Automated determination of distance visual acuity: towards teleophthalmology services

Alleviating an Increasingly Burdened Healthcare System with Telemedicine: Anterior Segment

Tele-ophthalmology is a rapidly evolving and exciting field that has become increasingly relevant amidst the current global pandemic. With advancements in technology, many components of an evaluation previously possible only in an office setting are becoming possible remotely, paving the way for at-home visits. Examples of these technologies include measurement of visual acuity using smartphones, remote monitoring of intraocular pressure using self-administered tonometers or implantable sensors, and use of digitally acquired slit-lamp or smartphone images for diagnosis of anterior segment pathology. While many examples showcasing the utility of telemedicine have been shown for diseases such as diabetic retinopathy, concerted efforts are needed to develop similar technology for anterior segment diseases. As technology continues to advance, it may be possible to diagnose and manage more anterior segment disease with telemedicine.

Ophthalmologists on Smartphones: Image-Based Teleconsultation

Background:

Teleophthalmology has the potential to facilitate wider access to expert advice. It includes viewing of ophthalmic images by experts either on handheld devices like smartphones/tablets or office devices such as computer screens. However, to ensure rapid feedback, the turnaround time of any consultation must be kept to a minimum which requires use of handheld user-friendly devices. The purpose of this study was to assess whether images of different eye ailments viewed on smartphones and tablets are of comparable subjective quality as those viewed on a computer screen.

Methods:

This was a prospective study comparing the subjective quality of images on a smartphone, tablet and computer screen. Thirty images were analysed – 10 of extraocular morphology, 10 of the anterior segment pathology and 10 of retinal diseases. Ten ophthalmologists participated and were instructed to rate the overall quality of each image on a 7-point Likert scale (terrible-1, poor-2, average-3, fair-4, good-5, very good-6, excellent-7).

Results:

Overall smartphones were found to have higher ratings of subjective image quality (5.9 ± 0.48) than images displayed on tablets (5.13 ± 0.51) and computers (5.0 ± 0.37). The images were rated ‘good’ or ‘very good’ in all (100%) of the smartphone images. Fundus images and extraocular images were rated higher than anterior segment images on the smartphone. When comparing the two handheld devices with computers, both smartphones and tablets had similar image quality (p > 0.05, not significant) to computer images. However, for extraocular diseases, smartphone (6.1 ± 0.32) had significantly better image quality and images were easier to interpret compared to images on the computer (p < 0.05).

Smartphones were rated ‘very good’ in 88.33% cases. All consultants (n = 10) were comfortable with the use of smartphone images and were already using it for teleconsultation at least three times in a month. Vision technicians reported minimum delay in getting advice when sending the images on mobile application to expert ophthalmologists.

Conclusion:

Smartphones can be used for teleconsultation. Subjective qualities of ophthalmic images on a smartphone are similar to those on tablets and computers. For rural communities that rely on teleconsultation, this small study provides useful evidence which may support the use of smartphones, tablets or computers for viewing ophthalmic images.

Mobile Apps for Eye Care in Canada: An Analysis of the iTunes Store

Background

Mobile phone screens can facilitate stimulation to various components of the visual system and many mobile apps are accepted as a means of providing clinical assessments for the oculo-visual system. Although many of these apps are intended for use in clinical settings, there is a growing number of apps in eye care developed for self-tests and eye exercises for lay people. These and other features, however, have not yet been well described.

Objective

Our objective was to identify, describe, and categorize mobile apps related to eye care that are available to users in the Canadian iTunes market.

Methods

We conducted an extensive search of the Apple iTunes Store for apps related to eye care. We used the terms “eye,” “eye care,” “vision,” and “eye test” and included apps that are targeted at both lay people and medical professionals. We excluded apps whose primary function is not related to eye care. Eligible apps were categorized by primary purpose, based on how they were described by their developers in the iTunes Store.

