“Smart Optometry” phone-based application as a visual acuity testing tool among pediatric population

Lina H. Raffa; Nasser T. Balbaid; Mariam M. Ageel

doi:10.15537/smj.2022.43.8.20220374

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Figure 1
- Study flowchart visual acuity testing sequence.
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Figure 2
- Paired t-test between standard (S), application by clinician (AC), application by parent/caregiver (AP), and near (N) methods. NS: non-significant, ^*indicates significance
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Figure 3
- Bland Altman plots for limits of agreement between visual acuity tested with A) Smart Optometry and standard Snellen chart and B) near vision chart.

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Table 1

- Six pair comparison of 200 eyes of 100 patients between visual acuity measured by clinic-based VA (at near and distance) and “Smart Optometry” application.

Paired samples statistics		n	Mean ± SD	Mean difference	95% CI of the difference		P-value
Paired samples statistics		n	Mean ± SD	Mean difference	Lower	Upper	P-value
Pair 1	logMAR S	200	0.11 ± 0.2	-0.023	-0.041	-0.006	0.010^*
Pair 1	logMAR AC	200	0.13 ± 0.2	-0.023	-0.041	-0.006	0.010^*
Pair 2	logMAR S	94	0.06 ± 0.1	-0.013	-0.040	0.013	0.326
Pair 2	logMAR AP	94	0.08 ± 0.1	-0.013	-0.040	0.013	0.326
Pair 3	logMAR S	194	0.11 ± 0.2	-0.004	-0.021	0.013	0.634
Pair 3	logMAR N	194	0.12 ± 0.2	-0.004	-0.021	0.013	0.634
Pair 4	logMAR AC	94	0.09 ± 0.2	0.014	-0.007	0.034	0.184
Pair 4	logMAR AP	94	0.08 ± 0.1	0.014	-0.007	0.034	0.184
Pair 5	logMAR AC	194	0.13 ± 0.2	0.018	0.002	0.034	0.024^*
Pair 5	logMAR N	194	0.12 ± 0.2	0.018	0.002	0.034	0.024^*
Pair 6	logMAR AP	90	0.08 ± 0.1	0.004	-0.026	0.035	0.776
Pair 6	logMAR N	90	0.08 ± 0.1	0.004	-0.026	0.035	0.776

↵^* Significant using paired samples test at <0.05 level. CI: confidence interval, VA: visual acuity, n: number

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Table 2

- Sensitivity and specificity of “Smart Optometry” application (clinician-performed) in detecting subnormal vision in 100 patients.

	Subnormal vision in the conventional
Variables	Yes	No	Total	Predictive value	P-value
Variables	Subnormal vision in the application
Yes	25	22	47	PPV (95% CI) 53.2%	<0.001^*
No	3	50	53	NPV (95% CI) 94.3%	<0.001^*
Total	28	72	100
Properties	Sensitivity (95% CI) 89.3%	Specificity (95% CI) 69.4%

↵^* Significant using Chi-square test at <0.05 level. PPV: positive predictive value, NPV: negative predictive value

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Table 3

- Sensitivity and specificity of “Smart Optometry” application (clinician-performed) in detecting amblyopia.

	Amblyopia by conventional test				P-value
Variables	Yes	No	Total	Predictive value	P-value
Amblyopia by application
Yes	7	15	78	PPV (95% CI) 31.8%	0.001^*
No	5	73	22	NPV (95% CI) 93.6%	0.001^*
Total	12	88	100
Properties	Sensitivity (95% CI) 58.3%	Specificity (95% CI) 83.0%