Assessment of Visual Acuity and Stereopsis in Older Adults: A Comparison Between a Screening Application and Clinical...

Background and Objectives: Visual impairment and reduced stereovision significantly impact the quality of life and increase fall risk in older adults. While standard clinical assessment of visual functions is essential in this population, its use is often limited by the need for specialized equipment and trained personnel. Tablet-based screening tools offer a practical alternative but require clinical validation. This study aimed to assess the agreement, reliability, and diagnostic performance of a tablet-based screening application (index methods) compared to established clinical reference methods for assessing visual acuity (VA) and stereovision (SV) in adults over 60 years. Materials and Methods: This prospective, non-blinded, cross-sectional, feasibility study included two cohorts: a test-retest group of 24 older adults assessed twice within 7 days, and a clinical cross-sectional group of 135 participants recruited from primary care practices. VA was measured using tablet-based Landolt C test and compared with an ETDRS-style chart, while stereovision was assessed using tablet-based static and dynamic random dot stereograms and compared with the TNO stereotest. Agreement and reliability were evaluated using Bland-Altman analysis, intraclass correlation coefficients (ICC), and receiver operating characteristic (ROC) curves. Results: The index VA method demonstrated good test-retest reliability (ICC = 0.79) with no significant difference between repeated measurements. In the clinical cross-sectional group, visual acuity measurements showed a small mean bias (0.022 logMAR) between the index and reference methods, which remained within clinically acceptable limits, particularly in the intermediate acuity range. For stereovision, the index SV tests showed high test-retest agreement. Using a TNO cutoff of 480 arcsec, the index SV method demonstrated good diagnostic accuracy (AUC 0.87 for static and 0.85 for dynamic stimuli) with high sensitivity for detecting impaired stereovision. Conclusions: The tablet-based index method provided reliable and clinically comparable results for VA and SV assessments in older adults, supporting its potential use as a screening tool in primary care and community-based settings.