UNASSIGNED: Proper access to primary eye care is essential in addressing vision impairment, and tele-eye care examinations are a promising solution that could facilitate this access in many rural or remote areas. Even though remote eye exams are becoming increasingly frequent, comprehensive tele-eye care exams are still limited by the lack of published data. The aim of this study is to compare a comprehensive tele-eye care exam with a gold standard in-person primary eye care exam with an emphasis on refractive measurements, ocular health assessment, confidence level of the eye care providers and patient satisfaction.
UNASSIGNED: Sixty-six participants underwent two comprehensive eye exams performed by two eye care providers. One was a gold standard in-person exam, while the other was a remote exam performed by an eye care provider through videoconference. An overall patient satisfaction survey and a questionnaire for visual comfort with a trial frame from each modality were completed and the eye care providers scored their confidence level for each test. Exam results and diagnoses were compared between both modalities.
UNASSIGNED: Tele-refraction has a good to excellent agreement with in-person subjective refraction in terms of sphero-cylindrical power and best corrected visual acuity. There was no statistically significant difference for visual comfort between both modalities. The agreement between in-person and remote exams for ocular health assessment ranged from fair to almost perfect, but there was a low prevalence of ocular pathologies within the study sample. The confidence level of the eye care providers and patient satisfaction were statistically higher in-person.
UNASSIGNED: Tele-eye care appears to be statistically and clinically non-inferior to in-person eye exams, especially for refraction, but the low prevalence of ocular pathologies somewhat limits the comparison of its efficacy for ocular health assessment. More studies on comprehensive tele-eye care exams are needed.

Refraction is an important part of a comprehensive eye examination, and when performed remotely through information and communication technology or when its results are transmitted for remote analysis, this procedure is called tele-refraction. Uncorrected refractive errors are the main reason for consultation in primary eye care, and an increasing number of eye care providers offer tele-refraction services in response to the global demand. Even so, very little literature exists on how the correction of refractive errors can be managed through tele-eye care. The objectives of this review are to examine the integration of tele-refraction in different eye care models and to report the existing findings regarding patient satisfaction towards tele-refraction and the efficacy of tele-refraction. Searches were undertaken on Medline, Embase, EBM Reviews, CINAHL and Web of Science to identify relevant articles. All original studies describing a clinical tele-refraction service and its outcomes were included. Out of 1322 articles, 15 were retained for analysis and have shown that tele-refraction has been provided for general eye care (n = 10; 67%), refractive-only examinations (n = 3; 20%) or disease-specific screening (n = 2; 13%). Ten (67%) had a hybrid telemedicine modality. Given the small number of included studies and the lack of outcomes comparing refractive errors between face-to-face and remote refraction, it is concluded that the current scientific literature does not reflect the increasing availability of tele-refraction in clinical practice. More studies on remote refraction should be conducted to better understand its efficacy, cost-effectiveness and impacts on patient satisfaction and management.

OBJECTIVE: The Indian government announced a nationwide lockdown as a preventive measure to control the prevailing COVID-19 pandemic. This survey was developed and conducted to assess the impact of lockdown on Indian optometry practice.
METHODS: A survey questionnaire was designed and circulated across the optometrists practicing in India through multiple social media platforms. All the data were extracted and only valid response were analyzed and reported.
RESULTS: A total of 691 optometrists participated in the survey. Most of the participants (22.25%) were in private practice followed by academics (14.89%). Among the valid responses collected, it was found that 43.37% of the respondents were consulting patients during the lockdown. Of these, 27.17% of optometrists were examining infectious cases and 48.68% were examining all the patients who came for consultation. Approximately 50.94% of the participated optometrist had begun telephonic/e‑mail/video consultations. In addition, 64.48% reported that optometrists were at an equal risk of clinching COVID‑19 on comparison with other domains during patient examination. Nearly 30.44% respondents felt that optometrists would face challenges in approaching the patient post COVID-19 considering the close working distance.
CONCLUSIONS: A proportion of optometrist have switched to some form of teleconsultation in order to aid patients during this prevailing pandemic. Regulatory bodies should issue appropriate guidelines regarding the safe optometry practice for the betterment of both patient and practitioners during face-to-face consultation.

OBJECTIVE: The objective of this study was to identify and validate smartphone-based visual acuity (VA) apps that can be used in a teleophthalmology portal.
METHODS: The study was conducted in three phases: A survey to investigate if the SmartOptometry App was easy to download, understand and test (phase I), an in-clinic comparison of VA measured in a random testing order with four tools namely COMPlog, Reduced Snellen near vision, Peek Acuity (Distance VA) and SmartOptometry (Near VA) (phase II) and a repeatability study on these 4 tools by measuring VA again (phase III). The study recruited the employees of our institute and adhered to the strict COVID-19 protocols of testing.
RESULTS: Phase I Survey (n = 40) showed 90% of participants used android phones, 60% reported that instructions were clear, and all users were able to self-assess their near VA with SmartOptometry App. Phase II (n = 68) revealed that Peek Acuity was comparable to COMPlog VA (P = 0.31), however SmartOptometry was statistically significantly different (within 2 log MAR lines) from Reduced Snellen near vision test, particularly for young (n = 44, P = 0.004) and emmetropic (n = 16, P = 0.04) participants. All the 4 tests were found to be repeatable in phase III (n = 10) with a coefficient of repeatability ≤0.14.
CONCLUSIONS: Smartphone-based apps were easy to download and can be used for checking patient\'s distance and near visual acuity. An effect of age and refractive error should be considered when interpreting the results. Further studies with real-time patients are required to identify potential benefits and challenges to solve.