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Daich Varela M, Sanders Villa A, Pontikos N, Crossland MD, Michaelides M. Digital health and wearable devices for retinal disease monitoring. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06634-3. [PMID: 39297890 DOI: 10.1007/s00417-024-06634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/30/2024] [Accepted: 08/29/2024] [Indexed: 09/21/2024] Open
Abstract
Digital health is wielding a growing influence across all areas of healthcare, encompassing various facets such as telemedicine, artificial intelligence (AI), and electronic healthcare records. In Ophthalmology, digital health innovations can be broadly divided into four categories: (i) self-monitoring home devices and apps, (ii) virtual and augmented reality visual aids, (iii) AI software, and (iv) wearables. Wearable devices can work in the background, collecting large amounts of objective data while we do our day-to-day activities, which may be ecologically more valid and meaningful to patients than that acquired in traditional hospital settings. They can be a watch, wristband, piece of clothing, glasses, cane, smartphone in our pocket, earphones, or any other device with a sensor that we carry with us. Focusing on retinal diseases, a key challenge in developing novel therapeutics has been to prove a meaningful benefit in patients' lives and the creation of objective patient-centred endpoints in clinical trials. In this review, we will discuss wearable devices collecting different aspects of visual behaviour, visual field, central vision, and functional vision, as well as their potential implementation as outcome measures in research/clinical trial settings. The healthcare landscape is facing a paradigm shift. Clinicians have a key role of collaborating with the development and fine-tuning of digital health innovations, as well as identifying opportunities where they can be leveraged to enhance our understanding of retinal diseases and improve patient outcomes.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Alejandro Sanders Villa
- Facultad de Enfermería y Obstetricia, Universidad Nacional Autónoma de México, Mexico City, México
- Primero Salud, Mexico City, México
| | - Nikolas Pontikos
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Michael D Crossland
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Michel Michaelides
- Moorfields Eye Hospital, London, UK.
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK.
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Fitzpatrick NK, Chachay V, Capra S, Briskey D, Jackman S, Shore A, Bowtell J. Assessing electronic device use behaviours in healthy adults: development and evaluation of a novel tool. BMC Public Health 2024; 24:186. [PMID: 38225654 PMCID: PMC10790453 DOI: 10.1186/s12889-024-17637-4] [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: 09/28/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Chronic exposure of the macula to blue light from electronic devices has been identified as a potential macular health concern. The impacts remain poorly investigated as no validated methods to capture usual device use behaviours exist. PURPOSE The aim of this study was to develop and validate the Electronic Device Use Questionnaire (EDUQ) against multiple 24-h electronic device use diaries in healthy Australian and United Kingdom adults. METHODS The EDUQ and diaries were developed to capture device use across categories (television, computer and handheld devices). Over eight weeks 56 Australian and 24 United Kingdom participants completed three questionnaires and eight diaries via online platforms. Tool validity was determined through Bland-Altman plot analysis of mean daily hours of device use between the tools. RESULTS The EDUQ demonstrated poor validity in both cohorts with poor agreement when compared with the diaries. When the device categories were combined, a mean difference between the tools of 1.54 h/day, and 95% limits of agreement between -2.72 h/day and 5.80 h/day was observed in the Australian cohort. Across both cohorts and all device categories the mean differences indicated individuals were more likely to report higher device use through the questionnaire rather than diaries. CONCLUSIONS The EDUQ is a novel tool and demonstrated the difficulty for participants of accurately recalling usual behaviour of device use. Poor agreement in reported device use occurred across all device categories. The poor agreement may be related to factors such as memory recall bias, and the number of diaries captured not being reflective of usual use. Future studies should look to address these factors to improve validity of device use capture.
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Affiliation(s)
- Naomi K Fitzpatrick
- Sport and Health Sciences, University of Exeter, Exeter, UK.