Results

Our search yielded 10,657 apps, of which 427 met our inclusion criteria. After removing duplicates, 355 unique apps were subject to further review. We assigned the eligible apps to three distinct categories: 39/355 apps (11.0%) were intended for use by medical professionals, 236 apps (66.5%, 236/355) were intended for use by lay people, and 80 apps (22.5%, 80/355) were intended for marketing eye care and eye-care products. We identified 9 subcategories of apps based on the descriptions of their primary functions. Apps for medical professionals fell into three subcategories: clinical calculators (n=6), clinical diagnostic tools (n=18), and education and networking apps for professionals (n=15). Apps for lay people fell into four subcategories: self-testing (n=153), eye exercises (n=30), patient tools and low vision aids (n=35), and apps for patient education (n=18). Mixed-use apps (n=80) were placed into two subcategories: marketing of individual practitioners or eye-care products (n=72) and marketing of multiple eye-care products or professional services.

Conclusions

The most extensive subcategory pertaining to eye care consisted of apps for use by lay people, especially for conducting self-tests (n=236). This study revealed a previously uncharacterized category of apps intended for use by doctors and patients, of which the primary goal is marketing of eye-care services and products (n=80).

Recent Directions in Telemedicine: Review of Trends in Research and Practice

Objectives

Healthcare is now routinely delivered by telecommunications-based services in all developed countries and an increasing number of developing countries. Telemedicine is used in many clinical specialities and across numerous healthcare settings, which range from mobile patient-centric applications to complex interactions amongst clinicians in tertiary referral hospital settings. This paper discusses some recent areas of significant development and progress in the field with the purpose of identifying strong trends in both research and practice activities.

Methods

To establish the breadth of new ideas and directions in the field, a review of literature was made by searching PubMed for recent publications including terms (telemedicine OR telehealth) AND (challenge OR direction OR innovation OR new OR novel OR trend), for all searchable categories. 3,433 publications were identified that have appeared since January 1, 2005 (2,172 of these since January 1, 2010), based on a search conducted on June 1, 2015.

Results

The current interest areas in these papers span both synchronous telemedicine, including intensive care, emergency medicine, and mental health, and asynchronous telemedicine, including wound and burns care, dermatology and ophthalmology.

Conclusions

It is concluded that two major drivers of contemporary tele medicine development are a high volume demand for a particular clinical service, and/or a high criticality of need for clinical exper tise to deliver the service. These areas offer promise for further study and enhancement of applicable telemedicine methods and have the potential for large-scale deployments internationally, which would contribute significantly to the advancement of healthcare.

Reliability and validity of an automated computerized visual acuity and stereoacuity test in children using an interactive video game

PURPOSE

To evaluate the test-retest reliability and validity of the new automated computerized distance visual acuity and stereoacuity test for children, which uses an interactive video game.

DESIGN

Retrospective, observational case series.

METHODS

A total of 102 children aged between 3 and 7 years underwent the Snellen visual acuity test, the Distance Randot Stereotest, and the new automated computerized distance visual acuity and stereoacuity test. The test-retest reliability and validity of the automated computerized tests were assessed and compared with the Snellen visual acuity test and the Distance Randot Stereotest with frequency distributions of the differences, Bland-Altman plots, and Deming regression.

RESULTS

The automated computerized distance visual acuity test had high test-retest reliability (95% limits of agreement ±0.18 logMAR, 90.0% of the differences within 0.2 logMAR) and acceptable validity as compared with the Snellen visual acuity chart (95% limits of agreement ±0.27 logMAR, 81.3% of the differences within 0.2 logMAR). The automated computerized distance stereoacuity test had high test-retest reliability (95% limits of agreement ±0.29 log arc second, 95.1% of the differences within 0.3 log arc second) and acceptable validity as compared with the Distance Randot Stereotest (95% limits of agreement ±0.35 log arc second, 93.9% of the differences within 0.3 log arc second).

CONCLUSIONS

The new automated computerized distance visual acuity and stereoacuity test, which uses an interactive video game, has good reliability and acceptable validity compared with the Snellen visual acuity chart and the Distance Randot Stereotest.