–site method consistently referred more students than the remote method. The remote program yielded no false positives; every student who passed the on–site evaluation also passed the computer evaluation. Of the 8 students who were referred by the therapist but not via internet, 5 displayed head and/or body movements undetectable remotely, 2 showed suppression on closer testing, and 1 complained of discomfort while being tested. These results are similar to those obtained in a comparison of objective and subjective referrals in a retrospctive study of over 100 students from schools in California. Conclusions: An objective, internet screening procedure can provide valid information regarding visual skills (tracking, accommodative facility and vergence) in a school context. Possibly because of the psychophysical procedures, there were no false positives. The higher referral rate by the school therapist was most likely due to the opportunity to observe overt behaviors, thus adding information to the basic data available via the internet program.
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