Childrens visual acuity tests at home: A prospective repeated measures study

BackgroundHome visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of a variety of patients. Home tests may have further utility in giving service users frequent updates of vision outcomes during therapy, identifying vision problems in an asymptomatic population, and engaging stakeholders in therapy. The accuracy of home vision tests for children when completed without supervision from a professional is unknown. MethodsChildren attending outpatient clinics had their visual acuity measured 3 times in a randomised order at the same appointment. Once by a registered orthoptist as per standard clinical protocols, once by an orthoptist using a tablet-based visual acuity test (iSight Pro, Kay Pictures), and once by an unsupervised parent or carer using the tablet-based test. Results42 children were recruited to the study. The mean age was 5.6 years (range 3.3 to 9.3 years). Median measurements (interquartile range) for clinical standard, orthoptic-led and parent/carer-led iSight visual acuity measurements were 0.155 (0.18), 0.180 (0.26), and 0.300 (0.33) respectively. The iSight app in the hands of parents/carers was significantly different from the standard of care measurements (P=0.009). In the hands of orthoptists, there was no significant difference between the iSight app and standard of care (P=0.551), nor was there significant difference between parents/carers using the app and orthoptists using the app (P=0.133). ConclusionThis technique of unsupervised home visual acuity measures for children is not comparable to clinical measures and is unlikely to be valuable to clinical decision making and screening. Future work should focus on improving the technique through, for example, gamification of vision tests. What is already known on this topic?Childrens game visual acuity tests could improve things for hospital services and patients. The tablet-based tests are accurate when used by professionals to tests adults vision. What this study addsThis study provides data about the accuracy of home tests when used by untrained parents or carers on their children. How this study might affect research, practice, or policyCurrent policy recommends apps home tests are not used to test childrens eyes for clinical decision-making purposes. Our data supports this policy and highlights the need for future research to focus on improving the tests. Synopsis / precis ("At a glance")Visual acuity testing at home could improve patient care and reduce clinical visits, but data to show clinicians that they can rely upon the results in children are lacking. Our study shows the tests cannot be relied upon for clinical purposes. Improvements to the tests are required before they become useful and can be implemented into practice.