Smartphone Home-Vision Monitoring Uptake Negatively Associated With Increased Age


Engagement had positive associations with higher comfort with technology, visual acuity, nAMD diagnosis, and the number of intravitreal injections.

Due to the aging population, modern ophthalmology practices are dealing with an increasing disease prevalence and the need for regular monitoring of chronic conditions.

Moreso, the recent social distancing practices parallel to advancements in technology have proven the potential for telemedicine in medicine and ophthalmology, benefiting older adults or those with blinding eye conditions who may have trouble traveling to appointments.

Led by Konstantinos Balaskas, MD, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, a team of investigators reported outcomes of a real-world development of a smartphone-based home vision monitoring app, Home Vision Monitor (HVM), in patients attending a high-volume intravitreal injection clinic.

The data show uptake was negatively associated with age and positively associated with visual acuity in a patients better seeing eye and baseline number of intravitreal injections, while use rate was higher with an increasing level of comfort with the use of modern technologies.

The Study

The patients population consisted of consecutive patients attending Moorfields Eye Hospital (MEH) between May 2020 - February 2021 for planned anti-VEGF intravitreal injections. Those with a smart device during the study period were offered the HVM smartphone app and advised to self-test twice a week.

The app uses shape discrimination hyperacuity to detect metamorphopsia in the central degrees of vision as a metric of visual function. As such, a change in visual function equivalent to a predefined threshold of 2 SDs above the baseline on the longMAR scale on 2 consecutive occasions triggered an alert message sent to the clinician.

Demographic variables included were age at baseline, self-reported biological sex, and ethnicity, obtained from the patient’s hospital record.

Additionally, investigators defined metrics of patients, including uptake as a successful installation and subsequent use of the app at least once and defined as “active.”

Engagement for active app users was assessed via compliance and use rate. Compliance was defined as any continuous period of ≥4 weeks during which vision tests were performed weekly. The mean use rate represented the total number of tests conducted by a patient divided by the overall period since the app was prescribed.


Out of the 417 included patients, 236 (56.5%) were female with a mean age of 72.8 years. From that number, a total of 258 patients were considered active users (61.9%), with 166 of 258 (64.3%) fulfilling the definition of compliance.

Each ETDRS line of better VA in the better-seeing eye was associated with a 1.7% increase in likelihood of being an active user (OR, 1.02; 95% CI, 1.00 - 1.03, P = .01). Then, every additional injection before baseline was associated with a 0.8% increase in likelihood of being an active user (OR, 1.01; 95% CI, 1.00 - 1.02, P = .02).

Increasing age had a negative association with uptake, with a 1.8% decrease in likelihood of being an active user with an increase of 1 year of age (OR, 0.98; 95% CI, 0.97 - 0.998; P = .02).

In terms of compliance in the 258 active patients, 166 (64.3%) fulfilled the definition. Those diagnosed with neovascular age-related macular degeneration (OR, 1.94; 95% CI, 1.07 - 3.53, P = .002) had associations with compliance, as well as White British ethnicity (OR, 1.69; 95% CI, 0.96 - 3.01, P = .02), and visual acuity in the better-seeing eye at baseline (OR, 1.02; 95% CI, 1.01-1.04, P = .04).

For weekly mean use per patient, data show patients with lower vision in the worse-seeing eye (β = .001; 95% CI, 0 - 0.002, P = .03) and higher number of previous injections (β = 0.001; 95% CI, 0-0.001, P = .03) had associations with an increased weekly use rate.

Additionally, user rates were higher with increased levels of comfort using modern technologies (β = 0.031; 95% CI, 0.007 - 0.055, P = .02). A total of 119 patients (98.4%) found the app easy to use, while 96 (82.1%) noted increased reassurance from using the app.


“A strong association was found between weekly use rate and surveyed comfort with modern technologies, suggesting substantial potential gains by increasing digital literacy through educational initiatives, patient outreach, feedback, and support networks,” investigators wrote.

The study, “Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings,” was published in JAMA Ophthalmology.

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