Allen Louise, Thirunavukarasu Arun James, Podgorski Simon, Mullinger Deborah
Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
BMJ Open Ophthalmol. 2021 Sep 30;6(1):e000801. doi: 10.1136/bmjophth-2021-000801. eCollection 2021.
The difficulty in accurately assessing distance visual acuity (VA) at home limits the usefulness of remote consultation in ophthalmology. A novel web application, DigiVis, enables automated VA self-assessment using standard digital devices. This study aims to compare its accuracy and reliability in children with clinical assessment by a healthcare professional.
Children aged 4-10 years were recruited from a paediatric ophthalmology service. Those with VA worse than +0.8 logMAR (Logarithm of the Minimum Angle of Resolution) or with cognitive impairment were excluded. Bland-Altman statistics were used to analyse both the accuracy and repeatability of VA self-testing. User feedback was collected by questionnaire.
The left eyes of 89 children (median 7 years) were tested. VA self-testing showed a mean bias of 0.023 logMAR, with a limit of agreement (LOA) of ±0.195 logMAR and an intraclass correlation coefficient (ICC) of 0.816. A second test was possible in 80 (90%) children. Test-retest comparison showed a mean bias of 0.010, with an LOA of ±0.179 logMAR, an ICC of 0.815 and a repeatability coefficient of 0.012. 96% of children rated the test as good or excellent, as did 99% of their parents.
Digital self-testing gave comparable distance VA assessments with clinical testing in children and was well accepted. Since DigiVis self-testing can be performed under direct supervision using medical video consultation software, it may be a useful tool to enable a proportion of paediatric eye clinic attendances to be moved online, reducing time off school and releasing face-to-face clinical capacity for those who need it.
在家中准确评估远视力（VA）存在困难，这限制了眼科远程会诊的实用性。一种新型网络应用程序DigiVis能够使用标准数字设备进行自动VA自我评估。本研究旨在比较其在儿童中与医疗保健专业人员进行的临床评估的准确性和可靠性。
从儿科眼科服务机构招募4至10岁的儿童。排除那些VA比+0.8 logMAR（最小分辨角对数）差或有认知障碍的儿童。使用Bland-Altman统计分析VA自我测试的准确性和可重复性。通过问卷调查收集用户反馈。
对89名儿童（中位数7岁）的左眼进行了测试。VA自我测试显示平均偏差为0.023 logMAR，一致性界限（LOA）为±0.195 logMAR，组内相关系数（ICC）为0.816。80名（90%）儿童可以进行第二次测试。重测比较显示平均偏差为0.010，LOA为±0.179 logMAR，ICC为0.815，重复性系数为0.012。96%的儿童将测试评为良好或优秀，其父母的这一比例为99%。
数字自我测试在儿童中给出的远视力评估结果与临床测试相当，并且被广泛接受。由于DigiVis自我测试可以使用医学视频会诊软件在直接监督下进行，它可能是一个有用的工具，使一部分儿科眼科门诊能够转移到线上，减少缺课时间，并为有需要的人释放面对面的临床服务能力。
