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ImportanceHundreds of thousands of ophthalmology clinic appointments have been converted to telemedicine assessments. Here we validate a simple paper vision test (the Home Acuity Test) for ophthalmology telemedicine appointments, which can be used by people who are digitally excluded.ObjectiveTo determine the repeatability of vision measured on the Home Acuity Test, and the agreement between the Home Acuity Test and the last in-clinic visual acuity.DesignBland-Altman analysis of the Home Acuity Test chart, compared to the last measured visual acuity on a standard clinical test.SettingRoutine outpatient ophthalmology telemedicine clinics in a large specialist eye hospital.Participants50 control subjects with no eye disease and 100 consecutive adult ophthalmology outpatients from strabismus and low vision telemedicine clinics. Participants were excluded if they reported subjective changes in their vision.Main outcomes and measuresFor control participants, test/retest variability of the HAT and agreement with standard logMAR visual acuity measurement. For ophthalmology outpatients, agreement with the last recorded clinic visual acuity and with ICD-11 visual impairment category.Results50 control subjects and 100 ophthalmology patients with a wide range of disease were recruited. For control participants, Home Acuity Test test/retest variability was -0.012 logMAR (95% CI: -0.25 to 0.11 logMAR). Agreement with standard vision charts was -0.14 logMAR, with a 95% confidence interval of -0.39 to +0.12 logMAR. For ophthalmology outpatients, agreement in visual acuity was -0.10 logMAR (one line on a conventional logMAR sight chart), with the Home Acuity Test indicating poorer vision than the previous in-clinic test. The 95% confidence interval for difference was –0.44 to +0.24 logMAR. Agreement in visual impairment category was good for patients (Cohen’s k test, k = 0.77 (95% CI, 0.74 to 0.81), and control participants (Cohen’s k test, k = 0.88 (95% CI, 0.88 to 0.88).Conclusions and relevanceThe Home Acuity Test can be used to measure vision by telephone for a wide range of ophthalmology outpatients with diverse conditions, including those who are severely visually impaired. Test/retest variability is low and agreement in visual impairment category is good.

BackgroundThe COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services.ObjectiveTo describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform ‘Attend Anywhere’ in Moorfields Eye Hospital’s accident and emergency (A&E) department (London, UK).MethodPatient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service.ResultsIn the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5–31 min) and the wait time was 6 min (range 0–37 min).ConclusionVideo consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.

Background In the assessment of a pituitary mass, objective visual field testing represents a valuable means of evaluating mass effect, and thus in deciding whether surgical management is warranted. Case presentation In this vignette, we describe a 73 year-old lady who presented with a three-week history of frontal headache, and ‘blurriness’ in the left side of her vision, due to a WHO grade III anaplastic haemangiopericytoma compressing the optic chiasm. We report how timely investigations, including an iPad-based visual field test (Melbourne Rapid Field, (MRF)) conducted at the bedside aided swift and appropriate management of the patient. Conclusions We envisage such a test having a role in assessing bed-bound patients in hospital where access to formal visual field testing is difficult, or indeed in rapid testing of visual fields at the bedside to screen for post-operative complications, such as haematoma.