Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months

Abstract

Purpose To assess accuracy and adherence of visual field (VF) home-monitoring in a pilot sample of glaucoma patients. Design Prospective longitudinal feasibility and reliability study. Methods Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet-perimeter (Eyecatcher), and were asked to perform one VF home-assessment per eye, per month, for 6 months (12 tests total). Before and after home-monitoring, two VF assessments were performed in-clinic using Standard Automated Perimetry (SAP; 4 tests total, per eye). Results All 20 participants could perform monthly home-monitoring, though one participant stopped after 4 months (Adherence: 98%). There was good concordance between VFs measured at home and in the clinic ( r = 0.94, P < 0.001). In 21 of 236 tests (9%) Mean Deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets’ front-facing camera (Area Under the ROC Curve = 0.78). Adding home-monitoring data to 2 SAP tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 mins ( Quartiles : 3.9 – 5.2 mins). Substantial variations in ambient illumination had no observable effect on VF measurements ( r = 0.07, P = 0.320). Conclusions Home-monitoring of VFs is viable for some patients, and may provide clinically useful data.

Uptake, Persistence, and Performance of Weekly Home Monitoring of Visual Field in a Large Cohort of Patients With Glaucoma

“…Of note, Jones et al made use of free space viewing when testing a limited 20° region of the central visual field and they also find a high correlation (0.94) between their tablet-based outcomes and repeat HFA 24-2 SITAfast test results. 18 This high concordance is also evident in our Bland-Altman plots ( Figure 7D) and in the Coefficient of Repeatability (CoR) listed in Table 5. The CoR defines the limits that should contain 95% of data on retest and Table 5 shows that the CoR is smaller for the home testing environment derived from 6 tests (4.3 dB) than for the HFA derived from two tests (6.2 dB).…”

“…Similar to our study, participants received email reminders on a monthly basis for testing, promoting timely participation although, the timeliness of test returns was not reported by the authors. 18 The high compliance of glaucoma participants achieved in our shorter intervention (87%), appears to flow through to longer term 6monthly trials and suggests that high compliance can be achieved in the long-term in the presence of incentives. This will be the topic of a future paper reporting 12months of clinical follow up of glaucoma patients.…”

“…In a recent trial that recruited 20 glaucoma patients to monthly self-testing for a period of 6-months the authors report a compliance rate of 95%. 18 In that study, participants were recruited by advertisement and were also loaned a tablet with broadband, so their levels of motivation and participation could be expected to be high. Similar to our study, participants received email reminders on a monthly basis for testing, promoting timely participation although, the timeliness of test returns was not reported by the authors.…”

The performance of iPad-based noise-field perimeter versus Humphrey Field Analyser in detecting glaucomatous visual field loss

“…The provision of telemedicine via iPads has been well-received, particularly for its convenience and effectiveness in reducing barriers to assessing specialist care [ 22 ]. Studies also reported good short-term compliance (over 6 months) with home-based visual field monitoring using tablets, and the test results were comparable to measurements in the clinic [ 23 , 24 ]. Validation of VFF may provide an alternative method to facilitate the conduct of telemedicine, by offering means to remotely assess patients with VF complaints.…”

Remote Vision Testing: Validation Of A Simple Home-Printable Vision Screening Test for Telemedicine

“…7 Trials of computer based vision measurements have involved giving participants laptops with known screen parameters. 8,9…”