eHealth tools for the self-testing of visual acuity: a scoping review

Wai Kent Yeung, Piers Dawes, Annie Pye, Malcolm Neil, Tariq Aslam, Christine Dickinson, Iracema Leroi, Wai Kent Yeung, Piers Dawes, Annie Pye, Malcolm Neil, Tariq Aslam, Christine Dickinson, Iracema Leroi

Abstract

Uncorrected refractive error is a major cause of vision impairment, and is indexed by visual acuity. Availability of vision assessment is limited in low/middle-income countries and in minority groups in high income countries. eHealth tools offer a solution; two-thirds of the globe own mobile devices. This is a scoping review of the number and quality of tools for self-testing visual acuity. Software applications intended for professional clinical use were excluded. Keyword searches were conducted on Google online, Google Play and iOS store. The first 100 hits in each search were screened against inclusion criteria. After screening, 42 tools were reviewed. Tools assessed near and distance vision. About half (n = 20) used bespoke optotypes. The majority (n = 25) presented optotypes one by one. Four included a calibration procedure. Only one tool was validated against gold standard measures. Many self-test tools have been published, but lack validation. There is a need for regulation of tools for the self-testing of visual acuity to reduce potential risk or confusion to users.

Keywords: Diagnosis; Neuroscience; Refractive errors; Vision disorders; Visual system.

Conflict of interest statement

Competing interestsThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow diagram indicating the tools search and screening process
Fig. 2
Fig. 2
Prisma flow diagram indicating attempts to contact and survey the tool developers for further information

