Implementing digital applications for self-monitoring of visual function in the MONARCH study: technological and practical challenges.

Abstract

Purpose : Purpose: To report technical and practical challenges when implementing digital applications (apps) for self-testing visual function by people with neovascular AMD (nAMD).

Methods : The MONARCH study is a UK cohort study evaluating the diagnostic test accuracy of self-testing at home to detect nAMD reactivation, compared to clinic-detected reactivation. Two tests of visual function are issued to patients as digital apps (My Vision Track (mVT) and MultiBit (MB)) on an iPod touch. Patients are asked to test their vision weekly. Data are transmitted automatically over the internet.

Results : 226/239 (95%) participants (38% male) from 6 sites have self-tested their vision at least once using the mVT (n=7085) and MB (n=7593) apps.

Key technical challenges have been: a lack of control over the apps, the requirement for internet connectivity to transmit data, and constraints of the Apple platform. App providers have had server and portal issues which have stopped apps from working properly for <=4 weeks, the need for wireless routers has limited connectivity, and Apple’s Multiple Device Management system (used to manage all study iPods) gives limited control of the iPods and has caused issues with iOS updates and iPod settings.

Practical challenges include the need for a telephone helpline to address problems that participants experience, which has consumed substantial resources: 146 calls (932 minutes) from participants, and 178 calls (722 minutes) to participants. Study personnel find it difficult to distinguish technical problems from users’ errors without seeing the iPod.

After 17 months, 59 (26%) have stopped testing with both apps (see Figure 1), including 44 study withdrawals. Median test frequency for both tests is 3 times/month. Common reasons for not testing include internet connectivity, personal circumstances and app specific issues. The most common reasons for withdrawal include personal reasons (44%), tests too time-consuming (36%) and difficulties operating the equipment (28%).

Conclusions : Patients are willing and interested in the potential for home testing. However, there are substantial technical and practical issues when implementing digital apps for self-testing visual function that require a significant support infrastructure.

This is a 2020 ARVO Annual Meeting abstract.

 

Figure 1 – “Survival” of self-testing with mVT and MB apps