New technologies in paediatric acuity assessment

Livingstone, I.A.T. (2019) New technologies in paediatric acuity assessment. MD thesis, University of Glasgow.

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The present research has evaluated the utility of the computer tablet as a means to test vision in an infant population. The following points summarise the main findings:

Regards the physical properties of mobile tablet computer with reference to National and International Standards for Chart Design:

Photometric standards of luminance, contrast, and luminance uniformity are met more effectively by the range of iPads under test than by dedicated ETDRS (Early Treatment Diabetic Retinopathy Study) charts in active clinical use in a tertiary referral unit. The study met its aim of documenting the suitability of this mobile technology regards high contrast acuity standards, providing a practical guide to health care professionals working within eye care.
These standards were then, where possible, extended to card-based infant vision tests.

There are intrinsic advantages to digital platforms regards achieving a mean average luminance “grey” background relative to the black and white values of composite foreground gratings. There is marked heterogeneity across traditional card-based platforms regards luminance and contrast measurements relating to black, white and grey components.
These observations informed the design of a prototype build of a computer-tablet based infant acuity test, peekaboo vision (PVb1). This build was evaluated in a blurred adult cohort.

PVb1 performed well across a range of artificially degraded acuities, with observed potential benefits regards test-retest repeatability.

PVb1 was then evaluated in an infant population in rural Africa in a pilot study (Study 1). A subsequent formal build (PVi) was evaluated in a UK setting with a similar methodology (Study 2), comparing with Keeler Acuity Cards for Infants (KACI) as the reference standard.

Across Studies 1 and 2, the mean difference between reference standard and digital version was modest (-0.03 to 0.01), with notable differences in upper and lower limits of agreement in favour of the digital platform (exhibiting narrower LoA). Peekaboo Vision evidenced improved repeatability than KACI: coefficients of repeatability were 0.27 for Peekaboo Vision versus 0.37 for Keeler cards in study 1, and 0.32 for Peekaboo Vision versus 0.42 for Keeler cards in study 2. The mean time-to-test was over 1 minute shorter (by 26%) for Peekaboo Vision than for Keeler cards (p= 0.0021).

Item Type: Thesis (MD)
Qualification Level: Doctoral
Additional Information: Livingstone I A. T, Tarbert CM, Giardini ME, Bastawrous A, Middleton D, Hamilton R. Photometric Compliance of Tablet Screens and Retro-Illuminated Acuity Charts As Visual Acuity Measurement Devices. PLOS ONE. 2016 Mar 22;11(3) Livingstone I A T, Lok ASL, Tarbert C. New mobile technologies and visual acuity. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:2189–92. Livingstone I, Butler L, Misanjo E, Lok A, Middleton D, Wilson JW, et al. Testing Pediatric Acuity With an iPad: Validation of “Peekaboo Vision” in Malawi and the UK. Trans Vis Sci Tech. 2019 Jan 2;8(1):8–8. Butler LA, Misanjo E, Middleton D, Livingstone I, Kayange P. Evaluation of a Novel Digital Infant Acuity Test. Invest Ophthalmol Vis Sci. 2015 Jun 11;56(7):3196–3196.
Keywords: Infant vision, digital health, acuity, high spatial frequency gratings, iPad, tablet computer, photometric compliance.
Subjects: R Medicine > RE Ophthalmology
R Medicine > RJ Pediatrics
T Technology > T Technology (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences
Supervisor's Name: Parks, Dr. Stuart and Pignatelli, Dr. Massimo
Date of Award: 2019
Depositing User: Dr IAT Livingstone
Unique ID: glathesis:2019-75179
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 10 Jul 2020 07:38
Last Modified: 04 Jul 2023 07:33
Thesis DOI: 10.5525/gla.thesis.75179
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