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Testing Pediatric Acuity With an iPad: Validation of "Peekaboo Vision" in Malawi and the UK
Iain Livingstone1,2, Laura Butler3, Esther Misanjo4,5
1Falkirk Community Hospital, NHS Forth Valley, Falkirk, UK.
Insights
The Peekaboo Vision (PV) digital acuity test shows results comparable to traditional methods in infants across Malawi and the UK. PV offers improved repeatability and shorter testing times, enhancing infant vision screening accessibility.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Digital Health
Background:
- Accurate visual acuity testing in infants is crucial for early detection of vision impairments.
- Traditional methods like Keeler Acuity Cards for Infants (KACI) can be time-consuming and require specific settings.
- Digital health solutions offer potential for more accessible and efficient vision screening.
Purpose of the Study:
- To evaluate the performance of two builds of the "Peekaboo Vision" (PV) digital grating acuity test.
- To compare PV with the Keeler Acuity Cards for Infants (KACI) in young children (6-60 months).
- To assess PV's reliability, repeatability, and efficiency in diverse hospital settings (Malawi and UK).
Main Methods:
- Two studies were conducted in Malawi (N=58) and the UK (N=60) with infants aged 6-60 months.
- Visual acuity was measured using both PV and KACI, with test-retest reliability assessed.
- Bland-Altman analysis was used to compare agreement and repeatability between the two tests. Child engagement and test duration were also compared.
Main Results:
- PV demonstrated comparable results to KACI, with slight mean differences in logMAR (0.02 in Malawi, 0.01 in UK).
- PV showed better test-retest repeatability with narrower limits of agreement and lower coefficient of repeatability in both studies.
- PV testing was approximately one minute shorter than KACI, and showed higher child engagement in the Malawi study.
Conclusions:
- The "Peekaboo Vision" (PV) digital acuity test provides reliable and comparable results to KACI in pediatric populations.
- PV offers advantages in repeatability and test duration, making it a potentially more efficient screening tool.
- Tablet-based vision testing like PV can extend reliable infant acuity assessment to diverse settings, improving accessibility and reducing costs.
Purpose:
To evaluate two builds of the digital grating acuity test, "Peekaboo Vision" (PV), in young (6-60 months) populations in two hospital settings (Malawi and United Kingdom).
Methods:
Study 1 evaluated PV in Blantyre, Malawi (N = 58, mean age 33 months); study 2 evaluated an updated build in Glasgow, United Kingdom (N = 60, mean age 44 months). Acuities were tested-retested with PV and Keeler Acuity Cards for Infants (KACI). Bland-Altman techniques were used to compare results and repeatability. Child engagement was compared between groups. Study 2 included test-time comparison.
Results:
Study 1 (Malawi): The mean difference between PV and KACI was 0.02 logMAR with 95% limits of agreement (LoA) of 0.33 to 0.37 LogMAR. On test-retest, PV demonstrated 95% LoA of -0.283 to 0.198 logMAR with coefficient of repeatability (CR) 0.27. KACI demonstrated 95% LoA of -0.427 to 0.323 logMAR, and larger CR was 0.37. PV evidenced higher engagement scores than KACI (P = 0.0005). Study 2 (UK): The mean difference between PV and KACI was 0.01 logMAR; 95% LoA was -0.413 to 0.437 logMAR. Again, on test-retest, PV had narrower LoA (-0.344 to 0.320 logMAR) and lower CR (0.32) versus KACI, with LoA -0.432 to 0.407 logMAR, CR 0.42. The two tests did not differ in engagement score (P = 0.5). Test time was ∼1 minute shorter for PV (185 vs. 251 s, P = 0.0021).
Conclusions:
PV gives comparable results to KACI in two pediatric populations in two settings, with benefits in repeatability indices and test duration.
Translational Relevance:
Leveraging tablet technology extends reliable infant acuity testing to bedside, home, and rural settings, including areas where traditional equipment cannot be financed.