scholarly journals Validation of an Independent Web-Based Tool for Measuring Visual Acuity and Refractive Error (the Manifest versus Online Refractive Evaluation Trial): Prospective Open-Label Noninferiority Clinical Trial. (Preprint)

2019 ◽  
Author(s):  
Robert P L Wisse ◽  
Marc B Muijzer ◽  
Francesco Cassano ◽  
Daniel A Godefrooij ◽  
Yves F D M Prevoo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Visual Acuity ◽  
Healthy Volunteers ◽  
Refractive Error ◽  
Reference Test ◽  
Open Label ◽  
Web Based ◽  
Corrected Visual Acuity ◽  
Manifest Refraction ◽  
The Web

BACKGROUND Digital tools provide a unique opportunity to increase access to eye care. We developed a Web-based test that measures visual acuity and both spherical and cylindrical refractive errors. This test is Conformité Européenne marked and available on the Easee website. The purpose of this study was to compare the efficacy of this Web-based tool with traditional subjective manifest refraction in a prospective open-label noninferiority clinical trial. OBJECTIVE The aim of this study was to evaluate the outcome of a Web-based refraction compared with a manifest refraction (golden standard). METHODS Healthy volunteers from 18 to 40 years of age, with a refraction error between –6 and +4 diopter (D), were eligible. Each participant performed the Web-based test, and the reference test was performed by an optometrist. An absolute difference in refractive error of <0.5 D was considered noninferior. Reliability was assessed by using an intraclass correlation coefficient (ICC). Both uncorrected and corrected visual acuity were measured. RESULTS A total of 200 eyes in 100 healthy volunteers were examined. The Web-based assessment of refractive error had excellent correlation with the reference test (ICC=0.92) and was considered noninferior to the reference test. Uncorrected visual acuity was similar with the Web-based test and the reference test (<italic>P</italic>=.21). Visual acuity was significantly improved using the prescription obtained by using the Web-based tool (<italic>P</italic><.01). The Web-based test provided the best results in participants with mild myopia (ie, <3 D), with a mean difference of 0.02 (SD 0.49) D (<italic>P</italic>=.48) and yielding a corrected visual acuity of >1.0 in 90% (n=77) of participants. CONCLUSIONS Our results indicate that Web-based eye testing is a valid and safe method for measuring visual acuity and refractive error in healthy eyes, particularly for mild myopia. This tool can be used for screening purposes, and it is an easily accessible alternative to the subjective manifest refraction test. CLINICALTRIAL Clinicaltrials.gov NCT03313921; https://clinicaltrials.gov/ct2/show/NCT03313921.

scholarly journals Validation of an Independent Web-Based Tool for Measuring Visual Acuity and Refractive Error (the Manifest versus Online Refractive Evaluation Trial): Prospective Open-Label Noninferiority Clinical Trial.

10.2196/14808 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e14808 ◽  
Author(s):  
Robert P L Wisse ◽  
Marc B Muijzer ◽  
Francesco Cassano ◽  
Daniel A Godefrooij ◽  
Yves F D M Prevoo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Visual Acuity ◽  
Healthy Volunteers ◽  
Refractive Error ◽  
Reference Test ◽  
Open Label ◽  
Web Based ◽  
Corrected Visual Acuity ◽  
Manifest Refraction ◽  
The Web

