Correlation and Agreement Between the Occupational Vision Screener and Ophthalmologic Tests in Visual Performance Assessment of Surgical Health Professionals
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Abstract
Objective This study aims to evaluate the correlation and agreement between occupational vision tests and standard ophthalmological examinations across five dimensions of visual performance.
Methods Fifty-three participants underwent assessments for visual acuity (VA), red-green color vision, stereoscopic depth, and phoria using both the Titmus occupational vision screener and ophthalmologist-administered tests, including the Early Treatment Diabetic Retinopathy Study (ETDRS) chart for VA, Farnsworth D-15 for color vision, Stereotest- Circles for stereoscopic depth, and the cover-uncover test for phoria. To compare the correlation or agreement of each parameter between the two methods, correlation coefficients were used to evaluate VA and stereoscopic depth perception, Kappa analysis for color blindness, phoria and astigmatism. Statistical significance was set at p < 0.05.
Results Test results were finalized with 53 participants, mean age of 29.4 years. A majority of the participants (62.30%) reported a history of prior and/or present use of visual aids. The assessment of visual capacity demonstrated a good correlation between occupational stereoscopic depth and Stereotest-circles (0.5997, p < 0.001) and a moderate correlation between the Occupational best corrected VA and ETDRS best corrected VA (maximum 20/20) (0.4616, p < 0.001). Color vision screening showed a high level of statistical agreement with a kappa value of 1.00. However, the results for phoria and astigmatism were inconsistent with only left-eye astigmatism demonstrating statistical significance (p = 0.047), but with only a fair Kappa value (0.21).
Conclusions Occupational vision tests showed strong to moderate correlation for stereoacuity and visual acuity and high agreement of color with standard methods. These tests are useful for visual screening of surgical professionals. Further extensive examinations of other parameters and with a wider variety of participants are required for a more comprehensive assessment of visual capacity related to specific job tasks.
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References
National Fire Protection Association. NFPA 1582, Standard on comprehensive occupational medical program for fire departments. Quincy, MA, USA: UK; 2022.
Driver and Vehicle Licensing Agency [Internet]. Assessing fitness to drive: a guide for medical professionals. 2016. [cite 2025 Jan 31]. Available from: https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals
Matthews M, Stretanski M. Pilot Medical Certification. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Michael Stretanski declares no relevant financial relationships with ineligible companies. 2024.
Ryu R, Behrens P, Malik A, Lester J, Ahmad C. Are we putting ourselves in danger? Occupational hazards and job safety for orthopaedic surgeons. J Orthop. 2021;24:96-101.
Hirata T. Simple, near, visual perception test for microsurgeon ‐parallelism‐. Clinical and Experimental Dental Research. 2022;9:165-70.
Gazit N, Ben-Gal G, Eliashar R. Using job analysis for identifying the desired competencies of 21st-Century surgeons for improving trainees selection. J Surg Educ. 2023;80:81-92.
Zheng B, Jiang X, Bednarik R, Atkins MS. Action-related eye measures to assess surgical expertise. BJS Open. 2021;5(5):zrab068. PubMed PMID: 34476467
Yanoff M, Duker J. Ophthalmology E-Book: Elsevier Health Sciences; 2018.
Mukherjee P. Clinical examination in ophthalmology-e-book: clinical examination in ophthalmology- E-Book: Elsevier Health Sciences; 2016.
Good G, Weaver J, Augsburger A. Determination and application of vision standards in industry. Am J Ind Med. 1996;30:633-40.
McAlister W, Peters J. The validity of Titmus Vision testing results. Mil Med. 1990;155:396-400.
Dimitrijevic T, Kahler B, Evans G, Collins M, Moule A. Depth and distance perception of dentists and dental students. Oper Dent. 2011;36:467-77.
Al-Saud LM, Mushtaq F, Mirghani I, Balkhoyor A, Keeling A, Manogue M, et al. Drilling into the functional significance of stereopsis: the impact of stereoscopic information on surgical performance. Ophthalmic Physiol Opt. 2017;37:498-506.
Tamenti G, Rasengane T, Mashige K. The association between road traffic accidents and visual functions: A systematic review and meta-analysis. Afr J Prim Health Care Fam Med. 2024;16:e1-e10. PubMed PMID: 39221740
Daniel W, Cross C. Biostatistics: a foundation for analysis in the health sciences: John Wiley & Sons; 2018.
Alhusuny A, Cook M, Khalil A, Johnston V. Visual symptoms, neck/shoulder problems and associated factors among surgeons performing Minimally Invasive Surgeries (MIS): A comprehensive survey. Int Arch Occup Environ Health. 2021;94:959-79.
