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Randomized Controlled Trial
. 2022 May 1;140(5):465-471.
doi: 10.1001/jamaophthalmol.2022.0396.

Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era

Kellyn N Bellsmith  1 , Michael J Gale  1 , Sen Yang  1 , Isabelle B Nguyen  1 , Christa J Prentiss  1 , Luan T Nguyen  1 , Sam Mershon  1 , Allison I Summers  1 , Merina Thomas  1
Affiliations
Randomized Controlled Trial

Validation of Home Visual Acuity Tests for Telehealth in the COVID-19 Era

Kellyn N Bellsmith et al. JAMA Ophthalmol. .

Abstract

Importance: Visual acuity (VA) is one of the most important clinical data points in ophthalmology. However, few options for validated at-home VA assessments are currently available.

Objective: To validate 3 at-home visual acuity tests in comparison with in-office visual acuity.

Design, setting, and participants: Between July 2020 and April 2021, eligible participants with VA of 20/200 or better were recruited from 4 university-based ophthalmology clinics (comprehensive, cornea, glaucoma, and retina clinics). Participants were prospectively randomized to self-administer 2 of 3 at-home VA tests (printed chart, mobile phone app, and website) within 3 days before their standard-of-care clinic visit. Participants completed a survey assessing usability of the at-home tests. At the clinic visit, best-corrected Snellen distance acuity was measured as the reference standard.

Main outcomes and measures: The at-home VA test results were compared with the in-office VA test results using paired and unpaired t tests, Pearson correlation coefficients, analysis of variance, χ2 tests, and Cohen κ agreement. The sensitivity, specificity, positive predictive value, and negative predictive value of each at-home test were calculated to detect significant VA changes (≥0.2 logMAR) from the in-office baseline.

Results: A total of 121 participants with a mean (SD) age of 63.8 (13.0) years completed the study. The mean in-office VA was 0.11 logMAR (Snellen equivalent 20/25) with similar numbers of participants from the 4 clinics. Mean difference (logMAR) between the at-home test and in-office acuity was -0.07 (95% CI, -0.10 to -0.04) for the printed chart, -0.12 (95% CI, -0.15 to -0.09) for the mobile phone app, and -0.13 (95% CI, -0.16 to -0.10) for the website test. The Pearson correlation coefficient for the printed chart was 0.72 (95% CI, 0.62-0.79), mobile phone app was 0.58 (95% CI, 0.46-0.69), and website test was 0.64 (95% CI, 0.53-0.73).

Conclusions and relevance: The 3 at-home VA test results (printed chart, mobile phone app, and website) appeared comparable within 1 line to in-office VA measurements. Older participants were more likely to have limited access to digital tools. Further development and validation of at-home VA testing modalities is needed with the expansion of teleophthalmology care.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Bland Altman Plots Comparing Differences in Mean Visual Acuity Between In-Office Measurements and Results From Each of the 3 At-home Tests
Plots showed similar upper limit of agreement (LOA) for the at-home tests, but the mobile phone app and website test had greater lower LOA and more instances in which the at-home test underestimated the in-office acuity.
See this image and copyright information in PMC

Comment in

  • Valid but Undervalued.
    Li JO, Keane PA, Thomas P. Li JO, et al. JAMA Ophthalmol. 2022 May 1;140(5):471. doi: 10.1001/jamaophthalmol.2022.0549. JAMA Ophthalmol. 2022. PMID: 35357424 No abstract available.

References

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