Amplify EyeCare Manhattan Logo
Authors
Anderson, Heather A.; Manny, Ruth E.; Cotter, Susan A.; Mitchell, G Lynn; Irani, Jasmine A.

Effect of Examiner Experience and Technique on the Alternate Cover Test

publication date
December 1, 2009
Category
see more

Abstract/Introduction

Purpose

To compare the repeatability of the alternate cover test between experienced and inexperienced examiners and the effects of dissociation time and examiner bias.

 

Methods

Two sites each had an experienced examiner train 10 subjects (inexperienced examiners) to perform short and long dissociation time alternate cover test protocols at near. Each site conducted testing sessions with an examiner triad (experienced examiner and two inexperienced examiners) who were masked to each other's results. Each triad performed the alternate cover test on 24 patients using both dissociation protocols. In an attempt to introduce bias, each of the paired inexperienced examiners was given a different graph of phoria distribution for the general population. Analysis techniques that adjust for correlations introduced when multiple measurements are obtained on the same patient were used to investigate the effect of examiner and dissociation time on each outcome.


Conclusion/Results

Results

The range of measured deviations spanned 27.5 prism diopters (Δ) base-in to 17.5Δ base-out. The absolute mean difference between experienced and inexperienced examiners was 2.28 ± 2.4Δ and at least 60% of differences were ≤2Δ. Larger deviations were measured with the long dissociation protocol for both experienced and inexperienced examiners (mean difference range = 1.17 to 2.14Δ, p < 0.0001). The percentage of measured small deviations (2Δ base-out to 2Δ base-in) did not differ between inexperienced examiners biased with the narrow vs. wide theoretical distributions (p = 0.41). The magnitude and direction of the deviation had no effect on the size of the differences obtained with different examiners or dissociation times.

 

Conclusions

Although inexperienced examiners differed significantly from experienced examiners, most differences were <2Δ suggesting good reliability of inexperienced examiners' measurements. Examiner bias did not have a substantial effect on inexperienced examiner measurements; however, increased dissociation resulted in larger measured deviations for all examiners.


Testimonials


At Amplify with Dr Wernick I was seeking help for seemingly intractable, probably age-related dryness. I've seen other doctors about it, and that has been helpful, but what he explained to me about it and the careful way he answered all my questions gave me so much more of a clear understanding of what is going on (and is not) that I am more able to implement all his and others' recommendations than I was before. And he gave me additional resources for further follow-up. I am most grateful.


Cynthia Norton

Wow! This is a great Eye Care medical facility. I was thoroughly examined by Dr. Pinkhasov for over 2 hours. She made sure to check my eyes for pretty much everything and patiently explained proper care for my eyes. They definitely know how to provide great care and treat their patients right. Now I know why they have such a great reputation and been around for so long.


Steve Fay

Dr. Kavner is a gifted diagnostician and orthoptic therapist. He treated me several decades ago for a condition similar to dyslexia. I was having migraines five times per week. I worked with him for about a year and I experienced tremendous improvement (down to 3-4 per year) that has lasted.


Mary K.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!


Peter G.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!


Kinkie F.

I have always found Dr Kavner's work, expertise and wisdom of the highest caliber. As one of the fathers of OT, occupational othomology, his depth and breadth of knowledge about the eyes' health and wellbeing of the patient is exemplary. Cannot say enough good things about him.


Allen B.
1 2 3

Blog

retval02low

How does an ERG work? Advanced vision care in Manhattan

RETeval ERG is an amazing device that provides comprehensive information about your retina's functionality. The retina is the back part […]

Read More
stressful-day-office-young-businessman-holding-hands-his-face-while-sitting-desk-creative-office-stock-exchange-trading-forex-finance-graphic-concept (1)

Esophoria treatment in New York City

Esophoria also known as Divergence Insufficiency is a condition in which our eyes are naturally more in than out when […]

Read More
MTN-heroimage-01

Exotropia treatment in NYC

Exotropia is one of the most common types of childhood strabismus, where one or both eyes are turned outwards, with […]

Read More
see all blogs

Contact Us To Amplify Your EyeCare

Working Hours

Monday - Thursday
8:00 am - 5:15pm
friday-sunday
Closed
Location
235 East 67th Street, Suite 201, New York, New York, United States, 10065
Website Accessibility Policy
Safety protocols page
phone-handsetarrow-uparrow-right linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram