Real-World Application of Home Visual Acuity Testing for Pediatric Teleophthalmology During the COVID-19 Pandemic

Purpose: To review the ability of home visual acuity testing during teleophthalmology consultations to ac-curately assess visual acuity in pediatric patients in a real-world setting. Methods: This was a retrospective study of pediat-ric patients who were examined via teleophthalmol-ogy consultation due to the coronavirus disease 2019 (COVID-19) pandemic-related community restrictions between May and June 2020 at a single private oph-thalmology practice. Home visual acuity findings were compared with the subsequent in-person assessment to determine agreement between measures. Results: Forty-three patients (86 eyes) were included in the study. The mean patient age at the time of tele-ophthalmology assessment was 75.9 months (range: 29 to 173 months). The correlation between home vi-sual acuity findings and subsequent in-person assess-ment across all participants was 0.56 (P < .001). The upper and lower limits of agreement were 0.38 loga-rithm of the minimum angle of resolution (logMAR) units and-0.33 logMAR. The correlation reduced to 0.46 (P = .013) in patients younger than 5 years and in-creased to 0.70 (P < .001) in patients 8 years and older. Conclusions: Home visual acuity assessment for tele-ophthalmology is of increased clinical value in older pe-diatric patients. In-person assessment by a trained clini-cian is the optimal method to determine visual acuity. Because home visual acuity assessment may be neces-sitated by local and global factors, further research is re-quired regarding the optimal methods for assessment, particularly in younger patients.