Author Of 1 Presentation
LB1275 - Enriching neuroimmunology telemedicine encounters with objective measures of vision during the SARS-CoV-2 pandemic (ID 2174)
Abstract
Background
Patients with multiple sclerosis (MS) and antibody-mediated optic neuritis attend periodic outpatient clinic visits to quantify visual acuity, color vision and visual fields. Many of these tests involve prolonged proximity and contact, which patients who are immunocompromised may wish to avoid during the SARS-CoV-2 pandemic. Telemedicine is increasingly used to lessen the need for clinic visits but lacks objective means for vision monitoring.
Objectives
With the goal of enriching pandemic telemedicine encounters, we conducted a pilot study testing the feasibility of telemedicine-guided computer tests for monitoring vision.
Methods
For this pilot study, 22 patients with optic neuropathies from the Neuro-Ophthalmology outpatient clinic were recruited. Participants were asked to repeat their clinic eye exams with a home-based adaptation of the Freiburg Acuity Test (FRACT ), a robust and validated computer-based method for measuring visual acuity, the EYESAGE visual field test (http://www.eyesage.org/?lang=us), and a computer-based Ishihara color perception application. Blinded reviewers interpreted the results of both home-based and outpatient tests, and the correlation of the results was analyzed alongside patient cooperation and reliability indices.
Results
18/22 patients completed the visual monitoring tests during the telemedicine-guided encounters. Patients’ mean age was 44yrs. (SD 13.42), of whom four were male. Patients with low vision (n=2, one patient with hand motion, second patient 6/30) on clinic visit had a similar low visual acuity with the telemedicine guided FRACT method. No patient with good FRACT vision had low visual acuity documented during their clinic visit. Significant visual field defects (n=6, homonymous hemianopsia and quadrantanopia (n=3), inferior altitudinal (n=1) and central scotomas (n=2)) were all picked up by the EYESAGE home method. Smaller nasal steps and peripheral concentric field scotomas were unreliably detected by the EYESAGE method.
Conclusions
This pilot study of enriching telemedicine visits with a method for monitoring vision reveals that FRACT and EYESAGE potentially identify low visual acuities and severe visual field defects. Further improvement of home vision monitoring methods can enrich telemedicine encounters with objective means of monitoring vision. A large-scale multicenter international study is currently underway to examine the sensitivity of these visual monitoring methods in patients with demyelinating disease.