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Remote and unsupervised visual acuity testing results in lower precision than clinic supervised testingDifferent testing methods impact the accuracy of vision tests

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Key Takeaway
Note that remote and unsupervised visual acuity testing results in lower precision than supervised clinic testing.

This meta-analysis evaluated the impact of various visual acuity (VA) testing strategies on intertest and test-retest accuracy and precision. The analysis included 10,873 participants and compared factors such as optotype sampling, response input methods, supervision levels, and testing sites. The study found a pooled mean bias of 0.01 logMAR, though it noted that while mean bias was low, variability was substantial.

Specific comparisons revealed that remote sites (0.27 logMAR) and unsupervised testing (0.26 logMAR) resulted in larger LoA half-widths compared to clinic settings (0.19 logMAR) and supervised testing (0.19 logMAR). Conversely, no significant differences in precision were observed between optotype sampling methods (adaptive vs. fixed) or response input methods (examiner vs. self-run).

The authors noted that patient selection was the primary domain of concern regarding bias. Clinicians should note that while mean bias remains low across methods, precision is notably lower in remote and unsupervised settings. These findings suggest that supervised, clinic-based testing may offer more consistent results for visual acuity monitoring.

When you go for an eye exam, the accuracy of the test depends on more than just your eyes. It also depends on how the test is set up. Researchers looked at over 10,000 tests to see how different methods, like remote testing or unsupervised stations, affected the results. They wanted to see if these methods still gave a clear picture of your vision.

The study found that while the average results were consistent, the precision of the test dropped significantly in certain settings. Specifically, tests done at remote sites or without a supervisor were less precise than those done in a clinic with a professional present. This means there is more variation in the results when you aren't in a traditional clinic setting.

Other factors, like how the test chooses the letters you see or whether you enter your own answers, did not change the accuracy as much. However, the lack of precision in remote and unsupervised tests is a notable finding. Because of these differences, you should talk to your doctor about how the testing environment might affect your results.

What this means for you:
Remote and unsupervised vision tests are less precise than those performed in a clinic with a supervisor.

Common questions

Is a remote vision test as accurate as a clinic visit?

While the average results are similar, remote tests are less precise. The study found that the precision of a test in a clinic was 0.19 logMAR, while remote sites showed a higher variation of 0.27 logMAR. This means clinic visits provide more consistent results.

Does having a supervisor during the test make a difference?

Yes, supervision helps with precision. The study showed that supervised tests had a precision of 0.19 logMAR, while unsupervised tests were less precise at 0.26 logMAR. This suggests that having a professional present helps ensure more consistent results.

Do different ways of showing letters affect the results?

The study found that the method used to sample the letters (adaptive versus fixed) did not make a significant difference in the precision of the results. Both methods provided similar levels of accuracy for the patient.

Study Details

Study typeMeta analysis
Sample sizen = 10,873
EvidenceLevel 1
PublishedNov 2026
View Original Abstract ↓
Purpose: Visual acuity (VA) testing has expanded from examiner-guided to examinee self-guided assessments, yet measurement variability may limit clinical utility. This meta-analysis investigated VA-test's intertest and test-retest accuracy and precision across different testing strategies. Methods: Following PRISMA guidelines, we searched PubMed, Google Scholar, and Scopus for VA validation studies published between 1 January 1983 to 02 December 2024. Eligible studies reported intertest or test-retest Bland-Altman mean bias and limits of agreement (LoA); objective VA assessments and correlation coefficient only studies were excluded. Testing strategies were classified by test site, optotype sampling methods, response input methods, and level of supervision. Accuracy outcomes were reported as mean biases. Precision outcomes were reported as intertest LoA half-width and test-retest coefficient of repeatability (CoR) for test-retest. Multilevel random-effects models accounted for multiple estimates per study. Risk of bias was assessed using QUADAS-2. Results: Across 82 included studies (10,873 participants), pooled intertest and test-retest mean biases were both 0.01 logMAR. Intertest LoA half-width was 0.19 logMAR and test-retest CoR was 0.14 logMAR. Variability showed marginal difference by optotype sampling (adaptive: LoA half-width 0.20 logMAR, CoR 0.15 logMAR; fixed: 0.18, 0.13) or response input method (examiner: 0.19, 0.13; self-run: 0.19, 0.18). Only few studies reported results for test site and level of supervision, hence only intertest was compared (test site, clinic: LoA half-width 0.19 logMAR vs remote 0.27 logMAR and level of supervision, supervised: 0.19 logMAR vs unsupervised 0.26 logMAR). QUADAS-2 identified patient selection as the domain of greatest bias concern. Conclusion: Across testing strategies, VA assessments showed minimal systematic bias but substantial variability. Lack of precision is more notable in remote and unsupervised testing while no difference within optotype sampling and response-input methods. Future development should prioritize on improving precision of visual acuity tests with finer adaptive optotype resolution and remote/unsupervised testings through repeatability studies.
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