Background Digital tools provide a unique opportunity to increase access to eye care. We developed a Web-based test that measures visual acuity and both spherical and cylindrical refractive errors. This test is Conformité Européenne marked and available on the Easee website. The purpose of this study was to compare the efficacy of this Web-based tool with traditional subjective manifest refraction in a prospective open-label noninferiority clinical trial. Objective The aim of this study was to evaluate the outcome of a Web-based refraction compared with a manifest refraction (golden standard). Methods Healthy volunteers from 18 to 40 years of age, with a refraction error between –6 and +4 diopter (D), were eligible. Each participant performed the Web-based test, and the reference test was performed by an optometrist. An absolute difference in refractive error of <0.5 D was considered noninferior. Reliability was assessed by using an intraclass correlation coefficient (ICC). Both uncorrected and corrected visual acuity were measured. Results A total of 200 eyes in 100 healthy volunteers were examined. The Web-based assessment of refractive error had excellent correlation with the reference test (ICC=0.92) and was considered noninferior to the reference test. Uncorrected visual acuity was similar with the Web-based test and the reference test (P=.21). Visual acuity was significantly improved using the prescription obtained by using the Web-based tool (P<.01). The Web-based test provided the best results in participants with mild myopia (ie, <3 D), with a mean difference of 0.02 (SD 0.49) D (P=.48) and yielding a corrected visual acuity of >1.0 in 90% (n=77) of participants. Conclusions Our results indicate that Web-based eye testing is a valid and safe method for measuring visual acuity and refractive error in healthy eyes, particularly for mild myopia. This tool can be used for screening purposes, and it is an easily accessible alternative to the subjective manifest refraction test. Trial Registration Clinicaltrials.gov NCT03313921; https://clinicaltrials.gov/ct2/show/NCT03313921.

scholarly journals The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: A method comparison study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256087
Author(s):  
Marc B. Muijzer ◽  
Janneau L. J. Claessens ◽  
Francesco Cassano ◽  
Daniel A. Godefrooij ◽  
Yves F. D. M. Prevoo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Mean Difference ◽  
Index Test ◽  
Spherical Equivalent ◽  
Reference Test ◽  
Web Based ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity ◽  
The Web

Purpose To evaluate the outcome of a web-based digital assessment of visual acuity and refractive error, compared to a conventional supervised assessment, in keratoconus patients with complex refractive errors. Material and methods Keratoconus patients, aged 18 to 40, with a refractive error between -6 and +4 diopters were considered eligible. An uncorrected visual acuity and an assessment of refractive error was taken web-based (index test) and by manifest refraction (reference test) by an optometrist. Corrected visual acuity was assessed with the prescription derived from both the web-based tool and the manifest refraction. Non-inferiority was defined as the 95% limits-of-agreement (95%LoA) of the differences in spherical equivalent between the index and reference test not exceeding +/- 0.5 diopters. Agreement was assessed by a Bland-Altman analyses. Results A total of 100 eyes of 50 patients were examined. The overall mean difference of the uncorrected visual acuity measured -0.01 LogMAR (95%LoA:-0.63–0.60). The variability of the differences decreased in the better uncorrected visual acuity subgroup (95%LoA:-0.25–0.55). The overall mean difference in spherical equivalent between the index and reference test exceeded the non-inferiority margin: -0.58D (95%LoA:-4.49–3.33, P = 0.008). The mean differences for myopic and hyperopic subjects were 0.09 diopters (P = 0.675) and -2.06 diopters (P<0.001), respectively. The corrected visual acuities attained with the web-based derived prescription underachieved significantly (0.22±0.32 logMAR vs. -0.01±0.13 LogMAR, P <0.001). Conclusions Regarding visual acuity, the web-based tool shows promising results for remotely assessing visual acuity in keratoconus patients, particularly for subjects within a better visual acuity range. This could provide physicians with a quantifiable outcome to enhance teleconsultations, especially relevant when access to health care is limited. Regarding the assessment of the refractive error, the web-based tool was found to be inferior to the manifest refraction in keratoconus patients. This study underlines the importance of validating digital tools and could serve to increase overall safety of the web-based assessments by better identification of outlier cases.

scholarly journals The evaluation of a web‐based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a prospective open‐label method comparison study

2021 ◽  
Author(s):  
Marc B Muijzer ◽  
Janneau L J Claessens ◽  
Francesco Cassano ◽  
Daniel A Godefrooij ◽  
Yves F D M Prevoo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Intraclass Correlation ◽  
Mean Difference ◽  
Spherical Equivalent ◽  
Reference Test ◽  
Web Based ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity ◽  
The Web

