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Al-Essa A. Snellen iPad App versus Traditional Light-Box Snellen Chart in Distance Visual Acuity. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1745-S1747. [PMID: 38882850 PMCID: PMC11174297 DOI: 10.4103/jpbs.jpbs_875_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 06/18/2024] Open
Abstract
This study aimed to discover distance visual acuity (VA) assessments through the display of the Snellen chart on the iPad tablet. The findings are equivalent to those obtained using the conventional light-box Snellen chart. In this work, the Snellen iPad app and Eye Chart HD iOS app are utilized among the participants in the Ophthalmology Outpatient Department (OPD) for determining VA. A cross-sectional method was used for the examination, which included 100 new patients who were chosen by random selection. The age requirement for new patients was 8 years and up for both genders. Patients with a VA of less than 6/30 were disqualified from the experiment. Two testing modalities are used to measure VA, such as the iPad Mini 2 with the iOS software Eye Chart HD and the classic Snellen light-box chart. The observation revealed that the Snellen iPad app and the classic light-box Snellen chart produced equivalent findings. The classic Snellen chart may have been memorized by participants before their eye examination, undermining the accuracy of the conclusions of the initial testing modality used. Patient-related variables were also identified as confounders. Future studies should adjust the brightness of the iPad Mini 2 and the traditional light-box Snellen chart to make sure that neither experiment modality's brightness affects the accuracy of the findings. Future research should also investigate the use of premium apps, use both devices, and employ a bigger sample size.
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Affiliation(s)
- Aiad Al-Essa
- Department of Ophthalmology, MMU Solan, Himachal Pradesh, India
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Abdelshafy Tabl A, Bendary M, Abdelshafy Tabl M. Accuracy of Mobile-Based Vision Chart in Clinical Practice during the COVID-19 pandemic. Ophthalmic Epidemiol 2024; 31:107-111. [PMID: 37114364 DOI: 10.1080/09286586.2023.2207202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE The accuracy of mobile-based visual acuity testing in clinical practice is debatable. This study aimed to analyze the accuracy of mobile-based distant vision chart in comparison to the standard chart projector. METHODS In this cross-sectional study, monocular distant best-corrected visual acuity (BCVA) in 571 eyes of 288 subjects was measured twice, using the Tumbling E vision chart by standard chart projector and repeated using mobile-based vision chart application with screen mirroring on a 22-inch monitor. The decimal results of BCVA were compared to analyze the accuracy of the mobile-based chart in comparison to the standard vision chart projector. RESULTS The mean age of the studied patients was 29 ± 14 years. The most frequent refractive error was hyperopia (35.4%), followed by emmetropia (26.7%), myopia (22.9%), and astigmatism (14.9%). The mean BCVA in decimal form was 0.9 ± 0.2 and 0.91 ± 0.26 by the standard and mobile-based charts, respectively. An excellent agreement was reported between both tests as the intraclass correlation coefficient (ICC) was 0.976, with a confidence interval (CI) of 0.965-0.982. Bland-Altman analysis revealed that most visual acuity differences between both methods lie on the equality line or within the allowed difference zone. CONCLUSIONS The mobile-based vision chart is an economical, accessible, and accurate way for distant vision assessment, and its results are comparable to the standard chart projector in clinical practice.
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Affiliation(s)
| | - Mohamed Bendary
- Department of Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
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Cheng L, Peng S, Hao H, Ye D, Xu L, Zuo Y, Huang J. Effect of different screen brightness and devices on online visual acuity test. Graefes Arch Clin Exp Ophthalmol 2024; 262:641-649. [PMID: 37606825 DOI: 10.1007/s00417-023-06206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE This study aimed to study the difference in test results of online visual acuity (VA) test under different devices and screen brightness conditions and to compare online VA test with Early Treatment Diabetic Retinopathy Study (ETDRS). METHODS Healthy volunteers with the best corrected VA of 0.0 LogMAR or higher were recruited. VAs under ETDRS were tested first, and then online VA test (the Stanford Acuity Test, StAT) visual acuities using iPad Air2 and Microsoft Surface pro4 under 50% and 100% screen brightness were performed. The VA results and the testing times were compared between different devices and screen brightness conditions. RESULTS A total of 101 eyes were included in this study. The VA results measured by the StAT were better than those of ETDRS. The VA results measured at 100% screen brightness were better than those of 50% brightness (mean difference, 0.013 logMAR at most, less than 1 letter); the VA results measured by iPad Air2 were better than those of Surface pro4 (mean difference, -0.009 logMAR at most, less than 1 letter). Significantly less time was spent on VA testing under StAT than that under ETDRS. CONCLUSION The impact of screen brightness and the device on the VA results generated by online VA tests was clinically insignificant. In addition, online VA tests are found to be reliable and more time efficient than ETDRS.
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Affiliation(s)
- Lu Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
| | - Shi Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
| | - Hua Hao
- Environmental Health Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dan Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
| | - Liya Xu
- Department of Biology, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Yajing Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China.
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China.
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Rosenthal E, O’Neil J, Hoyt B, Howard M. Inter-Rater Reliability of EyeSpy Mobile for Pediatric Visual Acuity Assessments by Parent Volunteers. Clin Ophthalmol 2024; 18:235-245. [PMID: 38283182 PMCID: PMC10822126 DOI: 10.2147/opth.s440439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To assess the inter-rater test reliability of the EyeSpy Mobile visual acuity smartphone algorithm when administered to children by eye professionals and parent volunteers. Patients and Methods Visual acuity test-retest results were analyzed for 106 children assigned to one of three different screenings: (1) An eye technician and pediatric ophthalmologist using their typical visual acuity testing method on a M&S computer; (2) An eye technician and pediatric ophthalmologist using EyeSpy Mobile; (3) An eye technician and parent volunteer using EyeSpy Mobile. Results All three phases demonstrated a strong agreement between the two testers, with mean test-retest equivalency results within 0.05 logMAR (2.5 letters, 90% CI). Whether testing using their typical technique on an M&S computer or using EyeSpy Mobile, eye professionals obtained statistically closer mean test-retest results than parent volunteers by 1 letter, with equivalency results within 0.03 logMAR (1.5 letters, 90% CI). Conversely, the number of retests within 2 vision lines was statistically greater when EyeSpy mobile was used by parents as compared to eye professional's customary technique on the M&S computer. Conclusion EyeSpy Mobile provides clinically useful visual acuity test-retest results even when used by first-time parent volunteers. Adaptive visual acuity algorithms have the potential to improve reliability, lessen training requirements, and expand the number of vision screening volunteers in community settings.
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Affiliation(s)
- Elyssa Rosenthal
- Department of Ophthalmology, Phoenix Children’s, Phoenix, AZ, USA
| | - James O’Neil
- Department of Ophthalmology, Phoenix Children’s, Phoenix, AZ, USA
| | - Briggs Hoyt
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Howard
- Cleveland Clinic Neurology Residency Program, Cleveland Clinic, Cleveland, OH, USA
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Queguiner F, Bezirganyan K, Courjaret JC, Curel L, Penaranda G, Bonomini J, Righini Chossegros M. Reliability of self-measurement of visual acuity in AMD patients with two electronic devices based on the ETDRS chart: A randomized study. J Fr Ophtalmol 2024; 47:103911. [PMID: 37648551 DOI: 10.1016/j.jfo.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) requires continuous visual acuity (VA) monitoring, increasing the burden on the health care system. Self-measurement VA tests are available on various devices. However, none of them have been based on an internationally validated benchmark chart, such as that of the Early Treatment Diabetic Retinopathy Study (ETDRS). The goal of this study was to assess the reliability of two digitized ETDRS charts adapted to two electronic devices for self-measurement of VA. MATERIAL AND METHODS A prospective, single-center, 1:1 randomized, two-arm, parallel group trial was conducted. The main objective was to compare VA variation as conventionally measured on a 4-m ETDRS chart versus self-measured with digitized ETDRS charts in patients treated for AMD. At each visit, conventional measurement and patient self-measurement, either on a computer at 80-cm (arm 1) or on a tablet at 40-cm (arm 2), were performed. RESULTS Eighty patients were included (25 men, 55 women, mean age 81.3±7.4 years). No significant differences were observed between VA variation, conventionally measured and self-measured on a computer (arm 1; P=0.914) or tablet (arm 2; P=0.913). CONCLUSION These results confirm the reliability of these two methods for self-measurement of VA, and will lead to the development of a wider "telemedicine" project extended to self-measurement of VA in various pathologies.
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Affiliation(s)
- F Queguiner
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France.
| | - K Bezirganyan
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - J C Courjaret
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
| | - L Curel
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - G Penaranda
- Biostatistics department, AlphaBio Laboratory, 13003 Marseille, France
| | - J Bonomini
- Clinical Research department, Saint Joseph Hospital, 13008 Marseille, France
| | - M Righini Chossegros
- Ophthalmology and Clinical Research departments, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France
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Labiris G, Panagiotopoulou EK, Delibasis K, Duzha E, Bakirtzis M, Panagis C, Boboridis K, Mokka A, Balidis M, Damtsi C, Ntonti P. Validation of a web-based distance visual acuity test. J Cataract Refract Surg 2023; 49:666-671. [PMID: 36853857 DOI: 10.1097/j.jcrs.0000000000001176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To validate the Democritus Digital Acuity and Reading Test (DDART) as a distance VA (dVA) test against a series of prevalent conventional distance vision charts. SETTING Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece; Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece; and Ophthalmica Institute of Ophthalmology & Microsurgery, Thessaloniki, Greece. DESIGN Prospective multicenter validation study. METHODS The distance best spectacle-corrected visual acuity (dBSCVA) was compared in normal (NVG) and low (LVG) vision participants against 4 prevalent conventional distance vision charts (ETDRS, Snellen, Landolt C, and Tumbling E) by a predefined 2.5-symbol noninferiority margin and intraclass correlation coefficients (ICCs). DDART's test-retest (TRT) reliability was assessed with ICCs. RESULTS 534 participants (471 and 63 with normal and low vision, respectively) were included in the study. The mean difference between dBSCVA measured with DDART and conventional charts ranged between -0.84 and +0.85 symbols, without exceeding the 2.5-symbol noninferiority margin. ICCs indicated an excellent level of agreement for all patient groups (from 0.848 to 0.985). TRT reliability indicated differences below 1 symbol both for the NVG and LVG, with ICCs ranging between 0.912 and 0.964 for the 4 DDARTs. CONCLUSIONS DDART was a valid web-based dVA test that provided reliable measurements in clinical and telemedical settings, both for normal and low vision patients.
