September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Comparison of iPad-Based Visual Function Tests for the Detection of Early Manifest Glaucoma
Author Affiliations & Notes
  • Meredith Kim
    George Washington University School of Medicine, Washington, District of Columbia, United States
  • Aiai Ren
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • Peter Bex
    College of Science, Northeastern University, Boston, Massachusetts, United States
  • Matthew Gardiner
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Carolyn Kloek
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Peggy Chang
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lucy Shen
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Angela Turalba
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Louis R Pasquale
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Brian J. Song
    Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Meredith Kim, None; Aiai Ren, None; Peter Bex, Co-inventor on a patent for QCSF (P), Equity in Adaptive Sensory Technology (I); Matthew Gardiner, None; Carolyn Kloek, None; Peggy Chang, None; Lucy Shen, None; Angela Turalba, None; Louis Pasquale, None; Brian Song, None
  • Footnotes
    Support  Harvard-Vision Clinical Scientist Development Program 5K12EY016335, American Glaucoma Society Mentoring for the Advancement of Physician Scientists, Harvard Glaucoma Center of Excellence
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Meredith Kim, Aiai Ren, Peter Bex, Matthew Gardiner, Carolyn Kloek, Peggy Chang, Lucy Shen, Angela Turalba, Louis R Pasquale, Brian J. Song; Comparison of iPad-Based Visual Function Tests for the Detection of Early Manifest Glaucoma. Invest. Ophthalmol. Vis. Sci. 201657(12):.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : To determine the sensitivity, specificity, positive and negative predictive values of frequency doubling technology (FDT) and three iPad-based tests of visual function for the detection of early manifest glaucoma.

Methods : 76 eyes of 76 patients with early manifest glaucoma and 13 eyes of 13 age-matched controls were recruited from the Massachusetts Eye and Ear Infirmary between April 2014 and October 2015. All subjects underwent four tests at the same clinic visit in random order: FDT, visualFields easy iPad app, blue arc entoptic phenomenon testing, and quick contrast sensitivity function (QCSF) testing. Sensitivity, specificity, positive and negative predictive values were calculated for all tests. Receiver operating characteristic (ROC) curves were plotted for the area under the log contrast sensitivity function (AULCSF) as well as the contrast sensitivity function acuity (CSF Acuity) of the QCSF test.

Results : Mean age of all patients was 65.4±11.3 years; 38% male, 74% Caucasian, and 79% phakic. There were no significant differences in baseline demographics between glaucoma and control patients (P>0.05 for all characteristics). Sensitivity, specificity, positive and negative predictive values of each of the four tests is shown in the Table. Optimal cut-off values based on the Youden index for CSF Acuity and AULCSF were 18.3 and 1.78, respectively. Areas under the ROC curves for detection of early manifest glaucoma using CSF Acuity and AULCSF from the QCSF test were 0.82±0.05 and 0.81±0.06, respectively (Figure).

Conclusions : The iPad-based QCSF test has similar sensitivity and specificity as the FDT for the detection of early manifest glaucoma. The QCSF test also has the advantage of being fixation independent. As remote eye disease detection and screening become more prevalent, effective telemedical visual function tests have the potential to become significant adjunctive components of glaucoma evaluations in the future.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Mean values with 95% confidence intervals for various tests to detect glaucoma. Quick contrast sensitivity function (QCSF), Contrast sensitivity function acuity (CSF Acuity), area under the log CSF (AULCSF), frequency doubling technology (FDT), visualFields easy iPad app (Easyfield), blue arc entoptic phenomenon (Blue Arc). PPV=positive predictive value; NPV=negative predictive value.

Mean values with 95% confidence intervals for various tests to detect glaucoma. Quick contrast sensitivity function (QCSF), Contrast sensitivity function acuity (CSF Acuity), area under the log CSF (AULCSF), frequency doubling technology (FDT), visualFields easy iPad app (Easyfield), blue arc entoptic phenomenon (Blue Arc). PPV=positive predictive value; NPV=negative predictive value.

 

Receiver operating characteristic curves for: CSF Acuity (Left) and AULCSF (Right).

Receiver operating characteristic curves for: CSF Acuity (Left) and AULCSF (Right).

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