Validity of at Home Visual Acuity Measurements for Telemedicine During Corona Virus (COVID-19) Pandemic
Condition: Visual Impairment
MeSH terms: Coronavirus Infections; Vision Disorders; Vision, Low
Study type: Observational

Summary: 
      Prompted by the current COVID-19 pandemic, the American Academy of Ophthalmology has
      recommended the use of telemedicine to continue ophthalmic care while maintaining patient and
      provider social distancing. As part of remote examinations, patients may be expected to
      perform home eye testing for visual acuity and the use of various home visual acuity charts
      have been proposed to provide clinicians with this vital data. However, the use of home
      visual acuity exams has not been validated in our patient population. This project aims to
      determine the efficacy and validity of measuring visual acuity at home with a printed-out
      ETDRS chart.
    

Detailed description: 
      Project Title Validity of Home Visual Acuity Measurements with an ETDRS Chart

      Project Summary Prompted by the current COVID-19 pandemic, the American Academy of
      Ophthalmology has recommended the use of telemedicine to continue ophthalmic care while
      maintaining patient and provider social distancing. As part of remote examinations, patients
      may be expected to perform home eye testing for visual acuity and the use of various home
      visual acuity charts have been proposed to provide clinicians with this vital data. However,
      the use of home visual acuity exams has not been validated in our patient population. This
      project aims to determine the efficacy and validity of measuring visual acuity at home with a
      printed-out ETDRS chart.

      Project Description Rationale: Many ophthalmology visits are being conducted remotely via
      telehealth. The use of home ETDRS charts is being proposed for patients to report their
      visual acuity. However, the efficacy and validity of this method in our population should be
      determined.

      Objective: Determine the efficacy and validity of measuring visual acuity at home with a
      printed-out ETDRS chart in the population served by Vanderbilt Eye Institute. Our hypothesis
      is that measuring visual acuity at home with a printed-out ETDRS is non-inferior to visual
      acuity measurements by a trained technician in the clinic.

      Methodology: The study population will include patients scheduled for in-person visits for
      various subspecialties (Glaucoma, Retina/Uveitis, Pediatrics and Cornea) at Vanderbilt Eye
      Institute's (VEI) Nashville campus during the period of 4/27/20-5/27/20. Patients will be
      excluded if they have a last best corrected visual acuity worse than 20/200, have not
      activated a My Health at Vanderbilt (MHAV) account, or do not speak English. Patients will
      also need to be between the ages of 18-90 to Approximately one week prior to their
      appointments, patients will be called to obtain e-consent and provide detailed instructions
      for measuring best corrected visual acuity at home with the ETDRS chart that is calibrated
      for 5 feet. Instructions will also be sent via MHAV along with the ETDRS chart and the
      consent form. Data collected will include age, sex, and primary ophthalmological diagnosis as
      well as last measured Snellen visual acuity (+/-3months). The department, provider, and date
      of the in-person appointment will also be collected. Patients will be instructed to complete
      a home visual acuity check two-four days prior to appointment and send a message through MHAV
      with the results. Participants will record the smallest full line ( 5 letters) in each eye
      that they can read. If a message is not received two days prior to the appointment, a
      research assistant will call the patient back to reconfirm the plan. At the in-person visit,
      patients will begin their encounter with an ETDRS assessment at VEI, using the ETDRS chart at
      20 feet. Again, the full line of 5 letters read will be used for analysis. Patients will
      receive a survey to be completed in clinic with a 5-point Likert scale to rate the ease of
      home visual acuity as well as a short response question about barriers to assessment.

      Data Management and Analysis: Data will be collected from the electronic health record (EHR)
      and kept in a password-protected deidentified Excel document. Visual acuities will be
      converted to logMAR for analysis.

      Ethical Considerations: There are no ethical considerations to report.

      Barriers to Home Visual acuity testing

        -  Poor/no access to the technical requirements - computer, printer, internet

        -  Do not feel confident of being able to test vision accurately at home

        -  Attempted to test vision at home but was unable to follow instructions completely

        -  Do not want to try it at home, medical procedures should be done in a clinic

        -  Vision too poor to perform these tasks

      The Home visual acuity test was easy to set up and perform

        1. Strongly disagree

        2. Disagree

        3. Neither agree nor disagree

        4. Agree

        5. Strongly agree
    

Intervention name(s): Non invasive visual acuity testing
Intervention type(s): Other
Intervention description(s): This will be visual acuity at home and visual acuity in clinic both using an ETDRS chart.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population will include patients scheduled for in-person visits for various
        subspecialties (Glaucoma, Retina/Uveitis, pediatrics and Cornea) at Vanderbilt Eye
        Institute's (VEI) Nashville campus during the period of 4/27/20-5/8/20.

        Between the ages of 18-90.
      
Keywords: ETDRS Visual acuity