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Affiliation(s)
- Georgios Labiris
- From the Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece (Labiris, Panagiotopoulou, Bakirtzis, Panagis, Damtsi, Ntonti); Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece (Delibasis, Duzha); Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece (Boboridis, Mokka); Ophthalmica Institute of Ophthalmology & Microsurgery, Thessaloniki, Greece (Balidis, Damtsi)
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Karampatakis V, Almaliotis D, Talimtzi P, Almpanidou S. Design and Validation of a Novel Smartphone-Based Visual Acuity Test: The K-VA Test. Ophthalmol Ther 2023; 12:1657-1670. [PMID: 36961662 PMCID: PMC10037403 DOI: 10.1007/s40123-023-00697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Visual acuity (VA) testing is a critical screening examination for the assessment of visual function. This study describes the development and validation of a smartphone-based VA test: the K-VA test. METHODS A total of 171 patients with various ocular diseases were examined in our outpatient unit at Aristotle University of Thessaloniki, School of Medicine in Greece. Participants underwent VA examination using the standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the K-VA smartphone-based test. The K-VA test was performed by participants themselves. The Bland-Altman method was employed to assess the agreement between the ETDRS charts and the new test for the examination of VA at 1 m and 40 cm. Test-retest reliability was also calculated. A questionnaire regarding the participants' feedback on the K-VA test was completed. RESULTS No significant bias was observed between the gold standard ETDRS charts and the K-VA test measurements. The mean difference (95% limits of agreement, LoA) between the K-VA test at 1 m and the ETDRS chart at 4 m was -0.006 (95% LoA -0.129 to 0.117) logarithm of the minimal angle of resolution (logMAR). The agreement of the K-VA test at 40 cm with the near ETDRS chart was also high with a mean difference of -0.007 (95% LoA -0.105 to 0.090) logMAR. Test-retest reliability was found to be high with a mean difference of 0.003 (95% LoA -0.045 to 0.033) logMAR and 0.005 (95% LoA -0.065 to 0.076) logMAR for the K-VA test at 1 m and 40 cm, respectively. A total of 97 participants answered the questionnaire and 71 (73.2%) stated that the test was easy to very easy to use for self-performance. CONCLUSIONS The study demonstrated that the K-VA application performed well compared with the ETDRS charts and provides reliable and repeatable measurements of VA across a wide range of VA.
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Affiliation(s)
- Vasileios Karampatakis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diamantis Almaliotis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Persefoni Talimtzi
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Almpanidou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Samanta A, Mauntana S, Barsi Z, Yarlagadda B, Nelson PC. Is your vision blurry? A systematic review of home-based visual acuity for telemedicine. J Telemed Telecare 2023; 29:81-90. [PMID: 33222600 DOI: 10.1177/1357633x20970398] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Visual acuity (VA) testing is a vital screening tool for the assessment of ocular function. The coronavirus 2019 pandemic has caused an immediate need for synchronous telemedicine in all specialties, including ophthalmology. While a plethora of mobile VA applications exist, there is no consensus as to what technology can accurately and reproducibly measure a patient's vision at home. METHODS A systematic literature search was performed in April 2020 using PubMed, Embase and Medline, identifying English publications from 2010 to 2020 on remote VA tests: 4338 articles were identified and 14 were ultimately included in the review. RESULTS Of those 14, the highest quality studies, best reproducibility and correlation with in-clinic acuities measured were found using the Peek Acuity application. The studies included patients throughout the world aged 3-97, with and without correction, with known ocular pathology.The Peek Acuity studies measured distance vision on a Samsung Galaxy S3 with a mean difference of 0.055 Logarithm of the Minimum Angle of Resolution (LogMAR) for home testing compared with the Early Treatment Diabetic Retinopathy Study (ETDRS). Test-retest variability was ±0.029 LogMAR for 95% confidence interval limits. DISCUSSION There can be one or more lines of variability in vision testing in a clinical setting using reference standard ETDRS and clinical standard Snellen charts. Test-retest reliability is not perfect even on standard clinical charts (variation up to 0.48 LogMAR). Of the technologies reviewed, Peek Acuity home testing had the greatest correlation with ETDRS clinical vision and high test-retest reliability. Peek Acuity performed no worse than Snellen and ETDRS charts.
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Affiliation(s)
- Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Shielah Mauntana
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Zahra Barsi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Bina Yarlagadda
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Patricia C Nelson
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Abdulhussein D, Abdul Hussein M, Szymanka M, Farag S. A systematic review of the current availability of mobile applications in eyecare practices. Eur J Ophthalmol 2022; 33:11206721221131397. [PMID: 36199266 PMCID: PMC9999269 DOI: 10.1177/11206721221131397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 09/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an increasing shift towards non-communicable eye diseases (NCEDs) because of a demographic transition. Incorporation of telemedicine into everyday clinical practice is becoming increasingly popular. We sought to carry out a systematic review to look at which applications on portable devices are available for use in eyecare practices for patients with NCEDs, specifically refractive error, diabetic retinopathy, age-related macular degeneration (AMD) and glaucoma. METHODS Pubmed, EMBASE, Medline, PsychInfo databases were systematically searched using keywords and MeSH terms. Eligible articles included peer-reviewed, original full text articles evaluating apps for use on portable devices aimed at patients with NCEDs. RESULTS The initial search yielded 100 studies. Nine studies met the inclusion criteria, and an additional eight studies were identified through reference screening. Of the included studies, 29.4%% (n = 5) evaluated applications aimed for use to identify refractive errors, 35.3% (n = 6) aimed at patients with glaucoma, 23.5% (n = 4) for use by patients with AMD, 11.7% (n = 2) for the non-specific monitoring of visual acuity/fields. 76.5% (n = 13) of the studies showed that the application evaluated was an effective and reliable tool compared to clinical standards. CONCLUSIONS Portable device applications in patients with NCED have been shown to be effective. The use of these apps for patients is limited to either diagnostic or monitoring use. There is scope for apps which encompass other aspects of patient care that have been used in other specialties that may be applied to ophthalmic patients, including those with an educational aim which have a role in increasing compliance.
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Affiliation(s)
- D Abdulhussein
- The Imperial College Ophthalmic Research Group, Imperial College London, London, UK
| | | | - M Szymanka
- Faculty of Medicine, Imperial College London, London, UK
| | - S Farag
- Faculty of Medicine, Imperial College London, London, UK
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Altınbay D, Şahlı E, İdil ŞA. Comparison of Reading Test Parameters from the Print and Tablet Application Forms of the Minnesota Low Vision Reading Test. Turk J Ophthalmol 2022; 52:186-192. [PMID: 35770299 PMCID: PMC9249109 DOI: 10.4274/tjo.galenos.2021.33581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Suptaweeponboon J, Bhornmata A, Tanprasertkul C, Makornwattana M. Comparison of near vision in glaucoma patients using standard and reversed-contrast charts. Clin Exp Optom 2022:1-7. [PMID: 35605620 DOI: 10.1080/08164622.2022.2071602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CLINICAL RELEVANCE Reversed-contrast testing is easy to perform via electronic devices and may improve reading performance and the quality of life of most glaucoma patients. BACKGROUND Electronic devices are becoming increasing popularity and most devices have easily adjustable contrast settings. This study investigated near vision acuity and preference between the standard visual acuity chart (black text on white background) and a reversed-contrast chart (white text on black background) in glaucoma patients with decreasing contrast sensitivity. METHODS This cross-sectional study evaluated 177 eyes of 177 patients from a single glaucoma clinic. The better eye of primary glaucoma patients (visual acuity of 6/20 or better) was evaluated. Patients with any other condition affecting visual acuity or reading performance were excluded. Near visual acuity was measured using a device with an anti-glare screen at 40 cm distance for both standard and reversed-contrast charts. RESULTS Glaucoma patients had a significantly better average near visual acuity using the reversed-contrast chart than using the standard chart (median best-corrected visual acuity, LogMAR = 0.12; interquartile range = 0.18 vs median best-corrected visual acuity, LogMAR = 0.2; interquartile range = 0.26; respectively; P < 0.01), with more prominent differences in the advanced glaucoma group (median best-corrected visual acuity of reversed contrast chart: median best-corrected visual acuity of standard chart = 0.12:0.2, 0.12:0.13, and 0.18:0.22 in the early, moderate, and severe groups, respectively, P < 0.01 in early and severe group and P = 0.02 in moderate group). One hundred and nine (109) out of 177 patients (61.58%) preferred the reversed contrast version. CONCLUSION Reversed contrast materials may improve the reading performance and quality of life of patients with glaucoma, especially those with severe disease.
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Affiliation(s)
| | - Anant Bhornmata
- Department of Ophthalmology, Thammasat University Klong Luang, Pathum Thani, Thailand
| | - Chamnan Tanprasertkul
- Research unit Department of Obstetrics and Gynecology, Thammasat University Klong Luang, Pathum Thani, Thailand
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12
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Stoll N, Di Foggia E, Speeg-Schatz C, Meunier H, Rimele A, Ancé P, Moreau PH, Sauer A. Development and validation of a new method for visual acuity assesment on tablet in pediatric population: eMOVA test. BMC Ophthalmol 2022; 22:180. [PMID: 35439959 PMCID: PMC9020062 DOI: 10.1186/s12886-022-02360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amblyopia is a major public health concern. Its screening and management require reliable methods of visual acuity assessment. New technologies offer nowadays many tests available on different app stores for smartphone or tablet but most of them often lack of scientific validation for a medical use. The aim of our study was to attempt validating a tablet-based near visual acuity test adapted to the pediatric population: the eMOVA test (electronic Measurement Of Visual Acuity) by comparing visual acuity measured with more conventional test. METHODS A cohort of 100 children aged 3 to 8 attending the ophthalmic-pediatric for eye examination between September 2016 and June 2017 were included in the study. Near visual acuity was assessed on participants using both the eMOVA test and a Standard test (Rossano-Weiss test). Duration of each test, its comprehension, its acceptability and the attention of the child during the test was also investigated. RESULTS The eMOVA test overestimated near visual acuity by 0.06 logMAR. This difference, statistically significant, was not clinically relevant. The duration of the eMOVA test was longer than the reference test, but less discomfort and preferred by children and their parents compared to standard tests. CONCLUSION The eMOVA test appears as a reliable test to assess near visual acuity in children. By its portability and efficiency, this application proved to be a relevant tool to be used for children eye examination in daily routine at the hospital.
