At-home visual acuity in children using a custom iPhone application compared with standardized in-office visual acuity testing.

Creator(s)

• Tawna L. Roberts
• Erick D. Bothun
• Yufeng Zhu
• Robert J. Henderson
• Nicole M. Boyle
• David A. Leske
• Sarah R. Hatt
• Suzanne M. Wernimont
• Carrie E. Marino
• Aparna Raghuram
• Vivian M. Manh
• Jillian M. Youngerman
• Jennifer N. Qayum, Children's Mercy Kansas CityFollow
• Gayathri Srinivasan
• Jenna R. Titelbaum
• Eric R. Crouch
• Jeffrey D. Colburn
• Christina A. Esposito
• V Lori Zeto
• Katie S. Connolly
• Rita M. Bhakta
• Ingryd J. Lorenzana
• Paula S. McDowell
• Wesley T. Beaulieu
• Raymond T. Kraker
• Jonathan M. Holmes
• Stacy L. Pineles
• Katherine K. Weise
• Susan A. Cotter
• Pediatric Eye Disease Investigator Group

Document Type

Article

Publication Date

4-2026

Identifier

DOI: 10.1002/ovs2.70040

Abstract

PURPOSE: To validate a custom smartphone application for at-home visual acuity (VA) measurement in children.

METHODS: A total of 452 children aged 3-17.5 years participated. Certified examiners measured in-office test-retest VA (logMAR) using gold-standard Amblyopia Treatment Study HOTV (3-to-6-year-olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7-to-17.5-year-olds, older cohort) protocols at 3-4.5 m and app-based VA at 1.5 m. Caregivers measured at-home app-based VA at 1.5 m.

RESULTS: Comparing at-home app-based with gold-standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.04; 95% limits-of-agreement half-width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in-office app-based VA with gold-standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold-standard test-retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15).

CONCLUSIONS: Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.

Journal Title

Optometry and vision science : official publication of the American Academy of Optometry

Volume

103

Issue

4

First Page

70040

Last Page

70040

MeSH Keywords

Humans; Child; Visual Acuity; Male; Child, Preschool; Adolescent; Female; Mobile Applications; Vision Tests; Smartphone; Reproducibility of Results

PubMed ID

42062237

Keywords

Visual Acuity; Mobile Applications; Vision Tests; Smartphone; Reproducibility of Results

Comments

Grants and funding

• EY011751/EY/NEI NIH HHS/United States

Recommended Citation

Roberts TL, Bothun ED, Zhu Y, et al. At-home visual acuity in children using a custom iPhone application compared with standardized in-office visual acuity testing. Optom Vis Sci. 2026;103(4):e70040. doi:10.1002/ovs2.70040