논문 상세보기
pp.33-41
목 적: 본 연구는 ROC curve를 분석하여 나안시력과 자동굴절검사의 민감도/특이도에 따른 최상의 절단점(Optimal cutoff point)을 산출하고, 자동굴절검사가 선별검사(Screening)로 타당한지 알아보고자 한다. 방 법: 초등학생 293명을 대상으로 나안시력, 자동굴절검사, 자각적 굴절검사를 실시하여, 나안시력 0.5를 기준으로 자각적 굴절검사에 대한 최상의 절단점을 산출하고 이를 황금기준(GoldStandard)으로 가정한 후 이 절단점 및 인접한 값을 기준으로 정상/추가검사의뢰를 분류하였고, 나안시력과 자동굴절검사 결과에 대해 ROC curve를 이용하여 민감도/특이도가 가장 높은 최상의 절단점을 산출하였다. 또한 곡선아래면적(Area Under the Curve)을 이용하여 자각적 굴절검사의 분류 결과와 차이가 있는지 확인하여 자동굴절검사가 선별검사로서 타당한지 알아보았다. 결 과: ROC Curve를 이용하여 나안시력 0.5를 기준으로 한 자각적 굴절검사의 최상의 절단점은 -0.63D로 나타났다. 자각적 굴절검사 -0.75D를 황금기준으로 가정할 때 절단점은 나안시력은 0.5, 자동굴절검사는 -1.00D로 나타났으며, 두 검사법을 비교한 결과 나안시력과 자동굴절검사의 곡선아래면적은 통계적으로 차이가 없었다. 결 론: 어린이의 시각 선별검사를 위해 나안시력과 함께 자동굴절검사를 활용할 수 있을 것으로 생각된다.
Purpose: To assess the optimal cutoff point of visual acuity, auto refraction which is both high sensitivity and specificity with ROC curve analysis, and to evaluate the validity of auto refraction for vision screening of elementary school children. Methods: 553 eyes of elementary students were recruited and tested visual acuity, auto refraction and subjective refraction. The subjective refraction was considered as gold standard to differentiate normal or referral, and the sensitivity/specificity and cutoff point of the tests was calculated with ROC analysis. The accuracy of tests were assessed with comparing Area under the curve(AUC) of ROC curve and evaluated the validity of auto refraction whether it is useful for vision screening of elementary school children. Results: The optimal cutoff point of subjective refraction for decimal visual acuity 0.5 criteria is -0.63D. Therefore, gold standard was assumed to be -0.75D respectively. For subjective refraction -0.75D criteria, optimal cutoff point of visual acuity was 0.5, auto refraction was -1.00D, respectively. The AUC of the tests were not significantly different(p = 0.118). For subjective refraction -0.50D criteria, optimal cutoff point of visual acuity was 0.7, auto refraction was -0.78D, respectively. The AUC of visual acuity and auto refraction were not significantly different(p= 0.923). Conclusion: When subjective refraction was assumed as gold standard and compared AUC of visual acuity with auto refraction, the accuracy of tests were not significantly different. therefore, auto refraction and unaided visual acuity were both considered as useful tools of vision screening.