Ferris F, 3rd, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research. Am J Ophthalmol. 1982;94:91-6.
Read J, Rafiq S, Hugill J, Casanova T, Black C, O’Neill A, et al. Characterizing the Randot Preschool stereotest: Testability, norms, reliability, specificity and sensitivity in children aged 2-11 years. PLoS One. 2019;14:e0224402. PubMed PMID: 31697704
Cole B, Orenstein J. Does the Farnsworth D15 test predict the ability to name colours? Clin Exp Optom. 2003;86:221-9.
Mori D, Kuchhangi A, Tame J, Cooper K, Hajkazemshirazi L, Indaram M, et al. Evaluation of a novel virtual reality simulated alternate cover test to assess strabismus: a prospective, masked study. Am J Ophthalmol. 2025;269:266-72.
Hazra A, Gogtay N. Biostatistics series module 6: correlation and linear regression. Indian J Dermatol. 2016;61:593-601.
Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159-74.
Biddle M, Hamid S, Ali N. An evaluation of stereoacuity (3D vision) in practising surgeons across a range of surgical specialities. Surgeon. 2014;12:7-10.
Odell N, Hatt S, Leske D, Adams W, Holmes J. The effect of induced monocular blur on measures of stereoacuity. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2009;13:136-41.
Deepa B, Valarmathi A, Benita S. Assessment of stereo acuity levels using random dot stereo acuity chart in college students. J Family Med Prim Care. 2019;8:3850-3.
Hahn E, Comstock D, Durling S, MacCarron J, Mulla S, James P, et al. Monocular clues in seven stereotests. Dalhousie Medical Journal. 2010;37(1).
Wong N, Stokes J, Foss A, McGraw P. Should there be a visual standard for ophthalmologists and other surgeons? Postgraduate Medical Journal. 2010;86:354-8.
Di Foggia E, Stoll N, Meunier H, Rimele A, Ance P, Moreau PH, et al. A new visual acuity test on touchpad for vision screening in children. Int J Ophthalmol. 2020;13:1436-42.
Kumar N, Karvonen-Gutierrez C, Musch D, Harlow S, Burnett D, Valenzuela C, et al. Validity of the Titmus Vision Screener: A Comparison with the Snellen Chart. Journal of Ophthalmic Science. 2019;2:35-43.
Chaikitmongkol V, Nanegrungsunk O, Patikulsila D, Ruamviboonsuk P, Bressler NM. Repeatability and agreement of visual acuity using the ETDRS number chart, Landolt C Chart, or ETDRS alphabet chart in eyes with or without sight-threatening diseases. JAMA Ophthalmol. 2018;136:286-90.
Lai Y-H, Wu H-J, Chang S-J. A reassessment and comparison of the Landolt C and tumbling E charts in managing amblyopia. Scientific Reports. 2021;11:18277.
Becker R, Gräf M. [Landolt C and snellen e acuity: differences in strabismus amblyopia?]. Klin Monbl Augenheilkd. 2006;223:24-8.
Teerasantipun C, Pichetweerachai W, Theerakul T, Chaiwong W, Kunanusont C. Validity of vision screener among workers in a private hospital in the northern part of Thailand. The Bangkok Medical Journal. 2019;15:140.
Jimenez R, Martinez-Almeida L, Salas C, Ortiz C. Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function? Graefes Arch Clin Exp Ophthalmol. 2011;249:925-35.
Nilforoushan MR, Latkany RA, Speaker MG. Effect of artificial tears on visual acuity. Am J Ophthalmol. 2005;140:830-5.
Tan TF, Grzybowski A, Ruamviboonsuk P, Tan ACS. Color vision restrictions for medical school admission: a discussion on regulations in ASEAN countries compared to countries across the world. International Journal of Retina and Vitreous. 2023;9:5.
Fanlo Zarazaga A, Gutierrez Vasquez J, Pueyo Royo V. Review of the main colour vision clinical assessment tests. Arch Soc Esp Oftalmol (Engl Ed). 2019;94:25-32.
Melamud A, Hagstrom S, Traboulsi E. Color vision testing. Ophthalmic Genet. 2004;25:159-87.
Lee YY, Granger-Donetti B, Chang C, Alvarez TL. Sustained convergence induced changes in phoria and divergence dynamics. Vision Res. 2009;49:2960-72.
Wong SW, Ang ZH, Crowe P. Enhancing ergonomics in robotic surgery-a review. AME Surgical Journal. 2024;4:1-7.
