A novel smartphone App to support the clinical practice of pediatric ophthalmology and strabismus: the validation of visual acuity tests

Racano, Elisabetta; Malfatti, Giulia; Pertile, Riccardo; Site, Roberta Delle; Romanelli, Federica; Nicolini, Andrea

doi:10.1007/s00431-023-05058-1

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…Furthermore, as long as the self-administered at-home test follows a standardized protocol, it is equivalent to a standard technician-administered VA test in a clinic in the examined population [2]. There is a broad agreement that both smartphone apps and printable materials assessing VA are easy, intuitive to use for patients, and reliable for clinicians [16]. Investigating the feasibility of remote testing and its value in enhancing patient convenience and healthcare accessibility, future research is setting up a framework for the remote application of the HSVA test.…”

Section: Discussionmentioning

confidence: 99%

“…Various digital tools have emerged in recent years to monitor patients' VA [12], including smartphone-based applications such as V@home [13], Peek Acuity [14], GoCheck Kids [1], Sightbook [15], TreC Oculistica [16], the web-based index test [17], the Pocket Vision Screener [18], self-administered tests, such ad as the Early Treatment Diabetic Retinopathy Study (ETDRS) home VA test [2] and the Accustat ® [3], and even the first smart TV-based VA test, the Democritus Digital Visual Acuity Test (DDiVAT) [19]. However, though a low mean difference between digital tools and the standard charts and clinical equivalence indications were previously reported, the wide 95% limits of agreement revealed the lower precision of the digital self-assessments, especially in patients with decreased VA [20].…”

Section: Introductionmentioning

confidence: 99%

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Development and Evaluation of a New Self-Administered Near Visual Acuity Chart: Accuracy and Feasibility of Usage

Ben-Eli,

Banin,

Levy

et al. 2024

JCM

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Background: Visual acuity (VA) assessments are crucial in ophthalmology but traditionally rely on in-clinic evaluations. The emergence of telemedicine has spurred interest in creating dependable self-administered VA tests for use beyond standard clinical environments. This study evaluated the practicality and validity of a self-administered near VA card test against traditional Snellen and Rosenbaum Pocket Vision Screener (RPVS) methods for home monitoring and enhancing clinical workflow. Methods: In a cross-sectional study, a near VA card (Hadassah Self-Visual Acuity Screener (HSVA)) was developed with written and videotaped instructions for self-use. Patients with a minimal best-corrected VA (BCVA) of 1.0 LogMAR in at least one eye were recruited from ophthalmology and optometry clinics. Outcomes included the mean BCVA difference between the self-administered values and those obtained by the examiner, and correlations between BCVA values obtained by the Snellen, RPVS, HSVA, and previous distance BCVA methods according to the patients’ electronic medical records. Results: A total of 275 participants (mean age: 42.5 ± 19.4 years; range: 18–89 years; 47% female) were included. Test–retest reliability analysis of the HSVA demonstrated a very good correlation and repeatability (n = 38 patients; Rs = 1.0; p < 0.001). Accuracy analysis revealed the mean LogMAR BCVA values of an additional 237 patients obtained by the Snellen, RPVS, and HSVA methods were similar (p = 0.10). The self-test BCVA results obtained by the HSVA agreed with the masked examiner-tested VA results (n = 67 patients; p = 0.17; Rs = 0.87; ICC = 0.96). Similar results were obtained when stratification by median age (42 years) was performed. Bland–Altman analysis of the HSVA and RPVS methods demonstrated a good agreement. To assess whether the HSVA could predict the VA results in the clinically used charts, multivariate analysis was used and revealed that the HSVA predicted the RPVS results (β = 0.91; p = 0.001; R2 = 0.88), and the self-test HSVA predicted the Snellen VA results within two lines (β = 0.93; p = 0.01; R2 = 0.36). Conclusions: The home-based HSVA assessment exhibited high test–retest reliability, accuracy, and alignment with clinical-standard VA tests. Its efficacy in self-testing mirrored examiner-conducted VA assessments and accurately predicted Snellen VA outcomes, indicating the HSVA’s suitability for self-monitoring in chronic ocular conditions or when access to conventional examinations is limited. The utility of self-administered VA tests may extend beyond ophthalmology and optometry, potentially benefiting primary care, emergency medicine, and neurology. Further research is needed to explore and validate the practical applications of remote VA testing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a New Self-Administered Near Visual Acuity Chart: Accuracy and Feasibility of Usage

Ben-Eli,

Banin,

Levy

et al. 2024

JCM

View full text Add to dashboard Cite

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“…Several tests exist for home monitoring of visual acuity in children 56–58 . In this study, we have chosen to look at tests that measure contrast sensitivity, as we were interested in two specific populations: children receiving treatment for amblyopia and those with other vision impairments.…”

