title: Automated Measurement of Visual Acuity in Pediatric Ophthalmic Patients Using Principles of Game Design and Tablet Computers.
abstract: OBJECTIVE
  To report on the utility of a computer tablet-based method for automated testing of visual acuity in children based on the principles of game design. We describe the testing procedure and present repeatability as well as agreement of the score with accepted visual acuity measures.
  
  
  METHODS
  Reliability and validity study.
  
  
  METHODS
  Setting: Manchester Royal Eye Hospital Pediatric Ophthalmology Outpatients Department.
  
  
  METHODS
  Total of 112 sequentially recruited patients.
  
  
  METHODS
  For each patient 1 eye was tested with the Mobile Assessment of Vision by intERactIve Computer for Children (MAVERIC-C) system, consisting of a software application running on a computer tablet, housed in a bespoke viewing chamber. The application elicited touch screen responses using a game design to encourage compliance and automatically acquire visual acuity scores of participating patients. Acuity was then assessed by an examiner with a standard chart-based near ETDRS acuity test before the MAVERIC-C assessment was repeated.
  
  
  METHODS
  Reliability of MAVERIC-C near visual acuity score and agreement of MAVERIC-C score with near ETDRS chart for visual acuity.
  
  
  RESULTS
  Altogether, 106 children (95%) completed the MAVERIC-C system without assistance. The vision scores demonstrated satisfactory reliability, with test-retest VA scores having a mean difference of 0.001 (SD ±0.136) and limits of agreement of 2 SD (LOA) of ±0.267. Comparison with the near EDTRS chart showed agreement with a mean difference of -0.0879 (±0.106) with LOA of ±0.208.
  
  
  CONCLUSIONS
  This study demonstrates promising utility for software using a game design to enable automated testing of acuity in children with ophthalmic disease in an objective and accurate manner.
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom; Vision Science Centre, Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Heriot-Watt University, Edinburgh, United Kingdom. Electronic address: Tariq.aslam@cmft.nhs.uk.
authors.forename: Tariq M
authors.initials: TM
authors.lastname: Aslam
authors.affiliation: Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Humza J
authors.initials: HJ
authors.lastname: Tahir
authors.affiliation: Centre for Hearing and Vision Research, Institute of Human Development, University of Manchester, Manchester, United Kingdom; Vision Science Centre, Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom.
authors.forename: Neil R A
authors.initials: NR
authors.lastname: Parry
authors.affiliation: Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom; Vision Science Centre, Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Murray
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Kun
authors.initials: K
authors.lastname: Kwak
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Heyes
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Mahani M
authors.initials: MM
authors.lastname: Salleh
authors.affiliation: Department of Eye and Vision Science and Biostatistics, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Czanner
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom; Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom; Vision Science Centre, Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Ashworth
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D034201:Computers, Handheld; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D018910:Video Games; D014787:Vision Tests / Q000295:instrumentation*; D014792:Visual Acuity / Q000502:physiology*