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      Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

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          Abstract:

          Purpose

          With the recent rise of teleophthalmology due to coronavirus disease, we are in need of accurate and reliable methods of checking visual acuity remotely. We compare the visual acuity as measured by the GoCheck Kids application, HOTV with the amblyopia treatment study (ATS), and our clinic protocol.

          Design

          This is a prospective, comparison of visual acuity assessment methods.

          Methods

          Established patients (aged 3-18) in the practice of a single pediatric ophthalmologist were eligible. Visual acuity was measured by: 1) GoCheck Kids mobile application (by patient’s family member), 2) HOTV-ATS (by study personnel), and 3) regular clinic protocol (by ophthalmic technician). To assess agreement between measures of acuity, intraclass correlations with 95% confidence intervals were computed.

          Results

          Fifty-three children participated. The mean difference between GoCheck Kids and HOTV-ATS acuities (0.094) was significantly different (p<0.001); the intraclass correlation (ICC) was 0.55 (95% CI: 0.40, 0.68). The mean difference between GoCheck Kids and chart acuities (0.010) was not significantly different (p=0.319); ICC: 0.59 (95% CI: 0.45, 0.71). The mean difference between HOTV-ATS and chart acuities (0.084) was significantly different (p<0.001); ICC: 0.66 (95% CI: 0.53, 0.76). The percent of eyes with visual acuity as measured by GoCheck Kids that was within 1 line of the HOTV-ATS and chart acuity was 65.3% and 86.7%, respectively.

          Conclusions

          GoCheck Kids as checked by a family member provides a modest correlation of visual acuity compared to the chart screen and a fair correlation of visual acuity compared to HOTV-Amblyopia Treatment Study protocol, though a vast majority are within 1 line.

          Highlights

          • •

            Teleophthalmology is part of our practices due to coronavirus disease (COVID-19)

          • •

            Visual acuity can be checked at home with paper charts or devices

          • •

            GoCheck Kids has a modest correlation of visual acuity compared to the chart screen

          • •

            GoCheck Kids has a fair correlation of visual acuity compared to HOTV-ATS

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          Most cited references36

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          Evaluation of telemedicine for screening of diabetic retinopathy in the Veterans Health Administration.

          Jennifer Sisson, Michael Williams, Claire Barnes … (2013)
          To explore the cost-effectiveness of telemedicine for the screening of diabetic retinopathy (DR) and identify changes within the demographics of a patient population after telemedicine implementation.
          Article 0 comments Cited 52 times – based on 0 reviews     Review now
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            The amblyopia treatment study visual acuity testing protocol.

            , Raymond T Kraker, R. Blair … (2001)
            To evaluate the reliability of a new visual acuity testing protocol for children using isolated surrounded HOTV optotypes. After initial pilot testing and modification, the protocol was evaluated using the Baylor-Video Acuity Tester (BVAT) to present isolated surrounded HOTV optotypes. At 6 sites, the protocol was evaluated for testability in 178 children aged 2 to 7 years and for reliability in a subset of 88 children. Twenty-eight percent of the 178 children were classified as having amblyopia. Using the modified protocol, testability ranged from 24% in 2-year-olds to 96% in 5- to 7-year-olds. Test-retest reliability was high (r = 0.82), with 93% of retest scores within 0.1 logMAR unit of the initial test score. The 95% confidence interval for an acuity score was calculated to be the score +/-0.125 logMAR unit. For a change between 2 acuity scores, the 95% confidence interval was the difference +/-0.18 logMAR unit. The visual acuity protocol had a high level of testability in 3- to 7-year-olds and excellent test-retest reliability. The protocol has been incorporated into the multicenter Amblyopia Treatment Study and has wide potential application for standardizing visual acuity testing in children.
            Article 0 comments Cited 49 times – based on 0 reviews     Review now
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              Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study.

              Bruce Moore, Mary G Quinn, Gui-Shuang Ying … (2004)
              To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). Multicenter, cross-sectional study. A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). Sensitivity for detecting children with > or =1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance. At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower (P or =1 targeted conditions and for detecting the most important conditions. Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having > or =1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.
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                Author and article information

                Contributors
                Evan Silverstein
                Journal
                Journal ID (nlm-ta): Am J Ophthalmol
                Journal ID (iso-abbrev): Am. J. Ophthalmol
                Title: American Journal of Ophthalmology
                Publisher: Elsevier Inc.
                ISSN (Print): 0002-9394
                ISSN (Electronic): 1879-1891
                Publication date PMC-release: 11 August 2020
                Publication date (Electronic): 11 August 2020
                Affiliations
                [1 ]Virginia Commonwealth University, Department of Ophthalmology 401 N 11 th Street, Suite 439 Richmond, VA 23298
                [2 ]Louisiana State University Health, Department of Ophthalmology 533 Bolivar Street, Room 459 New Orleans, LA 70112
                [3 ]Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100 Richmond, VA 23298
                [4 ]Duke University Medical Center, Department of Ophthalmology, DUMC 3802 Durham, NC 27710
                Author notes
                [∗ ]Corresponding Author:Evan Silverstein, MD Virginia Commonwealth University; Department of Ophthalmology 401 N 11 th Street, Suite 439 Richmond, VA 23298 P: 804-828-9315F: 804-828-1010 evan.silverstein@ 123456vcuhealth.org
                Article
                Publisher ID: S0002-9394(20)30426-8
                DOI: 10.1016/j.ajo.2020.08.007
                PMC ID: 7417903
                PubMed ID: 32791067
                SO-VID: c6cd4487-fd53-4020-9c8e-ee4dc3089baf
                Copyright © © 2020 Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 27 April 2020
                Date revision received : 3 August 2020
                Date accepted : 3 August 2020
                Categories
                Subject: Article

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