AbstractPurposeTo evaluate the outcome of a web‐based digital assessment of visual acuity and refractive error, compared to a manifest refraction assessment, in keratoconus patients with complex refractive errors.Material and methodsKeratoconus patients, aged 18 to 40, with a refractive error between ‐6 and +4 diopters were eligible. Each participant subsequently underwent an uncorrected visual acuity and a refractive assessment. Refractive error was assessed with the web‐based tool (index test), an autorefractor, and a manifest refraction (reference test) by an optometrist. Corrected visual acuity was assessed with the web‐based and manifest refractive prescription. Non‐inferiority was defined as the 95% limits‐of‐agreement (95%LoA) of the differences in spherical equivalent between the index and reference test not exceeding +/‐ 0.5 diopters. Agreement was assessed by an intraclass correlation coefficient and Bland‐Altman analyses.ResultsA total of 100 eyes of 50 patients were examined. The overall mean difference of the uncorrected visual acuity measured ‐0.01 LogMAR (95%LoA:‐0.63–0.60). The variability decreased in the high uncorrected visual acuity subgroup (mean difference: 0.15 LogMAR, 95%LoA:‐0.25–0.55). The intraclass correlation coefficient of the three refractive assessments was 0.32. The overall mean difference in spherical equivalent between the index and reference test measured ‐0.58 diopters (95%LoA:‐4.49 – 3.33, P=0.008). The mean differences for myopic and hyperopic subjects were 0.09 diopters (P=0.675) and ‐2.06 diopters (P<0.001), respectively.ConclusionsOur results show promising results in the ability of the web‐based tool to remotely assess visual acuity in keratoconus patients. The agreement is better in higher visual acuity ranges and could provide physicians with an objective measurement to enhance teleconsultations, especially relevant when access to health care is limited. The assessment of the refractive error using the web‐based tool was found to be inferior to the manifest refraction and deserves further training of the tools algorithm.

Hyperopia Correction Using an Erodible Mask Excimer Laser Delivery System Coupled to an Axicon: Preliminary Results

1997 ◽  
Vol 7 (3) ◽  
pp. 203-210 ◽  
Author(s):  
R. Brancato ◽  
F. Carones ◽  
A. Morico ◽  
E. Venturi ◽  
L. Vigo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Excimer Laser ◽  
Delivery System ◽  
Refractive Error ◽  
Large Area ◽  
Preliminary Results ◽  
Corrected Visual Acuity ◽  
Visual Acuity Loss ◽  
Age Range ◽  
Best Corrected Visual Acuity

Purpose. This paper presents the results of the first human trial on the correction of hyperopia using an erodible mask excimer laser delivery system coupled to an axicon. Methods. We treated 17 eyes of 17 patients (age range 34–62 years) for the correction of +3.21 ± 1.04 D (range +1.00 to +4.00 D). The hyperopic correction was made using an erodible mask inserted on the laser optical pathway, to produce a circular ablation measuring 6.5 mm in diameter. An axicon was then used to create a blend transition zone from 6.5 mm up to 9.4 mm in diameter. Eyes were evaluated at one, three and six months after surgery. Results. Reepithelization was always observed by the fifth postoperative day, despite the large area of deepithelization (diameter 9.5 mm). Mean refractive error one month after treatment was −2.44 ± 1.59 D (range 0.00 to −6.50 D). Five eyes (29.4%) had a best corrected visual acuity loss more than two to three lines; all eyes showed mild annular haze not involving the central part of the cornea. Six months after treatment, mean refractive error was −0.88 ± 0.99 D (range +0.50 to −3.00 D). Compared to preoperative status, 13 eyes (76.5%) showed an improvement in uncorrected distance visual acuity (1–8 lines), and 14 eyes (82.4%) showed an improvement in uncorrected vision at reading distance (3–7 lines). Two eyes (11.7%) showed a best corrected visual acuity loss of two of three lines. Conclusions. These preliminary results indicate this approach is effective in reducing hyperopia, while its predictability has still to be proved in a larger treatment group with longer follow-up. A cautious approach to this technique is still advisable, especially for higher hyperopic corrections, in view of the large best corrected visual acuity loss seen in two eyes at six months.

