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

Thirunavukarasu, AJ; Mullinger, D; Rufus-Toye, RM; Farrell, S; Allen, LE

Journal article

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 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.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Thirunavukarasu, A. J., Mullinger, D., Rufus-Toye, R. M., Farrell, S., & Allen, L. E. (2021). Clinical validation of a novel web-application for remote assessment of distance visual acuity. Eye, 36(10), 2057–2061.

MLA Style

Thirunavukarasu, AJ, et al. “Clinical Validation of a Novel Web-Application for Remote Assessment of Distance Visual Acuity.” Eye, vol. 36, no. 10, 2021, pp. 2057–61.

Chicago Style

Thirunavukarasu, AJ, D Mullinger, RM Rufus-Toye, S Farrell, and LE Allen. 2021. “Clinical Validation of a Novel Web-Application for Remote Assessment of Distance Visual Acuity.” Eye 36 (10): 2057–61.
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