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Affiliation(s)
- Noémie Stoll
- Three borders ophthalmologic center, 76 rue de Battenheim, 68170, Rixheim, France.
| | - Elsa Di Foggia
- Colmar Civil Hospitals, 39 avenue de la Liberté, 68000, Colmar, France
| | - Claude Speeg-Schatz
- University professor, University hospitals of Strasbourg, 1 quai Louis Pasteur, 67000, Strasbourg, France
| | - Hélène Meunier
- Cognitive and Adaptative Neuroscience Laboratory, Strasbourg University, 67000, Strasbourg, Alsace, France
| | - Adam Rimele
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Pascal Ancé
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Pierre-Henri Moreau
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Arnaud Sauer
- University professor, University hospitals of Strasbourg, 1 quai Louis Pasteur, 67000, Strasbourg, France
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Vasudevan B, Baker J, Miller C, Feis A. Analysis of the Reliability and Repeatability of Distance Visual Acuity Measurement with EyeSpy 20/20. Clin Ophthalmol 2022; 16:1099-1108. [PMID: 35422608 PMCID: PMC9005137 DOI: 10.2147/opth.s352164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Visual acuity is a critical component of visual function assessment for all ages. Standardized vision testing protocols may help prevent testing inconsistencies resulting from variations in test administration and interpretation of different examiners. However, most vision assessments outside of research settings, including in doctor’s offices, rarely employ standardized protocols. Validated protocols such as the Early Treatment for Diabetic Retinopathy Study (ETDRS) are frequently employed by vision researchers to ensure accurate and repeatable visual acuity measurements. Methods This study evaluates a desktop-based standardized vision testing algorithm (EyeSpy 20/20) specifically designed for use on mobile electronic platforms. Subjects were tested on a desktop version of the EyeSpy software for both the accuracy and duration of measurement of visual acuity and compared to a e-ETDRS chart in a randomized sequence. Children were recruited for this study and tested between two different visual acuity measurement systems. Bland–Altman analysis and correlation tests were done. Results Hundred and ten children were recruited for the study. The EyeSpy 20/20 visual acuity testing algorithm as tested with the desktop version was non-inferior to the gold standard e-ETDRS testing algorithm on a desktop platform, but statistically faster to implement when administered on the same electronic testing platform. Conclusion EyeSpy 20/20 is a promising tool for vision screening and visual acuity evaluation in children.
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Affiliation(s)
- Balamurali Vasudevan
- Arizona College of Optometry, Midwestern University, Glendale, AZ, USA
- Correspondence: Balamurali Vasudevan, Tel +623-572-3905, Email
| | - Joshua Baker
- Arizona College of Optometry, Midwestern University, Glendale, AZ, USA
| | - Caitlin Miller
- Arizona College of Optometry, Midwestern University, Glendale, AZ, USA
| | - Alicia Feis
- Arizona College of Optometry, Midwestern University, Glendale, AZ, USA
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Suo L, Ke X, Zhang D, Qin X, Chen X, Hong Y, Dai W, Wu D, Zhang C, Zhang D. Use of Mobile Apps for Visual Acuity Assessment: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e26275. [PMID: 35156935 PMCID: PMC8887635 DOI: 10.2196/26275] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/20/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background Vision impairments (VIs) and blindness are major global public health issues. A visual acuity (VA) test is one of the most crucial standard psychophysical tests of visual function and has been widely used in a broad range of health care domains, especially in many clinical settings. In recent years, there has been increasing research on mobile app–based VA assessment designed to allow people to test their VA at any time and any location. Objective The goal of the review was to assess the accuracy and reliability of using mobile VA measurement apps. Methods We searched PubMed, Embase, Cochrane Library, and Google Scholar for relevant articles on mobile apps for VA assessment published between January 1, 2008, and July 1, 2020. Two researchers independently inspected and selected relevant studies. Eventually, we included 22 studies that assessed tablet or smartphone apps for VA measurement. We then analyzed sensitivity, specificity, and accuracy in the 6 papers we found through a meta-analysis. Results Most of the 22 selected studies can be considered of high quality based on the Quality Assessment of Diagnostic Accuracy Studies–2. In a meta-analysis of 6 studies involving 24,284 participants, we categorized the studies based on the age groups of the study participants (ie, aged 3-5 years, aged 6-22 years, and aged 55 years and older), examiner (ie, professional and nonprofessional examiners), and the type of mobile devices (ie, smartphone, iPad). In the group aged 3 to 5 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.87 (95% CI 0.79-0.93; P=.39), and the pooled specificity was 0.78 (95% CI 0.70-0.85; P=.37). In the group aged 6 to 22 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (95% CI 0.84-0.87; P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (95% CI 0.90-0.91; P=.27). In the group aged 55 years and older, the pooled sensitivity for VA app tests versus clinical VA tests was 0.85 (95% CI 0.55-0.98), and the pooled specificity for VA app tests versus clinical VA tests was 0.98 (95% CI 0.95-0.99). We found that the nonprofessional examiner group (AUC 0.93) had higher accuracy than the professional examiner group (AUC 0.87). In the iPad-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86, and the pooled specificity was 0.79. In the smartphone-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (P<.001). Conclusions In this study, we conducted a comprehensive review of the research on existing mobile apps for VA tests to investigate their diagnostic value and limitations. Evidence gained from this study suggests that mobile app–based VA tests can be useful for on-demand VI detection.
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Affiliation(s)
- Lingge Suo
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xianghan Ke
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Di Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xuejiao Qin
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Xuhao Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Ying Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Wanwei Dai
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Defu Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Dongsong Zhang
- Department of Business Information Systems and Operations Management, University of North Carolina at Charlotte, Charlotte, NC, United States
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Mena-Guevara KJ, Piñero DP, de Fez D. Validation of Digital Applications for Evaluation of Visual Parameters: A Narrative Review. Vision (Basel) 2021; 5:vision5040058. [PMID: 34842847 PMCID: PMC8628957 DOI: 10.3390/vision5040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
The current review aimed to collect and critically analyze the scientific peer-reviewed literature that is available about the use of digital applications for evaluation of visual parameters in electronic devices (tablets and smartphones), confirming if there are studies calibrating and validating each of these applications. Three bibliographic search engines (using the search equation described in the paper) and the Mendeley reference manager search engine were used to complete the analysis. Only articles written in English and that are evaluating the use of tests in healthy patients to measure or characterize any visual function aspects using tablets or smartphones were included. Articles using electronic visual tests to assess the results of surgical procedures or are conducted in pathological conditions were excluded. A total of 19 articles meeting these inclusion and exclusion criteria were finally analyzed. One critical point of all these studies is that there was no mention of the characterization (spatial and/or colorimetrical) of screens and the stimuli used in most of them. Only two studies described some level of calibration of the digital device before the beginning of the study. Most revised articles described non-controlled comparatives studies (73.7%), reporting some level of scientific evidence on the validation of tools, although more consistent studies are needed.
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Affiliation(s)
- Kevin J. Mena-Guevara
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; (K.J.M.-G.); (D.d.F.)
- Department of Pathology, University Miguel Hernández, Sant Joan d’Alacant, 03550 Alicante, Spain
| | - David P. Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; (K.J.M.-G.); (D.d.F.)
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain
- Correspondence: ; Tel.: +34-965903500
| | - Dolores de Fez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; (K.J.M.-G.); (D.d.F.)
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16
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Chen TA, Li J, Schallhorn JM, Sun CQ. Comparing a Home Vision Self-Assessment Test to Office-Based Snellen Visual Acuity. Clin Ophthalmol 2021; 15:3205-3211. [PMID: 34349497 PMCID: PMC8326937 DOI: 10.2147/opth.s309727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
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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Affiliation(s)
- Tiffany A Chen
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan Li
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Julie M Schallhorn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- F.I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Catherine Q Sun
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- F.I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
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Varadaraj V, Assi L, Gajwani P, Wahl M, David J, Swenor BK, Ehrlich JR. Evaluation of Tablet-Based Tests of Visual Acuity and Contrast Sensitivity in Older Adults. Ophthalmic Epidemiol 2020; 28:293-300. [PMID: 33185485 DOI: 10.1080/09286586.2020.1846758] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Purpose: Recent innovations in mobile technology for the measurement of vision present a valuable opportunity to measure visual function in non-clinical settings, such as in the home and in field-based surveys. This study evaluated agreement between a tablet-based measurement of distance and near acuity and contrast sensitivity as compared to gold-standard clinical tests.Methods: Participants aged ≥55 years recruited from a tertiary eye clinic underwent testing with three tablet-based and corresponding gold-standard clinical measures (ETDRS distance acuity, Pelli-Robson contrast sensitivity, and MNRead near acuity). Correlation and agreement between tablet-based and clinical tests were assessed.Results: A total of 82 participants with a mean age of 69.1 (SD = 7.6) years, and majority female (67.1%) and white (64.6%), were enrolled in this study. The mean (SD) difference between the tests (gold-standard - tablet) was -0.04 (0.08) logMAR for distance acuity, -0.11 (0.13) log units for contrast sensitivity, and -0.09 (0.12) logMAR for near acuity. 95% limits of agreement for distance acuity (-0.21, 0.12 logMAR), near acuity (-0.34, 0.14 logMAR), and contrast sensitivity (-0.36, 0.14 logCS) were also determined. The correlation between tablet-based and gold-standard tests was strongest for distance acuity (r = 0.78), followed by contrast sensitivity (r = 0.75), and near acuity (r = 0.67). The agreement between the standard and tablet-based methods did not appear to be dependent on the level of vision.Conclusions: This study demonstrates the agreement of tablet-based and gold-standard tests of visual function in older adults. These findings have important implications for future population vision health surveillance and research.
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Affiliation(s)
- Varshini Varadaraj
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Lama Assi
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Prateek Gajwani
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Madison Wahl
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Jenina David
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Bonnielin K Swenor
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, Center for Eye Policy and Innovation University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Abstract
Psychophysical tests are commonly carried out using software applications running on desktop or laptop computers, but running the software on mobile handheld devices such as smartphones or tablets could have advantages in some situations. Here, we present StimuliApp, an open-source application in which the user can create psychophysical tests on the iPad and the iPhone by means of a system of menus. A wide number of templates for creating stimuli are available including patches, gradients, gratings, checkerboards, random-dots, texts, tones or auditory noise. Images, videos and audios stored in files could also be presented. The application was developed natively for iPadOS and iOS using the low-level interface Metal for accessing the graphics processing unit, which results in high timing performance.
