Damian McNamara

May 31, 2013

SEATTLE, Washington — An overwhelming majority of people with age-related macular degeneration would rather test their vision with an iPad app than with traditional methods, a new study shows.

"One of the major advantages of iPad testing is that patients are much more involved in their disease. They're engaged," Matthias Hartmann, MD, an ophthalmologist in private practice from Berlin, Germany, told Medscape Medical News. "It's like a game, and many tell us they think they can do better."

Dr. Hartmann presented the study results during a poster session that generated a great deal of attention here at the Association for Research in Vision and Ophthalmology 2013 Annual Meeting.

The study involved 74 women and 38 men with age-related macular degeneration and baseline vision of at least 0.05. Every 4 weeks for 6 months, participants visited 1 of 4 private ophthalmology practices in Berlin and underwent 3 forms of vision testing: Landolt ring with the iPad app; projection of the Landolt ring on the office wall; and near-vision eye chart (Oculus).

Participants were asked which testing strategy they preferred. The majority, 81%, chose the iPad method, even though 96% reported never having used an iPad before study enrollment. In fact, "some purchased an iPad so they could check their eyes at home as often as they wanted," Dr. Hartmann reported.

The projected Landolt ring method was preferred by 13% and the near-vision eye chart was preferred by 6%.

When the near-vision eye chart was used as the control test, results with the iPad and projected Landolt ring were consistent 76% of the time in the right eye and 83% of the time in the left eye. A difference in visual acuity up to 1 line was the cut-off for consistency.

 
Some purchased an iPad so they could check their eyes at home as often as they wanted.
 

"I have a practice in Berlin with a large number of patients with age-related macular degeneration. When Apple introduced the iPad, I thought it might be good for patients," Dr. Hartmann said.

Although the "Eyetest - control your visual acuity" app — which costs US$3.99 and is available in English, German, Japanese, and Spanish — also works on an iPhone, the larger iPad screen makes more sense for this patient population, he explained.

"This is clinically very relevant because age-related macular degeneration is the leading cause of severe and irreversible visual impairment in patients over 60," said Saadia Rashid, MD, a retina specialist from the Montefiore Medical Center in the Bronx, New York, who was asked by Medscape Medical News to comment.

The concept of using an iPad to enable patients with age-related macular degeneration to monitor changes in their vision is very interesting, Dr. Rashid said. "The study shows that the conventional visual acuity testing done in the office with the chart is consistent with the iPad testing in over 75% of the patients."

Dr. Hartmann said he sees a future for this technology for routine self-monitoring of vision loss. "Once a patient notices their vision decreasing, we can bring them in for additional testing."

Patients who like the iPad are more likely to use it and may be more likely to detect vision changes sooner, he said. "If we can get patients in earlier, it's better for them in the long run." The iPad app can also remind people when it's time to test their vision.

"Although home monitoring of visual acuity should not replace routine follow-up in dilated eyes done by an ophthalmologist, it can assist in the early detection of visual loss," Dr. Rashid said. "Patients who have worsening of macular degeneration in one eye may not notice any visual loss if the other eye has stable vision. If the iPad is used for home monitoring separately in each eye, this may prompt an earlier visit to the office...and can lead to earlier detection of the dry form converting to the wet form or the wet form becoming worse."

Because more than 80% of patients preferred the iPad testing, compliance with home monitoring looks promising, Dr. Rashid said. The iPad can also be used as an electronic diary to store data on visual acuity changes, which will help clinicians monitor response to treatment.

The study is ongoing, Dr. Hartmann said. Future aims include assessing the feasibility of home testing and determining whether the iPad brings patients to an ophthalmologist for evaluation sooner than traditional follow-up visits. Planned enhancements to the app include the addition of an Amsler grid and automated distance adjustment.

Dr. Hartmann reports receiving financial support from Novartis. Dr. Rashid has disclosed no relevant financial relationships.

Association for Research in Vision and Ophthalmology (ARVO) 2013 Annual Meeting. Abstract A0180. Presented May 8, 2013.

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