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Utilisation and perceptions towards smart device visual acuity assessment in Australia: a mixed methods approach
  1. Stuart Keel1,
  2. Jane Scheetz1,
  3. Edith Holloway1,
  4. Xiaotong Han2,
  5. William Yan1,
  6. Andreas Mueller1,
  7. Mingguang He2,3
  1. 1Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
  2. 2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
  3. 3Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Vic, Australia
  1. Correspondence to Professor Mingguang He; mingguang_he{at}


Objectives To investigate mobile health product use in Australia and societal and clinician perceptions towards smartphone based visual acuity (VA) assessment tools.

Design Quantitative analysis of a cross-sectional survey delivered to the general public and thematic analysis of in-depth interviews of eye health clinicians.

Setting Online survey within Australia and face-to-face in-depth interviews of clinicians.

Participants 1016 adults were recruited via Survey Monkey Audience, social media (Facebook and Twitter), Rotary Australia and Lions Clubs Australia. Six clinicians were recruited from private and public settings in Melbourne, Australia.

Primary and secondary outcome measures The study assessed socio-demographic characteristics, history of mobile health product use and perceived advantages and potential drawbacks of smartphone based VA assessment tools.

Results A total of 14.4% of the study population had previously used a mobile-based health product. After adjusting for covariates, younger age (p=0.001), male gender (p=0.01) and higher income (>$45 000) were associated with increased likelihood of having used a mobile health product (p=0.005). Seventy-two per cent of participants would use an automated smartphone based VA assessment tool, provided that the accuracy was on par to that of human assessors. Convenience (37.3%) and cost-savings (15.5%) were ranked as the greatest perceived advantages. While test accuracy (50.6%), a lack of personal contact with healthcare providers (18.3%) and data security (11.9%) were the greatest concerns. Themes to emerge from clinician qualitative data included the potential benefits for identifying refractive error in patients, as well as the ability to self-monitor vision. Concerns were raised over the potential misuse of self-testing vision apps and the inability to detect pathology.

Conclusion Our findings suggest that a substantial proportion of the Australian population do not use mobile health products. Furthermore, there remains notable concerns, including test accuracy and data privacy, with smartphone-based VA assessment tools by both clinicians and the public.

  • mobile health
  • visual acuity
  • perceptions

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  • Contributors SK, JS, EH, WY and AM performed data collection and interpretation. EH, JS and XH conducted data analysis. SK, JS and EH wrote the main manuscript text and prepared figures. MH directed and supervised the project. All co-authors were actively involved in reviewing the manuscript.

  • Funding This work was supported in part by a Google Australia grant. Professor receives support from the University of Melbourne Research Accelerator Program and the CERA Foundation. The Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian State Government. The sponsor or funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Ethics approval Royal Victorian Eye and Ear Hospital Human Research Ethics Committee (HREC-17/1336).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated during and/or analysed during the current study may be available from the corresponding author on reasonable request.

  • Patient consent for publication Obtained.

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