Development and validation of a new method for visual acuity assesment on tablet in pediatric population: eMOVA test.

BACKGROUND: Amblyopia is a major public health concern. Its screening and management require reliable methods of visual acuity assessment. New technologies offer nowadays many tests available on different app stores for smartphone or tablet but most of them often lack of scientific validation for a medical use. The aim of our study was to attempt validating a tablet-based near visual acuity test adapted to the pediatric population: the eMOVA test (electronic Measurement Of Visual Acuity) by comparing visual acuity measured with more conventional test. METHODS: A cohort of 100 children aged 3 to 8 attending the ophthalmic-pediatric for eye examination between September 2016 and June 2017 were included in the study. Near visual acuity was assessed on participants using both the eMOVA test and a Standard test (Rossano-Weiss test). Duration of each test, its comprehension, its acceptability and the attention of the child during the test was also investigated. RESULTS: The eMOVA test overestimated near visual acuity by 0.06 logMAR. This difference, statistically significant, was not clinically relevant. The duration of the eMOVA test was longer than the reference test, but less discomfort and preferred by children and their parents compared to standard tests. CONCLUSION: The eMOVA test appears as a reliable test to assess near visual acuity in children. By its portability and efficiency, this application proved to be a relevant tool to be used for children eye examination in daily routine at the hospital.

[Screening for visual disturbances in children]. / Dépistage des troubles visuels chez l'enfant.

"Screening for visual disturbances in children.Vision screening in children is a public health concern, as untreated visual disorders may have irreversible consequences, as well as an important social, scholar, and financial impact. Moreover, most of these disturbances such as refractive errors or strabismus can easily be corrected. Guidelines to improve the screening were recently issued by a French expert group (AFSOP). They emphasize the importance of an ophthalmological examination for children at risk of organic and functional amblyopia, respectively during the first week or first year of life. They also recommend a systematic screening for amblyopia, refractive errors or strabismus in general population at age 3, using three different tests. In addition, warning signs such as a leukocoria or a buphthalmia should be recognized by every physician and addressed immediately for an extensive ophthalmo- logical examination."

"Dépistage des troubles visuels chez l'enfant. Le dépistage visuel chez l'enfant représente un objectif de santé publique en raison de l'impact social, scolaire et financier d'une anomalie de la vision, potentiellement irréversible en l'absence de prise en charge précoce. De plus, la plupart de ces troubles sont corrigibles, c'est le cas notamment des anomalies de la réfraction et du strabisme. Un groupe d'experts de l'Association francophone de strabologie et d'ophtalmologie pédiatrique (AFSOP) a récemment mis à jour des recommandations consensuelles pour l'optimisation de ce dépistage. Ce travail souligne l'importance d'un examen ophtalmologique rapide dans la première semaine ou première année de vie respectivement pour les enfants à risque d'amblyopie organique et fonctionnelle, ainsi que d'un dépistage systématique de tous les enfants à l'âge de 3 ans à l'aide de trois examens visant à détecter respectivement un trouble de la réfraction, un strabisme ou une amblyopie. Par ailleurs, certains signes d'appel, comme la présence d'une leucocorie ou d'une buphtalmie, conduisant à un examen ophtalmologique sans délai, doivent être reconnus par tout professionnel en charge de l'examen global de l'enfant."

A new visual acuity test on touchpad for vision screening in children.

AIM: To validate a visual acuity (VA) test application on touchpad in the screening of pediatric population by comparing VA results obtained with conventional tests. METHODS: A cohort of 101 patients, 44 girls and 57 boys with a median of 6.5 years old (3-10 years of age), presenting for eye examinations in Ophthalmology Department (Strasbourg, France) between November 1st, 2018, and February 1st, 2019 were enrolled. Monocular and binocular VA testing was performed on the subject using both a standard test and the touchpad application (Monoyer, "E" or, Pigassou depending of children's capacities). Patients were excluded if they were physically or mentally unable to use the touchpad. The duration of each tests, the painfulness, the comprehension, the attention of children during the test and test's preferences were also evaluated. RESULTS: There was a good linear correlation and intra-class correlation coefficient [ICC=0.50 (0.34, 0.64) for binocular acuity, 0.74 (0.64, 0.82) for right eyes and 0.525 (0.37, 0.66) for left eye]. The standard errors of measurement were very low (0.08, 0.05, 0.08 for binocular VA, right eyes VA and left eyes VA, respectively). There was no difference between two tests for right eye (P=0.126), left eye (P=0.098) and binocular acuity (P=0.085). Non inferiority was proved for all binocular [-0.06 (-0.09, -0.03)], right eye [-0.04 (-0.07, -0.01)] and left eye [-0.06 (-0.09, -0.02)] VA. The sensitivity and specificity, which correspond to the ability for our app to detect amblyopia, were 92% and 80% respectively. CONCLUSION: Our touchpad application represents an efficient and valid test of VA in children with a high specificity to detect visual impairment.

When biology supports clinical diagnosis: review of techniques to diagnose ocular toxoplasmosis.

Toxoplasmosis is a common infection whose worldwide prevalence is estimated at 30%, with large disparities across the world. Among infected subjects, the prevalence of ocular toxoplasmosis (OT) is, however, limited to about 2% in Europe and 17% in South America. In France, it is estimated that about 1 000 000 patients present either active OT or subsequent chorioretinal scars. Toxoplasmagondii is the first cause of posterior uveitis worldwide, responsible for retinochoroiditis, at times associated with anterior uveitis. To date, there is no consensus yet on how to diagnose OT, which is often based only on clinical presentation. Nevertheless, OT-associated symptoms are often atypical and misleading. Over the last 20 years, tremendous progress has been made in biological tools, enabling parasitologists to confirm the diagnosis in most suspected cases of OT. Using anterior chamber puncture, a safe and fast procedure, ophthalmologists sample aqueous humour for analysis using multiple techniques in order to reach high specificity and sensitivity in OT diagnosis. In this article, we present the different techniques available for the biological diagnosis of OT, along with their characteristics, and propose a diagnostic algorithm designed to select the best of these techniques if clinical examination is not sufficient to ascertain the diagnosis.