References

    1. Flaxman Seth R, Bourne Rupert R A, Resnikoff Serge, Ackland Peter, Braithwaite Tasanee, Cicinelli Maria V, Das Aditi, Jonas Jost B, Keeffe Jill, Kempen John H, Leasher Janet, Limburg Hans, Naidoo Kovin, Pesudovs Konrad, Silvester Alex, Stevens Gretchen A, Tahhan Nina, Wong Tien Y, Taylor Hugh R, Bourne Rupert, Ackland Peter, Arditi Aries, Barkana Yaniv, Bozkurt Banu, Braithwaite Tasanee, Bron Alain, Budenz Donald, Cai Feng, Casson Robert, Chakravarthy Usha, Choi Jaewan, Cicinelli Maria Vittoria, Congdon Nathan, Dana Reza, Dandona Rakhi, Dandona Lalit, Das Aditi, Dekaris Iva, Del Monte Monte, deva Jenny, Dreer Laura, Ellwein Leon, Frazier Marcela, Frick Kevin, Friedman David, Furtado Joao, Gao Hua, Gazzard Gus, George Ronnie, Gichuhi Stephen, Gonzalez Victor, Hammond Billy, Hartnett Mary Elizabeth, He Minguang, Hejtmancik James, Hirai Flavio, Huang John, Ingram April, Javitt Jonathan, Jonas Jost, Joslin Charlotte, Keeffe Jill, Kempen John, Khairallah Moncef, Khanna Rohit, Kim Judy, Lambrou George, Lansingh Van Charles, Lanzetta Paolo, Leasher Janet, Lim Jennifer, LIMBURG Hans, Mansouri Kaweh, Mathew Anu, Morse Alan, Munoz Beatriz, Musch David, Naidoo Kovin, Nangia Vinay, Palaiou Maria, Parodi Maurizio Battaglia, Pena Fernando Yaacov, Pesudovs Konrad, Peto Tunde, Quigley Harry, Raju Murugesan, Ramulu Pradeep, Rankin Zane, Resnikoff Serge, Reza Dana, Robin Alan, Rossetti Luca, Saaddine Jinan, Sandar Mya, Serle Janet, Shen Tueng, Shetty Rajesh, Sieving Pamela, Silva Juan Carlos, Silvester Alex, Sitorus Rita S., Stambolian Dwight, Stevens Gretchen, Taylor Hugh, Tejedor Jaime, Tielsch James, Tsilimbaris Miltiadis, van Meurs Jan, Varma Rohit, Virgili Gianni, Wang Ya Xing, Wang Ning-Li, West Sheila, Wiedemann Peter, Wong Tien, Wormald Richard, Zheng Yingfeng. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health. 2017;5(12):e1221–e1234. doi: 10.1016/S2214-109X(17)30393-5.
    1. Tournier Marie, Moride Yola, Ducruet Thierry, Moshyk Andriy, Rochon Sophie. Depression and mortality in the visually-impaired, community-dwelling, elderly population of Quebec. Acta Ophthalmologica. 2008;86(2):196–201. doi: 10.1111/j.1600-0420.2007.01024.x.
    1. Gopinath Bamini, McMahon Catherine M., Burlutsky George, Mitchell Paul. Hearing and vision impairment and the 5-year incidence of falls in older adults. Age and Ageing. 2016;45(3):409–414. doi: 10.1093/ageing/afw022.
    1. Seland Johan H., Vingerling Johannes R., Augood Cristina A., Bentham Graham, Chakravarthy Usha, deJong Paulus T. V. M., Rahu Mati, Soubrane Gisele, Tomazzoli Laura, Topouzis Fotis, Fletcher Astrid E. Visual Impairment and quality of life in the Older European Population, the EUREYE study. Acta Ophthalmologica. 2009;89(7):608–613. doi: 10.1111/j.1755-3768.2009.01794.x.
    1. Rogers M. A. M., Langa K. M. Untreated Poor Vision: A Contributing Factor to Late-Life Dementia. American Journal of Epidemiology. 2010;171(6):728–735. doi: 10.1093/aje/kwp453.
    1. Carrière Isabelle, Delcourt Cécile, Daien Vincent, Pérès Karine, Féart Catherine, Berr Claudine, Laure Ancelin Marie, Ritchie Karen. A prospective study of the bi-directional association between vision loss and depression in the elderly. Journal of Affective Disorders. 2013;151(1):164–170. doi: 10.1016/j.jad.2013.05.071.
    1. Resnikoff Serge. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bulletin of the World Health Organization. 2008;86(1):63–70. doi: 10.2471/BLT.07.041210.
    1. Ferreyra Henry A. Management of Autoimmune Retinopathies With Immunosuppression. Archives of Ophthalmology. 2009;127(4):390. doi: 10.1001/archophthalmol.2009.24.
    1. World Health Organization. Draft action plan for the prevention of avoidable blindness and visual impairment 2014-2019. Towards universal eye health: a global action plan 2014–2019. Sixty-Sixth World Health Assembly (2013).
