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Evaluating a web-based visual acuity and refractive error self-assessment tool in myopic children
Janneau L J Claessens1, Marloes A Janssen1, Casper van der Zee1
1Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
Home-based vision tests for children show good accuracy for visual acuity (VA) but overestimate myopia progression. Further calibration is needed for refractive error assessments in pediatric myopia management.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Digital Health
Background:
- Growing demand for myopia management necessitates innovative solutions.
- Web-based tools for self-assessment of visual acuity (VA) and refractive error show promise for hybrid care models.
- Previous validation in adults, but not yet evaluated in myopic children.
Purpose of the Study:
- To compare home-performed VA and refraction self-assessments with conventional clinical measurements in myopic children.
- To evaluate the agreement and repeatability of a web-based eye testing tool.
- To identify associations between clinical characteristics and the accuracy of web-based tests.
Main Methods:
- 147 myopic children (aged ≥6 years) performed web-based eye tests at home with parental assistance.
- Clinical measurements included Snellen chart VA and cycloplegic autorefraction.
- Analysis focused on agreement, repeatability, and accuracy of the web-based tool.
Main Results:
- 116 children completed the study (mean age 13 years, mean SEQ -5.58 D).
- Home-based VA self-assessment showed good agreement with clinical Snellen chart testing (mean difference 0.03 logMAR).
- The web-based refractive error algorithm overestimated myopia progression (mean difference SEQ 0.40 D).
Conclusions:
- Web-based self-assessment of VA in children offers precision comparable to clinical settings.
- The refractive error algorithm requires recalibration for accurate myopia progression monitoring in children.
- Home-based tools can support hybrid care pathways for pediatric myopia management.
Introduction:
Demands for myopia management are rising. A web-based tool that allows home-performed self-assessments of visual acuity (VA) and refractive error may enable hybrid care pathways and aid in identifying those with deteriorating visual performance. The tool has been validated in adult populations, but has yet to be evaluated in children. This study compared home-performed VA and refraction self-assessments to conventional measurements obtained at the clinic in a population of myopic children.
Methods:
Myopic children aged ≥6 years old were invited to perform web-based eye tests at home, assisted by a parent. At two myopia control clinics, they also underwent measurements of VA using a Snellen chart and refractive error using cycloplegic autorefraction. Agreement between the tests, repeatability of the web-based test and associations between clinical characteristics and web-based test accuracy were evaluated.
Results:
A total of 147 children were enrolled, of whom 116 (51% male; mean age 13 ± 3 years; mean spherical equivalent refraction (SEQ) -5.58 ± 3.05) performed the web-based tests at home. Overall, the home-performed VA self-assessment and the Snellen chart assessment at the clinic agreed well (mean difference 0.03 ± 0.11 logMAR). A significant proportional bias was identified (β 0.65, p < 0.001), indicating underestimated web-based VA scores when the child's vision declined. The sensitivity to detect VA poorer than 0.10 logMAR was 94%; the specificity was 71%. The web-based refractive error algorithm measured more myopia progression compared to clinic observations (mean difference SEQ 0.40 ± 0.51 dioptres). Age, sex or use of atropine drops were not significantly associated with test accuracy.
Conclusions:
The web-based test for self-assessing vision, performed at home by children with assistance from their parents, yielded VA scores with a precision similar to Snellen chart testing conducted in a clinical setting. However, the web-based refractive error algorithm overestimated myopia progression and requires recalibration for this specific age group.
