Children’s visual acuity tests at home: A prospective repeated measures study

Abstract

Background Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of a variety of patients. Home tests may have further utility in giving service users frequent updates of vision outcomes during therapy, identifying vision problems in an asymptomatic population, and engaging stakeholders in therapy. The accuracy of home vision tests for children when completed without supervision from a professional is unknown. Methods Children attending outpatient clinics had their visual acuity measured 3 times in a randomised order at the same appointment. Once by a registered orthoptist as per standard clinical protocols, once by an orthoptist using a tablet-based visual acuity test (iSight Pro, Kay Pictures), and once by an unsupervised parent or carer using the tablet-based test. Results 42 children were recruited to the study. The mean age was 5.6 years (range 3.3 to 9.3 years). Median measurements (interquartile range) for clinical standard, orthoptic-led and parent/carer-led iSight visual acuity measurements were 0.155 (0.18), 0.180 (0.26), and 0.300 (0.33) respectively. The iSight app in the hands of parents/carers was significantly different from the standard of care measurements (P=0.009). In the hands of orthoptists, there was no significant difference between the iSight app and standard of care (P=0.551), nor was there significant difference between parents/carers using the app and orthoptists using the app (P=0.133). Conclusion This technique of unsupervised home visual acuity measures for children is not comparable to clinical measures and is unlikely to be valuable to clinical decision making and screening. Future work should focus on improving the technique through, for example, gamification of vision tests.

Implementation of anterior segment ophthalmic telemedicine

“…The potential for user error must be considered, with attention to operators’ familiarity with the platform in question, as well as factors that can affect measurements such as screen brightness and resolution, device stability, and ambient lighting [38]. Published trials often utilize measurements obtained by trained individuals such as technicians or optometrists; caution is advised in when applying such trial findings to ‘real-world’ settings where measurements will be obtained by patients or caregivers who potentially lack medical training [31 ▪ ,34,39]. Additionally, when interpreting results, consideration of underlying ocular diseases, including any refractive disorders, is important, as some devices demonstrate reduced accuracy in emmetropic patients [35].…”