Casey Eye Institute, Oregon Health & Science University, Portland.
JAMA Ophthalmol. 2022 May 1;140(5):465-471. doi: 10.1001/jamaophthalmol.2022.0396.
Visual acuity (VA) is one of the most important clinical data points in ophthalmology. However, few options for validated at-home VA assessments are currently available.
To validate 3 at-home visual acuity tests in comparison with in-office visual acuity.
DESIGN, SETTING, AND PARTICIPANTS: Between July 2020 and April 2021, eligible participants with VA of 20/200 or better were recruited from 4 university-based ophthalmology clinics (comprehensive, cornea, glaucoma, and retina clinics). Participants were prospectively randomized to self-administer 2 of 3 at-home VA tests (printed chart, mobile phone app, and website) within 3 days before their standard-of-care clinic visit. Participants completed a survey assessing usability of the at-home tests. At the clinic visit, best-corrected Snellen distance acuity was measured as the reference standard.
The at-home VA test results were compared with the in-office VA test results using paired and unpaired t tests, Pearson correlation coefficients, analysis of variance, χ2 tests, and Cohen κ agreement. The sensitivity, specificity, positive predictive value, and negative predictive value of each at-home test were calculated to detect significant VA changes (≥0.2 logMAR) from the in-office baseline.
A total of 121 participants with a mean (SD) age of 63.8 (13.0) years completed the study. The mean in-office VA was 0.11 logMAR (Snellen equivalent 20/25) with similar numbers of participants from the 4 clinics. Mean difference (logMAR) between the at-home test and in-office acuity was -0.07 (95% CI, -0.10 to -0.04) for the printed chart, -0.12 (95% CI, -0.15 to -0.09) for the mobile phone app, and -0.13 (95% CI, -0.16 to -0.10) for the website test. The Pearson correlation coefficient for the printed chart was 0.72 (95% CI, 0.62-0.79), mobile phone app was 0.58 (95% CI, 0.46-0.69), and website test was 0.64 (95% CI, 0.53-0.73).
The 3 at-home VA test results (printed chart, mobile phone app, and website) appeared comparable within 1 line to in-office VA measurements. Older participants were more likely to have limited access to digital tools. Further development and validation of at-home VA testing modalities is needed with the expansion of teleophthalmology care.
视力（VA）是眼科学中最重要的临床数据点之一。然而，目前可供验证的家庭 VA 评估方法很少。
将 3 种家庭视力测试与门诊视力进行比较。
设计、设置和参与者：2020 年 7 月至 2021 年 4 月期间，从 4 家大学眼科诊所（综合、角膜、青光眼和视网膜诊所）招募了视力为 20/200 或更好的合格参与者。参与者被前瞻性随机分配在标准护理就诊前 3 天内自行进行 3 种家庭 VA 测试中的 2 种（印刷图表、手机应用程序和网站）。参与者完成了一项评估家庭测试可用性的调查。在就诊时，使用最佳矫正距离视力（Snellen 视力）作为参考标准。
使用配对和非配对 t 检验、Pearson 相关系数、方差分析、χ2 检验和 Cohen κ 一致性，比较家庭 VA 测试结果和门诊 VA 测试结果。计算每个家庭测试检测门诊基线时视力显著变化（≥0.2 logMAR）的敏感性、特异性、阳性预测值和阴性预测值。
共有 121 名平均（SD）年龄为 63.8（13.0）岁的参与者完成了研究。门诊 VA 平均为 0.11 logMAR（Snellen 等效值为 20/25），来自 4 家诊所的参与者数量相似。印刷图表的家庭测试与门诊视力的平均差异（logMAR）为-0.07（95%CI，-0.10 至-0.04），手机应用程序为-0.12（95%CI，-0.15 至-0.09），网站测试为-0.13（95%CI，-0.16 至-0.10）。印刷图表的 Pearson 相关系数为 0.72（95%CI，0.62-0.79），手机应用程序为 0.58（95%CI，0.46-0.69），网站测试为 0.64（95%CI，0.53-0.73）。
3 种家庭 VA 测试结果（印刷图表、手机应用程序和网站）与门诊 VA 测量结果在 1 行内似乎相当。年龄较大的参与者可能更难以获得数字工具。随着远程眼科学护理的扩展，需要进一步开发和验证家庭 VA 测试模式。
