Testing Pediatric Acuity With an iPad: Validation of “Peekaboo Vision” in Malawi and the UK

PURPOSE: To evaluate two builds of the digital grating acuity test, “Peekaboo Vision” (PV), in young (6–60 months) populations in two hospital settings (Malawi and United Kingdom). METHODS: Study 1 evaluated PV in Blantyre, Malawi (N = 58, mean age 33 months); study 2 evaluated an updated build in Glasgow, United Kingdom (N = 60, mean age 44 months). Acuities were tested-retested with PV and Keeler Acuity Cards for Infants (KACI). Bland-Altman techniques were used to compare results and repeatability. Child engagement was compared between groups. Study 2 included test-time comparison. RESULTS: Study 1 (Malawi): The mean difference between PV and KACI was 0.02 logMAR with 95% limits of agreement (LoA) of 0.33 to 0.37 LogMAR. On test-retest, PV demonstrated 95% LoA of −0.283 to 0.198 logMAR with coefficient of repeatability (CR) 0.27. KACI demonstrated 95% LoA of −0.427 to 0.323 logMAR, and larger CR was 0.37. PV evidenced higher engagement scores than KACI (P = 0.0005). Study 2 (UK): The mean difference between PV and KACI was 0.01 logMAR; 95% LoA was −0.413 to 0.437 logMAR. Again, on test-retest, PV had narrower LoA (−0.344 to 0.320 logMAR) and lower CR (0.32) versus KACI, with LoA −0.432 to 0.407 logMAR, CR 0.42. The two tests did not differ in engagement score (P = 0.5). Test time was ∼1 minute shorter for PV (185 vs. 251 s, P = 0.0021). CONCLUSIONS: PV gives comparable results to KACI in two pediatric populations in two settings, with benefits in repeatability indices and test duration. TRANSLATIONAL RELEVANCE: Leveraging tablet technology extends reliable infant acuity testing to bedside, home, and rural settings, including areas where traditional equipment cannot be financed.