Dataset Information

Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home).

ABSTRACT:

Purpose

To describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home).

Methods

Three study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. V@home VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability.

Results

The mean difference between V@home and ETDRS distance VA across all groups ranged from -0.010 to -0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of V@home with near ETDRS VA across all groups, with a mean difference of -0.092 to -0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: -0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: -0.289 to 0.258 for distance and -0.235 to 0.199 for near). The majority of participants were satisfied with V@home.

Conclusions

V@home could accurately and reliably measure both distance and near VA and is well accepted by participants.

Translational relevance

The V@home system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.

SUBMITTER: Han X

PROVIDER: S-EPMC6701871 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home).

Han Xiaotong X Scheetz Jane J Keel Stuart S Liao Chimei C Liu Chi C Jiang Yu Y Müller Andreas A Meng Wei W He Mingguang M

Translational vision science & technology 20190701 4

<h4>Purpose</h4>To describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home).<h4>Methods</h4>Three study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocul ...[more]

PMID: 31440424

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Project description:IMPORTANCE:Visual acuity is the most frequently performed measure of visual function in clinical practice and most people worldwide living with visual impairment are living in low- and middle-income countries. OBJECTIVE:To design and validate a smartphone-based visual acuity test that is not dependent on familiarity with symbols or letters commonly used in the English language. DESIGN, SETTING, AND PARTICIPANTS:Validation study conducted from December 11, 2013, to March 4, 2014, comparing results from smartphone-based Peek Acuity to Snellen acuity (clinical normal) charts and the Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart (reference standard). This study was nested within the 6-year follow-up of the Nakuru Eye Disease Cohort in central Kenya and included 300 adults aged 55 years and older recruited consecutively. MAIN OUTCOMES AND MEASURES:Outcome measures were monocular logMAR visual acuity scores for each test: ETDRS chart logMAR, Snellen acuity, and Peek Acuity. Peek Acuity was compared, in terms of test-retest variability and measurement time, with the Snellen acuity and ETDRS logMAR charts in participants' homes and temporary clinic settings in rural Kenya in 2013 and 2014. RESULTS:The 95% CI limits for test-retest variability of smartphone acuity data were ±0.033 logMAR. The mean differences between the smartphone-based test and the ETDRS chart and the smartphone-based test and Snellen acuity data were 0.07 (95% CI, 0.05-0.09) and 0.08 (95% CI, 0.06-0.10) logMAR, respectively, indicating that smartphone-based test acuities agreed well with those of the ETDRS and Snellen charts. The agreement of Peek Acuity and the ETDRS chart was greater than the Snellen chart with the ETDRS chart (95% CI, 0.05-0.10; P?=?.08). The local Kenyan community health care workers readily accepted the Peek Acuity smartphone test; it required minimal training and took no longer than the Snellen test (77 seconds vs 82 seconds; 95% CI, 71-84 seconds vs 73-91 seconds, respectively; P?=?.13). CONCLUSIONS AND RELEVANCE:The study demonstrated that the Peek Acuity smartphone test is capable of accurate and repeatable acuity measurements consistent with published data on the test-retest variability of acuities measured using 5-letter-per-line retroilluminated logMAR charts.

Project description:PurposeThe recent exponential growth in teleophthalmology has been limited in part by the lack of a validated method to measure visual acuity (VA) remotely. We investigated the validity of a self-administered Early Treatment Diabetic Retinopathy Study (ETDRS) home VA test. We hypothesized that a home VA test with a printout ETDRS chart is equivalent to a standard technician-administered VA test in clinic.DesignProspective cohort study.ParticipantsTwo hundred nine eyes from 108 patients who had a scheduled in-person outpatient ophthalmology clinic visit at an academic medical center.MethodsEnrolled patients were sent a .pdf document consisting of instructions and a printout ETDRS vision chart calibrated for 5 feet. Patients completed the VA test at home before the in-person appointment, where their VA was measured by an ophthalmic technician using a standard ETDRS chart. Survey questions about the ease of testing and barriers to completion were administered. For the bioequivalence test with a 5% nominal level, the 2 1-sided tests procedure was used, and an equivalent 90% confidence interval (CI) was constructed and compared with the prespecified 7-letter equivalence margin.Main outcome measuresThe primary outcome was the mean adjusted letter score difference between the home and clinic tests. Secondary outcomes included the unadjusted letter difference, absolute letter difference, and survey question responses.ResultsThe mean adjusted VA letter score difference was 4.1 letters (90% CI, 3.2-4.9 letters), well within the 7-letter equivalence margin. Average unadjusted VA scores in clinic were 3.9 letters (90% CI, 3.1-4.7 letters) more than scores at home. The absolute difference was 5.2 letters (90% CI, 4.6-5.9 letters). Ninety-eight percent of patients agreed that the home test was easy to perform.ConclusionsAn ETDRS VA test self-administered at home following a standardized protocol was equivalent to a standard technician-administered VA test in clinic in the examined population.

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Dataset Information

Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home).

Purpose

Methods

Results

Conclusions

Translational relevance

Publications

Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home).

Similar Datasets

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