Is the 15∆ Base in Prism Test Reliable for Detection of Amblyopia in Anisometropic Patients?

PURPOSE: The 15∆ base in prism test (15∆BIPT) introduced by Gobin is often used in The Netherlands to detect fixation preference, especially in young and preverbal children in whom a reliable measurement of the visual acuity (VA) is difficult. It is assumed that the fixation preference detected by the 15∆BIPT can be used to predict the presence of amblyopia. The aim of this retrospective case note review was to investigate the accuracy of the 15∆BIPT in detection of amblyopia in anisometropic patients.

METHODS: Four hundred and twelve files of anisometropic patients visiting the orthoptic department of The Rotterdam Eye Hospital were analyzed. Amblyopia was defined as an intraocular difference in VA of 2 or more Snellen lines. The sensitivity, specificity, and positive and negative predictive values of the 15∆BIPT were calculated and the receiver operating characteristic (ROC) curve was plotted.

RESULTS: One hundred and fifty-two patients ranging from 3.3-13.1 years of age (median 5.4 years) met the inclusion criteria. One hundred and two patients were diagnosed with amblyopia. Best-corrected median VA of the best eye was 1.0 (range 0.5-1.2) and the worst eye 0.70 (range 0.05-1.2). Sensitivity of the 15∆BIPT (based on detecting amblyopia) was 34.3%. Specificity was 88.0%. The positive predictive value was 85.4% versus a negative predictive value of 39.6%. The area under the ROC curve (AUC) was 0.65 (95% CI 0.56-0.74).

CONCLUSION: The low sensitivity, large number of false negatives and the AUC show that the 15∆BIPT can be considered a poor test for detecting amblyopia in anisometropic patients.