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Hazari H, Curtis R, Eden K, Hopman WM, Irrcher I, Bona MD. Validation of the visual acuity iPad app Eye Chart Pro compared to the standard Early Treatment Diabetic Retinopathy Study chart in a low-vision population. J Telemed Telecare 2020; 28:680-686. [PMID: 32985378 DOI: 10.1177/1357633x20960640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A low-vision assessment (LVA) is central to developing a vision rehabilitation plan. However, access to LVAs is often limited by the quantity and geographic distribution of low-vision providers, as well as patient-centred transportation challenges. A tablet-based LVA tool kit, delivered virtually, has the potential to overcome many of these barriers. The purpose of this research was to validate a key component of the tablet-based tool kit - a commercially available iPad visual acuity (VA) test (Eye Chart Pro) iPad app - in a low-vision population. METHODS Participants with low vision (n = 26) and those who were normally sighted (n = 25) underwent VA testing with both the iPad VA test application and the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The VA data were compared using a t-test, linear regression and Bland-Altman analysis. RESULTS There was no significant difference in the mean absolute difference in VA (log of minimum angle of resolution (logMAR)=0.11; p = 0.82). Eye Chart Pro and Standard ETDRS Chart measures were also not significantly different (p = 0.98). However, there were significant differences between test methods in the low-vision group and the normally sighted group (p > 0.0001 and p = 0.007, respectively). The Bland-Altman analysis showed a mean bias (difference) of -0.0005 logMAR between methods, and 95% limits of agreement of 0.298 and -0.299 logMAR. DISCUSSION The ETDRS chart function on the Eye Chart Pro application can reliably measure VA across a range, from normally sighted patients to those with low vision.
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Affiliation(s)
- Hassan Hazari
- Department of Ophthalmology, Queen's University and Hotel Dieu Hospital, Canada
| | - Rachel Curtis
- Department of Ophthalmology, Queen's University and Hotel Dieu Hospital, Canada
| | - Karen Eden
- Department of Ophthalmology, Queen's University and Hotel Dieu Hospital, Canada
| | - Wilma M Hopman
- Kingston Health Sciences Centre- Kingston General Hospital Research Institute, Canada
| | - Isabella Irrcher
- Department of Ophthalmology, Queen's University and Hotel Dieu Hospital, Canada
| | - Mark D Bona
- Department of Ophthalmology, Queen's University and Hotel Dieu Hospital, Canada
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Di Foggia E, Stoll N, Meunier H, Rimelé A, Ance P, Moreau PH, Speeg-Schatz C, Sauer A. A new visual acuity test on touchpad for vision screening in children. Int J Ophthalmol 2020; 13:1436-1442. [PMID: 32953584 DOI: 10.18240/ijo.2020.09.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To validate a visual acuity (VA) test application on touchpad in the screening of pediatric population by comparing VA results obtained with conventional tests. METHODS A cohort of 101 patients, 44 girls and 57 boys with a median of 6.5 years old (3-10 years of age), presenting for eye examinations in Ophthalmology Department (Strasbourg, France) between November 1st, 2018, and February 1st, 2019 were enrolled. Monocular and binocular VA testing was performed on the subject using both a standard test and the touchpad application (Monoyer, "E" or, Pigassou depending of children's capacities). Patients were excluded if they were physically or mentally unable to use the touchpad. The duration of each tests, the painfulness, the comprehension, the attention of children during the test and test's preferences were also evaluated. RESULTS There was a good linear correlation and intra-class correlation coefficient [ICC=0.50 (0.34, 0.64) for binocular acuity, 0.74 (0.64, 0.82) for right eyes and 0.525 (0.37, 0.66) for left eye]. The standard errors of measurement were very low (0.08, 0.05, 0.08 for binocular VA, right eyes VA and left eyes VA, respectively). There was no difference between two tests for right eye (P=0.126), left eye (P=0.098) and binocular acuity (P=0.085). Non inferiority was proved for all binocular [-0.06 (-0.09, -0.03)], right eye [-0.04 (-0.07, -0.01)] and left eye [-0.06 (-0.09, -0.02)] VA. The sensitivity and specificity, which correspond to the ability for our app to detect amblyopia, were 92% and 80% respectively. CONCLUSION Our touchpad application represents an efficient and valid test of VA in children with a high specificity to detect visual impairment.
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Affiliation(s)
- Elsa Di Foggia
- Ophthalmology Department, CHU Strasbourg, Strasbourg, Alsace 67091, France
| | - Noémie Stoll
- Ophthalmology Department, CH Colmar, Colmar, Alsace 68024, France
| | - Hélène Meunier
- Cognitive and Adaptative Neuroscience Laboratory, Strasbourg, Alsace 67000, France
| | - Adam Rimelé
- Plateforme SILABE, Strasbourg University, Alsace 67207, France
| | - Pascal Ance
- Plateforme SILABE, Strasbourg University, Alsace 67207, France
| | | | | | - Arnaud Sauer
- Ophthalmology Department, CHU Strasbourg, Strasbourg, Alsace 67091, France
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21
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A critical review: Psychophysical assessments of diabetic retinopathy. Surv Ophthalmol 2020; 66:213-230. [PMID: 32866468 DOI: 10.1016/j.survophthal.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
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Abstract
Supplemental Digital Content is Available in the Text.
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23
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Comparison of Perimetric Outcomes from Melbourne Rapid Fields Tablet Perimeter Software and Humphrey Field Analyzer in Glaucoma Patients. J Ophthalmol 2020; 2020:8384509. [PMID: 32908686 PMCID: PMC7463344 DOI: 10.1155/2020/8384509] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare visual field results obtained using Melbourne Rapid Fields (MRF) iPad-based perimeter software and Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm (SITA) standard program in glaucoma patients. Design A cross-sectional observational study. Methods In this single-centre study involving patients diagnosed with glaucoma, the perimetric outcomes of MRF were compared against those returned from the HFA 24-2 SITA standard. Outcomes included mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI)/visual capacity (VC), foveal threshold, test time, number of points depressed at P < 5% on PSD probability plot, and glaucoma hemifield test/color coded indicator. Results The study included 28 eyes of 28 glaucoma patients. Mean (standard deviation) test times were 342.07 (56.70) seconds for MRF and 375.11 (88.95) for HFA 24-2 SITA standard (P=0.046). Mean MD was significantly lower for MRF (Δ = 3.09, P < 0.001), and mean PSD was significantly higher for MRF (Δ = 1.40, P=0.005) compared with HFA. The mean foveal threshold for the MRF was significantly lower than the mean HFA foveal threshold ((Δ = 9.25, P < 0.001). The number of points depressed at P < 5% on the PSD probability plot was significantly less for MRF (P < 0.001). Other perimetric outcomes showed no significant differences between both. Bland–Altman plots showed that considerable variability existed between the programs. Conclusion MRF is a good cost-effective, time-saving, user-friendly tool for monitoring visual fields in settings where access to traditional perimetry is limited. The lack of Internet strength in rural areas and questionable detection of early cases may be two points in MRF fields requiring an upgrade.
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Rono H, Bastawrous A, Macleod D, Bunywera C, Mamboleo R, Wanjala E, Burton M. Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study. JMIR Mhealth Uhealth 2020; 8:e16345. [PMID: 32558656 PMCID: PMC7334755 DOI: 10.2196/16345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/17/2019] [Accepted: 12/15/2019] [Indexed: 01/18/2023] Open
Abstract
Background The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs’ referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). Conclusions Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context.
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Affiliation(s)
- Hillary Rono
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Kitale County and Referral Hospital, Kitale, Kenya
| | - Andrew Bastawrous
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Peek Vision Foundation, London, United Kingdom
| | - David Macleod
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cosmas Bunywera
- Kitale County and Referral Hospital, Kitale, Kenya.,Peek Vision Foundation, London, United Kingdom
| | | | | | - Matthew Burton
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital NHS Trust, London, United Kingdom
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Ansell K, Maconachie G, Bjerre A. Does the EyeChart App for iPhones Give Comparable Measurements to Traditional Visual Acuity Charts? Br Ir Orthopt J 2020; 16:19-24. [PMID: 32999989 PMCID: PMC7510399 DOI: 10.22599/bioj.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim To investigate if the EyeChart app gives accurate visual acuity (VA) measurements that are comparable to those achieved using traditional VA charts. Method Twenty-four participants (aged 18-27 years, mean 20.13 ± 1.78 years) with VA of 6/60 Snellen or better regardless of any strabismus, amblyopia, or ocular pathology volunteered for this prospective study. The best-corrected monocular VA of each participant's right eye was measured on the Snellen chart at 6 m, the ETDRS chart at 3 m, and the EyeChart app presented on an iPhone SE at 1.2 m (4ft). Results The mean VA scores obtained were: -0.13 ± 0.08 logMAR on the Snellen chart, -0.11 ± 0.08 logMAR on the ETDRS chart, and -0.09 ± 0.07 logMAR on the EyeChart app. After Bonferroni Correction adjustments were applied, a significant difference was found between the EyeChart app and the Snellen chart (t = -3.756, p = 0.003), however the difference between the EyeChart app and the ETDRS chart did not reach statistical significance (t = -2.391, p = 0.076). The EyeChart app had a strong correlation with both the Snellen (r = 0.79, p < 0.01) and ETDRS charts (r = 0.88, p < 0.01). The Coefficients of Agreement revealed a variation of less than one logMAR line between the EyeChart app and the traditional VA charts (Snellen: 0.09 logMAR; ETDRS: 0.08 logMAR). Conclusion This study found that the EyeChart app gives accurate VA scores that are comparable to those achieved using the gold-standard ETDRS chart in a healthy young adult population. However, the accuracy and repeatability of the EyeChart app when testing a patient population must be investigated before it can be integrated into clinical practice.
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Jones PR, Tigchelaar I, Demaria G, Wilson I, Bi W, Taylor DJ, Crabb DP. Refinement and preliminary evaluation of two tablet-based tests of real-world visual function. Ophthalmic Physiol Opt 2019; 40:35-46. [PMID: 31879994 PMCID: PMC7028122 DOI: 10.1111/opo.12658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/09/2019] [Indexed: 01/07/2023]
Abstract
Purpose To describe, refine, evaluate, and provide normative control data for two freely available tablet‐based tests of real‐world visual function, using a cohort of young, normally‐sighted adults. Methods Fifty young (18–40 years), normally‐sighted adults completed tablet‐based assessments of (1) face discrimination and (2) visual search. Each test was performed twice, to assess test‐retest repeatability. Post‐hoc analyses were performed to determine the number of trials required to obtain stable estimates of performance. Distributions were fitted to the normative data to determine the 99% population‐boundary for normally sighted observers. Participants were also asked to rate their comprehension of each test. Results Both tests provided stable estimates in around 20 trials (~1–4 min), with only a further reduction of 14%–17% in the 95% Coefficient of Repeatability (CoR95) when an additional 40 trials were included. When using only ~20 trials: median durations for the first run of each test were 191 s (Faces) and 51 s (Search); test‐retest CoR95 were 0.27 d (Faces) and 0.84 s (Search); and normative 99% population‐limits were 3.50 d (Faces) and 3.1 s (Search). No participants exhibited any difficulties completing either test (100% completion rate), and ratings of task‐understanding were high (Faces: 9.6 out of 10; Search: 9.7 out of 10). Conclusions This preliminary assessment indicated that both tablet‐based tests are able to provide simple, quick, and easy‐to‐administer measures of real‐world visual function in normally‐sighted young adults. Further work is required to assess their accuracy and utility in older people and individuals with visual impairment. Potential applications are discussed, including their use in clinic waiting rooms, and as an objective complement to Patient Reported Outcome Measures (PROMs).
