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James Fan Wu, Stephen Eyler, Alexis Visotcky, Aniko Szabo, Gregory Griepentrog, Clinton Warren, Dennis P Han; Implementation of a novel visual acuity chart in an urgent care setting. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1086.
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Accuracy of visual acuity (VA) measurements in urgent care settings can be affected by patient immobility and lack of standardized testing conditions. To counter these factors, a novel VA chart, the Runge Sloan letter near card (Runge card, Figure 1, Goodlite,Elgin, IL), previously validated against standard VA charts, was implemented at our institution. We performed a retrospective study evaluating agreement of VA testing with this device between non-ophthalmic and ophthalmic personnel in an emergency department (ED) as a possible indicator of its clinical utility.
After IRB approval, Runge card VA data were obtained from the records of 97 ophthalmology consult patients seen in the ED age≥18 years and with VA≥20/500. Generalized estimating equation models, accounting for left and right eye measurements within the same patient, were used to obtain the proportion of measurement pairs that had no more than prespecified logMAR visual acuity differences between ED technicians and ophthalmology residents, including differences of ≤2 lines (0.204 logMAR), and ≤5 lines (0.498 logMAR). Sub-analyses also assessed these factors: good vs. poor VA (>20/80 vs. ≤20/80), spectacle use, and consult indication of trauma.
The proportions of VA measurements differing between technicians and residents by ≤2 lines and ≤5 lines respectively, were as follows: Overall group, without pinhole (PH), 51% and 90%; with PH, 64% and 92%; Group with good VA, without PH, 58% and 97%; with PH, 73% and 96%; Group with poor VA, without PH, 35% and 73%; with PH, 41% and 83% (Figure 2). Agreement was more likely in patients with good VA relative to poor VA: without pinhole (O.R. 2.5, p=0.047 for ≤2 lines difference; O.R. 5.0, p=0.003 for ≤5 lines); with pinhole (O.R. 3.8, p=0.003 for ≤2 lines; O.R. 5.1, p=0.045 for ≤5 lines). Factors such as trauma or whether spectacles were used did not influence agreement.
Use of the Runge Sloan letter near card with pinhole in an urgent care setting by non-ophthalmic and ophthalmic personnel was associated with agreement within 2 logMAR lines of VA in about 73% of patients with good VA, and 64% of patients overall. Testing with pinhole appeared to be a useful adjunct. Given the numerous testing variables in urgent care settings, our findings suggest potential utility of the Runge Sloan letter near card in such environments.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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