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Repeatability of the Modified Thorington Card Used to Measure Far Heterophoria

Cebrian, Jose Luis*; Antona, Beatriz; Barrio, Ana; Gonzalez, Enrique*; Gutierrez, Angel*; Sanchez, Isabel*

Optometry and Vision Science: July 2014 - Volume 91 - Issue 7 - p 786–792
doi: 10.1097/OPX.0000000000000297
Original Articles

Purpose To determine the interexaminer and intraexaminer repeatability of the modified Thorington test (TH) for distance vision in young adults and to compare these results with those observed for the heterophoria tests most commonly used in clinical practice. Agreement among tests was also assessed.

Methods Distance heterophoria was quantified on two separate occasions by two examiners in 110 subjects aged 18 to 32 years (mean, 19.74 years; SD, 2.5 years) using four different tests: cover test (CT) Von Graefe, Maddox rod, and modified TH. The repeatability of the tests and agreement between them was estimated by the Bland and Altman method whereby the mean difference and the 95% limits of agreement were determined as the coefficient of repeatability (COR) and coefficient of agreement.

Results The Thorington test showed best interexaminer repeatability (COR = ±1.43Δ), followed closely by CT (COR = ±1.65Δ), whereas best intraexaminer repeatability was observed for CT (COR = ±1.28Δ) followed by TH (COR = ±1.51Δ). Among the different combinations of tests, TH and CT showed best agreement indicated by the lowest coefficient of agreement (±2.23Δ) and a low mean difference (−0.63Δ) between measurements.

Conclusions Good interexaminer and intraexaminer repeatability was observed for both TH and CT, and agreement between the two tests was also good. Given the simple administration of the TH, we recommend its clinical use to quantify distance horizontal heterophoria.



Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain (all authors).

Beatriz Antona Facultad de Óptica y Optometría Universidad Complutense de Madrid C/ Arcos de Jalón-11828037 Madrid Spain e-mail:

© 2014 American Academy of Optometry