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Iris Tigchelaar
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Ocusweep, Turku, Finland.,Doctoral Program in Clinical Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Giorgia Demaria
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, the Netherlands
| | - Iain Wilson
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Wei Bi
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Pang Y, Sparschu L, Nylin E. Validation of an automated-ETDRS near and intermediate visual acuity measurement. Clin Exp Optom 2019; 103:663-667. [PMID: 31822041 DOI: 10.1111/cxo.13018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/20/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the repeatability of an automated-ETDRS (Early Treatment Diabetic Retinopathy Study) near and intermediate visual acuity measurement in subjects with normal visual acuity and subjects with reduced visual acuity. The agreement of automated-ETDRS with gold standard chart-based visual acuity measurement was also studied. METHODS Fifty-one subjects were tested (aged 23 to 91 years; 33 subjects with normal visual acuity: 6/7.5 or better; 18 subjects with reduced visual acuity: 6/9 to 6/30). Near and intermediate visual acuity of one eye from each subject was measured with an automated tablet-computer system (M&S Technologies, Inc.) and Precision Vision paper chart in a random sequence. Subjects were retested one week later. Repeatability was evaluated using the 95 per cent limits of agreement (LoA) between the two visits. RESULTS Average difference between automated-ETDRS near visual acuity and near visual acuity by paper chart was 0.02 ± 0.10 logMAR (p > 0.05). Agreement of near visual acuity between automated-ETDRS and paper chart was good, with 95 per cent LoA of ±0.19 logMAR. Furthermore, automated-ETDRS near visual acuity showed good repeatability (95 per cent LoA of ±0.20). Mean difference between automated-ETDRS intermediate visual acuity and intermediate visual acuity by paper chart was 0.02 ± 0.10 logMAR (p > 0.05). Agreement of intermediate visual acuity between automated-ETDRS and paper chart was good, with 95 per cent LoA of ±0.20 logMAR. In addition, automated-ETDRS intermediate visual acuity had good repeatability (95 per cent LoA of ±0.16). CONCLUSION Automated-ETDRS near and intermediate visual acuity measurement showed good repeatability and agreement with the gold standard chart-based visual acuity measurement. The findings of this study indicate the automated visual acuity measurement system may have potential for use in both patient care and clinical trials.
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Affiliation(s)
- Yi Pang
- Department of Dean's Education, Illinois College of Optometry, Chicago, Illinois, USA
| | - Lauren Sparschu
- Department of Dean's Education, Illinois College of Optometry, Chicago, Illinois, USA
| | - Elyse Nylin
- Department of Dean's Education, Illinois College of Optometry, Chicago, Illinois, USA
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Łabuz G, Auffarth GU, Özen A, van den Berg TJ, Yildirim TM, Son HS, Khoramnia R. The Effect of a Spectral Filter on Visual Quality in Patients with an Extended-Depth-Of-Focus Intraocular Lens. Am J Ophthalmol 2019; 208:56-63. [PMID: 31323200 DOI: 10.1016/j.ajo.2019.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/05/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Wavelength dependence of diffractive intraocular lenses (IOLs) was recognized in vitro but not yet assessed in vivo. By examining pseudophakic patients who had extended-depth-of-focus diffractive implants, this spectral effect on their vision was measured clinically and the lens was tested in vitro. DESIGN Cross-sectional study with laboratory investigation. METHODS Twelve pseudophakic patients (23 eyes) with a Symfony lens (Johnson & Johnson Vision) were measured monocularly under red and white light at far, intermediate, and near distances. Corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance corrected near visual acuity (DCNVA) were assessed. Contrast sensitivity was examined at several spatial frequencies. The in vitro lens modulation transfer function was measured under different spectral conditions by using an IOL metrology device. RESULTS CDVA was comparable under red and white light. DCIVA and DCNVA were significantly better under white light by 0.06 and 0.09, respectively. Contrast sensitivity was slightly better with a red filter at far distance but was worse at intermediate distance, although differences were significant only at 1 frequency. Near contrast sensitivity was better under polychromatic than red light, which was significant at 3 frequencies. The in vitro analysis confirmed Symfony's wavelength dependence: performance was improved at far distance but was worse at intermediate and near distances. CONCLUSIONS Symfony's spectral dependence was observed to affect visual acuity and contrast sensitivity. Although the red filter did not improve distance vision, it caused visual deterioration at near distance. One should take this effect into account when optimizing the reading performance of patients with diffractive IOLs.
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Han X, Scheetz J, Keel S, Liao C, Liu C, Jiang Y, Müller A, Meng W, He M. Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home). Transl Vis Sci Technol 2019; 8:27. [PMID: 31440424 PMCID: PMC6701871 DOI: 10.1167/tvst.8.4.27] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home). Methods Three study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. V@home VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability. Results The mean difference between V@home and ETDRS distance VA across all groups ranged from -0.010 to -0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of V@home with near ETDRS VA across all groups, with a mean difference of -0.092 to -0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: -0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: -0.289 to 0.258 for distance and -0.235 to 0.199 for near). The majority of participants were satisfied with V@home. Conclusions V@home could accurately and reliably measure both distance and near VA and is well accepted by participants. Translational Relevance The V@home system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.
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Affiliation(s)
- Xiaotong Han
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jane Scheetz
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chimei Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Andreas Müller
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Wei Meng
- Guangzhou Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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Rono H, Bastawrous A, Macleod D, Wanjala E, Gichuhi S, Burton M. Peek Community Eye Health - mHealth system to increase access and efficiency of eye health services in Trans Nzoia County, Kenya: study protocol for a cluster randomised controlled trial. Trials 2019; 20:502. [PMID: 31412937 PMCID: PMC6694474 DOI: 10.1186/s13063-019-3615-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/26/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. STUDY DESIGN A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit. DISCUSSION We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. TRIAL REGISTRATION The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018.
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Affiliation(s)
- Hillary Rono
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Kitale County referral and teaching Hospital, Ravine Road, P.O. Box 98, Kitale, 30200 Kenya
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- The Peek Vision Foundation, 1 Fore Street, London, EC2Y 9DT UK
| | - David Macleod
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emmanuel Wanjala
- Kitale County referral and teaching Hospital, Ravine Road, P.O. Box 98, Kitale, 30200 Kenya
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Jones PR, Smith ND, Bi W, Crabb DP. Portable Perimetry Using Eye-Tracking on a Tablet Computer-A Feasibility Assessment. Transl Vis Sci Technol 2019; 8:17. [PMID: 30740267 PMCID: PMC6364754 DOI: 10.1167/tvst.8.1.17] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/22/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose Visual field (VF) examination by standard automated perimetry (SAP) is an important method of clinical assessment. However, the complexity of the test, and its use of bulky, expensive equipment makes it impractical for case-finding. We propose and evaluate a new approach to paracentral VF assessment that combines an inexpensive eye-tracker with a portable tablet computer (“Eyecatcher”). Methods Twenty-four eyes from 12 glaucoma patients, and 12 eyes from six age-similar controls were examined. Participants were tested monocularly (once per eye), with both the novel Eyecatcher test and traditional SAP (HFA SITA standard 24-2). For Eyecatcher, the participant's task was to simply to look at a sequence of fixed-luminance dots, presented relative to the current point of fixation. Start and end fixations were used to determine locations where stimuli were seen/unseen, and to build a continuous map of sensitivity loss across a VF of approximately 20°. Results Eyecatcher was able to clearly separate patients from controls, and the results were consistent with those from traditional SAP. In particular, mean Eyecatcher scores were strongly correlated with mean deviation scores (r2 = 0.64, P < 0.001), and there was good concordance between corresponding VF locations (∼84%). Participants reported that Eyecatcher was more enjoyable, easier to perform, and less tiring than SAP (all P < 0.001). Conclusions Portable perimetry using an inexpensive eye-tracker and a tablet computer is feasible, although possible means of improvement are suggested. Translational Relevance Such a test could have significant utility as a case finding device.
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Nicholas D Smith
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Wei Bi
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Charlesworth JM, Davidson MA. Undermining a common language: smartphone applications for eye emergencies. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:21-40. [PMID: 30697086 PMCID: PMC6339640 DOI: 10.2147/mder.s186529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Emergency room physicians are frequently called upon to assess eye injuries and vision problems in the absence of specialized ophthalmologic equipment. Technological applications that can be used on mobile devices are only now becoming available. Objective To review the literature on the evidence of clinical effectiveness of smartphone applications for visual acuity assessment marketed by two providers (Google Play and iTunes). Methods The websites of two mobile technology vendors (iTunes and Google Play) in Canada and Ireland were searched on three separate occasions using the terms “eye”, “ocular”, “ophthalmology”, “optometry”, “vision”, and “visual assessment” to determine what applications were currently available. Four medical databases (Cochrane, Embase, PubMed, Medline) were subsequently searched with the same terms AND mobile OR smart phone for papers in English published in years 2010–2017. Results A total of 5,024 Canadian and 2,571 Irish applications were initially identified. After screening, 44 were retained. Twelve relevant articles were identified from the health literature. After screening, only one validation study referred to one of our identified applications, and this one only partially validated the application as being useful for clinical purposes. Conclusion Mobile device applications in their current state are not suitable for emergency room ophthalmologic assessment, because systematic validation is lacking.
