Validation of visual acuity applications for teleophthalmology during COVID-19

Satgunam, PremNandhini; Thakur, Monika; Sachdeva, Virender; Reddy, S. Rama; Rani, Padmaja Kumari

doi:10.4103/ijo.ijo_2333_20

Cited by 23 publications

(16 citation statements)

References 28 publications

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“…4 A different study using an Android tablet reported the mean difference was less than 0.1 LogMAR (LoAs: ±0.3 LogMAR). 13 Our findings were consistent with those of previous studies, suggesting the feasibility and practical value of mobile devices for performing different kinds of VA tests.…”

Section: Discussionsupporting

confidence: 92%

“…In addition, the highest brightness of the smartphone screen was greater than that of the VA light box (425 cd/m 2 vs. 250 cd/m 2 ), and it was easier to distinguish optotypes. Some studies have shown a slight underestimation of NVA with ASC 4,13,19 or no significant difference 21 . In addition, the discrepancy in the initial size of the optotypes and settings of the testing endpoints may also be a contributing factor to the difference in results.…”

Section: Discussionmentioning

confidence: 99%

“…This study had some limitations. First, this study did not include different devices for the VA self‐test, but differences in the brightness, contrast ratio, and resolution of screens may have an impact on the test results, especially the NVA test 13 . Future research comparing different devices for the VA self‐test may help to further distinguish the different testing outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have suggested deviations in NVA testing utilising smart devices, 17,18 and this could be attributed to the differences in device parameters, including brightness, contrast ratio, or resolution. 4 Satgunam et al 13 suggested that a viewing angle of approximately 1.4 0 for one pixel at a distance of 40 cm was larger than the minimum resolution angle of the human eye (1 0 ) and may lead to image distortion, thereby underestimating VA in the younger population with relatively good vision. Similarly, Phung et al 19 suggested that the difference in NVA between various VA testing methods was greater in subjects with good VA.…”

Section: Discussionmentioning

confidence: 99%

“…First, this study did not include different devices for the VA self-test, but differences in the brightness, contrast ratio, and resolution of screens may have an impact on the test results, especially the NVA test. 13 Future research comparing different devices for the VA self-test may help to further distinguish the different testing outcomes. Second, subjects were required to maintain a correct measuring distance, therefore, a home-based or fixed setting was recommended to ensure the best accuracy.…”

Section: Discussionmentioning

confidence: 99%

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Agreement between a mobile applet‐based visual acuity self‐test program and the conventional method for distance and near visual acuity tests

Xian

Liu

et al. 2022

Clinical Exper Ophthalmology

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PURPOSE: To investigate the agreement between a mobile applet-based visual acuity (VA) self-test program and the conventional VA tests. METHODS: This consecutive case series study included 121 children and adults (242 eyes). Patients were classi ed into three groups according to age (children, adolescents, and adults). They underwent uncorrected distance visual acuity (UDVA) testing, distance visual acuity with frame spectacle (DVA with FS) testing at 2.5-m distance, uncorrected near visual acuity (UNVA) testing, and near visual acuity with frame spectacle (NVA with FS) testing at a 0.4-m distance using a mobile applet-based VA self-test program and conventional VA tests in two eyes.RESULTS: Correlations among UDVA, DVA with FS, UNVA, and NVA with FS between the two methods were signi cant in all subjects (all P<0.001). The intraclass correlation coe cient were 0.960. 0.845, 0.960, and 0.669, respectively (all P<0.001). The proportions of bias outside the 95% con dence interval limit of agreements were 6.20%, 4.82%, 7.08%, and 6.10%, respectively. There were signi cant differences in NVA with FS between the two methods (P<0.05) in the adolescent group, but no differences in measured parameters were found among children and adult groups.CONCLUSIONS: There is good agreement between the mobile applet-based VA self-test program and the conventional VA tests. The VA self-test has good practical value especially in the current pandemic, allowing self-screening of visual acuity, myopia control, and remote management of visual impairment in oculopathy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Agreement between a mobile applet‐based visual acuity self‐test program and the conventional method for distance and near visual acuity tests

Xian

Liu

et al. 2022

Clinical Exper Ophthalmology

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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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