Real-world evaluation of online visual acuity self-testing and remote consultation: three years of implementation experience in a paediatric ophthalmology service.

BACKGROUND/

OBJECTIVES

Our previous validation studies indicated that automated best corrected visual acuity (BCVA) testing using the DigiVis web application is comparable to standard testing. Here, we evaluate real-world experience of digital BCVA self-testing (DVA) and remote consultation (RC) in a paediatric ophthalmology service.

METHODS

Electronic records of children assigned follow up RC with home DVA testing for their routine clinical care between March 2021 and October 2024 were reviewed. Demographic and clinical features, test duration and usability scores were analysed. Serial BCVA and DVA results were compared using Bland Altman statistical methods. Clinical outcomes and service adaptations were assessed.

RESULTS

205 RC appointments with DVA testing were scheduled for children (aged 4-14, median 6 years). DVA results were available for 192 (93.7%) RCs, with 166 (86.5%) tests undertaken without clinical supervision. The mean bias between serial BCVA and DVA was 0.005 logMAR (p < 0.001) with upper and lower limits of agreement of +0.182 (95%CI: 0.169 to 0.195) and -0.173 (-0.186 to -0.160) logMAR respectively. Expedited follow-up face-to-face consultations (f2fC) were arranged for 13 families unwilling or unable to self-test, 5 children with poor concentration and 9 with self-detected deterioration of BCVA. Informative DVA results were available for 187 (91.2%) encounters. 116 (81.7%) of 142 families voluntarily completing Likert scoring rated the application good/excellent.

CONCLUSION

In this real-world evaluation, 91.2% of offered DVA tests were informative and contributed to clinical decision making. DVA correctly identified unexpected deterioration in 9 children supporting the utility of this innovative service model.