Clinical validation of a novel web-application for remote assessment of distance visual acuity

Abstract Background/Objectives Ophthalmic disorders cause 8% of hospital clinic attendances, the highest of any specialty. The fundamental need for a distance visual acuity (VA) measurement constrains remote consultation. A web-application, DigiVis, facilitates self-assessment of VA using two intern...

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Bibliographic Details
Published in:Eye (London) 2022-10, Vol.36 (10), p.2057-2061
Main Authors: Thirunavukarasu, Arun James, Mullinger, Deborah, Rufus-Toye, Remi Mohan, Farrell, Sarah, Allen, Louise E
Format: Article
Language:English
Subjects:
Accuracy
Acuity
Automation
Bias
Consent
Coronaviruses
COVID-19
Data storage
Diabetic retinopathy
Hospitals
Internet
Ophthalmology
Patients
Questionnaires
Self-assessment
Smartphones
Usability
Validation studies
Vision
Visual acuity
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Summary:Abstract Background/Objectives Ophthalmic disorders cause 8% of hospital clinic attendances, the highest of any specialty. The fundamental need for a distance visual acuity (VA) measurement constrains remote consultation. A web-application, DigiVis, facilitates self-assessment of VA using two internet-connected devices. This prospective validation study aimed to establish its accuracy, reliability, usability and acceptability. Subjects/Methods In total, 120 patients aged 5–87 years (median = 27) self-tested their vision twice using DigiVis in addition to their standard clinical assessment. Eyes with VA worse than +0.80 logMAR were excluded. Accuracy and test-retest (TRT) variability were compared using Bland–Altman analysis and intraclass correlation coefficients (ICC). Patient feedback was analysed. Results Bias between VA tests was insignificant at −0.001 (95% CI −0.017 to 0.015) logMAR. The upper limit of agreement (LOA) was 0.173 (95% CI 0.146 to 0.201) and the lower LOA −0.175 (95% CI −0.202 to −0.147) logMAR. The ICC was 0.818 (95% CI 0.748 to 0.869). DigiVis TRT mean bias was similarly insignificant, at 0.001 (95% CI −0.011 to 0.013) logMAR, the upper LOA was 0.124 (95% CI 0.103 to 0.144) and the lower LOA −0.121 (95% CI −0.142 to −0.101) logMAR. The ICC was 0.922 (95% CI 0.887 to 0.946). 95% of subjects were willing to use DigiVis to monitor vision at home. Conclusions Self-tested distance VA using DigiVis is accurate, reliable and well accepted by patients. The app has potential to facilitate home monitoring, triage and remote consultation but widescale implementation will require integration with NHS databases and secure patient data storage.
ISSN:0950-222X
1476-5454
DOI:10.1038/s41433-021-01760-2