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Veronique Chachay
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Sandra Capra
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - David Briskey
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Sarah Jackman
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Angela Shore
- NIHR Exeter Clinical Research Facility, University of Exeter, Exeter, UK
| | - Joanna Bowtell
- Sport and Health Sciences, University of Exeter, Exeter, UK
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Shneor E, Gordon-Shaag A, Doron R, Benoit JS, Ostrin LA. Utility of the Actiwatch Spectrum Plus for detecting the outdoor environment and physical activity in children. JOURNAL OF OPTOMETRY 2024; 17:100483. [PMID: 37797567 PMCID: PMC10551654 DOI: 10.1016/j.optom.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To describe the performance of the Actiwatch Spectrum Plus (Philips, Respironics) for determining real world indoor and outdoor environments and physical activity in children. METHODS Children wore the device while performing 10 different activities, ranging from sedentary to vigorous physical-activity, and under different indoor and outdoor conditions. Repeated measures ANOVA was implemented via mixed effects modeling to determine illuminance (lux) and physical activity (counts per 15 s, CP15) across conditions. Receiver operator characteristics (ROC) analysis assessed the accuracy to detect indoor versus outdoor settings. RESULTS Illuminance was found to be statistically different across indoor (793 ± 348 lux) and outdoor (4,413 ± 518 lux) conditions (P<.0001), with excellent diagnostic accuracy to detect indoor versus outdoor settings (Area under the ROC Curve, AUC 0.94); 1088 lux was identified as the optimal threshold for outdoor illuminance (sensitivity: 93.0%; specificity: 85.0%). Using published activity ranges, we found that when children were sitting, 94% of the physical-activity readings were classified as sedentary or light. When children were walking, 88% of readings were classified as light, and when children were running, 77% of readings were classified as moderate or vigorous. CONCLUSION The Actiwatch Spectrum Plus performed well during real world activities in children, showing excellent diagnostic accuracy at 1088 lux as a threshold to detect indoor versus outdoor environments and in categorizing physical activity.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel.
| | - Ariela Gordon-Shaag
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel
| | - Ravid Doron
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel
| | - Julia S Benoit
- College of Optometry, University of Houston, Houston, TX 77004, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX 77004, USA
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, TX 77004, USA
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Hönekopp A, Weigelt S. Using Light Meters to Investigate the Light-Myopia Association - A Literature Review of Devices and Research Methods. Clin Ophthalmol 2023; 17:2737-2760. [PMID: 37743889 PMCID: PMC10517690 DOI: 10.2147/opth.s420631] [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: 05/24/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
With the increasing prevalence of myopia, evaluating its relationship with objective light exposure as a potential adjustable environmental factor in myopia development has been an emerging research field in recent years. From a thorough literature search, we identify ten wearable light meters from human studies on light exposure and myopia and present an overview of their parameters, thereby demonstrating the wide between-device variability and discussing its implications. We further identify 20 publications, including two reanalyses, reporting investigations of light-myopia associations with data from human subjects wearing light meters. We thoroughly review the publications with respect to general characteristics, aspects of data collection, participant population, as well as data analysis and interpretation, and also assess potential patterns regarding the absence or presence of light-myopia associations in their results. In doing so, we highlight areas in which more research is needed as well as several aspects that warrant consideration in the study of light exposure and myopia.