scholarly journals Corneal Cross-Linking for Progressive Keratoconus in Children: Our Experience

2012 ◽  
Vol 1 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Erez Bakshi ◽  
Yaniv Barkana ◽  
Yakov Goldich ◽  
Isaac Avni ◽  
David Zadok
Keyword(s):  
Visual Acuity ◽  
Medical Center ◽  
Statistical Significance ◽  
Cross Linking ◽  
Long Term Stability ◽  
Corrected Visual Acuity ◽  
Department Of Ophthalmology ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity

ABSTRACT Purpose To assess the effect of corneal cross-linking on progressive keratoconus in children. Method In this retrospective study we enrolled nine eyes of nine consecutive children aged 11 to 17 years old who underwent corneal riboflavin-UVA induced cross-linking for progressive keratoconus at the Department of Ophthalmology at Assaf Harofeh Medical Center. They were followed for 6 to 24 months (average 16 ± 8.1 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit lamp examination and corneal topography. Results Cross-linking resulted in stability of visual acuity in seven of the nine (77.8%) treated eyes. We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder. Furthermore, there was an improvement in spherical equivalent that was close to statistical significance (p = 0.07). There was 0.86 D reduction of average Kmax value postoperatively (p = 0.36). Most patients (7 of 9, 77.8%) showed a long-term stability or reduction in Kmax. Conclusion In this study, we demonstrated the efficacy of corneal cross-linking in arresting the progression of keratoconus in children. We believe that larger scale studies in this age group should be performed to further establish the relevance of this technique in children. How to cite this article Bakshi E, Barkana Y, Goldich Y, Avni I, Zadok D. Corneal Cross-Linking for Progressive Keratoconus in Children Our Experience. Int J Keratoco Ectatic Corneal Dis 2012;1(1):53-56.

scholarly journals The evaluation of a novel tool to remotely assess visual acuity in chronic uveitis patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
J.L.J. Claessens ◽  
J. van Egmond ◽  
J.H. de Boer ◽  
R.P.L. Wisse
Keyword(s):  
Visual Acuity ◽  
Healthy Population ◽  
Index Test ◽  
Cross Sectional ◽  
Web Based ◽  
Promising Tool ◽  
Accuracy Study ◽  
Visual Acuity Test ◽  
Acuity Test ◽  
The Web

AbstractBackgroundRestrictions due to the recent COVID-19 pandemic catalysed the deployment of telehealth solutions. A novel web‐based visual acuity test, validated in a healthy population, may be of great value in the follow‐up of uveitis patients.ObjectiveTo determine the measurement accuracy of the unsupervised remote Easee web‐based visual acuity test in uveitis patients, when compared to a conventional in‐hospital assessment.MethodsCross‐sectional diagnostic accuracy study. Between April 2020 and September 2020, consecutive adult uveitis patients were invited for the web‐based visual acuity test (index test) within two weeks prior to their conventional in‐hospital assessment (reference test).ResultsA total of 269 patients were invited by mail, of whom 84 visited the website (31%). Ultimately 98 eyes met the criteria for statistical analysis. The mean difference between the two tests was low and non‐significant: 0.02 logMAR (SD 0.12, P = 0.085). The 95% limits of agreement ranged from ‐0.21 to 0.26 logMAR. No relevant differences were identified in clinical characteristics between subgroups with a good performance (i.e. difference between the tests 0.15 logMAR) or underperformance (i.e. difference >0.15 logMAR) on the web‐based test.ConclusionThe web‐based visual acuity test is a promising tool to remotely assess visual acuity in the majority of uveitis patients, especially relevant when access to ophthalmic care is limited. No association between patient‐ or uveitis‐related variables and (under)performance of the test were identified. These outcomes underline the potential of remote vision testing in other common ophthalmic conditions. A proper implementation of this web‐based tool in health care could be of great value for revolutionizing teleconsultations.

scholarly journals Efficacy and Tolerability of a Combined Moxifloxacin/Dexamethasone Formulation for Topical Prophylaxis in Phacoemulsification: An Open-Label Single-Arm Clinical Trial

