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Brief Report
August 2018

Multiple-Choice Answer Form Completion Time in Children With Amblyopia and Strabismus

Author Affiliations
  • 1Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas
  • 2College of Optometry, University of Houston, Houston, Texas
  • 3Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
JAMA Ophthalmol. 2018;136(8):938-941. doi:10.1001/jamaophthalmol.2018.2295
Key Points

Question  Do fine motor deficits found in amblyopia and strabismus affect performance on an academic-related motor skill—marking answers with a pencil on a multiple-choice answer form?

Findings  In this cross-sectional study of 85 children, children with amblyopia or strabismus were approximately 28% slower than control children at marking answers on a multiple-choice answer form.

Meaning  Children with amblyopia and strabismus may not perform to their full academic potential if they take longer to complete a multiple-choice answer form, which is typically used in timed, standardized tests.


Importance  Abnormal binocular experience during infancy or childhood from strabismus and/or anisometropia results in visual acuity deficits (eg, amblyopia) and impaired stereoacuity. These pediatric eye conditions have also been linked to slow reading and fine motor impairment.

Objective  To assess an academic-related fine motor outcome—multiple-choice answer form completion time—in children with amblyopia and strabismus.

Design, Setting, and Participants  In this cross-sectional study completed between May 2014 and November 2017 at a nonprofit eye research institute, 47 children with amblyopia treated for strabismus, anisometropia, or both, 18 children with nonamblyopic strabismus, and 20 normal controls were enrolled.

Exposures  Children were asked to transfer the correct answers from a standardized reading achievement test booklet to a multiple-choice answer form as quickly as possible without making mistakes or reading the text.

Main Outcomes and Measures  The time to complete the task was recorded and analyzed between groups.

Results  Of the 85 included children, 40 (47%) were female, the mean (SD) age was 10.09 (0.91) years, and the last mean (SD) grade completed was 3.42 (0.92). Compared with children in the control group (mean [SD] time to completion, 230 [63] seconds), children with amblyopia (mean [SD] time to completion, 297 [97] seconds; difference, 63 seconds; 95% CI, 24-102; P = .001) and children with nonamblyopic strabismus (mean [SD] time to completion, 293 [53] seconds; difference, 68 seconds; 95% CI, 21-115; P = .002) required approximately 28% (95% CI, 20-37) more time to fill out a multiple-choice answer form. Completion time was not associated with etiology, visual acuity, or stereoacuity.

Conclusions and Relevance  Multiple-choice answer forms typically accompany standardized testing in schools in the United States. Longer completion time in children with amblyopia or strabismus may affect a child’s performance on tests using multiple-choice answer forms and may hinder academic success.

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