Official ESCRS | European Society of Cataract & Refractive Surgeons


Clinical validation of the new Easee online test to assess visual acuity and refractive errors: the Manifest vs Online Refractive Evaluation (MORE trial)

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Session Details

Session Title: Ocular Infections & Other Topics

Session Date/Time: Sunday 15/09/2019 | 08:00-10:00

Paper Time: 09:36

Venue: Free Paper Forum: Podium 4

First Author: : R.Wisse THE NETHERLANDS

Co Author(s): :    M. Muijzer   F. Cassano   D. Godefrooij   Y. Prevoo   N. Soeters                 

Abstract Details


Sixty percent of people globally need a visual aid like spectacles or contact lenses for good visual functioning. Worldwide, 42% of preventable blindness is due to uncorrected refractive errors, with severe economic implications. Even in countries with accessible health services, this rate remains unacceptably high and calls for rethinking how to increase the accessibility of a refractive exam. We recently launched an online eye-test that measures visual acuity and refractive errors. The purpose of this study is to validate the online test vs. the golden standard reference test (manifest subjective refraction).


Prospective open-label non-inferiority mono-centre clinical trial performed at the University Medical Center Utrecht


Healthy volunteers between 18-40 year old with a refraction error between -6D and +4D were eligible for inclusion. The manifest refractive error was assessed by an optometrist, and the online refraction was attained independently by the participants using a smartphone and PC (see for the test and instruction video). Outcomes were converted to vectors and spherical equivalents, with a non-inferiority margin of 0.5D considered clinically relevant. Best corrected distance visual acuity with either prescription was recorded. The algorithm was optimized after an interim assessment, and analyses where stratified for denomination (hyperopia vs myopia).


199 eyes of 100 healthy volunteers were enrolled. Overall, the mean difference in spherical equivalent was 0.18±0.77D for myopia and 0.63±0.89D for hyperopia. The optimized cohort performed better: 0.13±0.62D for myopia, 0.50±0.81D for hyperopia. A subgroup analysis for low myopia range (up to -3D) revealed 80% of eyes scored within 0.5D of a manifest refraction, with a mean difference of 0.02±0.49D. In this subgroup, the mean CDVA attained with the online refraction was 1.22±0.29 (20/16, with 88% >1.0), on average one line less than after the reference test (1.39±0.20, 20/14, P < 0.001).


The Easee online assessment of visual acuity and refractive error appears to be a safe and valid test, especially for mild myopes. Whilst this test does not replace a comprehensive eye exam, it increases the accessibility of health care and might serve as a screening tool for visual acuity. Future endeavours should aim at broadening the age-range, and implementation in cataract care. Online eye testing improves the accessibility of healthcare and has the potential to reduce costs.

Financial Disclosure:

gains financially from product or procedure presented, research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, is employed by a for profit company with an interest in the subject of the presentation, has significant investment interest in a company producing, developing or supplying product or procedure presented

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