    1. Bourne Rupert R A, Stevens Gretchen A, White Richard A, Smith Jennifer L, Flaxman Seth R, Price Holly, Jonas Jost B, Keeffe Jill, Leasher Janet, Naidoo Kovin, Pesudovs Konrad, Resnikoff Serge, Taylor Hugh R. Causes of vision loss worldwide, 1990–2010: a systematic analysis. The Lancet Global Health. 2013;1(6):e339–e349. doi: 10.1016/S2214-109X(13)70113-X.
    1. Naidoo Kovin S., Leasher Janet, Bourne Rupert R., Flaxman Seth R., Jonas Jost B., Keeffe Jill, Limburg Hans, Pesudovs Konrad, Price Holly, White Richard A., Wong Tien Y., Taylor Hugh R., Resnikoff Serge. Global Vision Impairment and Blindness Due to Uncorrected Refractive Error, 1990–2010. Optometry and Vision Science. 2016;93(3):227–234. doi: 10.1097/OPX.0000000000000796.
    1. Sherwin Justin C, Lewallen Susan, Courtright Paul. Blindness and visual impairment due to uncorrected refractive error in sub-Saharan Africa: review of recent population-based studies. British Journal of Ophthalmology. 2012;96(7):927–930. doi: 10.1136/bjophthalmol-2011-300426.
    1. Sabanayagam Charumathi, Cheng Ching-Yu. Global causes of vision loss in 2015: are we on track to achieve the Vision 2020 target? The Lancet Global Health. 2017;5(12):e1164–e1165. doi: 10.1016/S2214-109X(17)30412-6.
    1. Naidoo, K. & Ravilla, D. Delivering refractive error services: primary eye care centres and outreach. Community Eye Health J.20, 42–44 (2007).
    1. Khandekar, R., Mohammed, A. J. & Al Raisi, A. Compliance of spectacle wear and its determinants among schoolchildren of Dhakhiliya region of Oman: a descriptive study. Sultan Qaboos Univ. Med. J. 4, 1–2 (2002).
    1. Vitale Susan, Cotch Mary Frances, Sperduto Robert D. Prevalence of Visual Impairment in the United States. JAMA. 2006;295(18):2158. doi: 10.1001/jama.295.18.2158.
    1. Varma Rohit, Wang Michelle Y., Ying-Lai Mei, Donofrio Jill, Azen Stanley P. The Prevalence and Risk Indicators of Uncorrected Refractive Error and Unmet Refractive Need in Latinos: The Los Angeles Latino Eye Study. Investigative Opthalmology & Visual Science. 2008;49(12):5264. doi: 10.1167/iovs.08-1814.
    1. Thiagalingam S. Factors associated with undercorrected refractive errors in an older population: the Blue Mountains Eye Study. British Journal of Ophthalmology. 2002;86(9):1041–1045. doi: 10.1136/bjo.86.9.1041.
    1. Dawes Piers, Dickinson Christine, Emsley Richard, Bishop Paul N., Cruickshanks Karen J., Edmondson-Jones Mark, McCormack Abby, Fortnum Heather, Moore David R., Norman Paul, Munro Kevin. Vision impairment and dual sensory problems in middle age. Ophthalmic and Physiological Optics. 2014;34(4):479–488. doi: 10.1111/opo.12138.
    1. Naël Virginie, Moreau Gwendoline, Monfermé Solène, Cougnard-Grégoire Audrey, Scherlen Anne-Catherine, Arleo Angelo, Korobelnik Jean-François, Delcourt Cécile, Helmer Catherine. Prevalence and Associated Factors of Uncorrected Refractive Error in Older Adults in a Population-Based Study in France. JAMA Ophthalmology. 2019;137(1):3. doi: 10.1001/jamaophthalmol.2018.4229.
    1. IQVIA Institute. The Growing Value of Digital Health in the United Kingdom. 1–40 (IQVIA Institute, Parsippany, NJ, 2017).
    1. GSMA Intelligence. Global Mobile Trends 2017. 1–105 (GSMA Intelligence, London, 2017).
    1. Hamilton A.D., Brady R.R.W. Medical professional involvement in smartphone ‘apps’ in dermatology. British Journal of Dermatology. 2012;167(1):220–221. doi: 10.1111/j.1365-2133.2012.10844.x.
    1. Rosser Benjamin A, Eccleston Christopher. Smartphone applications for pain management. Journal of Telemedicine and Telecare. 2011;17(6):308–312. doi: 10.1258/jtt.2011.101102.
    1. Rodrigues M. A., Visvanathan A., Murchison J. T., Brady R. R. Radiology smartphone applications; current provision and cautions. Insights into Imaging. 2013;4(5):555–562. doi: 10.1007/s13244-013-0274-4.
