The Fix and Follow Grade: A New Method of Grading the Visual Performance in Infant
Hyeshin Jeon, MD; Jaeho Jung, MD, PhD; Heeyoung Choi, MD, PhD
Pusan National University Hospital
Amidong 1ga, seogu, Busan, South Korea
Introduction: Optokinetic nystagmus, visual evoked cortical potential, forced choice preferential looking have been used to evaluate the visual acuity in infants, but there are limitations to the methods that are objective and easy to apply to clinical practice. We performed this study to describe the development and application of a novel scoring system for grading the ability for fixation and following in infant who are not able to cooperate in testing visual acuity.
Methods: We made the grading system of fixation and follow(FFG) as followed; Fixation: Grade1; no response to target, grade2; response to target but not last > 3seconds, grade3; satisfy the one criteria, grade4; satisfy the two criteria; (1) fix the target lasting > 3seconds (2) move gaze from target to another. Follow: Grade1;poor, grade2;partial, grade3;complete movement. Two ophthalmologist evaluate the FFG of 21 infants. One ophthalmologist (A) repeated the exam within 4 weeks.
Results: In fixation grading, intra-observer (test-test) reliability was very good(r= 0.95, 95% CI 0.95 – 1.0) while inter-observer reliability was moderate(r= 0.51, 95% CI 0.21 – 0.81). Similar result was observed in follow grading. Intra-observer (test-test) reliability was very good (r= 0.85, 95% CI 0.65 – 1.0) while inter-observer reliability was moderate (r= 0.45, 95% CI 0.12 – 0.76).
Discussion: Limitation in ocular movement was significantly more frequent in the patients with grade disparity. (p=0.021)
Conclusion: It is more appropriate for longitudinal follow-up by the same examiner, and grading and interpretation should be careful in patients with ocular motility disorder.
References: 2001 Editorial: The end of ‘fix, follow and maintain’; stereopsis in seniors; lorazepam for accommodative esotropia?; surgery for congenital fibrosis of the inferior rectus. Binocul Vis Strabismus Q 16(2):83-4. Atilla, H., et al.
2001 Poor correlation between ‘fix-follow-maintain’ monocular/binocular fixation pattern evaluation and presence of functional amblyopia. Binocul Vis Strabismus Q 16(2):85-90.