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Cesar Ramon G. Espiritu ◽  
Mary Ellen A. Sy ◽  
Tommee Lynne G. Tayengco
Keyword(s):  
Visual Acuity ◽  
Day Treatment ◽  
Prednisolone Acetate ◽  
Eye Drops ◽  
Infection Prophylaxis ◽  
Ocular Pain ◽  
Open Label ◽  
Iol Implantation ◽  
Asian Patients ◽  
Corrected Visual Acuity

Background. The use of a fixed-combination antibiotic corticosteroid for infection prophylaxis in Asian patients undergoing phacoemulsification has not been reported.Methods. A 15-day, open-label, single-arm trial of 64 patients for phacoemulsification with intraocular lens (IOL) implantation is described. Patients applied moxifloxacin 0.5%/dexamethasone 0.1% (Vigadexa) eye drops four times daily before and until 15 days after surgery. Anterior chamber (AC) reaction, visual acuity, ocular pain and signs, and intraocular pressure (IOP) were assessed at baseline and on postoperative days 1, 3, 8, and 15.Results. At day 15, 55 (91.7%) patients scored 0 (<5 cells) in AC reaction. No surgery-related infection occurred. Mean best-corrected visual acuity improved 0.5 logMAR from baseline to 0.0 logMAR (P<.0001). Mean IOP remained at 12-13 mm Hg over the 15-day treatment. Only 2 patients (3.1%) reported minimum ocular pain. Two (3.1%) patients were shifted to prednisolone acetate for severe inflammation. At the end of the study period, 8.3% were given fluorometholone for 1 week for AC reaction grade >0. No drug-related adverse event was reported.Conclusion. Following phacoemulsification and IOL implantation, the topical combination moxifloxacin 0.5%/dexamethasone 0.1% was effective in preventing infection and controlling inflammation and was well tolerated.

Use of new-generation hybrid contact lenses for managing challenging corneas

2020 ◽  
pp. 112067212094275
Author(s):  
Ibrahim Inan Harbiyeli ◽  
Elif Erdem ◽  
Puren Isik ◽  
Meltem Yagmur ◽  
Reha Ersoz
Keyword(s):  
Visual Acuity ◽  
Medical Records ◽  
Contact Lenses ◽  
Corrected Visual Acuity ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity ◽  
The Mean ◽  
New Generation ◽  
Generation Hybrid ◽  
Irregular Astigmatism

Introduction: To evaluate the safety and efficacy of new-generation hybrid contact lenses (HCL) among patients with irregular astigmatism. Methods: Medical records of 25 patients fit with new-generation HCL (Eyebrid® and AirFlex®) were retrospectively reviewed. The data collected included etiology of irregular astigmatism, uncorrected visual acuity, manifest refraction, spectacle-corrected visual acuity (S-CDVA), steep / flat keratometric values, corneal astigmatism, records of rigid / soft CL fitted before HCL, all parameters of the trial lenses, and the final prescribed HCL parameters and HCL-CDVA. Results: The study included 34 eyes from 25 patients (nine females and 16 males) with an average age of 29 ± 13 (ranging from 8–56) years. In total, 25 eyes with keratoconus, four with post - keratoplasty astigmatism, three with irregular astigmatism due to corneal trauma and two with residual astigmatism after radial keratotomy were fit with HCL. The mean S-CDVA (logMAR) improved significantly from 0.76 ± 0.41 to 0.14 ± 0.15 with HCL ( p < 0.01). The most common indication for HCL was inability to fit with rigid gas permeable (RGP) lenses (22 eyes). The average number of lenses to successful fit was 1.4 (mode, 1; median, 1) and ideal fit was achieved with the first trial lens in 25 eyes (73%). Seven patients (nine eyes, 36%) discontinued lens use within the first 6 months because of discomfort (six eyes, 24%), ocular allergy (two eyes, 8%) and tearing of contact lens (one eye, 4%). Discussion: New-generation HCL may be a suitable option for fitting challenging corneas with irregular astigmatism that cannot be rehabilitated efficiently with rigid lenses.

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