    1. Powell Adam C., Landman Adam B., Bates David W. In Search of a Few Good Apps. JAMA. 2014;311(18):1851. doi: 10.1001/jama.2014.2564.
    1. Medmont. AT20P Acuity Tester.
    1. Thomson Software Solutions. Vision Toolbox.
    1. Lennie, P. & Hemel, S. B. Van. Tests of Visual Functions. Vis. Impair. 10.17226/10320 (2002).
    1. World Health Organization. International statistical classification of diseases and related health problems (11th Revision). (World Health Organization, Geneva, 2018).
    1. Holladay Jack T., Msee Visual acuity measurements. Journal of Cataract & Refractive Surgery. 2004;30(2):287–290. doi: 10.1016/j.jcrs.2004.01.014.
    1. Jan-Bond, C. et al. REST—an innovative rapid eye screening. Test. J. Mob. Technol. Med.4, 20–25 (2015).
    1. Sastry, V., Shet, S., Jivangi, V., Katti, V. & Kanakpur, S. FP1078: RAPID EYE SCREENING TEST (REST)—MobiApp Based Visual Screening in Outreach Camps. In 76th Annual Conference of the All India Ophthalmological Society, 1–12 (2018).
    1. Huckvale, K., Adomaviciute, S., Prieto, J. T., Leow, M. K. S. & Car, J. Smartphone apps for calculating insulin dose: a systematic assessment. BMC Med. 10.1186/s12916-015-0314-7 (2015).
    1. Wolf Joel A., Moreau Jacqueline F., Akilov Oleg, Patton Timothy, English Joseph C., Ho Jonhan, Ferris Laura K. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatology. 2013;149(4):422. doi: 10.1001/jamadermatol.2013.2382.
    1. Steinhubl Steven R., Muse Evan D., Topol Eric J. Can Mobile Health Technologies Transform Health Care? JAMA. 2013;310(22):2395. doi: 10.1001/jama.2013.281078.
    1. Larson Richard S. A Path to Better-Quality mHealth Apps. JMIR mHealth and uHealth. 2018;6(7):e10414. doi: 10.2196/10414.
    1. Palmer Sean. Swipe Right for Health Care: How the State May Decide the Future of the mHealth App Industry in the Wake of FDA Uncertainty. Journal of Legal Medicine. 2017;37(1-2):249–263. doi: 10.1080/01947648.2017.1303289.
    1. Van Norman Gail A. Drugs and Devices. JACC: Basic to Translational Science. 2016;1(5):399–412.
    1. U.S. Food and Drug Administration. Mobile Medical Applications- Guidance for Industry and Food and Drug Administration Staff. 1, 1–44 (U.S. Food and Drug Administration, Maryland, USA, 2015).
    1. NHS. NHS Apps Library. . (2017).
    1. CMS. Clinical Laboratory Improvement Amendments. (1988)
    1. Yost Judith A. Laboratory Inspection: The View From CMS. Laboratory Medicine. 2003;34(2):136–140. doi: 10.1309/UV7DPF0U581Y2M8H.
    1. Cook Victoria E., Ellis Anne K., Hildebrand Kyla J. Mobile health applications in clinical practice: pearls, pitfalls, and key considerations. Annals of Allergy, Asthma & Immunology. 2016;117(2):143–149. doi: 10.1016/j.anai.2016.01.012.
    1. Rawstorn Jonathan C, Gant Nicholas, Meads Andrew, Warren Ian, Maddison Ralph. Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform. JMIR mHealth and uHealth. 2016;4(2):e57. doi: 10.2196/mhealth.5501.
    1. Parmanto, B., Pramana, G., Yu, D. X., Fairman, A. D. & Dicianno, B. E. Development of mHealth system for supporting self-management and remote consultation of skincare. BMC Med. Inform. Decis. Mak. 10.1186/s12911-015-0237-4 (2015).
    1. Sreelatha OK, Ramesh SV, Jose J, Devassy M, Srinivasan K. Virtually controlled computerised visual acuity screening in a multilingual Indian population. Rural Remote Health. 2014;14:2908.
    1. Statista. Apple App Store: Average app price 2018. (Statista, 2018)..
    1. Snyder Peter J., Jackson Colleen E., Petersen Ronald C., Khachaturian Ara S., Kaye Jeffrey, Albert Marilyn S., Weintraub Sandra. Assessment of cognition in mild cognitive impairment: A comparative study. Alzheimer's & Dementia. 2011;7(3):338–355. doi: 10.1016/j.jalz.2011.03.009.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe