Background:  Visual assessments are performed in the clinic as a standard practice which significantly limits access to care for the visually impaired living in rural or remote areas. We developed a tablet-based portable “tool-kit” to provide effective, individualized low vision assessment (LVA) to patients in their own communities via telemedicine.
Purpose: To validate a key component of the tablet-based tool-kit, a commercially available iPad visual acuity test (Eye Chart Pro) iPad app in a low vision population. 
Methods: Participants with low vision (n=26) or a normally-sighted group (n=25) underwent visual acuity testing with both the iPad visual acuity test application and the ETDRS chart in a prospective, randomized, crossover clinical study. The visual acuity data were compared using t-test, linear regession, and Bland-Altman analysis.
Results: There was no significant difference in the mean absolute difference in visual acuity (logMAR=0.11; p=0.82). Eye Chart Pro and Standard ETDRS Chart measures were also not significantly different (p=0.98). However, there were significant differences between test methods in the low vision and normally-sighted groups (p>0.0001 and p=0.007, respectively).  The Bland-Altman analysis showed a mean bias (difference) of -0.0005 logMAR between methods, and 95% limits of agreement of 0.298 and -0.299 logMAR Conclusions: The ETDRS chart function on the Eye Chart Pro app is a valid measure of visual acuity when compared with the international gold standard in-clinic assessment using the ETDRS chart in the low vision population.

Validation of an iPad application for visual acuity testing; A vision rehabilitation telemedicine study

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