Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Silverstein, Emanuel; Williams, Jonathan S.; Brown, Jeffrey R.; Bylykbashi, Enjana; Stinnett, Sandra S.

doi:10.1016/j.ajo.2020.08.007

Cited by 38 publications

(23 citation statements)

References 40 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…COMPlog, a distance VA test requiring a specifically sized computer monitor and trained observer, recorded TRT LOA at ±0.10–0.12 logMAR [ 14 ], and ICC of 0.964 when comparing face to face with remote testing [ 15 ]. Other smartphone-based VA testing apps have reported LOAs of ±0.198 logMAR [ 16 ] and ±0.10-0.30 logMAR under clinical supervision [ 17 ]. Together, these data provide a priori standards by which DigiVis can be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Clinical validation of a novel web-application for remote assessment of distance visual acuity

Thirunavukarasu

Mullinger

Rufus‐Toye

et al. 2021

Eye

View full text Add to dashboard Cite

Background/Objectives Ophthalmic disorders cause 8% of hospital clinic attendances, the highest of any specialty. The fundamental need for a distance visual acuity (VA) measurement constrains remote consultation. A web-application, DigiVis, facilitates self-assessment of VA using two internet-connected devices. This prospective validation study aimed to establish its accuracy, reliability, usability and acceptability. Subjects/Methods In total, 120 patients aged 5–87 years (median = 27) self-tested their vision twice using DigiVis in addition to their standard clinical assessment. Eyes with VA worse than +0.80 logMAR were excluded. Accuracy and test-retest (TRT) variability were compared using Bland–Altman analysis and intraclass correlation coefficients (ICC). Patient feedback was analysed. Results Bias between VA tests was insignificant at −0.001 (95% CI −0.017 to 0.015) logMAR. The upper limit of agreement (LOA) was 0.173 (95% CI 0.146 to 0.201) and the lower LOA −0.175 (95% CI −0.202 to −0.147) logMAR. The ICC was 0.818 (95% CI 0.748 to 0.869). DigiVis TRT mean bias was similarly insignificant, at 0.001 (95% CI −0.011 to 0.013) logMAR, the upper LOA was 0.124 (95% CI 0.103 to 0.144) and the lower LOA −0.121 (95% CI −0.142 to −0.101) logMAR. The ICC was 0.922 (95% CI 0.887 to 0.946). 95% of subjects were willing to use DigiVis to monitor vision at home. Conclusions Self-tested distance VA using DigiVis is accurate, reliable and well accepted by patients. The app has potential to facilitate home monitoring, triage and remote consultation but widescale implementation will require integration with NHS databases and secure patient data storage.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical validation of a novel web-application for remote assessment of distance visual acuity

Thirunavukarasu

Mullinger

Rufus‐Toye

et al. 2021

Eye

View full text Add to dashboard Cite

show abstract

“…Providing the estimation of refraction with valid photorefractors in a drive-by paradigm is a beneficial step. Visual acuity can be checked at home by a phone-based 18 or paper download 19 method. Further referral toward expert pediatric ophthalmic specialty care must be balanced with community needs for pandemic isolation.…”

Section: Discussionmentioning

confidence: 99%

Drive-by Photoscreening: Plusoptix, 2WIN and Blinq Amblyopia Detection During the COVID-19 Pandemic

Keffalos¹,

Martin²,

Arnold³

2021

OPTH

View full text Add to dashboard Cite

Background Community photoscreening for amblyopia had successfully been adopted by many communities, however many clinics curtailed screening as a result of the COVID-19 pandemic. We modified three conventional devices and tested them for outdoor, drive-by socially distanced photoscreening and refraction. Methods External frames that provide luminance control and focus distance were fashioned for plusoptiX S12 (Nuremberg, Germany), Adaptica 2WIN in Kaleidos case (Padova, Italy) and the Rebion blinq (Boston, USA). Children were screened by each device and then Retinomax (Righton, Japan) before AAPOS guideline validation. Results Eighty-eight children average age 8±7 years had precise refraction and alignment from which 69% AAPOS 2003 risk factors were determined. The sensitivity/specificity/inconclusive rate for plusoptiX was 85%/96%/16%, for 2WIN 79%/89%/5% and for blinq 43%/74%/8%. Blinq improved to 54%/70% when screening for amblyopia ± strabismus. Bland Altman analysis of spherical equivalent showed plusoptiX and 2WIN with less over-minus than Retinomax and J0 and J45 vectors highly reliable for astigmatism determination. Conclusion The infrared photorefractors in modified cases reliably screened amblyopia risk factors and refraction. The birefringent scanner provided drive-by results but less reliably with wire-frame opaque case than without the case in a dimly lit room. Modified drive-by photoscreeners could help reduce amblyopia and provide socially distanced refraction during an extended pandemic.

show abstract

“…This is an important step given that assessment at home introduces more sources of variability. During the COVID-19 pandemic, the use of apps to assess VA at home was evaluated, but one study had a very low participation rate (only 16% of parents that gave consent to participate provided data) (Painter et al 2021), and another reported a modest correlation with clinical tests (Silverstein et al 2021). Therefore, further evaluation of the Amblyopia Tracker app is underway, with parents testing children at home and then testing repeated on return to the clinic.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a New Method to Track Changes in Vision at Home for Children Undergoing Amblyopia Treatment

O’Connor

Waters

England

et al. 2021

British and Irish Orthoptic Journal

View full text Add to dashboard Cite

Purpose: A new amblyopia tracker app has been designed to provide parents with a method of monitoring a child's vision by presenting a single optotype size that the tester moves to identify the furthest distance the optotypes can be seen. The aim of this study is to evaluate this methodology in adults, comparing the findings to visual acuity (VA) measured with the iSight app and to determine the test retest variability. Methods: Adults, aged 18-39 years, with no known eye condition and VA ≤ 0.7 logMAR were recruited. Bangerter filters were used to simulate amblyopia, where VA was reduced below 0.0 with an interocular difference of at least 0.2 logMAR. Testing for both apps was performed monocularly, with the test order being randomised. Results: Data from 32 subjects were analysed. For the test retest variability analysis, paired t-tests showed no statistically significant difference between the tests for either eye, either app or the interocular acuity difference (p > 0.3 in all cases). Bland Altman plots showed similar limits of agreement between the two apps. When comparing measurements between the apps there was no statistically significant difference on the first or second test, either eye or the interocular acuity difference (p > 0.5 in all cases). Conclusion:The results support the theory that changing distance is a valid method of assessing VA as the measurements agree well with the standard approach of reducing optotype size. Test retest variability is similar between the two apps and there is good agreement between the measurements.

show abstract

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Cited by 38 publications

References 40 publications

Clinical validation of a novel web-application for remote assessment of distance visual acuity

Clinical validation of a novel web-application for remote assessment of distance visual acuity

Drive-by Photoscreening: Plusoptix, 2WIN and Blinq Amblyopia Detection During the COVID-19 Pandemic

Evaluation of a New Method to Track Changes in Vision at Home for Children Undergoing Amblyopia Treatment

Contact Info

Product

Resources

About