Testing pediatric acuity with an iPad: validation of “Peekaboo Vision” in Malawi and the UK

Livingstone, I., Butler, L., Misanjo, E., Lok, A., Middleton, D., Waterson Wilson, J., Delfin, S., Kayange, P. and Hamilton, R. (2019) Testing pediatric acuity with an iPad: validation of “Peekaboo Vision” in Malawi and the UK. Translational Vision Science and Technology, 8(1), 8. (doi: 10.1167/tvst.8.1.8) (PMID:30637178) (PMCID:PMC6327755)

Abstract

Purpose: To evaluate two builds of the digital grating acuity test, “Peekaboo Vision” (PV), in young (6–60 months) populations in two hospital settings (Malawi and United Kingdom). Methods: Study 1 evaluated PV in Blantyre, Malawi (N = 58, mean age 33 months); study 2 evaluated an updated build in Glasgow, United Kingdom (N = 60, mean age 44 months). Acuities were tested-retested with PV and Keeler Acuity Cards for Infants (KACI). Bland-Altman techniques were used to compare results and repeatability. Child engagement was compared between groups. Study 2 included test-time comparison. Results: Study 1 (Malawi): The mean difference between PV and KACI was 0.02 logMAR with 95% limits of agreement (LoA) of 0.33 to 0.37 LogMAR. On test-retest, PV demonstrated 95% LoA of −0.283 to 0.198 logMAR with coefficient of repeatability (CR) 0.27. KACI demonstrated 95% LoA of −0.427 to 0.323 logMAR, and larger CR was 0.37. PV evidenced higher engagement scores than KACI (P = 0.0005). Study 2 (UK): The mean difference between PV and KACI was 0.01 logMAR; 95% LoA was −0.413 to 0.437 logMAR. Again, on test-retest, PV had narrower LoA (−0.344 to 0.320 logMAR) and lower CR (0.32) versus KACI, with LoA −0.432 to 0.407 logMAR, CR 0.42. The two tests did not differ in engagement score (P = 0.5). Test time was ∼1 minute shorter for PV (185 vs. 251 s, P = 0.0021). Conclusions: PV gives comparable results to KACI in two pediatric populations in two settings, with benefits in repeatability indices and test duration. Translational Relevance: Leveraging tablet technology extends reliable infant acuity testing to bedside, home, and rural settings, including areas where traditional equipment cannot be financed.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Livingstone, Iain and Hamilton, Dr Ruth
• Authors: Livingstone, I., Butler, L., Misanjo, E., Lok, A., Middleton, D., Waterson Wilson, J., Delfin, S., Kayange, P., and Hamilton, R.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Translational Vision Science and Technology
• Publisher: Association for Research in Vision and Ophthalmology
• ISSN: 2164-2591
• ISSN (Online): 2164-2591
• Published Online: 09 January 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Translational Vision Science and Technology 8(1): 8
• Publisher Policy: Reproduced under a Creative Commons License