ABSTRACT
Introduction: Pediatric eye care access, particularly in rural areas, has been an ongoing concern. The COVID-19 pandemic has led to a growing appreciation and acceptance of a role for telemedicine in pediatric eye care. However, many at-home visual acuity (VA) charts and apps have poor test design or inaccurate optotype sizes, and may passively provide misinformation for clinical decision making.1-3 We evaluated the new M&S EyeSimplify At-Home Visual Acuity Tests, which include web-based versions of the ATS-HOTV and E-ETDRS tests commonly used in clinical trials. Method(s): Children with and without VA deficits were enrolled. In-office VA was tested with the M&S Smart System ATS-HOTV (ages 3-6;N = 34;68 eyes) or E-ETDRS (ages 7-12;N = 31;62 eyes) protocol. The child was registered on the EyeSimplify web-based portal and the parent was emailed a link to the at-home VA test. The portal notified us when at-home testing was completed and provided us on-line access to VA results. Equivalence of the two test settings was evaluated by mean difference and 95% limits of agreement (LOA) using Bland-Altmann analysis. Result(s): The mean difference between in-office and at-home was small for both ATS-HOTV (0.01 + 0.08 logMAR) and E-ETDRS 0.04 + 0.08 logMAR;95% LOA = -0.15 to 0.17 and -0.11 to 0.19, respectively, comparable to test-retest agreement in an office setting. Conclusion/Relevance: The M&S EyeSimplify At-Home Visual Acuity Tests provided VA equivalent to in-office testing. If the burden of travel is significant, at-home testing may provide the information needed to continue care via telemedicine consultation when it might otherwise be discontinued or delayed.Copyright © 2022
ABSTRACT
Purpose : 85% of US adults have a smartphone with 87 million people using a health or wellness app monthly in 20201. There are 350,000 eHealth apps2. Roughly 33M adults in the US have the chief complaint of vision loss. An estimated 93M are at high risk for serious visual impairment3 . Only half have visited an eye doctor in the past 12 months, due to COVID 193. American adults over the age of 18 fall into the demographic of mobile app users. Do free apps help our eye patients during this pandemic? Methods : We used the search terms “vision test” and “eye exam” in the Apple App Store to compile a list of the top 10 free apps. We looked for how many free apps have eye charts that are “recognized” such as Snellen chart, Landolt C, LogMAR chart, Amsler grid & Visual Field. Control: Inclusion criteria: 1) free;2) English language;3) ≥50 reviews, ≥4 star rating in the Apple App store. Exclusion criteria: 1) foreign languages 2) paid apps. Results : Results: Top 10 iOS apps (from most downloads to least) in the Apple App Store seen in Table 1. For all iOS apps, Snellen vision test: 9/10;Landolt C: 1/10;LogMAR chart: 3/10;Amsler grid: 3/10;Visual field 1/10. Only 1 app connected you with a local optometrist or ophthalmologist. Only 3/10 apps had >1K reviews. iOS apps do not provide a number of downloads. Conclusions : Although many adults have not received an eye exam over the past 12 months, physicians can still connect with their patients through public education with the use of mobile apps. However, current eHealth apps can improve their content for eye patients.
ABSTRACT
Purpose : Telemedicine allows physicians to provide care virtually, limiting patient exposure during the COVID-19 pandemic. As a follow up to a previous analysis (Gore R, et al. IOVS 2021;68:ARVO E- 146), we performed a retrospective chart review on a separate patient cohort to test whether virtual visual acuity (VA) tests are a reliable means of screening vision in a pediatric population. Methods : Families screened were sent instructions and an Early Treatment Diabetic Retinopathy Study (ETDRS) eye chart calibrated for 5 feet. Volunteer screeners instructed children over the phone, and those who failed the screen were referred to Wills Eye Hospital (WEH) for further evaluation. The institutional review board at WEH approved the current study. Demographic characteristics and VA screenings (virtual and in-person) were analyzed and compared using Pearson correlation coefficients. Bland-Altman plots were constructed to visualize this comparison. Results : A total of 242 eyes of 121 patients were included. The mean ± SD age was 11.7±3.1 years. Using Pearson correlations, the in-person and virtual VA measurements were moderately correlated in both the right eye (OD: r=0.506, p<0.001) and left eye (OS: r=0.610, p<0.001). Comparing in-person to virtual settings, the mean ± SD LogMAR of VA of the right eye (OD) was 0.37±0.36 (Snellen 20/46) vs. 0.55±0.30 (Snellen 20/70), respectively (p<0.001). The mean ± SD LogMAR of VA of the left eye (OS) was 0.38±0.43 (Snellen 20/47) in-person vs. 0.52±0.30 (Snellen 20/66) in the virtual setting (p<0.001). However, when the VA range was classified based on the median of in-person VA (LogMAR 0.3, Snellen 20/40), there was no significant difference between in-person and virtual VA measurements in VA >20/40 OD (0.70±0.30, 20/100 vs. 0.67±0.29, 20/93, p=0.538) and OS (0.76±0.45, 20/115 vs. 0.70±0.29, 20/100, p=0.274) (Table 1). Compared to in-person VA measurement (gold standard), the Bland-Altman plot shows a mean difference of 0.17 LogMAR with virtual VA measurements OD (Fig 1A) and a mean difference of 0.14 LogMAR with virtual VA measurements OS (Fig 1B). Conclusions : An ETDRS VA test delivered at home demonstrated good correlation with a standard ophthalmologist-administered VA test in a pediatric population. Virtual screening may underestimate vision in patients with good vision at the in-person visit, but the virtual screening does not fail to detect poor vision. (Figure Presented).