Validating Rules for Defining No Improvement of Visual Acuity in Childhood Amblyopia.

Purpose: When treating amblyopia, it is important to define when visual acuity (VA) is no longer improving (i.e., stable) because treatment decisions may be altered based on this determination.

Methods: Simulated observed VAs, incorporating measurement error, were compared with simulated true VAs to determine false-positive and false-negative rates for stable VA for six rules (using single VA or test/retest measurements, with or without averaging, over two or three visits). Four HOTV VA profiles were modeled: stable or improving VA over time with each of patching and spectacles.

Results: Across six rules and two treatments, when true VA was stable, false-negative rates for stability ranged from 26% to 67%; when true VA was improving, false-positive rates for stability ranged from 0% to 38%. Single VA measurements at consecutive visits had a false-negative rate of 30% with patching and 29% with spectacles, a false-positive rate of 38% with patching and 35% with spectacles. Averaging two VA tests at each visit slightly increased the false-negative rate (35% with patching and 36% with spectacles), while reducing the false-positive rate (22% with patching and 21% with spectacles).

Conclusions: Comparing false-negative and false-positive rates for stability across rules allows selection of the most appropriate rule for clinical practice or research. When considering less desirable treatments, a rule with a lower false-negative rate is preferable, whereas a rule with a lower false-positive rate would be preferred when it is important to correctly classify improving VA.