Letter to the Editor
Comment on: "Rebound tonometry with re-sterilised tips versus Goldmann applanation tonometry in children"
Comentario al artículo: «Tonometría de rebote con puntas nuevas y reesterilizadas versus tonometría de aplanación Goldmann en niños»
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Fau, L. del Valle, R. Castillo, I. Cisternas, S. Páez" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Fau" "email" => array:1 [ 0 => "chfauf@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "del Valle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "Cisternas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Páez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Fundación Oftalmológica 2020, Iberoamerican Cochrane Network, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Chile, Facultad de Medicina, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario al artículo: «Tonometría de rebote con puntas nuevas y reesterilizadas versus tonometría de aplanación Goldmann en niños»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this journal, Aceituno Paredes SC et al. published the article: “Rebound tonometry with new and re-sterilized tips versus Goldmann flattening tonometry in children”,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in which we found design errors that we will proceed to describe below.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the article, a non-probabilistic sampling was made, called convenience sampling, which is used because it is economic, convenient, since a captive sample is available, but its representativeness is very doubtful since it is not randomized. The authors did not indicate the random method used, generating a serious sampling error, furthermore, the sample was very small (only participants), they did not present a sample size calculation supporting it as 25, valid (only participants).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In an attempt to increase the sample, the authors incorporated 50 eyes of 25 patients, this generated an inter-eye correlation,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but the usual statistical techniques are based on the assumption that the values of the observations are independent in each measured eye. In this case this assumption is not fulfilled since the observations of both eyes of the same patient are not independent in relation to each other.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition the authors did not correct the problem by adjusting the sample size or the statistical analysis for the existing inter-eye correlation. When this occurs, it is assumed that we have more information than we really have, but this is not a true reflection of the reality of a sample<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> and therefore erroneous conclusions are generated.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In general, in cases where the sample is not normally distributed, the use of non-parametric tests is recommended. In this case, the authors used Spearman's correlation coefficient but also used an ANOVA test, which is parametric, assuming the normality of the data but without checking this assumption. Therefore, is this sample distributed normally or not? There are currently several statistical tests that allow checking the assumption of normality, these are: the Kolmogorov–Smirnov test (K–S), the K–S test with Lilliefors correction (K–S-L), the Shapiro–Wilk test (S–W), the Jarque-Bera test (J-B) and the Anderson-Darling test (A–D).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> The main tests to establish normality in this case would be the A–D test on samples smaller than 30 and S–W on samples larger than 50. In this study one of these 2 tests should have been used before proceeding to analyze the data.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of the authors in this study was to carry out a concordance analysis between two measurement methods in order to evaluate the degree of equivalence between the use of a new tip and a re-sterilized tip. The study used Spearman's linear correlation coefficient, which is not an adequate method to evaluate the degree of agreement between 2 variables, since a perfect correlation can be obtained r = 1, even though one of the measurement methods is proportionally biased. Therefore in all the measurements it marks a value X + a constant, that is to say, a null agreement between the measurements. For this reason, this test does not provide information about the agreement between 2 methods, but only measures the linear association between 2 variables.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, given that the study exhibits multiple methodological errors, the results should be interpreted as coming from a study with serious validity problems and, therefore, it cannot be concluded that the use of a new tip is better than the use of a re-sterilized tip.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This research received no external funding or sponsors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fau C, del Valle L, Castillo R, Cisternas I, Páez S. Comentario al artículo: «Tonometría de rebote con puntas nuevas y reesterilizadas versus tonometría de aplanación Goldmann en niños». Arch Soc Esp Oftalmol. 2021;96:227–228.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tonometría de rebote con puntas nuevas y reesterilizadas versus tonometría de aplanación Goldmann en niños" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.C. Aceituno Paredes" 1 => "A.L. Asturias de León" 2 => "J. 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Coeficiente de correlación por jerarquías de Spearman. p. 707–13." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009600000004/v1_202103300746/S2173579421000323/v1_202103300746/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009600000004/v1_202103300746/S2173579421000323/v1_202103300746/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421000323?idApp=UINPBA00004N" ]
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