Preliminary clinical validation of a new picture–based visual acuity test in children with amblyopia: a comparison of The Auckland Optotypes and crowded logMAR letters

McVeigh, Emma M.; Ludden, Siobhan; Mohamed, Sahra; Shah, Nilpa; Mulholland, Pádraig J.; Dahlmann‐Noor, Annegret

doi:10.1038/s41433-021-01840-3

Cited by 2 publications

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“…OKKO-Health have developed a VA-app for children, which includes the pictorial Auckland Optotypes (TAO). 1 Here we report our findings of in-clinic testing of a prototype in children with a wide range of eye conditions and VAs.This work was approved as service evaluation by Moorfields Eye Hospital (reference 603). Between 14/04/ 2020 and 15/05/2020 we approached consecutive children under the age of 16 years attending our clinics.…”

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Proof-of-concept evaluation of prototype mobile application for parents/carers monitoring visual acuity in young children using pictorial optotypes

Abbas

Ludden

Elfadaly

et al. 2023

European Journal of Ophthalmology

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Dear Editor,Visual acuity (VA) is a core component of any eyehealth consultation and contributes to management decisions. During COVID-19 lockdowns, clinic appointments for amblyopia management were suspended. Virtual consultations allowed clinicians to stay in touch with families, but VA assessments were not possible.Whilst several applications to monitor VA in adults at home are available, there is a gap in the provision of reliable solutions for younger children who are not yet able to co-operate with letter-optotype testing. OKKO-Health have developed a VA-app for children, which includes the pictorial Auckland Optotypes (TAO). 1 Here we report our findings of in-clinic testing of a prototype in children with a wide range of eye conditions and VAs.This work was approved as service evaluation by Moorfields Eye Hospital (reference 603). Between 14/04/ 2020 and 15/05/2020 we approached consecutive children under the age of 16 years attending our clinics. We recorded logMAR acuity at 3metres testing distance with Kay pictures or letters (Thomson-chart). Then we gave the parent/carer an iPhone-XS with pre-installed OKKO Health App, and asked them to carry out a supervised selfmeasurement test with their child. We recorded age, gender and worse-eye visual acuity.We collected data from 46 children, mean age 6.5 (SD3.3) years; 23 boys. Twenty-one had amblyopia/refractive error/ strabismus, 13 a lid or ocular surface condition, 5 congenital glaucoma, 5 healthy eyes/normal-for-age vision, and 1 each pseudophakia or anterior uveitis.Median OKKO-TAO acuity was 0.19 (IQR 0.00 to 0.40) and median VA on the reference standard 0.13 logMAR (IQR 0.03-0.21). Mean difference between OKKO and reference standard was 0.08 logMAR, SD 0.24, 95% CI (−0.15 to −0.04). Intraclass correlation coefficient was 0.7, and 95% of measurements between were between +/−0.48 logMAR (Figure 1).We found fair agreement between reference standard and TAO-element of the OKKO Health-app prototype. Limitations are that near acuity (OKKO-app) may overestimate "true" distance acuity, though evidence is conflicting. 2,3 Comparing the vanishing-optotype, picture-only OKKO-TAO-prototype with a non-vanishing optotype picture/letter reference standard may also have affected the accuracy of our comparison.OKKO-Health is the first application specifically designed for home acuity-testing in young children by parents/carers, using TAO optotypes. Previous studies used orthoptistsupervised remote testing 4 or letter optotypes, 5,6 some requiring both a computer display and a handheld device, increasing complexity for the user. 6 The updated, full version of the OKKO-Health app includes not only pictorial optotypes, but also other psychophysically robust targets which are anticipated to increase test performance. An auto-calibration mechanism that adjusts for brightness and greyscale obviates the need for calibration, and continuous automated measures of the

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confidence: 97%

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confidence: 97%