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Affiliation(s)
- Jennifer M Charlesworth
- School of Medicine, National University of Ireland, Galway, Ireland, .,AM Charlesworth & Associates Science and Technology Consultants, Ottawa, ON, Canada,
| | - Myriam A Davidson
- AM Charlesworth & Associates Science and Technology Consultants, Ottawa, ON, Canada,
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Hamm LM, Anstice NS, Black JM, Dakin SC. Recognition acuity in children measured using The Auckland Optotypes. Ophthalmic Physiol Opt 2018; 38:596-608. [PMID: 30575072 DOI: 10.1111/opo.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Sloan letters displayed by the Electronic Visual Acuity (EVA) system are the gold standard for recognition acuity measurement in research settings. However, letters are not always appropriate for children. The Auckland Optotypes (TAO) are a new, open-access set of 10 pictograms available in regular and vanishing formats. We sought to assess feasibility of using both formats of TAO for measuring visual acuity (VA) in children using a Bayesian adaptive staircase, in a community setting. METHODS We tested 121 children (5-12 years old) with both formats of TAO, a handheld flipchart vision screener (Parr vision test), as well as the gold standard EVA. We measured feasibility of the three comparison tests in three ways. First, using limits of agreement (LoA) with EVA, second, calculating area under the receiver operating characteristic curve (AUC), and finally, investigating trial-by-trial responses. RESULTS Agreement between tests was within test-retest reliability of EVA measures (LoATAO regular = ±0.14, LoATAO vanishing = ±0.15, LoAP arr = ±0.16 logMAR). TAO tests were highly effective at identifying children with vision impairment (AUCTAO regular = 0.96, AUCTAO vanishing = 0.95), whereas Parr was less effective (AUCP arr = 0.82). In 5-6 year old children there was an enhanced advantage of TAO (AUCTAO regular = 0.97, AUCTAO vanishing = 0.98) over Parr (AUCP arr = 0.75). Although each child completed 16 trials, approximately 10 trials were sufficient to achieve excellent LoA, and six trials sufficient for accurate screening. CONCLUSION Threshold VA assessment and vision screening are feasible using both vanishing and regular formats of TAO.
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Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand.,School of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand
| | - Steven C Dakin
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand.,UCL Institute of Ophthalmology, University College London, London, UK
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de Fez D, Luque MJ, Matea L, Piñero DP, Camps VJ. New iPAD-based test for the detection of color vision deficiencies. Graefes Arch Clin Exp Ophthalmol 2018; 256:2349-2360. [PMID: 30291435 DOI: 10.1007/s00417-018-4154-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To develop and validate a new iPad-based color vision test (Optopad). METHODS A total of 341 student eyes were enrolled in a first comparative study between Optopad and the Isihara tests. In a second comparative study, Optopad vs. the Farnworth-Munsell test (FM 100H), a total of 66 adult eyes were included. Besides the agreement between tests, the correlation between FM 100H and Optopad outcomes were investigated. Multiple regression analysis was used to predict the total error score (TES) from contrast thresholds measured with the Optopad test. RESULTS The Ishihara and Optopad tests detected the same anomalous patients. Concerning FM 100H vs. Optopad, 10 subjects were diagnosed as anomalous with both tests, 3 mild anomalous cases based on TES were classified as normal with Optopad, and 2 anomalous subjects based on Optopad test showed normal TES values. Statistically significant correlations of TES and partial error red-green (PTESRG) with thresholds measured with the red-green Optopad stimuli were found. A multiple quadratic regression model was obtained relating TES and chromatic contrast values from Optopad (R2 = 0.855), with only 13 cases showing residuals of ≥ 25 units. CONCLUSIONS The design and implementation of a chromatic contrast discrimination test has been carried out, with promising clinical results. This test seems to provide comparable outcomes to those obtained with Ishihara and FM 100H tests.
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Affiliation(s)
- Dolores de Fez
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain.
| | | | - Lucía Matea
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain.,Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - Vicente J Camps
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Rono HK, Bastawrous A, Macleod D, Wanjala E, Di Tanna GL, Weiss HA, Burton MJ. Smartphone-based screening for visual impairment in Kenyan school children: a cluster randomised controlled trial. Lancet Glob Health 2018; 6:e924-e932. [PMID: 30012273 PMCID: PMC6057135 DOI: 10.1016/s2214-109x(18)30244-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Childhood visual impairment is a major public health concern that requires effective screening and early intervention. We investigated the effectiveness of Peek school eye health, a smartphone-based sight test and referral system (comprising Peek Acuity test, sight simulation referral cards, and short message service [SMS] reminders), versus standard care (Snellen's Tumbling-E card and written referral). METHODS We initially compared the performance of both the Snellen Tumbling-E card and the Peek Acuity test to a standard backlit EDTRS LogMAR visual acuity test chart. We did a cluster randomised controlled trial to compare the Peek school eye health system with standard school screening care, delivered by school teachers. Schools in Trans Nzoia County, Kenya, were eligible if they did not have an active screening programme already in place. Schools were randomly allocated (1:1) to either the Peek school eye health screening and referral programmes (Peek group) or the standard care screening and referral programme (standard group). In both groups, teachers tested vision of children in years 1-8. Pupils with visual impairment (defined as vision less than 6/12 in either eye) were referred to hospital for treatment. Referred children from the standard group received a written hospital referral letter. Participants and their teachers in the Peek group were shown their simulated sight on a smartphone and given a printout of this simulation with the same hospital details as the standard referral letter to present to their parent or guardian. They also received regular SMS reminders to attend the hospital. The primary outcome was the proportion of referred children who reported to hospital within 8 weeks of referral. Primary analysis was by intention to treat, with the intervention effect estimated using odds ratios. This trial is registered with Pan African Clinical Trial Registry, number PACTR201503001049236. FINDINGS Sensitivity was similar for the Peek test and the standard test (77% [95% CI 64·8-86·5] vs 75% [63·1-85·2]). Specificity was lower for the Peek test than the standard test (91% [95% CI 89·3-92·1] vs 97·4% [96·6-98·1]). Trial recruitment occurred between March 2, 2015, and March 13, 2015. Of the 295 eligible public primary schools in Trans Nzoia County, 50 schools were randomly selected and assigned to either the Peek group (n=25) or the standard group (n=25). 10 579 children were assessed for visual impairment in the Peek group and 10 284 children in the standard group. Visual impairment was identified in 531 (5%) of 10 579 children in the Peek group and 366 (4%) of 10 284 children in the standard care group. The proportion of pupils identified as having visual impairment who attended their hospital referral was significantly higher in the Peek group (285 [54%] of 531) than in the standard group (82 [22%] of 366; odds ratio 7·35 [95% CI 3·49-15·47]; p<0·0001). INTERPRETATION The Peek school eye health system increased adherence to hospital referral for visual impairment assessment compared with the standard approach among school children. This indicates the potential of this technology package to improve uptake of services and provide real-time visibility of health service delivery to help target resources. FUNDING Seeing is Believing, Operation Eyesight Universal, Queen Elizabeth Diamond Jubilee Trust, and Wellcome Trust.
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Affiliation(s)
- Hillary K Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Kitale County and Referral Hospital, Kitale, Kenya.
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; The Peek Vision Foundation, London, UK
| | - David Macleod
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Gian Luca Di Tanna
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Cornea and External Eye Department, Moorfields Eye Hospital NHS Trust, London, UK
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Dorr M, Elze T, Wang H, Lu ZL, Bex PJ, Lesmes LA. New Precision Metrics for Contrast Sensitivity Testing. IEEE J Biomed Health Inform 2018; 22:919-925. [PMID: 28650831 PMCID: PMC6706861 DOI: 10.1109/jbhi.2017.2708745] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Visual sensitivity is comprehensively described by the contrast sensitivity function (CSF), but current routine clinical care does not include its assessment because of the time-consuming need to estimate thresholds for a large number of spatial frequencies. The quick CSF method, however, dramatically reduces testing times by using a Bayesian information maximization rule. We evaluate the test-retest variability of a tablet-based quick CSF implementation in a study with 100 subjects who repeatedly assessed their vision with and without optical correction. We first discuss two commonly used measures of repeatability, intraclass correlation and the Bland-Altman Coefficient of Repeatability, and show that they are vulnerable to artifacts. Instead, we propose to formulate precision as an information retrieval task: from all repeat test scores, can we retrieve a certain individual based on their first test score? We then use rank-based analyses such as mean average precision as a better measure to compare different test metrics, and show that the highest test-retest precision is achieved using a summary statistic, the area under the log CSF (AULCSF). This demonstrates the benefit of assessment of the whole CSF compared to sensitivity at individual spatial frequencies only. AULCSF also yields best discrimination performance (99.2%) between measurements that were taken with and without glasses, respectively, even better than CSF Acuity. The tablet-based quick CSF thus enables the rapid and reliable home monitoring of visual function, which has the potential to improve early diagnosis and treatment of ophthalmic pathologies such as diabetic retinopathy or age-related macular degeneration.
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Cohen M. Connected health and multiple sclerosis. Rev Neurol (Paris) 2018; 174:480-485. [PMID: 29680178 DOI: 10.1016/j.neurol.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 01/08/2023]
Abstract
There is as yet no consensual definition of "connected health". In general, the term refers to the growing use of technology and, in particular, mobile technology in medicine. Over the past 10 years, there have been an increasing number of published reports on the wide-ranging and heterogeneous fields involving the application of technology in medicine, ranging from telemedicine to tools to improve patients' evaluation and monitoring by physicians, as well as a multitude of patient-centered applications. They also represent promising tools in the field of clinical research. This report is a review of the importance of using this technology in the management of multiple sclerosis patients.
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Affiliation(s)
- M Cohen
- Service de neurologie, hôpital Pasteur 2, université Côte d'Azur, centre hospitalier universitaire de Nice, 30, voie Romaine, 06000 Nice, France.
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Boven LC, Jiang QL, Moss HE. Validation of Simplified Visual Acuity Testing Protocols in Amyotrophic Lateral Sclerosis. Neuroophthalmology 2018; 41:247-252. [PMID: 29339958 DOI: 10.1080/01658107.2017.1305422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 12/12/2022] Open
Abstract
High- and low-contrast visual acuity (HCVA, LCVA) are potential quantitative markers of neurological dysfunction in amyotrophic lateral sclerosis (ALS). The complex nature and duration of gold standard (GS) protocols precludes widespread use in neurology settings. This study compares simplified to GS visual acuity (VA) protocols. Monocular HCVA and LCVA were measured in ALS (n = 10) and control (n = 4) subjects using six protocols, varying by two chart and three refraction methods. Intraclass correlation coefficients between simplified and GS protocols ranged from 0.83 to 0.98 (HCVA, excellent agreement) and 0.56 to 0.75 (LCVA, moderate agreement). Differences between LCVA and GS protocols exceeded test-retest reliability. Simplified HCVA protocols using LCD (liquid crystal display) tablet charts and/or pinhole correction produced valid measurements. None of the modified LCVA testing protocols produced valid measurements.
