Can Visual Acuity Be Reliably Measured at Home? Validation of Telemedicine Remote Computerised Visual Acuity Measurements

Ritchie, Ailsa E.; Atamian, Silva; Shah, Nilpa; Laidlaw, Alistair; Hammond, Christopher J.

doi:10.22599/bioj.179

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…The present study demonstrates good (binocular) or excellent (monocular) agreement between standard acuity testing in clinic and the prototype NGVHVT on a household device, i.e., 0.00 logMAR difference and intraclass correlations of 0.65 and 0.75 for binocular and monocular testing, as has been found in other studies (Bellsmith et al 2022;Dawkins and Bjerre 2016;Laidlaw et al 2008;Ritchie et al 2021;Rosser et al 2001;Siderov and Tiu 1999;Silverstein et al 2021;Srinivasan et al 2012;Thirunavukarasu et al 2021). The LOAs were a little over ±0.3 logMAR for binocular and monocular conditions.…”

Section: Discussionsupporting

confidence: 87%

Diagnostic Accuracy of Online Visual Acuity Testing of Paediatric Patients

Painter

Hamilton

Livingstone

2023

British and Irish Orthoptic Journal

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Background/Objectives: Remote assessment of children's visual acuity became necessary during the COVID-19 pandemic. This study aimed to assess the extent of agreement between hospital-based clinical testing and clinician-led home-based testing.Subjects/Methods: 50 children aged 2-16 (median 8) years attending hospital eye services at two UK hospitals had routine hospital-based acuities compared with subsequent online, orthoptist-supervised home visual acuities. Agreement was assessed using intra-class correlation and Bland-Altman plots, as was test-retest (TRT) agreement of two, repeated home acuity tests. Results:Monocular acuities tested at hospital and at home were obtained from all 50 children; 33 also had binocular acuities in both settings and 35 had acuities retested immediately at home. Most children were tested at home using a computer or tablet; two were tested with a smartphone. No mean test differences were found for hospital vs home testing (−0.004 (95% CI −0.06-0.05) and −0.008 (95% CI −0.04-0.03) for binocular and monocular testing, respectively). Limits of agreement (LOAs) were ±0.32 and ±0.35 logMAR for binocular and monocular testing, respectively. LOAs for interocular acuity differences (hospital vs home) were −0.15-0.25 logMAR. TRT monocular acuity agreement was excellent, with an LOA of ±0.14 logMAR. Conclusions:We found good (binocular) and excellent (monocular) agreement between hospital and home acuity testing. LOAs were in keeping with multiple changes between measures (test; setting; time; tester) and a cohort including patients as young as two years old. Even smartphone testing proved feasible. Inability of the supervising orthoptist to check test distance or device calibration/orientation was a limitation, likely contributing to the breadth of LOAs. Home vision testing is feasible and accurate, but its precision, acceptability, health economic impact and carbon impact require more attention.

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Section: Discussionsupporting

confidence: 87%

Diagnostic Accuracy of Online Visual Acuity Testing of Paediatric Patients

Painter

Hamilton

Livingstone

2023

British and Irish Orthoptic Journal

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“…During a clinical encounter, this measurement is taken at specific distances using standardized charts, including Snellen, Early Treatment Diabetic Retinopathy Study (ETDRS), HOTV, and Tumbling E charts . Historically, VA testing has been done exclusively in a clinical setting under the guidance of a trained professional, but in recent years, various options have been created for testing outside of the clinic, including paper charts, web-based tests, and smartphone applications …”

