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Selwyn Marc Prea, Yu Xiang George Kong, Robyn H Guymer, Elizabeth Kate Baglin, Pyrawy Sivarajah, Algis J Vingrys; Home-monitoring by age-related macular degeneration patients using a tablet perimeter.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2386. doi: https://doi.org/.
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The Melbourne Rapid Fields (MRF) iPad app has voice commands to allow home-monitoring of vision to detect early change due to neovascular age-related macular degeneration (AMD). In-clinic the MRF is comparable to the Humphrey Field Analyzer, but it is not clear whether this will translate to home-monitoring assays.
Twenty-three participants (age 56-84, mean 72 years, 5 males and 18 females) with intermediate AMD have been included in this study. Patients attended an in-office review where high contrast (HC, 130 cd/sq.m) and low luminance (LL, 5 cd/sq.m) visual acuities and central visual field thresholds were established (0-9 degrees) using the MRF-macular test under the supervision of a trained orthoptist. Patients were taught to do these tests with voice over and asked to home-monitor on a weekly basis. Email reminders were sent when 2 consecutive tests were missed. Compliance was established for home-monitoring over the first 12 weeks of testing and outcome accuracy was compared with in-clinic assays. Data are expressed as mean [SD] and analysed using ANOVA or Bland-Altman methods.
All patients have complied with the request for regular home-monitoring over a 12-37 week observation period. Test frequency for the group is 1.1 weeks (8 days) and the average test time for perimetry is 2.1 ±0.5 mins. No significant difference was found between the in-office and at home results for: VA HC (LogMAR home: -0.04 ±0.18 (20/20+2), clinic: -0.02 ±0.15 (20/20+1)), VA LL (home: 0.15 ±0.38 (20/30+2), clinic: 0.10 ±0.24 (20/25)), or the perimetric indices of mean defect (home: -0.46 ±2.38 dB, clinic: -0.28 ±1.50 dB), pattern defect (home: 2.3 ±2.4 dB, clinic: 2.4 ±2.1 dB) or visual capacity (home: 96.7 ±7.8%, clinic: 96.8 ±11.1%). A learning effect (improvement) was apparent for VA LL with performance improving significantly (+1 line) after the first test at home (p=.01). Perimetry shows a gradual improvement from test 1 to test 4 at home but fails to reach statistical significance (MD -0.84 to -0.1 [0.49], p=.055).
AMD patients are highly motivated and compliant to home-monitoring of vision using the MRF-macular app. Results obtained at home are comparable with in-clinic outcomes. A learning effect was found for VA LL and is suggested in the perimetry data over the first 4 tests. The MRF offers a low-cost alternative to conventional in-office testing.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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