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Affiliation(s)
- Lindsay C Boven
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Qin Li Jiang
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Heather E Moss
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Calabrèse A, To L, He Y, Berkholtz E, Rafian P, Legge GE. Comparing performance on the MNREAD iPad application with the MNREAD acuity chart. J Vis 2018; 18:8. [PMID: 29351351 PMCID: PMC5774869 DOI: 10.1167/18.1.8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/31/2017] [Indexed: 01/14/2023] Open
Abstract
Our purpose was to compare reading performance measured with the MNREAD Acuity Chart and an iPad application (app) version of the same test for both normally sighted and low-vision participants. Our methods included 165 participants with normal vision and 43 participants with low vision tested on the standard printed MNREAD and on the iPad app version of the test. Maximum Reading Speed, Critical Print Size, Reading Acuity, and Reading Accessibility Index were compared using linear mixed-effects models to identify any potential differences in test performance between the printed chart and the iPad app. Our results showed the following: For normal vision, chart and iPad yield similar estimates of Critical Print Size and Reading Acuity. The iPad provides significantly slower estimates of Maximum Reading Speed than the chart, with a greater difference for faster readers. The difference was on average 3% at 100 words per minute (wpm), 6% at 150 wpm, 9% at 200 wpm, and 12% at 250 wpm. For low vision, Maximum Reading Speed, Reading Accessibility Index, and Critical Print Size are equivalent on the iPad and chart. Only the Reading Acuity is significantly smaller (I. E., better) when measured on the digital version of the test, but by only 0.03 logMAR (p = 0.013). Our conclusions were that, overall, MNREAD parameters measured with the printed chart and the iPad app are very similar. The difference found in Maximum Reading Speed for the normally sighted participants can be explained by differences in the method for timing the reading trials.
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Affiliation(s)
| | - Long To
- Minnesota Laboratory for Low-Vision Research, Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Yingchen He
- Minnesota Laboratory for Low-Vision Research, Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth Berkholtz
- Minnesota Laboratory for Low-Vision Research, Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Paymon Rafian
- Minnesota Laboratory for Low-Vision Research, Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Gordon E Legge
- Minnesota Laboratory for Low-Vision Research, Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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El-Khoury S, Hannen T, Dragnea DC, Ngounou F, Preußner PR. Pattern noise (PANO): a new automated functional glaucoma test. Int Ophthalmol 2017; 38:1993-2003. [PMID: 28815393 DOI: 10.1007/s10792-017-0690-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To present a newly developed visual field device (pattern noise: PANO) designed to be sensitive to glaucoma defects, cost-effective, material-practical and easy to repair and therefore particularly suited for low-income countries, where glaucoma can be highly prevalent (e.g. sub-Saharan Africa). METHODS This is primarily a descriptive paper, but it also includes a prospective matched case-control pilot study. Hardware, stimulus, target configuration, testing strategy and result sheet are described. The main outcome measure is the contrast level (range 2-64). Targets are composed of bright/dark pixels flickering with 18 Hz and have a size of 5°. Pixel size is approximated to the hill of vision. Average luminance of targets is constant and equals background luminance.The study was performed in the West Region in Cameroon. Twenty eyes of 20 newly presenting patients with glaucomatous optic disc cupping on funduscopy were compared with 20 eyes of 20 normal patients matched in age and laterality of eye. RESULTS Mean age was 32.9 ± 18.8 years for glaucoma patients and 32.2 ± 15.6 years for healthy subjects. Mean contrast threshold was significantly higher in eyes with abnormal disc (16.2 ± 14.3 vs. 4.4 ± 0.8, P = 0.002). Correlation of mean contrast thresholds and cup-to-disc ratio was significant (r = 0.59; P = 0.006). Average examination time was significantly longer for glaucoma eyes compared to healthy eyes (8.2 vs. 6.1 min, P < 0.001), whereas error rate did not differ (4.8 ± 2.5% vs. 4.1 ± 1.8%, P = 0.33). CONCLUSION PANO demonstrated visual field defects in patients with glaucomatous optic disc. Defects correlated significantly with glaucomatous optic nerve head morphological alterations. Healthy eyes obtained normal results. More studies are needed to establish PANO.
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Affiliation(s)
- Sylvain El-Khoury
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Thomas Hannen
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Diana Carmen Dragnea
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | | | - Paul-Rolf Preußner
- Department of Ophthalmology, University Medical Centre Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Parsons TD, McMahan T, Kane R. Practice parameters facilitating adoption of advanced technologies for enhancing neuropsychological assessment paradigms. Clin Neuropsychol 2017; 32:16-41. [DOI: 10.1080/13854046.2017.1337932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Thomas D. Parsons
- Department of Psychology, University of North Texas, Denton, TX, USA
- Computational Neuropsychology and Simulation Laboratory, University of North Texas, Denton, TX, USA
| | - Timothy McMahan
- Computational Neuropsychology and Simulation Laboratory, University of North Texas, Denton, TX, USA
| | - Robert Kane
- Cognitive Consults and Technology LLC, Washington, DC, USA
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Kong YXG, He M, Crowston JG, Vingrys AJ. A Comparison of Perimetric Results from a Tablet Perimeter and Humphrey Field Analyzer in Glaucoma Patients. Transl Vis Sci Technol 2016; 5:2. [PMID: 27847689 PMCID: PMC5106194 DOI: 10.1167/tvst.5.6.2] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/11/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the correlation between the perimetric outcomes from perimetry software Melbourne Rapid Fields (MRF) run on an Apple iPad tablet and those from the Humphrey Field Analyzer (HFA). Methods The MRF software was designed with features including variable fixation and fast thresholding using Bayes logic. Here, we report a cross-sectional study on 90 eyes from 90 participants: 12 had normal optic nerves and 78 had glaucoma with various degrees of visual field loss (41 mild and 37 moderate-severe). Exclusion criteria were patients with worse than 20/40 vision or recent intraocular surgery. The visual field outcomes of MRF were compared against those returned from the HFA 24-2 SITA standard. Participants were tested twice on the MRF to establish test–retest repeatability. Results The test durations were shorter on MRF than HFA (5.7 ± 0.1 vs. 6.3 ± 0.1 minutes, P < 0.001). MRF showed a high level of concordance in its outcomes with HFA (intraclass coefficient [ICC] = 0.93 for mean defect [MD] and 0.86 for pattern deviation [PD]) although the MRF tended to give a less negative MD (1.4 dB bias) compared with the HFA. MRF also showed levels of test–retest reliability comparable to HFA (ICC = 0.93 for MD and 0.89 for PD, 95% limits of agreement −4.5 to 4.3 dB). Conclusion The perimetry results from the MRF have a strong correlation to the HFA outcomes. MRF also has test–retest reliability comparable to HFA. Translational Relevance Portable tablet perimetry may allow accurate assessment of visual field when standard perimetry machines are unavailable or unsuitable.
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Affiliation(s)
- Yu Xiang George Kong
- Centre of Eye Research Australia, Department of Ophthalmology, The University of Melbourne, East Melbourne, Australia ; Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Mingguang He
- Centre of Eye Research Australia, Department of Ophthalmology, The University of Melbourne, East Melbourne, Australia
| | - Jonathan G Crowston
- Centre of Eye Research Australia, Department of Ophthalmology, The University of Melbourne, East Melbourne, Australia ; Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, The Melbourne School of Health, The University of Melbourne, Parkville, Australia
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Aslam TM, Tahir HJ, Parry NR, Murray IJ, Kwak K, Heyes R, Salleh MM, Czanner G, Ashworth J. Automated Measurement of Visual Acuity in Pediatric Ophthalmic Patients Using Principles of Game Design and Tablet Computers. Am J Ophthalmol 2016; 170:223-227. [PMID: 27544479 DOI: 10.1016/j.ajo.2016.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To report on the utility of a computer tablet-based method for automated testing of visual acuity in children based on the principles of game design. We describe the testing procedure and present repeatability as well as agreement of the score with accepted visual acuity measures. DESIGN Reliability and validity study. METHODS Setting: Manchester Royal Eye Hospital Pediatric Ophthalmology Outpatients Department. PATIENT POPULATION Total of 112 sequentially recruited patients. INTERVENTION For each patient 1 eye was tested with the Mobile Assessment of Vision by intERactIve Computer for Children (MAVERIC-C) system, consisting of a software application running on a computer tablet, housed in a bespoke viewing chamber. The application elicited touch screen responses using a game design to encourage compliance and automatically acquire visual acuity scores of participating patients. Acuity was then assessed by an examiner with a standard chart-based near ETDRS acuity test before the MAVERIC-C assessment was repeated. MAIN OUTCOME MEASURE Reliability of MAVERIC-C near visual acuity score and agreement of MAVERIC-C score with near ETDRS chart for visual acuity. RESULTS Altogether, 106 children (95%) completed the MAVERIC-C system without assistance. The vision scores demonstrated satisfactory reliability, with test-retest VA scores having a mean difference of 0.001 (SD ±0.136) and limits of agreement of 2 SD (LOA) of ±0.267. Comparison with the near EDTRS chart showed agreement with a mean difference of -0.0879 (±0.106) with LOA of ±0.208. CONCLUSIONS This study demonstrates promising utility for software using a game design to enable automated testing of acuity in children with ophthalmic disease in an objective and accurate manner.
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Livingstone IAT, Tarbert CM, Giardini ME, Bastawrous A, Middleton D, Hamilton R. Photometric Compliance of Tablet Screens and Retro-Illuminated Acuity Charts As Visual Acuity Measurement Devices. PLoS One 2016; 11:e0150676. [PMID: 27002333 PMCID: PMC4803292 DOI: 10.1371/journal.pone.0150676] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/16/2016] [Indexed: 11/19/2022] Open
Abstract
Mobile technology is increasingly used to measure visual acuity. Standards for chart-based acuity tests specify photometric requirements for luminance, optotype contrast and luminance uniformity. Manufacturers provide some photometric data but little is known about tablet performance for visual acuity testing. This study photometrically characterised seven tablet computers (iPad, Apple inc.) and three ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity charts with room lights on and off, and compared findings with visual acuity measurement standards. Tablet screen luminance and contrast were measured using nine points across a black and white checkerboard test screen at five arbitrary brightness levels. ETDRS optotypes and adjacent white background luminance and contrast were measured. All seven tablets (room lights off) exceeded the most stringent requirement for mean luminance (≥ 120 cd/m2) providing the nominal brightness setting was above 50%. All exceeded contrast requirement (Weber ≥ 90%) regardless of brightness setting, and five were marginally below the required luminance uniformity threshold (Lmin/Lmax ≥ 80%). Re-assessing three tablets with room lights on made little difference to mean luminance or contrast, and improved luminance uniformity to exceed the threshold. The three EDTRS charts (room lights off) had adequate mean luminance (≥ 120 cd/m2) and Weber contrast (≥ 90%), but all three charts failed to meet the luminance uniformity standard (Lmin/Lmax ≥ 80%). Two charts were operating beyond manufacturer's recommended lamp replacement schedule. With room lights on, chart mean luminance and Weber contrast increased, but two charts still had inadequate luminance uniformity. Tablet computers showed less inter-device variability, higher contrast, and better luminance uniformity than charts in both lights-on and lights-off environments, providing brightness setting was >50%. Overall, iPad tablets matched or marginally out-performed ETDRS charts in terms of photometric compliance with high contrast acuity standards.
