IbisVision develops software-based products and infrastructure for testing vision. Our equipment and software is normally used by an optometrist in an examination room but during lockdown we responded to the need for socially distanced testing by bringing forward a work programme to develop a remote tele-optometry system. The underlying technology and infrastructure needs to be secure, reliable, clinically validated and with encrypted data and communications handling. Our goal is to enable the optometrist to attend the consultation remotely by engaging in real-time with the patient via the patient's own internet and devices. This approach is innovative and different from most other approaches because others are trying to remove the physical need for an optometrist through the use of computer algorithms. We believe it is important to support optometrists and optometry businesses and also take advantage of all their human skill and training by providing a conduit for them to maintain continuity of care, personal relationships and business development through a mixture of digital and real consultations but always clinician-led with full clinician accountability and a synchronous audio, video and data engagement with the patient- as close as possible to a real examination room experience for both parties. A big challenge and one that has previously been pointed out to us is that to conduct a clinically valid eye examination for any reason one needs to have some means of quality control at the patient (remote) end, over which we have very little control. This application is to understand the factors introducing noise and variability at the remote location looking at: **Suitability of the patient's device and screen.** Variability across a screen (brightness, colour, contrast) may affect the validity of the result. We are developing ways to assess suitability of individual screens remotely and to either work around or compensate for the lack of uniformity. **Ergonomics** It is important that the patient is at the most relaxed and comfortable position relative to their screen and input device. We are developing methods to ensure they are optimally positioned using the limited domestic resources they have to hand, and ensure their movement and fidgeting during the test is minimised. **Human Factors/psychology** We are developing standard operating procedures and scripted instructions to optimise the relationship between the patient and the technology and to help build rapport and cooperation between the optometrist and the patient. **Project output** * A means of working around or compensating for variability in the patient's display device (screen) sufficient to ensure a high probability of a valid result. * A means of ensuring the patient is in the best possible position so they don't move during the test. * Procedures and scripts to conduct the tests in the most engaging and collaborative way to optimise compliance. To help us we will recruit a test population of those who have been introduced to virtual meetings during lockdown but are otherwise not technically minded. We know church and charity groups willing to help and we believe these individuals will be representative of our target demographic.

IbisVision was founded by an eye surgeon from Aberdeen and was established in 2013 to complete the development and commercialisation of a suite of computer-based tools backed up by a secure database and cloud-based patient management system. The objective was to make eye testing easier and more intuitive for both the optometrist and the patient by using the familiarity of a computer and simple inputs. We are continuing to improve the system which now includes visual field, colour vision and the Amsler grid test. The corona virus pandemic has highlighted that routine eye tests to prescribe glasses or contact lenses are impossible with social distancing and, at the time of writing are suspended completely. This application is a feasibility study to explore whether eye tests to prescribe corrective lenses can be done remotely with the optometrist in their consulting room and the patient somewhere else, maybe at home, with a laptop. This has been attempted before with mixed success and always by trying to develop automatic self-testing software that by-passes the optometrist and thus their skill and experience is lost in real-time. Our proposal is highly innovative because we want to keep the optometrist and provide a means for them to interact with the patient remotely in real-time using a fully integrated suite of tests to assess the person's vision and prescribe the correct lenses to correct any near- or farsightedness or astigmatism. This is a challenging undertaking but we will work closely with a large optometry chain to look at the feasibility of three possible ways of achieving it. If successful our product will make eye-testing and getting new glasses highly resilient to subsequent lockdown events and help the optometry sector build back better and compete outside their normal physical catchment area without increasing their carbon-footprint (Green Growth). From the patient's perspective they are responding to a real person in real-time who is conducting the test and taking responsibility for the outcome. This personal interaction and surrender of responsibility to the optometrist has mental health benefits over a purely technical interaction with abdication of responsibility for testing and outcome onto the patient themselves. Also, because people will not have to travel to get their eyes tested, we are saving about three journeys per patient which contributes to our aspiration towards a net zero carbon economy.