Testing Pediatric Acuity With an iPad: Validation of "Peekaboo Vision" in Malawi and the UK.

PURPOSE

To evaluate two builds of the digital grating acuity test, "Peekaboo Vision" (PV), in young (6-60 months) populations in two hospital settings (Malawi and United Kingdom).

METHODS

Study 1 evaluated PV in Blantyre, Malawi ( = 58, mean age 33 months); study 2 evaluated an updated build in Glasgow, United Kingdom ( = 60, mean age 44 months). Acuities were tested-retested with PV and Keeler Acuity Cards for Infants (KACI). Bland-Altman techniques were used to compare results and repeatability. Child engagement was compared between groups. Study 2 included test-time comparison.

RESULTS

Study 1 (Malawi): The mean difference between PV and KACI was 0.02 logMAR with 95% limits of agreement (LoA) of 0.33 to 0.37 LogMAR. On test-retest, PV demonstrated 95% LoA of -0.283 to 0.198 logMAR with coefficient of repeatability (CR) 0.27. KACI demonstrated 95% LoA of -0.427 to 0.323 logMAR, and larger CR was 0.37. PV evidenced higher engagement scores than KACI ( = 0.0005). Study 2 (UK): The mean difference between PV and KACI was 0.01 logMAR; 95% LoA was -0.413 to 0.437 logMAR. Again, on test-retest, PV had narrower LoA (-0.344 to 0.320 logMAR) and lower CR (0.32) versus KACI, with LoA -0.432 to 0.407 logMAR, CR 0.42. The two tests did not differ in engagement score ( = 0.5). Test time was ∼1 minute shorter for PV (185 vs. 251 s, = 0.0021).

CONCLUSIONS

PV gives comparable results to KACI in two pediatric populations in two settings, with benefits in repeatability indices and test duration.

TRANSLATIONAL RELEVANCE

Leveraging tablet technology extends reliable infant acuity testing to bedside, home, and rural settings, including areas where traditional equipment cannot be financed.