{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:41:52Z","timestamp":1792172512468,"version":"4.4.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>To validate a novel smartphone-based approach for subjective refraction, specifically for myopia screening, offering a cost-effective and accessible tool for at-home vision assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 230 healthy volunteers, encompassing 460 eyes, aged between 7 and 40 years (mean \u00b1 SD: 21.04 \u00b1 7.76), and exhibiting refractive error (RE) ranging from \u22126.25 to +0.50 diopter (D), were deemed eligible subjects in this research. Subjective refraction assessments were conducted on all subjects, involving both the conventional phoropter examination by experienced optometrists which served as the clinical gold-standard, and the smartphone-based methodology. During smartphone measurement, the screen was gradually moved toward the eye until achieving clear differentiation of the \u2018E\u2019 optotypes and the astigmatic dial. The eye-to-smartphone screen distances (ESD) were calculated based on the image of iris diameter (ID) acquired by the front-facing camera of the smartphone. Applying the definitions of the far point and the rule of thirty, this allowed for the computation of sphere (S), cylinder (C), and astigmatism axis (<jats:italic>\u03b1<\/jats:italic>) values. The concordance between the two methods was assessed by establishing the Limits of Agreement (LOAs), which were calculated as the mean difference \u00b1 1.96 times the standard deviation of the differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The smartphone-based screening technique showed that it closely matched the gold-standard subjective refraction used in clinical practice. The LOAs for S, C, and spherical equivalent refraction (SER) were 0.11 \u00b1 0.89 D, \u22120.03 \u00b1 0.82 D, and 0.10 \u00b1 0.89 D, respectively. The average deviation in measuring the <jats:italic>\u03b1<\/jats:italic> was 4.72\u00b0, with 64.35% of deviations falling within the \u00b115\u00b0 range. Additionally, the technique demonstrated impressive areas under the receiver operating characteristic curve (AUC) of 0.973 for the range of \u22123.00 D &amp;lt; SER \u2264 0.00 D and 0.986 for the range of \u22126.00 D &amp;lt; SER \u2264 \u22123.00 D.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The innovative vision screening through smartphones can expand access to measuring RE, especially in home. The study confirms the validity of an innovative vision-screening approach for myopia. Its effectiveness and accessibility make it a valuable tool for opportunistic or large-scale myopia screening programs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fbioe.2025.1678800","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T09:29:31Z","timestamp":1760952571000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Innovative myopic screening platform based on smartphones"],"prefix":"10.3389","volume":"13","author":[{"given":"Qiang","family":"Su","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yicheng","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinghui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haochen","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingxin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chea-Su","family":"Kee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bei","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruihua","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e19227","DOI":"10.7717\/peerj.19227","article-title":"Measurements of white-to-white corneal diameter and anterior chamber parameters using the pentacam AXL wave and their correlations in the adult Saudi population","volume":"13","author":"Alotaibi","year":"2025","journal-title":"PeerJ"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.18240\/ijo.2019.07.22","article-title":"A review of paediatric vision screening protocols and guidelines","volume":"12","author":"Atowa","year":"2019","journal-title":"Int. J. Ophthalmol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1038\/s41572-020-00231-4","article-title":"Myopia","volume":"6","author":"Baird","year":"2020","journal-title":"Nat. Rev. Dis. Prim."},{"key":"B4","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1001\/jamaophthalmol.2015.1468","article-title":"Development and validation of a smartphone-based visual acuity Test (Peek acuity) for clinical practice and community-based fieldwork","volume":"133","author":"Bastawrous","year":"2015","journal-title":"JAMA Ophthalmol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"406","DOI":"10.25122\/jml-2023-0535","article-title":"Normative data of corneal diameter and palpebral fissure height in a large cohort of South Indian children","volume":"17","author":"Challa","year":"2024","journal-title":"J. Med. Life"},{"key":"B6","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s10384-020-00733-4","article-title":"Prevalence and associations of myopia in Hong Kong primary school students","volume":"64","author":"Choy","year":"2020","journal-title":"Jpn. J. Ophthalmol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1111\/jpc.15971","article-title":"Towards a national pre-school vision screening programme","volume":"58","author":"Crippa","year":"2022","journal-title":"J. Paediatr. Child. Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/s12886-021-02134-8","article-title":"Prevalence and pattern of refractive error and visual impairment among schoolchildren: the Lhasa childhood eye study","volume":"21","author":"Cui","year":"2021","journal-title":"BMC Ophthalmol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1097\/01.opx.0000134906.98403.c3","article-title":"Clinical evaluation of the Topcon BV-1000 automated subjective refraction system","volume":"81","author":"Dave","year":"2004","journal-title":"Optometry Vis. Sci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e919","DOI":"10.7717\/peerj-cs.919","article-title":"Iris recognition approach for identity verification with DWT and multiclass SVM","volume":"8","author":"El-Sayed","year":"2022","journal-title":"PeerJ Comput. Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1167\/tvst.8.4.27","article-title":"Development and validation of a smartphone-based visual acuity Test (Vision at home)","volume":"8","author":"Han","year":"2019","journal-title":"Transl. Vis. Sci. & Technol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jcrs.2018.08.022","article-title":"Assessment of subjective refraction with a clinical adaptive optics visual simulator","volume":"45","author":"Hervella","year":"2019","journal-title":"J. Cataract. Refract Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ophtha.2022.10.031","article-title":"Refractive errors preferred practice pattern\u00ae","volume":"130","author":"Jacobs","year":"2023","journal-title":"Ophthalmology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12886-018-0836-9","article-title":"Incidence of myopia and biometric characteristics of premyopic eyes among Chinese children and adolescents","volume":"18","author":"Li","year":"2018","journal-title":"BMC Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1167\/iovs.63.1.8","article-title":"Annual incidences and progressions of myopia and high myopia in Chinese schoolchildren based on a 5-Year cohort Study","volume":"63","author":"Li","year":"2022","journal-title":"Investigative Opthalmology & Vis. Sci."},{"key":"B17","first-page":"48","article-title":"Derive principle of 30 degree in astigmatic dials Test","volume":"28","author":"Liu","year":"2012","journal-title":"J. Dezhou Univ."},{"key":"B18","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1542\/pir.2016-0191","article-title":"Pediatric vision screening","volume":"39","author":"Loh","year":"2018","journal-title":"Pediatr. Rev."},{"key":"B19","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1167\/tvst.11.2.40","article-title":"Preliminary evaluation of a smartphone app for refractive error measurement","volume":"11","author":"Luo","year":"2022","journal-title":"Transl. Vis. Sci. Technol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"9701","DOI":"10.1021\/acs.analchem.4c06421","article-title":"An integrated Nanosensor\/Smartphone platform for point-of-care biomonitoring of human exposure to pesticides","volume":"97","author":"Maanaki","year":"2025","journal-title":"Anal. Chem."},{"key":"B21","first-page":"212","article-title":"The validity of visual acuity assessment using mobile technology devices in the primary care setting","volume":"45","author":"O'Neill","year":"2016","journal-title":"Aust. Fam. Physician"},{"key":"B22","doi-asserted-by":"publisher","first-page":"96","DOI":"10.4103\/0974-9233.164621","article-title":"Determinants of utilization of eye care services in a rural adult population of a developing country","volume":"23","author":"Olusanya","year":"2016","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"134060","DOI":"10.1016\/j.snb.2023.134060","article-title":"Selective and smart dual-channel colorimetric sulfur ion sensing readout platform","volume":"392","author":"Qu","year":"2023","journal-title":"Sensors Actuators B-Chemical"},{"key":"B24","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/ICU.0000000000000834","article-title":"Beyond traditional subjective refraction","volume":"33","author":"Rodriguez-Lopez","year":"2022","journal-title":"Curr. Opin. Ophthalmol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"100494","DOI":"10.1016\/j.optom.2023.100494","article-title":"Measuring visual acuity and spherical refraction with smartphone screens emitting blue light","volume":"17","author":"Salmeron-Campillo","year":"2024","journal-title":"J. Optom."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/opo.13560","article-title":"Accuracy and precision of a sphero-cylindrical over-refraction app for smartphones","author":"Salmeron-Campillo","year":"2025","journal-title":"Ophthalmic Physiol. Opt."},{"key":"B27","doi-asserted-by":"publisher","first-page":"846601","DOI":"10.3389\/fpubh.2022.846601","article-title":"Global tendency and frontiers of research on myopia from 1900 to 2020: a bibliometrics analysis","volume":"10","author":"Shan","year":"2022","journal-title":"Front. Public Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s10916-018-0980-z","article-title":"Computer-aided diagnosis of anterior segment eye abnormalities using visible wavelength image analysis based machine learning","volume":"42","author":"Sv","year":"2018","journal-title":"J. Med. Syst."},{"key":"B29","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/00006324-199706000-00019","article-title":"Power vectors: an application of Fourier analysis to the description and statistical analysis of refractive error","volume":"74","author":"Thibos","year":"1997","journal-title":"Optom. Vis. Sci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1111\/cxo.12980","article-title":"Refractive status and prevalence of myopia among Chinese primary school students","volume":"103","author":"Thorn","year":"2021","journal-title":"Clin. Exp. Optometry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1038\/eye.2015.138","article-title":"Effectiveness of a smartphone application for testing near visual acuity","volume":"29","author":"Tofigh","year":"2015","journal-title":"Eye"},{"key":"B32","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1111\/cxo.13003","article-title":"Comparing the Netra smartphone refractor to subjective refraction","volume":"103","author":"Tousignant","year":"2020","journal-title":"Clin. Exp. Optom."},{"key":"B33","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1186\/s12886-021-02071-6","article-title":"Prevalence of myopia in 3-14-year-old Chinese children: a school-based cross-sectional study in Chengdu","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Ophthalmol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e14808","DOI":"10.2196\/14808","article-title":"Validation of an independent web-based tool for measuring visual acuity and refractive error (the Manifest versus Online Refractive Evaluation Trial): prospective open-label noninferiority clinical trial","volume":"21","author":"Wisse","year":"2019","journal-title":"J. Med. Internet Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/s12886-022-02436-5","article-title":"High prevalence of myopia and low hyperopia reserve in 4411 Chinese primary school students and associated risk factors","volume":"22","author":"Yue","year":"2022","journal-title":"BMC Ophthalmol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"5743","DOI":"10.1007\/s11042-021-11789-w","article-title":"Evaluation of effectiveness of eye massage therapy via classification of periocular images","volume":"81","author":"Zheng","year":"2022","journal-title":"Multimedia Tools Appl."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1678800\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T09:29:31Z","timestamp":1760952571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1678800\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":36,"alternative-id":["10.3389\/fbioe.2025.1678800"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1678800","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]},"article-number":"1678800"}}