School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom.
Corpus Christi College, University of Cambridge, Cambridge, United Kingdom.
PLoS One. 2023 Jun 22;18(6):e0281847. doi: 10.1371/journal.pone.0281847. eCollection 2023.
Remote self-administered visual acuity (VA) tests have the potential to allow patients and non-specialists to assess vision without eye health professional input. Validation in pragmatic trials is necessary to demonstrate the accuracy and reliability of tests in relevant settings to justify deployment. Here, published pragmatic trials of these tests were synthesised to summarise the effectiveness of available options and appraise the quality of their supporting evidence.
A systematic review was undertaken in accordance with a preregistered protocol (CRD42022385045). The Cochrane Library, Embase, MEDLINE, and Scopus were searched. Screening was conducted according to the following criteria: (1) English language; (2) primary research article; (3) visual acuity test conducted out of eye clinic; (4) no clinical administration of remote test; (5) accuracy or reliability of remote test analysed. There were no restrictions on trial participants. Quality assessment was conducted with QUADAS-2.
Of 1227 identified reports, 10 studies were ultimately included. One study was at high risk of bias and two studies exhibited concerning features of bias; all studies were applicable. Three trials-of DigiVis, iSight Professional, and Peek Acuity-from two studies suggested that accuracy of the remote tests is comparable to clinical assessment. All other trials exhibited inferior accuracy, including conflicting results from a pooled study of iSight Professional and Peek Acuity. Two studies evaluated test-retest agreement-one trial provided evidence that DigiVis is as reliable as clinical assessment. The three most accurate tests required access to digital devices. Reporting was inconsistent and often incomplete, particularly with regards to describing methods and conducting statistical analysis.
Remote self-administered VA tests appear promising, but further pragmatic trials are indicated to justify deployment in carefully defined contexts to facilitate patient or non-specialist led assessment. Deployment could augment teleophthalmology, non-specialist eye assessment, pre-consultation triage, and autonomous long-term monitoring of vision.
远程自我管理的视力（VA）测试有可能使患者和非专业人员无需眼科专业人员的输入即可评估视力。在实际试验中进行验证对于证明相关设置中测试的准确性和可靠性是必要的，以证明其部署的合理性。在这里，综合了这些测试的已发表的实用试验，以总结现有选择的有效性，并评估其支持证据的质量。
根据预先注册的方案（CRD42022385045）进行了系统评价。检索了 Cochrane 图书馆、Embase、MEDLINE 和 Scopus。筛选标准如下：（1）英语语言；（2）原始研究文章；（3）在眼科诊所外进行的视力测试；（4）远程测试无临床管理；（5）分析远程测试的准确性或可靠性。试验参与者没有限制。使用 QUADAS-2 进行质量评估。
在 1227 份确定的报告中，最终纳入了 10 项研究。一项研究存在较高的偏倚风险，两项研究存在偏倚的相关特征；所有研究均适用。两项研究中的三项试验（DigiVis、iSight Professional 和 Peek Acuity）来自两项研究，表明远程测试的准确性与临床评估相当。所有其他试验的准确性都较差，包括 iSight Professional 和 Peek Acuity 的汇总研究中存在相互矛盾的结果。两项研究评估了测试-再测试的一致性-一项研究表明 DigiVis 与临床评估一样可靠。三个最准确的测试需要访问数字设备。报告不一致且常常不完整，尤其是在描述方法和进行统计分析方面。
远程自我管理的 VA 测试似乎很有前途，但需要进一步的实用试验来证明在精心定义的情况下部署的合理性，以促进患者或非专业人员主导的评估。部署可以增强远程眼科、非专业人员眼部评估、预咨询分诊和视力的自主长期监测。
