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Assessment of Selected Eye Functions and Prediction of Chronic Major Eye Diseases Among the Aging Population

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Assessment of Selected Eye Functions and Prediction of Chronic Major Eye Diseases Among the Aging Population Employing mHealth Applications for the Self- Assessment of Selected Eye Functions and Prediction of Chronic Major Eye Diseases among the Aging Population By Gulnara Abdualiyeva Supervisor: Pavel Andreev, Ph.D. Co-Supervisor: Sarah Fraser, Ph.D. Thesis submitted to the University of Ottawa in partial Fulfillment of the requirements for the MSc Degree in Interdisciplinary Health Science Interdisciplinary School of Health Sciences Telfer School of Management Faculty of Health Sciences University of Ottawa ©Gulnara Abdualiyeva, Ottawa, Canada, 2019 i Abstract In the epoch of advanced mHealth (mobile health) use in ophthalmology, there is a scientific call for regulating the validity and reliability of eye-related apps. For a positive health outcome that works towards enhancing mobile-application guided diagnosis in joint decision-making between eye specialists and individuals, the aging population should be provided with a reliable and valid tool for assessment of their eye status outside the physician office. This interdisciplinary study aims to determine through hypothesis testing validity and reliability of a limited set of five mHealth apps (mHAs ) and through binary logistic regression the prediction possibilities of investigated apps to exclude the four major eye diseases in the particular demographic population. The study showed that 189 aging adults (45- 86 years old) who did complete the mHAs’ tests were able to produce reliable results of selected eye function tests through four out of five mHAs measuring visual acuity, contrast sensitivity, red desaturation, visual field and Amsler grid in comparison with a “gold standard” - comprehensive eye examination. Also, part of the participants was surveyed for assessing the Quality of Experience on mobile apps. Understanding of current reliability of existing eye-related mHAs will lead to the creation of ideal mobile application’ self-assessment protocol predicting the timely need for clinical assessment and treatment of age-related macular degeneration, diabetic retinopathy, glaucoma and cataract. Detecting the level of eye function impairments by mHAs is cost-effective and can contribute to research methodology in eye diseases’ prediction by expanding the system of clear criteria specially created for mobile applications and provide returning significant value in preventive ophthalmology. ii Table of Contents ACKNOWLEDGMENT .............................................................................................................................................................. VI ABBREVIATIONS..................................................................................................................................................................... VII INTRODUCTION...........................................................................................................................................................................1 RESEARCH QUESTION AND OBJECTIVES .............................................................................................................................3 THE RESEARCH QUESTION ...........................................................................................................................................................3 THE OBJECTIVES..........................................................................................................................................................................3 RESEARCH BACKGROUND .......................................................................................................................................................4 CHALLENGES OF PATIENT’S SCREENING OR MONITORING FOR EYE DISEASES .............................................................................5 MHEALTH POTENTIAL .................................................................................................................................................................8 MOBILE APPS FOR EYE ASSESSMENT ...........................................................................................................................................9 A SUMMARY OF RESEARCH PAPERS ON THE EXISTING FIVE TYPES OF MHAS ............................................................................11 MHAS FOR TESTING OF SPECIFIC EYE FUNCTIONS .....................................................................................................16 Visual acuity (VA) application ............................................................................................................................................16 Contrast sensitivity application ...........................................................................................................................................16 Amsler grid application .......................................................................................................................................................17 Red desaturation application ...............................................................................................................................................17 Visual fields application ......................................................................................................................................................17 METHODOLOGY ........................................................................................................................................................................19 RESEARCH ETHICS .....................................................................................................................................................................19 DESIGN ......................................................................................................................................................................................19 METHOD 1: SELECTION OF A LIMITED SET OF MHAS WITH CONVERSION OF MEASUREMENTS ..................................................19 The choice of apps in our study and relevance of the set creation ......................................................................................19 Conversion of measurements to core parameters of visual impairment ..............................................................................20 METHOD 2: HYPOTHESIS TESTING FOR PAIRED SAMPLES EMPLOYING PARAMETRIC, NON-PARAMETRIC TECHNIQUES AND INTRA-OBSERVER AGREEMENT..................................................................................................................................................20 METHOD 3: BINARY LOGISTIC REGRESSION MODELS WITH GROUPING VARIABLES’ TYPE ASSOCIATED WITH ARED ...............23 METHOD 4: ONLINE SURVEY TO ASSESS PARTICIPANTS’ EXPERIENCE RELATED TO MHAS USE ................................................25 SETTING MODALITIES, PROCEDURES, AND CRITERIA FOR DATA COLLECTION....................................................27 DATA COLLECTION....................................................................................................................................................................27 Why benchmark of 45 years was chosen.............................................................................................................................27 The one group Test on mHAs - Retest with Gold Standard ................................................................................................28 Population sample groups....................................................................................................................................................28 Voluntary response sample: ................................................................................................................................................29 ELIGIBILITY ...............................................................................................................................................................................30 Inclusion criteria: .................................................................................................................................................................30 Exclusion criteria with rationale: .........................................................................................................................................30 TESTING PROCEDURES...............................................................................................................................................................30 VARIABLES ...............................................................................................................................................................................31 RESULTS AND DATA ANALYSIS ...........................................................................................................................................32 VALIDITY AND RELIABILITY IN THIS STUDY ..............................................................................................................................32 DESCRIPTIVE STATISTICS OF THE SAMPLE .................................................................................................................................33 RESULTS OF SELECTION OF A LIMITED SET OF MHAS’ TESTS ....................................................................................................33 Reviewing the scientific literature .......................................................................................................................................34 Searching app stores ............................................................................................................................................................34
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