Wang Zheng, Kempen John, Luo Gang
School of Medicine, Jiaxing University, Jiaxing, China.
Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States.
JMIR Form Res. 2024 Apr 4;8:e55270. doi: 10.2196/55270.
While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge.
We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited.
A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel.
A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72-prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria).
The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas.
虽然屈光不正可治疗，但未经矫正的屈光不正是全球视力损害的首要原因。仅这种眼部疾病，或与眼球不正一起，还可导致弱视。弱视如果早期发现也可治疗，但仍在约4%的人群中发生。大规模视力筛查是解决这些问题的首要且最关键步骤，但由于资源有限，许多农村地区的视力筛查仍然是一项重大挑战。
我们旨在试点测试在眼科护理服务有限的地区使用智能手机应用程序加强视力筛查的可行性。
在中国四川省一个农村县的慈善夏令营项目中附带开展了一项视力筛查项目。共有73名四年级和五年级学生使用标准视力表进行了视力测试，然后由非专业人员使用2款智能手机应用程序（一款验光应用程序和一款斜视应用程序）分别对他们进行屈光不正和隐斜视测试。
73名学生中共有5名（6.8%，95%CI 2.3%-15.3%）至少一只眼睛的视力低于20/20（最小分辨角对数[logMAR]0）。在这5名学生中，根据验光应用程序，3名主要存在屈光不正。根据斜视应用程序，另外2名学生有明显斜视（一名有72棱镜度[PD]内斜视，一名有33-PD外斜视）。对于没有明显斜视的学生，还使用斜视应用程序的遮盖/去遮盖模式测量了隐斜。隐斜的中位数为0.0-PD（四分位距为2.9-PD内隐斜至2.2-PD外隐斜）。
这项视力筛查研究的结果与其他基于人群的视力筛查研究结果一致，后者使用传统工具由眼科专业人员进行。智能手机应用程序很有前景，有可能用于大规模视力筛查以识别弱视风险因素和控制近视。智能手机应用程序可能对低成本视力保健的未来产生重大影响，特别是在资源有限和地理位置偏远的地区。
