Title: Multiple-Choice Answer Form Completion Time in Children With Amblyopia and Strabismus
Abstract: <h3>Importance</h3> 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. <h3>Objective</h3> To assess an academic-related fine motor outcome—multiple-choice answer form completion time—in children with amblyopia and strabismus. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> 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. <h3>Main Outcomes and Measures</h3> The time to complete the task was recorded and analyzed between groups. <h3>Results</h3> 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;<i>P</i> = .001) and children with nonamblyopic strabismus (mean [SD] time to completion, 293 [53] seconds; difference, 68 seconds; 95% CI, 21-115;<i>P</i> = .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. <h3>Conclusions and Relevance</h3> 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.