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Affiliation(s)
- Astrid Hönekopp
- Department of Rehabilitation Sciences, Research Unit Vision, Visual Impairments & Blindness, TU Dortmund University, Dortmund, Germany
| | - Sarah Weigelt
- Department of Rehabilitation Sciences, Research Unit Vision, Visual Impairments & Blindness, TU Dortmund University, Dortmund, Germany
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Wagner P, Ho A, Kim J. Objective Quantification and Topographic Dioptric Demand of Near-Work. Transl Vis Sci Technol 2023; 12:28. [PMID: 36799872 PMCID: PMC9942781 DOI: 10.1167/tvst.12.2.28] [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] [Indexed: 02/18/2023] Open
Abstract
Purpose The assessment of myopigenic environmental risk factors such as near-work relies on subjective data. Although diaries and questionnaires on near-work show correlation to some degree, it remains unknown how they may correspond to ground truth. This is an important consideration because valid estimates of near-work have great utility for understanding the mechanisms by which dioptric demand drives excessive eye-growth, which is not yet entirely understood. To this end, we assessed a novel eye-tracking system to quantify near-work. Method We compared subjective entries from diaries to objective data on accommodative demand acquired with a three-dimensional eye-tracker in 20 participants. Each test involved approximately one-hour exposure to ecological near-work environments. Furthermore, topographical dioptric demand maps were computed in retinal coordinates. Results Our study suggests a frequent mismatch between objectively and subjectively labeled data of near-work tasks (concordance 74.6%). Objective and subjective estimates of dioptric demand showed a moderate correlation and were not significantly different (R2 = 0.59, P = .35). Instead, accommodative demand with an agreement between objective and subjective near-work labels showed a high correlation and were significantly different (R2 = 0.79, P = .016). The accumulated topographical dioptric demand of ecological near-work environments did not present myopigenic defocus stimuli to the retina periphery. Thus extreme close-up near-work presented peripheral defocus stimuli that have been proposed to curb excessive eye growth. Conclusions The proposed objective measurement method may provide improvements over subjective methods for estimating near-work parameters. Translational Relevance The topographic dioptric demand maps highlight a possible conflict of causal mechanisms of the two myopia models: "excessive near-work" and "peripheral optical defocus."
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Affiliation(s)
- Peter Wagner
- Brien Holden Vision Institute Limited, Sydney, NSW, Australia,School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Arthur Ho
- Brien Holden Vision Institute Limited, Sydney, NSW, Australia,School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Juno Kim
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
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Larouche R, Kleinfeld M, Charles Rodriguez U, Hatten C, Hecker V, Scott DR, Brown LM, Onyeso OK, Sadia F, Shimamura H. Determinants of Outdoor Time in Children and Youth: A Systematic Review of Longitudinal and Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1328. [PMID: 36674085 PMCID: PMC9859594 DOI: 10.3390/ijerph20021328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Spending more time outdoors can improve children's social and cognitive development, physical activity, and vision. Our systematic review summarized the determinants of outdoor time (OT) based on the social-ecological model. We searched nine databases: MEDLINE, APA PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORTDiscus, ERIC, SocINDEX, and ProQuest Dissertations and Theses. To be included, studies needed to be quantitative and longitudinal, include ≥1 potential determinant of OT among 0- to 17-year-olds, and be published in English, French, Japanese, or Spanish. We extracted the authors, publication year, country, design, sample size, OT measures, follow-up period, potential determinants, main results, and potential moderators or mediators. Fifty-five studies examining 119 potential determinants met the inclusion criteria. OT was consistently higher in warmer seasons and among participants reporting more OT at baseline. All three interventions that included both parent sessions and additional resources to promote OT (e.g., specific advice and community guides) were effective. COVID-19 restrictions and sun safety interventions discouraging midday outdoor activities led to less OT. The quality of evidence was rated as weak for 46 studies. Most potential determinants were examined in ≤3 studies; thus, more longitudinal studies are needed to enable stronger conclusions about the consistency of evidence and meta-analyses.
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Affiliation(s)
- Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Madeline Kleinfeld
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | | | - Cheryl Hatten
- School of Human Services, Lethbridge College, Lethbridge, AB T1K 1L6, Canada
| | - Victoria Hecker
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - David R. Scott
- Library, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Leanna Marie Brown
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Ogochukwu K. Onyeso
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Farzana Sadia
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Hanako Shimamura
- Faculty of Applied Community Studies, Douglas College, Coquitlam, BC V3B 7X3, Canada
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Balajadia E, Garcia S, Stampfli J, Schrader B, Guidolin C, Spitschan M. Usability and Acceptability of a Corneal-Plane α-Opic Light Logger in a 24-h Field Trial. Digit Biomark 2023; 7:139-149. [PMID: 37901367 PMCID: PMC10601946 DOI: 10.1159/000531404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/24/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Exposure to light fundamentally influences human physiology and behaviour by synchronising our biological clock to the external light-dark cycle and controlling melatonin production. In addition to well-controlled laboratory studies, more naturalistic approaches to examining these "non-visual" effects of light have been developed in recent years. As naturalistic light exposure is quite unlike well-controlled stimulus conditions in the laboratory, it is critical to measure light exposure in a person-referenced way, the "spectral diet." To this end, light loggers have been developed to capture personalised light exposure. As an alternative to light sensors integrated into wrist-worn actimeters, pendants, or brooch-based light loggers, a recently developed wearable light logger laterally attached to spectacle frames enables the measurement of biologically relevant quantities in the corneal plane. Methods Here, we examine the usability and acceptability of using the light logger in an undergraduate student sample (n = 18, mean±1SD: 20.1 ± 1.7 years; 9 female; Oxford, UK) in real-world conditions during a 24-h measurement period. We probed the acceptability of the light logger using rating questionnaires and open-ended questions. Results Our quantitative results show a modest acceptability of the light logger. A thematic analysis of the open-ended questions reveals that the form factor of the device, in particular, size, weight, and stability, and reactions from other people to the wearer of the light logger, were commonly mentioned aspects. Conclusion In sum, the results indicate the miniaturisation of light loggers and "invisible" integration into extant everyday objects as key areas for future technological development, facilitating the availability of light exposure data for developing personalised intervention strategies in both research, clinical and consumer contexts.
