Kelly, K. R., Jost, R. M., De La Cruz, A., & Birch, E. E. (2018). Multiple-choice answer form completion time in children with amblyopia and strabismus . Journal of the American Medical Association (JAMA) Ophthalmology , 136 (8), 938–941.

Journal Article
Kelly, K. R., Jost, R. M., De La Cruz, A., & Birch, E. E. (2018). Multiple-choice answer form completion time in children with amblyopia and strabismus. Journal of the American Medical Association (JAMA) Ophthalmology, 136(8), 938–941.


Also located on journal webpage


Elementary; Format; Individual; K-12; No disability; Reading; U.S. context; Visual impairment (including blindness)




The focus was not on assessment performance using accommodations per se, but rather, the comparison among groups of students with different types of visual impairments and students without visual impairments, on test-taking behaviors. Participants were presented with a testing task of documenting correct answers from a test booklet to a Scantron "bubble sheet" under the combined conditions of individual administration and timed administration. However, the findings of this study can provide insights into the potential benefits or limitations of individual administration and timed administration for students with and without visual impairments.


Participants were sampled (n=85) from the population of a nonprofit vision research institute (Retina Foundation of the Southwest in Dallas, TX). These child participants were 8.6–12.1 years old, presumably in grades 3–7. Three groups of children participated: 47 children with strabismus, anisometropia, or combined mechanism amblyopia; 18 children with nonamblyopic strabismus, and 20 children without visual impairments. Additional demographic data, gender and age, were reported; analyses demonstrated that the groups were equivalent in these demographics. Further definitions of participants' visual impairments were provided.

Dependent Variable

Participants' completion times were observed and documented by researchers using a stopwatch. The accuracy of students' test-taking behavior—transferring 40 already answered correct responses of the 2013 Texas Assessment of Academic Readiness grade 3 reading achievement test (publicly available version) from the test booklet to a blank Scantron "bubble sheet"—was measured based on the researchers' observation of the participants' transcribed answer forms in comparison to the actual provided item answers. In other words, student participants did not read the text passages or full questions or generate their own reading assessment responses, and accurate copying did not imply participants' academic achievement. Participants' visual impairments were prescreened for stereoacuity with the Randot Preschool Stereoacuity Test (Birch & The Retina Foundation of the Southwest, 2018) and Random Dot Stereo Butterfly test (Stereo Optical Company, Inc., 2018).


The task of documenting multiple choice test answers on a bubble sheet answer form for school-age children with visual impairments required more time than for their peers without visual impairments. In groupwise comparisons for children with two different visual impairments and children without visual impairments, children with amblyopia and children with nonamblyopic strabismus took about 28 percent longer on average to complete the task of copying item responses from test booklets to answer forms. The groups of children with these two visual impairments took essentially the same amount of time on average to complete the task. There were no significant differences in rates of making copying errors across the three groups. The researchers stated, "We found slower Scantron completion time, on average, for children with a history of abnormal binocular experience during infancy or early childhood due to strabismus, anisometropia, or both, regardless of whether the child had amblyopia" (p. 940). The significance of this finding for students with substantially different vision in one eye over the other, but who demonstrate fine motor impairment, was further clarified: "Currently, academic accommodations (eg, extended test time) are unavailable for these children because they have good vision when viewing with 2 eyes" (p. 940). Concern was noted for recognizing the needs of students with visual impairments but without blindness regarding access to accessibility and accommodations in high-stakes academic activities. Limitations of the study were reported, and future research directions were suggested.