A Smart Mobile Application to Monitor Visual Function in Diabetic Retinopathy and Age-related Macular Degeneration: The CLEAR Study: Mobile Device for Measuring Visual Acuity and Function.

Abstract Purpose : To determine if a mobile application, Checkup Vision Assessment System (Checkup; Verana Health, San Francisco, CA), can reliably monitor visual acuity (VA) and metamorphopsia remotely vs standard VA reference tests in the clinic. With the current COVID-19 pandemic, an even greater need for remote monitoring exists. Mobile tools enhance ability to monitor patients virtually by enabling remote monitoring of VA and Amsler grid findings. Design : Prospective, multicenter reliability analysis Participants : Patients (N=108) with near corrected VA better than 20/200 and a diagnosis of age-related macular degeneration, diabetic retinopathy or healthy patients without retinal disease (best corrected visual acuity [BCVA] 20/32 or better). Intervention : Participants were tested with Checkup and reference VA and Amsler tests, with the order of testing (Checkup or reference) randomized. Patients monitored their vision using Checkup at least twice a week at home between office visits. Main outcome measures : Near corrected VA, Amsler grid test results. Results : Agreement was strong between Checkup and reference tests for VA (r=0.86) and Amsler (sensitivity 93%, specificity 92%). Home vs clinic testing showed excellent agreement (r=0.96). Patients reported successful home use. There were no serious adverse events or discontinuations. Patients rated the usability of Checkup to be excellent. Conclusions : There was good agreement between Checkup and in-clinic tests for VA and Amsler grid. The low variance of Checkup testing, agreement between in-clinic and home results, and excellent usability, support Checkup as a reliable method for monitoring retinal pathology in clinic and home settings.