INTRODUCTION:Low income countries bear 90% of the burden of avoidable blindness. In particular, glaucoma is one of the major causes of visual impairment. Early detection is critical to avoid irreversible blindness due to this underdiagnosed disease. Mobile and connected technologies yield potential to support early detection. However, to realize this potential, they should be designed from a deep understanding of the needs of the local population, and the challenges unique to lowincome countries. OBJECTIVES: To gain a contextualized understanding of eye health care needs, and the challenges and opportunities for designing mobile health solutions for screening of glaucoma. METHODS: We conducted a qualitative user study at three different healthcare centres in Southwest Ethiopia, including semi-structured interviews with eight eye care health professionals and observations and informal interviews with 125 patients, at three different locations. Interview transcripts were analysed through inductive thematic analysis involving three iterations.. RESULTS: Seven themes were initially identified after two iterations. The themes provided insight into the organization of eye health care and highlighted the challenges faced by eye care professionals and patients. An additional of three themes were identified in the third iteration which were formulated as paradoxes("Money is not an issue, yet there is no money for glaucoma", "Shortage of eye health care, yet the work is repeated over and over", "The willing but uncooperative patient tested by the willing but unexperienced nurse"). CONCLUSION: Findings from this research bear the potential to inspire future designs of mobile health solutions targeting rural communities in Ethiopia and other LICs.

Purpose The aim of this study is to compare the performance of Glaucoma Easy Screener (GES), as a low cost and portable visual field screening tool to the glaucoma screening test (GST) from Octopus. Methods GES is comprised of a Moto G5 smartphone, Homido v1 virtual reality headset and a gaming joystick for user input. The screening app’s design is based on the recently introduced Octopus GST perimeter. The test contains 28 points in the central 300. Test stimuli at each location are presented at an intensity level that can be detected in 95% of the time in case of a normal visual field. The app monitors false positive errors with catch trials and fixation losses using the blind spot method. Test result is presented with a plot of seen and missed points along with other parameters including test duration and reliability indices. A normative database for the GES was constructed by testing 62 eyes of 33 normal subjects (aged 22–56, 10 male/23 female) using a threshold procedure. To evaluate agreement between Octopus GST and GES, 36 eyes of 18 subjects (among the 33 normal subjects) were tested both with GES and Octopus GST. Results There is a good level of agreement between Octopus GST and GES, with 31 eyes(86%) showing above 85% agreement, based on the count of seen and missed points. There was above 85% agreement for 24 points in all eyes. The remaining 4 points had an agreement between 78 and 85%. Test duration was slightly higher for GES with an average of 2 min per eye compared to 1.1 min with Octopus GST. Conclusions Results from this clinical trial show a good level of agreement between GES and Octopus GST. GES can serve as a low‐cost and portable visual field screening kit to complement other glaucoma tests, to make referral decisions in situations where standard equipment is not available.

Background Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment. Objective This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick. Methods A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology. Results Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses). Conclusions This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required.

BACKGROUND Glaucoma, the “silent thief of sight”, is a major cause of blindness worldwide. It is a burden for people in low-income countries specifically, where it accounts for 15% of the total blindness. More than half of the people living with glaucoma in low-income countries, are unaware of their disease until it progresses to an advanced stage, resulting in permanent visual impairment. OBJECTIVE To evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising of a smartphone, a stereoscopic VR headset and a gaming joystick. METHODS A mixed-method study was conducted to evaluate the acceptability of GES, including 24 eye care professionals from four hospitals in Southwest Ethiopia. A pre-post design was employed to collect perspectives before and after using GES, using questionnaires and semi-structured interviews. The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS Positive results were obtained both pre-use and post-use, suggesting acceptance of mHealth solutions for glaucoma screening, using a low-cost headset through a smartphone and a game controller. Ophthalmic professionals perceived GES as easy-to-use, enabling the screening of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on adequate accuracy of the tool. Moroever, ophtalmic professionals voiced the need to limit the tool to screening only, and not for diagnosis. CONCLUSIONS The study supports the feasibility of using a mobile device in combination with a low-cost VR headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness due to glaucoma. Yet, a further assessment of its sensitivity and specificity is needed.