Smartphone-based visual acuitymeasurement for screening and clinical assessment

Christopher J. Brady, Allen Eghrari, Alain B Labrique

Research output: Contribution to journalReview article

Abstract

Importance Visual acuity is the most frequently performed measure of visual function in clinical practice and most people worldwide living with visual impairment are living in low-and middle-income countries. Objective To design and validate a smartphone-based visual acuity test that is not dependent on familiarity with symbols or letters commonly used in the English language. Design, Setting, and Participants Validation study conducted from December 11, 2013, to March 4, 2014, comparing results from smartphone-based Peek Acuity to Snellen acuity (clinical normal) charts and the Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart (reference standard). This studywas nested within the 6-year follow-up of the Nakuru Eye Disease Cohort in central Kenya and included 300adults aged 55 years and older recruited consecutively. Main Outcomes and Measures Outcome measureswere monocular logMAR visual acuity scores for each test: ETDRS chart logMAR, Snellen acuity, and Peek Acuity. Peek Acuity was compared, in terms of test-retest variability and measurement time, with the Snellen acuity and ETDRS logMAR charts in participants' homes and temporary clinic settings in rural Kenya in 2013 and 2014. Results The 95%CI limits for test-retest variability of smartphone acuity data were ±0.029 logMAR. The mean differences between the smartphone-based test and the ETDRS chart and the smartphone-based test and Snellen acuity data were 0.07 (95%CI, 0.05-0.09) and 0.08 (95%CI, 0.06-0.10) logMAR, respectively, indicating that smartphone-based test acuities agreed well with those of the ETDRS and Snellen charts. The agreement of Peek Acuity and the ETDRS chart was greater than the Snellen chart with the ETDRS chart (95%CI, 0.05-0.10; P =.08). The local Kenyan community health care workers readily accepted the Peek Acuity smartphone test; it required minimal training and took no longer than the Snellen test (77 seconds vs 82 seconds; 95%CI, 71-84 seconds vs 73-91 seconds, respectively; P =.13). Conclusions and Relevance The study demonstrated that the Peek Acuity smartphone test is capable of accurate and repeatable acuity measurements consistent with published data on the test-retest variability of acuities measured using 5-letter-per-line retroilluminated logMAR charts.

Original languageEnglish (US)
Pages (from-to)2682-2683
Number of pages2
JournalJAMA - Journal of the American Medical Association
Volume314
Issue number24
DOIs
StatePublished - Dec 22 2015

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Diabetic Retinopathy
Visual Acuity
Kenya
Therapeutics
Community Health Services
Eye Diseases
Smartphone
Validation Studies
Vision Disorders
Language
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Smartphone-based visual acuitymeasurement for screening and clinical assessment. / Brady, Christopher J.; Eghrari, Allen; Labrique, Alain B.

In: JAMA - Journal of the American Medical Association, Vol. 314, No. 24, 22.12.2015, p. 2682-2683.

Research output: Contribution to journalReview article

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abstract = "Importance Visual acuity is the most frequently performed measure of visual function in clinical practice and most people worldwide living with visual impairment are living in low-and middle-income countries. Objective To design and validate a smartphone-based visual acuity test that is not dependent on familiarity with symbols or letters commonly used in the English language. Design, Setting, and Participants Validation study conducted from December 11, 2013, to March 4, 2014, comparing results from smartphone-based Peek Acuity to Snellen acuity (clinical normal) charts and the Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart (reference standard). This studywas nested within the 6-year follow-up of the Nakuru Eye Disease Cohort in central Kenya and included 300adults aged 55 years and older recruited consecutively. Main Outcomes and Measures Outcome measureswere monocular logMAR visual acuity scores for each test: ETDRS chart logMAR, Snellen acuity, and Peek Acuity. Peek Acuity was compared, in terms of test-retest variability and measurement time, with the Snellen acuity and ETDRS logMAR charts in participants' homes and temporary clinic settings in rural Kenya in 2013 and 2014. Results The 95{\%}CI limits for test-retest variability of smartphone acuity data were ±0.029 logMAR. The mean differences between the smartphone-based test and the ETDRS chart and the smartphone-based test and Snellen acuity data were 0.07 (95{\%}CI, 0.05-0.09) and 0.08 (95{\%}CI, 0.06-0.10) logMAR, respectively, indicating that smartphone-based test acuities agreed well with those of the ETDRS and Snellen charts. The agreement of Peek Acuity and the ETDRS chart was greater than the Snellen chart with the ETDRS chart (95{\%}CI, 0.05-0.10; P =.08). The local Kenyan community health care workers readily accepted the Peek Acuity smartphone test; it required minimal training and took no longer than the Snellen test (77 seconds vs 82 seconds; 95{\%}CI, 71-84 seconds vs 73-91 seconds, respectively; P =.13). Conclusions and Relevance The study demonstrated that the Peek Acuity smartphone test is capable of accurate and repeatable acuity measurements consistent with published data on the test-retest variability of acuities measured using 5-letter-per-line retroilluminated logMAR charts.",
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