Section: Introductionmentioning

confidence: 99%

Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era

et al. 2022

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uring the initial portion of the COVID-19 pandemic, eye care professionals needed to reduce the risk of exposure to patients while continuing to provide highquality health care. The Casey Eye Institute at Oregon Health and Science University saw a decrease in clinic visits to 25% of prepandemic levels in April 2020 and did not return to baseline until March 2021. 1 With the need to limit clinic visits and an increase in the Centers for Medicare & Medicaid reimbursement for telehealth services, 2 teleophthalmology has played a critical role in responding to the COVID-19 pandemic. 1,3,4 Although published data are limited regarding teleophthalmology during the pandemic, a study looking at ophthalmology visits insured by Blue Cross Blue Shield of Michigan found a 4-fold increase in virtual visits compared with baseline data from the first 3 months of the pandemic. 5 A study at Casey Eye Institute demonstrated positive clinician attitudes with telehealth implementation during the pandemic 1 ; however, access to an easy-to-use, validated at-home visual acuity (VA) test for adults limited telehealth care.With increased use of telehealth technology, it is crucial to ensure that quality of care remains optimal. A key factor in evaluating and treating patients during eye care visits is the VA measurement. During a clinical encounter, this measurement is taken at specific distances using standardized charts, including Snellen, Early Treatment Diabetic Retinopathy Study (ETDRS), HOTV, and Tumbling E charts. 6 Historically, VA test-IMPORTANCE Visual acuity (VA) is one of the most important clinical data points in ophthalmology. However, few options for validated at-home VA assessments are currently available.OBJECTIVE To validate 3 at-home visual acuity tests in comparison with in-office visual acuity.DESIGN, SETTING, AND PARTICIPANTS Between July 2020 and April 2021, eligible participants with VA of 20/200 or better were recruited from 4 university-based ophthalmology clinics (comprehensive, cornea, glaucoma, and retina clinics). Participants were prospectively randomized to self-administer 2 of 3 at-home VA tests (printed chart, mobile phone app, and website) within 3 days before their standard-of-care clinic visit. Participants completed a survey assessing usability of the at-home tests. At the clinic visit, best-corrected Snellen distance acuity was measured as the reference standard. MAIN OUTCOMES AND MEASURESThe at-home VA test results were compared with the in-office VA test results using paired and unpaired t tests, Pearson correlation coefficients, analysis of variance, χ 2 tests, and Cohen κ agreement. The sensitivity, specificity, positive predictive value, and negative predictive value of each at-home test were calculated to detect significant VA changes (Ն0.2 logMAR) from the in-office baseline. RESULTSA total of 121 participants with a mean (SD) age of 63.8 (13.0) years completed the study. The mean in-office VA was 0.11 logMAR (Snellen equivalent 20/25) with similar numbers of participants from the 4 clinics....

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“…Data from routine clinical practice might provide an excellent repository for further retrospective analyses and validations subject to design biases, such as selection bias or those introduced by variable follow-up. Furthermore, with increasing availability of mobile medical devices, VA or OCT data that are generated via home monitoring devices [15,16] may further enable prospective timein-range analyses. The approach used here to calculate time in range has certain limitations, especially when applied to a progressive disease and continuous endpoints.…”

Section: Discussionmentioning

confidence: 99%

Visual acuity time in range: a novel concept to describe consistency in treatment response in diabetic macular oedema

Kozák¹,

Pearce

Cheung

et al. 2023

Eye

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Objective To assess ‘time in range’ as a novel measure of treatment response in diabetic macular oedema (DMO). Methods This post hoc analysis of the Protocol T randomised clinical trial included 660 individuals with centre-involved DMO and best-corrected visual acuity (BCVA) letter score ≤78–≥24 (approximate Snellen equivalent 20/32–20/320). Study participants received intravitreal aflibercept 2.0 mg, repackaged (compounded) bevacizumab 1.25 mg, or ranibizumab 0.3 mg given up to every 4 weeks using defined retreatment criteria. Mean time in range was calculated using a BCVA letter score threshold of ≥69 (20/40 or better; minimum driving requirement in many regions), with sensitivity analyses using BCVA thresholds from 100 to 0 (20/10 to 20/800) in 1-letter increments. Results Time in range was defined as either the absolute or relative duration above a predefined BCVA threshold, measured in weeks or as a percentage of time, respectively. Using a BCVA letter score threshold of ≥69 (20/40 or better), the least squares mean time in range (adjusted for baseline BCVA) in Year 1 was 41.2 weeks with intravitreal aflibercept, 4.0 weeks longer (95% CI: 1.7, 6.3; p = 0.002) than bevacizumab and 3.6 weeks longer (1.3, 5.9; p = 0.004) than ranibizumab. Overall, mean time in range was numerically longer for intravitreal aflibercept for all BCVA letter score thresholds between 92 and 30 (20/20 to 20/250). In the Day 365–728 analysis, time in range was 3.9 (1.3, 6.5) and 2.4 (0.0, 4.9) weeks longer with intravitreal aflibercept vs bevacizumab and vs ranibizumab (p = 0.011 and 0.106), respectively. Conclusion BCVA time in range may represent another way to describe visual outcomes and potential impact on vision-related functions over time for patients with DMO and provide a better understanding, for physicians and patients, of the consistency of treatment efficacy.

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Can Visual Acuity Be Reliably Measured at Home? Validation of Telemedicine Remote Computerised Visual Acuity Measurements

Cited by 11 publications

References 22 publications

Diagnostic Accuracy of Online Visual Acuity Testing of Paediatric Patients

Diagnostic Accuracy of Online Visual Acuity Testing of Paediatric Patients

Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era

Visual acuity time in range: a novel concept to describe consistency in treatment response in diabetic macular oedema

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