Validation of a Standardized Home Visual Acuity Test for Teleophthalmology

Siktberg, Jonathan; Hamdan, Saif; Liu, Yuhan; Chen, Qingxia; Donahue, Sean P.; Patel, Shriji; Sternberg, Paul; Robinson, Julia; Kammer, Jeffrey A.

doi:10.1016/j.xops.2021.100007

Cited by 13 publications

(30 citation statements)

References 26 publications

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“…A similar study was recently published that evaluated the same home vision test used in this study for in-office ETDRS testing. 14 They found that the home vision test was equivalent to in-office technician-administered ETDRS VA with a mean adjusted VA letter score difference of approximately 4 letters. One major difference is that our study compared the home vision test to in-office Snellen VA.…”

Section: Discussionmentioning

confidence: 99%

Comparing a Home Vision Self-Assessment Test to Office-Based Snellen Visual Acuity

Chen¹,

Li²,

Schallhorn³

et al. 2021

OPTH

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Purpose To evaluate the agreement of a home vision screening test compared to standard in-office technician-measured Snellen visual acuity to allow for remote screening and triaging of patients. Patients and Methods In this prospective study, English-speaking patients with in-office ophthalmology appointments from May to August 2020 and visual acuity better than 20/125 were asked to complete a home vision test one week before their scheduled in-office appointment. The home vision test was a modified ETDRS chart displayed in a PDF document that could be printed or viewed on a monitor. The primary outcome was the mean difference between office-based and home visual acuity. Results Eighty-two eyes of 45 patients were included in the study with 45 study eyes analyzed. The mean difference between office-based and home visual acuity was −0.02 logMAR (SD 0.15, P =0.28) among study eyes. Of these eyes, 91% demonstrated agreement between the two methods within 0.2 logMAR of the mean difference, and 60% had agreement within 0.1 logMAR of the mean difference. There were no significant demographic or ocular risk factors leading to a greater difference between the tests. Conclusion There was good agreement between the home and in-office Snellen tests for patients with vision better than 20/125. The home vision test can be used to remotely determine if there is a significant vision change of >0.2 logMAR or approximately 2 lines of visual acuity.

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Section: Discussionmentioning

confidence: 99%

Comparing a Home Vision Self-Assessment Test to Office-Based Snellen Visual Acuity

Chen¹,

Li²,

Schallhorn³

et al. 2021

OPTH

View full text Add to dashboard Cite

show abstract

“…ing 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, [7][8][9][10] web-based tests, [11][12][13][14] and smartphone applications. [15][16][17][18][19][20][21][22][23][24] Many commercially available VA tests are not validated before public release, and many applications require users to pay a fee, making clinical application unrealistic for some patients.…”

mentioning

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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“…Verbal encouragement was the same in our 2 settings as patients were asked to read the next line of the chart over the telephone in the same manner as in clinic. As this finding has been replicated by other groups using different VA tests, [2][3][4] it is unlikely to be due to the test chart design. One way to confirm this would be to use a replica clinic acuity chart at home, which we did not attempt, as we wanted to test a smaller chart that we thought would be easier to mail without folding.…”

Section: Methods |mentioning

confidence: 60%

“…Others agree that VA is lower when measured at home. 2,3 A limitation of our previous work was that we compared at-home VA with VA recorded at the previous clinic visit, on average 12 months earlier (range, 1-69 months). Therefore, acuity may have genuinely decreased due to disease progression.…”

mentioning

confidence: 99%