@article {Allene000801, author = {Louise Allen and Arun James Thirunavukarasu and Simon Podgorski and Deborah Mullinger}, title = {Novel web application for self-assessment of distance visual acuity to support remote consultation: a real-world validation study in children}, volume = {6}, number = {1}, elocation-id = {e000801}, year = {2021}, doi = {10.1136/bmjophth-2021-000801}, publisher = {BMJ Specialist Journals}, abstract = {Objective The difficulty in accurately assessing distance visual acuity (VA) at home limits the usefulness of remote consultation in ophthalmology. A novel web application, DigiVis, enables automated VA self-assessment using standard digital devices. This study aims to compare its accuracy and reliability in children with clinical assessment by a healthcare professional.Methods and Analysis Children aged 4{\textendash}10 years were recruited from a paediatric ophthalmology service. Those with VA worse than +0.8 logMAR (Logarithm of the Minimum Angle of Resolution) or with cognitive impairment were excluded. Bland-Altman statistics were used to analyse both the accuracy and repeatability of VA self-testing. User feedback was collected by questionnaire.Results The left eyes of 89 children (median 7 years) were tested. VA self-testing showed a mean bias of 0.023 logMAR, with a limit of agreement (LOA) of {\textpm}0.195 logMAR and an intraclass correlation coefficient (ICC) of 0.816. A second test was possible in 80 (90\%) children. Test{\textendash}retest comparison showed a mean bias of 0.010, with an LOA of {\textpm}0.179 logMAR, an ICC of 0.815 and a repeatability coefficient of 0.012. 96\% of children rated the test as good or excellent, as did 99\% of their parents.Conclusion Digital self-testing gave comparable distance VA assessments with clinical testing in children and was well accepted. Since DigiVis self-testing can be performed under direct supervision using medical video consultation software, it may be a useful tool to enable a proportion of paediatric eye clinic attendances to be moved online, reducing time off school and releasing face-to-face clinical capacity for those who need it.All data relevant to the study are included in the article or uploaded as supplementary information.}, URL = {https://bmjophth.bmj.com/content/6/1/e000801}, eprint = {https://bmjophth.bmj.com/content/6/1/e000801.full.pdf}, journal = {BMJ Open Ophthalmology} }