Development and Validation of a Digital (Peek) Near Visual Acuity Test for Clinical Practice, Community-Based Survey, and Research

PURPOSE: Unaddressed near vision impairment (NVI) affects more than 500 million people. Testing near vision is necessary to identify those in need of services. To make such testing readily accessible, we have developed and validated a new smartphone-based near visual acuity (NVA) test: Peek Near Vision (PeekNV). METHODS: Two forms of the PeekNV test were developed: (1) quantitative measurement of NVA, and (2) binary screening test for presence or absence of NVI. The validity study was carried out with 483 participants in Sagarmatha Choudhary Eye Hospital, Lahan, Nepal, using a conventional Tumbling “E” Near Point Vision Chart as the reference standard. Bland–Altman limits of agreement (LoA) were used to evaluate test agreement and test–retest repeatability. NVI screening was assessed using Cohen's kappa coefficient, sensitivity, and specificity. RESULTS: The mean difference between PeekNV and chart NVA results was 0.008 logMAR units (95% confidence interval [CI], −0.005 to 0.021) in right eye data, and the 95% LoA between PeekNV and chart testing were within 0.235 and −0.218 logMAR. As a NVI screening tool, the overall agreement between tests was 92.9% (κ = 0.85). The positive predictive value of PeekNV was 93.2% (95% CI, 89.6% to 96.9%), and the negative predictive value 92.7% (95% CI, 88.9% to 96.4%). PeekNV had a faster NVI screening time (11.6 seconds; 95% CI, 10.5 to 12.6) than the chart (14.9 seconds; 95% CI, 13.5 to 16.2; P < 0.001). CONCLUSIONS: The PeekNV smartphone-based test produces rapid NVA test results, comparable to those of an accepted NV test. TRANSLATIONAL RELEVANCE: PeekNV is a validated, reliable option for NV testing for use with smartphones or digital devices.