Melbourne Rapid Fields Online Perimeter Home Visual Field Study for Glaucoma: 3-Month Results.

PURPOSE

To evaluate the reliability and concordance of visual field (VF) assessments conducted unsupervised at home using the web-browser-based Melbourne Rapid Fields (MRF) online perimetry system, in comparison with conventional supervised clinic-based Humphrey Field Analyzer Swedish Interactive Threshold Algorithm (SITA)-Faster (HFA-SFr) testing.

DESIGN

Prospective observational comparison study.

SUBJECTS/PARTICIPANTS

Fifty-three glaucoma patients.

METHODS

Fifty-three patients with glaucoma with prior experience using MRF platform were recruited. Participants completed bilateral 24-2 white-on-white automated perimetry tests at home using the MRF online system on their own personal computers. Humphrey Field Analyzer SITA-Faster results from the most recent clinic visits served as the comparator. Data from the first 3 months of home monitoring were analyzed in this study. Test-retest variability and agreement between MRF and HFA-SFr were analyzed using Bland-Altman plots and intraclass correlation coefficients (ICCs). Regional analysis was conducted using Garway-Heath structurally defined zones.

MAIN OUTCOME MEASURES

Mean deviation (MD), pattern deviation/pattern standard deviation (PD/PSD), test-retest variability, agreement between home-based MRF and clinic-based HFA-SFr, and regional visual field variability.

RESULTS

Participants comprised 19 preperimetric, 23 early, 6 moderate, and 5 advanced glaucoma cases. Visual field testing with MRF performed at home showed strong correlation for mean deviation (MD) values with HFA-SFr (ICC = 0.905) and moderate correlation for pattern deviation (PD)/pattern standard deviation (ICC = 0.685). Test-retest for MRF also showed strong correlation for MD (ICC = 0.983) and PD/pattern standard deviation (ICC = 0.947). Test-retest variability between MRF tests found a bias of -0.18 dB and 95% limits of agreement of (-2.97, 2.62 dB) for MD, and a bias of +0.21 dB and 95% limits of agreement of (-2.29, 2.68 dB) for PD. Zone-specific analysis showed that the temporal zone has a higher degree of test-retest variability compared with other zones.

CONCLUSIONS

Melbourne Rapid Fields online perimetry is a reliable and clinically valid tool for monitoring VF at home in glaucoma cases. Future study of a larger sample size and a more diverse cohort is required to assess its potential for teleophthalmology management of glaucoma and earlier detection of disease progression. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.