Purpose To describe a new stereotest in the form of a game on an autostereoscopic tablet computer designed to be suitable for use in the eye clinic and present data on its reliability and the distribution of stereo thresholds in adults. Methods Test stimuli were four dynamic random-dot stereograms, one of which contained a disparate target. Feedback was given after each trial presentation. A Bayesian adaptive staircase adjusted target disparity. Threshold was estimated from the mean of the posterior distribution after 20 responses. Viewing distance was monitored via a forehead sticker viewed by the tablet's front camera, and screen parallax was adjusted dynamically so as to achieve the desired retinal disparity. Results The tablet must be viewed at a distance of greater than ∼35 cm to produce a good depth percept. Log thresholds were roughly normally distributed with a mean of 1.75 log 10 arcsec = 56 arcsec and SD of 0.34 log 10 arcsec = a factor of 2.2. The standard deviation agrees with previous studies, but ASTEROID thresholds are approximately 1.5 times higher than a similar stereotest on stereoscopic 3D TV or on Randot Preschool stereotests. Pearson correlation between successive tests in same observer was 0.80. Bland-Altman 95% limits of reliability were ±0.64 log 10 arcsec = a factor of 4.3, corresponding to an SD of 0.32 log 10 arcsec on individual threshold estimates. This is similar to other stereotests and close to the statistical limit for 20 responses. Conclusions ASTEROID is reliable, easy, and portable and thus well-suited for clinical stereoacuity measurements. Translational Relevance New 3D digital technology means that research-quality psychophysical measurement of stereoacuity is now feasible in the clinic.

Magnetic resonance imaging is able to accurately depict the extent and course of branchial cleft abnormalities, and in the current cases could have been relied upon to determine the necessary surgical procedure. Branchial cleft abnormalities are sufficiently rare for magnetic resonance imaging to be recommended as the first-line imaging modality.

PurposeTo comprehensively assess the Randot Preschool stereo test in young children, including testability, normative values, test/retest reliability and sensitivity and specificity for detecting binocular vision disorders.MethodsWe tested 1005 children aged 2–11 years with the Randot Preschool stereo test, plus a cover/uncover test to detect heterotropia. Monocular visual acuity was assessed in both eyes using Keeler Crowded LogMAR visual acuity test for children aged 4 and over.ResultsTestability was very high: 65% in two-year-olds, 92% in three-year-olds and ~100% in older children. Normative values: In 389 children aged 2–5 with apparently normal vision, 6% of children scored nil (stereoblind). In those who obtained a threshold, the mean log threshold was 2.06 log10 arcsec, corresponding to 114 arcsec, and the median threshold was 100 arcsec. Most older children score 40 arcsec, the best available score. We found a small sex difference, with girls scoring slightly but significantly better. Test/retest reliability: ~99% for obtaining any score vs nil. Agreement between stereo thresholds is poor in children aged 2–5; 95% limit of agreement = 0.7 log10 arcsec: five-fold change in stereo threshold may occur without any change in vision. In children over 5, the test essentially acts only as a binary classifier since almost all non-stereoblind children score 40 arcsec. Specificity (true negative rate): >95%. Sensitivity (true positive rate): poor, <50%, i.e. around half of children with a demonstrable binocular vision abnormality score well on the Randot Preschool.ConclusionsThe Randot Preschool is extremely accessible for even very young children, and is very reliable at classifying children into those who have any stereo vision vs those who are stereoblind. However, its ability to quantify stereo vision is limited by poor repeatability in children aged 5 and under, and a very limited range of scores relevant to children aged over 5.

Background: Although considered important, the direct involvement of young children in research design is scarce and to our knowledge its impact has never been measured. We aim to demonstrate impact of young children's involvement in improving the understanding of a new 3D eye test or stereotest. Methods: After a pre-measure of understanding was taken, we explored issues with the test instructions in patient and public involvement (PPI) sessions where children acted as advisers in the test design. Feedback was collected via observations, rating scales and verbal comments. An interdisciplinary panel reviewed the feedback, discussed potential changes to the test design, and decided on the implementation. Subsequently, a post-measure of understanding (Study 1-2) and engagement (Study 3) was collected in a pre-post study design. Six hundred fifty children (2-11.8 years old) took part in the pre-measure, 111 children (1-12 years old) in the subsequent PPI sessions, and 52 children (4-6 years old) in the first post-measure. One hundred twenty-two children (1-12 years old) and unrelated adults took then part in a second series of PPI sessions, and 53 people (2-39 years old) in the final post-measure. Adults were involved to obtain verbal descriptions of the target that could be used to explain the task to children. Results: Following feedback in Study 1, we added a frame cue and included a shuffle animation. This increased the percentage of correct practice trials from 76 to 97% (t (231) = 14.29, p < .001), but more encouragements like 'Keep going!' were needed (t (64) = 8.25, p < .001). After adding a cardboard demo in Study 2, the percentage of correct trials remained stable but the number of additional instructions given decreased (t (103) = 3.72, p < .001) as did the number of encouragements (t (103) = 8.32, p < .001). Therefore, changes in test design following children's feedback significantly improved task understanding.

Mass provision of healthcare through a digital medium can be greatly enhanced by the use of serious games. The accessibility and engagement provided by a serious game to the subject can significantly increase participation. The commercial games industry employs numerous techniques to analyse soft data collected from early users of an application to evolve the application itself and improve the experience of playing it. A game for mass stereoacuity testing of young children is used as a case study in this paper, to illustrate how soft feedback can be used to improve the effectiveness of a clinical trial. The key to the approach is identified as rapid incremental evolution of the application and trial protocol in a manner which increases the amount and usefulness of soft data collected, and reacts to issues identified in the soft data in a timely fashion. It is hoped that the approach can be adopted for a wide range of digital applications for mass health provision.