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Affiliation(s)
- I. A. T. Livingstone
- Department of Ophthalmology & Glasgow Centre for Ophthalmic Research, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - C. M. Tarbert
- Department of Clinical Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - M. E. Giardini
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - A. Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - D. Middleton
- Department of Clinical Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - R. Hamilton
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Clinical Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
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Aslam TM, Parry NRA, Murray IJ, Salleh M, Col CD, Mirza N, Czanner G, Tahir HJ. Development and testing of an automated computer tablet-based method for self-testing of high and low contrast near visual acuity in ophthalmic patients. Graefes Arch Clin Exp Ophthalmol 2016; 254:891-9. [PMID: 26899899 DOI: 10.1007/s00417-016-3293-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Many eye diseases require on-going assessment for optimal management, creating an ever-increasing burden on patients and hospitals that could potentially be reduced through home vision monitoring. However, there is limited evidence for the utility of current applications and devices for this. To address this, we present a new automated, computer tablet-based method for self-testing near visual acuity (VA) for both high and low contrast targets. We report on its reliability and agreement with gold standard measures. METHODS The Mobile Assessment of Vision by intERactIve Computer (MAVERIC) system consists of a calibrated computer tablet housed in a bespoke viewing chamber. Purpose-built software automatically elicits touch-screen responses from subjects to measure their near VA for either low or high contrast acuity. Near high contrast acuity was measured using both the MAVERIC system and a near Landolt C chart in one eye for 81 patients and low contrast acuity using the MAVERIC system and a 25 % contrast near EDTRS chart in one eye of a separate 95 patients. The MAVERIC near acuity was also retested after 20 min to evaluate repeatability. RESULTS Repeatability of both high and low contrast MAVERIC acuity measures, and their agreement with the chart tests, was assessed using the Bland-Altman comparison method. One hundred and seventy-three patients (96 %) completed the self- testing MAVERIC system without formal assistance. The resulting MAVERIC vision demonstrated good repeatability and good agreement with the gold-standard near chart measures. CONCLUSIONS This study demonstrates the potential utility of the MAVERIC system for patients with ophthalmic disease to self-test their high and low contrast VA. The technique has a high degree of reliability and agreement with gold standard chart based measurements.
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Affiliation(s)
- Tariq M Aslam
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Vision Science Centre, Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University, Manchester, UK.,Heriot-Watt University, Edinburgh, UK
| | - Neil R A Parry
- Vision Science Centre, Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University, Manchester, UK.,Centre for Hearing and Vision Research, Institute of Human Development, University of Manchester, Manchester, UK
| | - Ian J Murray
- Vision Science Centre, Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University, Manchester, UK.,Faculty of Life Sciences, University of Manchester, Room 3.005, Carys Bannister Building, Dover Street, Manchester, M13 9PL, UK
| | - Mahani Salleh
- Centre for Hearing and Vision Research, Institute of Human Development, University of Manchester, Manchester, UK
| | - Caterina Dal Col
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Naznin Mirza
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Gabriela Czanner
- Department of Biostatistics, Faculty of Health and Life Sciences, Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Humza J Tahir
- Faculty of Life Sciences, University of Manchester, Room 3.005, Carys Bannister Building, Dover Street, Manchester, M13 9PL, UK.
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Abstract
PURPOSE Available applications for vision testing in mobile devices usually do not include detailed setup instructions, sacrificing rigor to obtain portability and ease of use. In particular, colorimetric characterization processes are generally obviated. We show that different mobile devices differ also in colorimetric profile and that those differences limit the range of applications for which they are most adequate. METHODS The color reproduction characteristics of four mobile devices, two smartphones (Samsung Galaxy S4, iPhone 4s) and two tablets (Samsung Galaxy Tab 3, iPad 4), have been evaluated using two procedures: 3D LUT (Look Up Table) and a linear model assuming primary constancy and independence of the channels. The color reproduction errors have been computed with the CIEDE2000 color difference formula. RESULTS There is good constancy of primaries but large deviations of additivity. The 3D LUT characterization yields smaller reproduction errors and dispersions for the Tab 3 and iPhone 4 devices, but for the iPad 4 and S4, both models are equally good. The smallest reproduction errors occur with both Apple devices, although the iPad 4 has the highest number of outliers of all devices with both colorimetric characterizations. CONCLUSIONS Even though there is good constancy of primaries, the large deviations of additivity exhibited by the devices and the larger reproduction errors make any characterization based on channel independence not recommendable. The smartphone screens show, in average, the best color reproduction performance, particularly the iPhone 4, and therefore, they are more adequate for applications requiring precise color reproduction.
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Livingstone IAT, Lok ASL, Tarbert C. New mobile technologies and visual acuity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2189-92. [PMID: 25570420 DOI: 10.1109/embc.2014.6944052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mobile devices have shown promise in visual assessment. Traditional acuity measurement involves retro-illuminated charts or card-based modalities. Mobile platforms bring potential to improve on both portability and objectivity. The present research activity relates to design and validation of a novel tablet-based infant acuity test. Early results in an adult cohort, with various levels of artificially degraded vision, suggest improved test-retest reliability compared with current standards for infant acuity. Future pragmatic trials will assess the value of this emerging technology in pediatric visual screening.
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Bastawrous A, Rono H, Livingstone IAT, Weiss HA, Jordan S, Kuper H, Burton M. Development and Validation of a Smartphone-Based Visual Acuity Test (Peek Acuity) for Clinical Practice and Community-Based Fieldwork. JAMA Ophthalmol 2015; 133:930-7. [PMID: 26022921 PMCID: PMC5321502 DOI: 10.1001/jamaophthalmol.2015.1468] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Visual acuity is the most frequently performed measure of visual function in clinical practice and most people worldwide living with visual impairment are living in low- and middle-income countries. OBJECTIVE To design and validate a smartphone-based visual acuity test that is not dependent on familiarity with symbols or letters commonly used in the English language. DESIGN, SETTING, AND PARTICIPANTS Validation study conducted from December 11, 2013, to March 4, 2014, comparing results from smartphone-based Peek Acuity to Snellen acuity (clinical normal) charts and the Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart (reference standard). This study was nested within the 6-year follow-up of the Nakuru Eye Disease Cohort in central Kenya and included 300 adults aged 55 years and older recruited consecutively. MAIN OUTCOMES AND MEASURES Outcome measures were monocular logMAR visual acuity scores for each test: ETDRS chart logMAR, Snellen acuity, and Peek Acuity. Peek Acuity was compared, in terms of test-retest variability and measurement time, with the Snellen acuity and ETDRS logMAR charts in participants' homes and temporary clinic settings in rural Kenya in 2013 and 2014. RESULTS The 95% CI limits for test-retest variability of smartphone acuity data were ±0.033 logMAR. The mean differences between the smartphone-based test and the ETDRS chart and the smartphone-based test and Snellen acuity data were 0.07 (95% CI, 0.05-0.09) and 0.08 (95% CI, 0.06-0.10) logMAR, respectively, indicating that smartphone-based test acuities agreed well with those of the ETDRS and Snellen charts. The agreement of Peek Acuity and the ETDRS chart was greater than the Snellen chart with the ETDRS chart (95% CI, 0.05-0.10; P = .08). The local Kenyan community health care workers readily accepted the Peek Acuity smartphone test; it required minimal training and took no longer than the Snellen test (77 seconds vs 82 seconds; 95% CI, 71-84 seconds vs 73-91 seconds, respectively; P = .13). CONCLUSIONS AND RELEVANCE The study demonstrated that the Peek Acuity smartphone test is capable of accurate and repeatable acuity measurements consistent with published data on the test-retest variability of acuities measured using 5-letter-per-line retroilluminated logMAR charts.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases. London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
| | - Hillary Rono
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases. London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
- Kitale and Zonal eye surgeon. North Rift Kenya
| | - Iain AT Livingstone
- Glasgow Centre for Ophthalmic Research, NHS Greater Glasgow & Clyde, Gartnavel General Hospital, Glasgow G12 0YN
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology & Population Health. London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
| | - Stewart Jordan
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases. London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
| | - Hannah Kuper
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases. London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
| | - Matthew Burton
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases. London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, EV1V 2PD, UK
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Wu Z, Guymer RH, Jung CJ, Goh JK, Ayton LN, Luu CD, Lawson DJ, Turpin A, McKendrick AM. Measurement of Retinal Sensitivity on Tablet Devices in Age-Related Macular Degeneration. Transl Vis Sci Technol 2015; 4:13. [PMID: 26175959 DOI: 10.1167/tvst.4.3.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/16/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We compared measurements of central retinal sensitivity on a portable, low-cost tablet device to the established method of microperimetry in age-related macular degeneration (AMD). METHODS A customized test designed to measure central retinal sensitivity (within the central 1° radius) on a tablet device was developed using an open-source platform called PsyPad. A total of 30 participants with AMD were included in this study, and all participants performed a practice test on PsyPad, followed by four tests of one eye and one test of the other eye. Participants then underwent standardized microperimetry examinations in both eyes. RESULTS The average test duration on PsyPad was 53.9 ± 7.5 seconds, and no significant learning effect was observed over the examinations performed (P = 1.000). The coefficient of repeatability of central retinal sensitivity between the first two examinations on PsyPad was ±1.76 dB. The mean central retinal sensitivity was not significantly different between PsyPad (25.7 ± 0.4 dB) and microperimetry (26.1 ± 0.4 dB, P = 0.094), and the 95% limits of agreement between the two measures were between -4.12 and 4.92 dB. CONCLUSIONS The measurements of central retinal sensitivity can be performed effectively using a tablet device, displaying reasonably good agreement with those obtained using the established method of microperimetry. TRANSLATIONAL RELEVANCE These findings highlight the potential of tablet devices as low-cost and portable tools for developing and performing visual function measures that can be easily and widely implemented.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chang J Jung
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jonathan K Goh
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chi D Luu
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - David J Lawson
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Andrew Turpin
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
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