# Usability Evaluation of a Macular Quantitative Square Grid Self-Examination Application in Patients With Macular Disease: Mixed Methods Study

## TL;DR

A new app for monitoring macular disease at home was tested and found to be user-friendly and effective at detecting vision distortion.

## Contribution

The study introduces and evaluates a novel touch-based app for quantitatively tracking macular distortion in patients at home.

## Key findings

- The app showed 100% diagnostic concordance with the traditional Amsler grid for detecting distortion.
- Users rated the app as 'good-excellent' in usability with a mean SUS score of 82.1.
- Qualitative feedback highlighted high usability, perceived advantages, and willingness for continued use.

## Abstract

Digital self-monitoring applications could provide individuals with macular disease with a convenient, quantitative method for tracking metamorphopsia at home; yet the usability of such tools remains to be fully established.

This study evaluated the usability of a macular quantitative square grid self-examination application, a semiquantitative, touch-based self-monitoring application for macular function.

This study used a convergent mixed methods design. The application quantifies (1) distortion severity, (2) distortion area, and (3) temporal trends through a 3-step touch interface. A total of 24 adults with neovascular age-related macular degeneration or diabetic macular edema, accompanied by self-reported metamorphopsia, participated in a single supervised test session. A 10-item System Usability Scale (SUS) was used to assess usability, and semistructured interviews were conducted to gather further insights. Quantitative data were summarized descriptively, and qualitative feedback underwent inductive thematic analysis.

A total of 24 participants completed the GridMacuScan application self-assessment, the SUS questionnaire, and 11 participants completed the interview when data saturation was achieved. All eyes that showed distortion on the Amsler grid also produced positive distortion maps on the GridMacuScan application, yielding 100% diagnostic concordance. The mean SUS score was 82.1 (SD 8.7), indicating “good-excellent” usability. The inductive thematic analysis yielded four overarching themes: (1) high usability and positive overall experience, (2) perceived functional advantages, (3) shortcomings and optimization suggestions, and (4) strong willingness for continued use.

The GridMacuScan application demonstrated diagnostic sensitivity comparable to that of the traditional Amsler grid and received high user ratings for usability. Furthermore, it provided quantitative distortion metrics that could facilitate longitudinal disease surveillance. Future research must be conducted to validate performance in unsupervised home environments and investigate whether sustained use improves time-to-disease-progression detection and treatment outcomes.