An Evaluation of the Agreement Between a Computerized Stereoscopic Game Test and the TNO Stereoacuity Test

Juan Antonio Portela-Camino,1 Santiago Martín-González,2 Javier Ruiz-Alcocer,3 Igor Illarramendi-Mendicute,4 Rafaela Garrido-Mercado3 1Department of Optometry, Begira Clinic, Bilbao, Spain; 2Department of Construction and Manufacturing Engineering, University of Oviedo, Oviedo, Asturias, Spain; 3Department of Optometry and Vision Science, Complutense University of Madrid, Madrid, Spain; 4Department of Optometry, Begitek Clinic, Donostia, SpainCorrespondence: Juan Antonio Portela-CaminoDepartment of Optometry, Begira Clinic, C/ Ibáñez de Bilbao, nº 10, Bilbao, 48001, Bizkaia, SpainTel +34 94 605 39 67Email juanportel@hotmail.comPurpose: Stereo-anomaly is commonly associated with amblyopia. An investigation was conducted to determine whether the measurements of stereoacuity obtained with the stereoacuity reference test (TNO Test) show an agreement with a computer stereoscope video game.Methods: Thirty-two subjects (mean age 9.37± 2.00 years) with an amblyopia history were selected for a blind and randomized study of stereoacuity improvement through a new random dot game. A masked examiner measured the stereoacuity three times per subject using the TNO test (at the beginning, at the end and after 6 months of the treatment). A second masked examiner measured stereoacuity using the new computerized game after the TNO masked evaluation.Results: The Pearson’s correlation coefficient one test against the other was r2 = 0.767 and the Bland–Altman plot was r2= 0.069 (mean difference − 0.03 log sec). Using three categories: poor (840– 300 seconds of arc), coarse (480– 210 seconds of arc) and moderate–fine stereoacuity (210– 30 seconds of arc). Positive predictive values were 89.5% for moderate–fine; 72.7% for coarse; and 90.0% for poor stereoacuity. In addition, the agreement was evaluated using the Kappa coefficient (K= 0.743) with a 0.95 confidence interval and lower and upper Kappa limits were (0.628 and 0.858), respectively. Kappa coefficient and limits were still good when analyzing data before (K =0.663, 0.420 and 0.906) and after the treatment (K= 0.765, 0.632 and 0.899).Conclusion: The Computerized Stereoscopic Game test allows the measure of stereoacuity. It can be used for both the purpose of detecting stereo vision deficits or tracking stereo vision development.Keywords: amblyopia, computerized game test, gamification, stereoacuity, TNO tes