Abstract
Purpose :
The ALabama Screening and Intervention for Glaucoma and eye Health through Telemedicine (AL-SIGHT) program aims to detect ocular conditions such as glaucoma earlier to reduce visual impairment and blindness in a rural, at-risk population. Visual field testing in AL-SIGHT utilizes the Melbourne Rapid Field (MRF) tablet-based portable perimeter and the Humphrey Field Analyzer (HFA). This study aims to compare the results obtained using the MRF and HFA in a telemedicine setting.
Methods :
Three federally qualified health centers in underserved communities in Alabama enrolled participants with one or more risk factors: black/ Hispanic ≥ 40 years, white ≥ 50 years, diabetes, glaucoma diagnosis, and/or family history of glaucoma. Participants in the sample were those who self-reported no glaucoma/suspect but had a family history of glaucoma and VA 20/40 or better in at least one eye. Eyes with unreliable tests (FP ≥15%, FL ≥30%, FN ≥20%), eye surgery within 6 months or other retinal/corneal disease noted on image review by an ophthalmologist were excluded. The MRF on an iPad tablet and HFA 24-2 SITA- fast program with the participant's reading lens power were used. Each participant undertook the MRF before HFA test. The intraclass correlation coefficient was calculated to assess the reliability of the mean deviations and visual field indexes between the two devices.
Results :
Of the 618 enrolled participants, 64 met all the criteria and completed both the MRF and HFA tests reliably in at least 1 eye (Table). At eye level, 46 right and 31 left eyes were sampled. The distributions of MD and VFI were similar in the two devices (Figure). The ICC (Shrout-Fleiss reliability, fixed set) were OD MD – 0.58[95% CI: 0.36-0.72]; OS MD – 0.43[95% CI: 0.37-0.75]; OD VFI – 0.60[95% CI: 0.26-0.64]; OS VFI – 0.62[95% CI: 0.41-0.78]. The reliability between both MD and VFI among MRF and HFA was poor to moderate.
Conclusions :
The MRF is an inadequate substitute as compared to HFA in this setting. Many were excluded due to unreliable test results. Accurate perimetry results are obtained after repeated testing. In community-based programs, most participants are not expert test takers hence it may be difficult to get reliable results. While the portability of the MRF is attractive for use in a telemedicine program in rural locations, the poor reliability compared to the HFA may limit its usefulness in a remote glaucoma detection program.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.