Automated vision screening of children using a mobile graphic device

ABSTRACT Background/Objective Can measures of interocular brightness disparity, acuity, and colour vision identify children with amblyopia? Subjects/Methods 208 subjects from 3 to 14 years were recruited for a prospective, observational protocol to measure interocular brightness disparity, acuities with and without a pinhole, and colour vision using an iPad. Interocular brightness disparity was assessed as the subject looked through a system of polarizing filters and chose the brighter of two spaceships. The differential brightness of image pairs was varied according to a staircase algorithm until equal brightness was perceived. Acuities were tested with tumbling Es. Colour vision was tested with AO-HRR colour plates. 2 subjects (1%) were later confirmed to have unilateral amblyopia. Results Binocular brightness balance on the iPad detected both amblyopes and excluded all 202 non-amblyopes, in this study with sensitivity and specificity of 100%. By using 20/30 as cutoff for normal acuity, 1 of the 2 amblyopes was detected and all non-amblyopes were excluded by visual acuity testing with pinhole. The mean difference between iPad and E-Chart visual acuities with pinhole was 0.02 logMAR with limits of agreement from -0.08 to +0.11 logMAR. Colour vision testing with iPad and printed plates gave identical results. Testing times were brief and exit pleasure poll responses were positive. Conclusions Interocular brightness disparity, acuity, and colour vision can be measured in children as young as 3 years playing a fun game on a mobile graphic device. Interocular brightness disparity may be a sensitive and specific method to detect unilateral amblyopia.