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Purpose The purpose of this study was to evaluate the discrepancy between the near visual acuity (VA) measurements using the EyeHandBook smartphone application and the conventional method of using the near vision card. Methods Using similar environmental/ examinational conditions, near VA measurements were obtained and compared using the near vision card and the EyeHandBook app for IPhone 5 from 100 subjects. The obtained data were changed to LogMAR format and the relationship between the two techniques was analyzed by paired sample t-test and scatterplot. Results With a P-value ofo0.0001, our results indicate that the EyeHandBook application running on IPhone 5 overestimates the near VA compared with the conventional near vision card by an average of 0.11 LogMAR unless the measurement done by the near vision card was 20/20. Conclusions Owing to vast utilization of portable high-definition screens in VA measurements, eye-care providers have to be mindful of the potential disparity in VA measurement between different platforms, which in our study was likely secondary to the high contrast and brightness levels of the smartphone's high-definition screen when compared with the near vision card.

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Introduction There is limited information on adherence to topical testosterone replacement therapy (TRT) among hypogonadal men. Aim To determine adherence rates among men treated with topical testosterone gels and to examine factors that may influence adherence, including age, presence of a specific diagnosis, and index dose. Methods Included were 15,435 hypogonadal men, from the Thomson Reuters MarketScan® Database, who had an initial topical testosterone prescription in 2009 and who were followed for 12 months. Main Outcome Measures Adherence to testosterone was measured by medication possession ratio (MPR), with high adherence defined as ≥0.8. Persistence was defined as the duration of therapy from the index date to the earliest of the following events: end date of the last prescription, date of the first gap of >30 days between prescriptions, or end of the study period (12 months). Results Adherence to topical TRT was low. By 6 months, only 34.7% of patients had continued on medication; at 12 months, only 15.4%. Adherence rates were numerically similar among men who received AndroGel® or Testim® topical gels and did not differ among men of different age groups. Approximately 80% of patients initiated at the recommended dose of 50 mg/day. Over time, an increased proportion of men used a higher dose. This change was the result of dose escalation, rather than of greater adherence among men initiating therapy at a high dose. Dose escalation was seen as early as 1 month into therapy. Approximately 50% of men who discontinued treatment resumed therapy; most men used the same medication and dose. Conclusions Discontinuation rates are high among hypogonadal men treated with testosterone gels, irrespective of their age, diagnosis, and index dose. Further study, evaluating other measurable factors associated with low adherence among patients receiving topical TRT, may lead to interventions designed to improve adherence with therapy.