Children’s visual acuity tests at home: A prospective repeated measures study

Background Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of a variety of patients. Home tests may have further utility in giving service users frequent updates of vision outcomes during therapy, identifying vision problems in an asymptomatic population, and engaging stakeholders in therapy. The accuracy of home vision tests for children when completed without supervision from a professional is unknown. Methods Children attending outpatient clinics had their visual acuity measured 3 times in a randomised order at the same appointment. Once by a registered orthoptist as per standard clinical protocols, once by an orthoptist using a tablet-based visual acuity test (iSight Pro, Kay Pictures), and once by an unsupervised parent or carer using the tablet-based test. Results 42 children were recruited to the study. The mean age was 5.6 years (range 3.3 to 9.3 years). Median measurements (interquartile range) for clinical standard, orthoptic-led and parent/carer-led iSight visual acuity measurements were 0.155 (0.18), 0.180 (0.26), and 0.300 (0.33) respectively. The iSight app in the hands of parents/carers was significantly different from the standard of care measurements (P=0.009). In the hands of orthoptists, there was no significant difference between the iSight app and standard of care (P=0.551), nor was there significant difference between parents/carers using the app and orthoptists using the app (P=0.133). Conclusion This technique of unsupervised home visual acuity measures for children is not comparable to clinical measures and is unlikely to be valuable to clinical decision making and screening. Future work should focus on improving the technique through, for example, gamification of vision tests. What is already known on this topic? Children’s game visual acuity tests could improve things for hospital services and patients. The tablet-based tests are accurate when used by professionals to tests adults’ vision. What this study adds This study provides data about the accuracy of home tests when used by untrained parents or carers on their children. How this study might affect research, practice, or policy Current policy recommends apps home tests are not used to test children’s eyes for clinical decision-making purposes. Our data supports this policy and highlights the need for future research to focus on improving the tests. Synopsis / precis (“At a glance”) Visual acuity testing at home could improve patient care and reduce clinical visits, but data to show clinicians that they can rely upon the results in children are lacking. Our study shows the tests cannot be relied upon for clinical purposes. Improvements to the tests are required before they become useful and can be implemented into practice. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement DO is funded by a National Institute for Health Research Pre-doctoral Clinical Academic Fellowship and equipment for the study was purchased by Gift of Sight (Southampton, UK). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study adhered to the tenets of the Declaration of Helsinki. The study was approved by the NHS Health Research Authority (HRA) and an NHS Research Ethics Committee (Queen Square NHS REC, Reference: 20/HRA/2585). Parents or carers gave written informed consent for their child to take part in the study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors