Citations 1
At‐home visual acuity in children using a custom iPhone application compared with standardized in‐office visual acuity testing
Roberts, Tawna L. , Bothun, Erick D. , Zhu, Yufeng, Henderson, Robert J. , Boyle, Nicole M, Leske, David A. , Wernimont, Suzanne M., Marino, Carrie E, Manh, Vivian M. , Youngerman, Jillian M, Qayum, Jennifer N, Srinivasan, Gayathri , Titelbaum, Jenna R. , Crouch, Eric R. , Colburn, Jeffrey, Esposito, Christina , Zeto, V Lori, Connolly, Katie, Bhakta, Rita M, Lorenzana, Ingryd J., McDowell, Paula, Beaulieu, Wesley T, Kraker, Raymond T, Holmes, Jonathan M, Pineles, Stacy L., Weise, Katherine K., Cotter, Susan A, Group, Pediatric Eye Disease Investigator, Beaulieu, Wesley T , Kraker, Raymond T , Hatt, Sarah R. , Raghuram, Aparna , McDowell, Paula S., Kraker, Raymond T. , Holmes, Jonathan M. , Cotter, Susan A.
Optometry and Vision Science | May 1, 2026 | Volume: 103 | Issue: 4 | Pages: No page available
ABSTRACT Purpose To validate a custom smartphone application for at‐home visual acuity (VA) measurement in children. Methods A total of 452 children aged 3–17.5 years participated. Certified examiners measured in‐office test–retest VA (logMAR) using gold‐standard Amblyopia Treatment Study HOTV (3‐to‐6‐year‐olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7‐to‐17.5‐year‐olds, older cohort) protocols at 3–4.5 m and app‐based VA at 1.5 m. Caregivers measured at‐home app‐based VA at 1.5 m. Results Comparing at‐home app‐based with gold‐standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = −0.03, older = −0.04; 95% limits‐of‐agreement half‐width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in‐office app‐based VA with gold‐standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = −0.03, older = −0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold‐standard test–retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15). Conclusions Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.