Section: Discussionmentioning

confidence: 99%

Can children measure their own vision? A comparison of three new contrast sensitivity tests

Crossland,

Dekker,

Dahlmann‐Noor

et al. 2023

Ophthalmic Physiologic Optic

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PurposeTo investigate the feasibility of children measuring their own contrast sensitivity using a range of tablet‐ and paper‐based tests.MethodsForty children aged 5–15 years with amblyopia (N = 10), bilateral vision impairment (N = 10) or good vision (N = 20) measured their own vision on a screen‐based optotype test (Manifold), a gamified vision test (PopCSF) and a paper‐based test (Spotchecks) in a laboratory with minimal supervision. Completion rate, test–retest repeatability, test duration and participants' preferences were recorded for each test.ResultsMost participants (36/40) were able to perform all three tests. All tests were correlated with clinically measured visual acuity and contrast sensitivity (p < 0.001). The 95% coefficient of repeatability was 0.30 dB for Manifold, 0.29 dB for PopCSF and 0.13 dB for Spotchecks. All tests differentiated between children with reduced contrast sensitivity and control participants. PopCSF and Spotchecks were also able to differentiate between children with amblyopia and those with good vision. Median test time was 152, 130 and 202 s for Manifold, PopCSF and Spotchecks, respectively. Twenty‐two participants preferred the PopCSF test, 10 preferred Spotchecks and 6 preferred Manifold. Thirty‐nine out of the 40 children (98%) said they would measure their own vision at home using at least one of these tests every month.ConclusionsChildren and young people can test their own contrast sensitivity with repeatable results. Of these three tests, the most repeatable was Spotchecks, the quickest was PopCSF and participants' favourite was PopCSF. Nearly all of the participants said they would be willing to use at least one of the three tests at home.

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Digitale Telemedizin zur Überwachung chronischer Netzhauterkrankungen – ein klinisches Werkzeug für die Zukunft?

Terheyden,

Mauschitz,

Wintergerst

et al. 2024

Ophthalmologie

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Zusammenfassung Hintergrund Angesichts der prognostizierten Zunahme chronischer Netzhauterkrankungen und einer Unterversorgung der Bevölkerung könnte Telemedizin einen Beitrag leisten, Zugangsbarrieren zur Gesundheitsversorgung zu reduzieren und Behandlungsergebnisse zu verbessern. Ziel der Arbeit Literaturübersicht zur Fernüberwachung chronischer Netzhauterkrankungen. Material und Methoden Die medizinische Literatur wurde nach Arbeiten zur Fernüberwachung chronischer Netzhauterkrankungen durchsucht. Die Ergebnisse wurden in einer Übersichtsarbeit zusammengestellt. Ergebnisse Vier Hauptthemen in der Literatur sind: Validierungsstudien, Implementierungsstrategien, Akzeptanz‑/Zielgruppenanalysen und gesundheitsökonomische Analysen. Systeme zur Fernüberwachung basieren auf Sehfunktionstests, Bildgebung oder Patientenberichten und wurden bislang insbesondere bei der altersabhängigen Makuladegeneration (AMD) und der diabetischen Augenerkrankung (DAE) untersucht. Studien deuten auf positive Effekte hinsichtlich einer Optimierung der Versorgung und ein günstiges Sicherheitsprofil hin, jedoch fehlen für die Mehrzahl der berichteten Werkzeuge randomisierte, kontrollierte Studien. Diskussion Fernüberwachung könnte eine Ergänzung zu bestehenden Versorgungsstrukturen bei Patienten mit chronischen Netzhauterkrankungen, insbesondere AMD und DAE, darstellen. Vielversprechende Systeme basieren etwa auf der Übersehschärfe oder der optischen Kohärenztomographie, während selbstberichtete Daten bislang wenig eingesetzt werden. Derzeit ist jedoch noch keine ausreichende Evidenz für eine Anwendung von Fernüberwachungssystemen bei chronischen Netzhauterkrankungen in Europa gegeben, und weitere Studien zur Validierung von Fernüberwachungssystemen sind notwendig.

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A novel smartphone App to support the clinical practice of pediatric ophthalmology and strabismus: the validation of visual acuity tests

Cited by 5 publications

References 7 publications

Development and Evaluation of a New Self-Administered Near Visual Acuity Chart: Accuracy and Feasibility of Usage

Development and Evaluation of a New Self-Administered Near Visual Acuity Chart: Accuracy and Feasibility of Usage

Can children measure their own vision? A comparison of three new contrast sensitivity tests

Digitale Telemedizin zur Überwachung chronischer Netzhauterkrankungen – ein klinisches Werkzeug für die Zukunft?

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