Abstract
Purpose :
Previous studies from our group show that visual field testing can be performed at home using Melbourne Rapid Fields (MRF) with iPad tablets (Prea et al. 2021, 2022). Here, we consider whether glaucoma patients can perform VF testing using their own home computer device and a web-browser version of the MRF (MRF-web) without direct supervision.
Methods :
Twenty-six glaucoma patients were asked to perform four 24-2 VF tests at home using the MRF-web. Written and verbal instructions were provided, and audio instructions guided completion at home. Patients were asked to complete four tests either over the coming week (daily) or month (weekly). Patients were advised to ensure their screen size was at least 246 mm (9.7”) and instructed on how to perform a calibration step and to turn the screen brightness to maximum. MRF results for the eye having the worst Humphrey Field Analyzer (HFA) SITA-Faster mean deviation (MD) were analysed. MRF MD and pattern standard deviation (PSD) outcomes were compared to HFA SITA-faster testing, obtained by a clinical assistant at the last visit (ave. 1 yr ago), using Bland-Altman methods and computing the intraclass correlation coefficient (ICC). The false positive rate (FP, %), fixation loss (FL, %), and test time (mins) was compared by t-test. Pointwise analysis of average retinal thresholds (MRF-HFA) was also undertaken. Analysing the better eye had little impact on conclusions.
Results :
Patient age ranged from 46 to 86 (average 65.9, SD 10.6 yrs). High concordance is found for MD and PSD, (ICC = 0.93 ±0.04, and 0.73±0.10, respectively). Bland-Altman methods found a bias of -0.69 dB for MD (HFA-MRF) and 95% Coefficient of Repeatability 5.4 dB. Similarly, the PSD found a bias of -0.89 dB and 95% Coefficient of Repeatability 6.1 dB. There was no statistical difference between MRF-web and HFA SITA-faster in terms of FP rate (12.0% ± 14.1% vs 5.7% ± 6.2%, p=0.07), FL rate (15.5 ± 16.2% vs 7.3% ± 12.9%, p=0.10), or test time (4.08 ± 0.14 min vs 3.99 ± 0.16 min, p =0.62). Both MRF and HFA flagged 4 patients (17%) each as unreliable for poor fixation. Pointwise analysis was consistent with differences in spot size.
Conclusions :
Novel MRF-web software returns outcomes comparable to HFA SITA-faster done in clinic. Future large-scale home monitoring of vision for glaucoma may be possible due to the device-independent nature of MRF-web.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.