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Affiliation(s)
- Eljoh Balajadia
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sophie Garcia
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Janine Stampfli
- Lucerne School of Engineering and Architecture, Horw, Switzerland
| | - Björn Schrader
- Lucerne School of Engineering and Architecture, Horw, Switzerland
| | - Carolina Guidolin
- Max Planck Institute for Biological Cybernetics, Translational Sensory & Circadian Neuroscience, Tübingen, Germany
| | - Manuel Spitschan
- Max Planck Institute for Biological Cybernetics, Translational Sensory & Circadian Neuroscience, Tübingen, Germany
- TUM School of Medicine and Health, Chronobiology & Health, Technical University of Munich, Munich, Germany
- Technical University of Munich, TUM Institute for Advanced Study (TUM-IAS), Garching, Germany
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Spitschan M, Smolders K, Vandendriessche B, Bent B, Bakker JP, Rodriguez-Chavez IR, Vetter C. Verification, analytical validation and clinical validation (V3) of wearable dosimeters and light loggers. Digit Health 2022; 8:20552076221144858. [PMID: 36601285 PMCID: PMC9806438 DOI: 10.1177/20552076221144858] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/25/2022] [Indexed: 12/27/2022] Open
Abstract
Background Light exposure is an important driver and modulator of human physiology, behavior and overall health, including the biological clock, sleep-wake cycles, mood and alertness. Light can also be used as a directed intervention, e.g., in the form of light therapy in seasonal affective disorder (SAD), jetlag prevention and treatment, or to treat circadian disorders. Recently, a system of quantities and units related to the physiological effects of light was standardized by the International Commission on Illumination (CIE S 026/E:2018). At the same time, biometric monitoring technologies (BioMeTs) to capture personalized light exposure were developed. However, because there are currently no standard approaches to evaluate the digital dosimeters, the need to provide a firm framework for the characterization, calibration, and reporting for these digital sensors is urgent. Objective This article provides such a framework by applying the principles of verification, analytic validation and clinical validation (V3) as a state-of-the-art approach for tools and standards in digital medicine to light dosimetry. Results This article describes opportunities for the use of digital dosimeters for basic research, for monitoring light exposure, and for measuring adherence in both clinical and non-clinical populations to light-based interventions in clinical trials.
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Affiliation(s)
- Manuel Spitschan
- Translational Sensory & Circadian Neuroscience, Max Planck
Institute for Biological Cybernetics, Tübingen, Germany
- Chronobiology & Health, TUM Department of Sport and Health
Sciences (TUM SG), Technical University of
Munich, Munich, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of
Munich, Garching, Germany
| | - Karin Smolders
- Human-Technology Interaction Group, Eindhoven University of
Technology, Eindhoven, The Netherlands
| | - Benjamin Vandendriessche
- Byteflies, Antwerp, Belgium
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve
University, Cleveland, OH, USA
| | | | | | | | - Céline Vetter
- Department of Integrative Physiology, University of Colorado
Boulder, Boulder, CO, USA
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