title: Reliability of visual acuity measurements taken with a notebook and a tablet computer in participants who were illiterate to Roman characters.
abstract: BACKGROUND
  Electronic measurement of visual acuity (VA) has been proposed and adopted as a method of determining VA scores in clinical research. Characters (optotypes) are displayed on a monitor screen and the examinee selects a match and inputs his choice to another electronic device. Unfortunately, the optotypes, called Sloan letters, in the standard protocol are 10 Roman characters. This limits their practicabilityfor measuring VA of patients who are illiterate to these characters. The authors introduced a method of displaying the Sloan letters one by one on a notebook and all 10 Sloan letters on a tablet computer screen. The former is for testing the patients whereas the latter is for them to input their responses by tapping on a letter that matches the one on the notebook screen.
  
  
  OBJECTIVE
  To assess test-retest reliability of VA scores determined with this method.
  
  
  METHODS
  Participants without ocular abnormality were recruited to have their right eyes measured with the same VA measurement method twice, one week apart. Those who were illiterate to Roman characters were enrolled for the aforementioned method for measuring their VA (Tablet group). A 15-inch display notebook computer and a 9-inch display tablet computer (iPad) communicated via a local wireless data network provided by a Wi-Fi router. Those who understood Roman characters were enrolled to have measurements with a 17-inch desktop computer and an infrared wireless keyboard (Keyboard group). Both methods used the same protocols and software for VA measurements. Reliability of VA scores obtained from each group was assessed by the confidence interval (CI) of the difference of the scores from the test and retest. The t test was used to analyze differences in mean VA scores between the test and retest in each group with p < 0.05 determined as statistically significant.
  
  
  RESULTS
  There were 49 and 50 participants in the Tablet and Keyboard group respectively. The 95% CI of the difference between the scores from the test and retest in each group was 2 letters. Approximately 95% of participants in each group had an absolute difference of the scores between the test and retest of 7 letters. The mean of VA scores from the first test was significantly different from that of the second test in the Keyboard group (one-letter difference, p = 0.049); there was no significant difference between these scores in the Tablet group (0.1-letter difference, p = 0.86).
  
  
  CONCLUSIONS
  Tablet computers may be used to assist patients who are illiterate to Roman characters in having their VA measured with the standard electronic protocol. This preliminary study suggested that the proposed method should be useful for reliable measuring VA outcome in multicenter international clinical trials without encountering a language barrier
authors.affiliation: Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand. tirinr@yahoo.com
authors.forename: Paisan
authors.initials: P
authors.lastname: Ruamviboonsuk
authors.forename: Napitchareeya
authors.initials: N
authors.lastname: Sudsakorn
authors.forename: Thanapong
authors.initials: T
authors.lastname: Somkijrungroj
authors.forename: Chayanee
authors.initials: C
authors.lastname: Engkagul
authors.forename: Montip
authors.initials: M
authors.lastname: Tiensuwan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016287:Computer Peripherals; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008838:Microcomputers; D008875:Middle Aged; D015203:Reproducibility of Results; D014786:Vision Disorders / Q000175:diagnosis; D014792:Visual Acuity; D055815:Young Adult