Comparison of portable devices with standard glaucoma diagnostic testing for the detection of glaucoma for the purposes of glaucoma case finding in low-and middle- income countries.

BACKGROUND/OBJECTIVES

Glaucoma is a leading cause of blindness worldwide, with the greatest burden in low- and middle-income countries (LMICs) where access to diagnostic services is limited. Portable devices, which are simple to use and comparable to standard tests, may strengthen early detection and referral. This study evaluated selected portable glaucoma assessment devices against standard reference tools in Nigeria and identified which tests or combinations most closely matched a glaucoma diagnosis.

SUBJECTS/METHODS

In this cross-sectional study at the University of Abuja Teaching Hospital, 312 participants (524 eyes) underwent both portable and conventional testing: Peek CS vs. Pelli-Robson (contrast sensitivity), Peek Acuity vs. LogMAR (visual acuity), iCare vs. Goldmann Applanation Tonometry (GAT) (intraocular pressure), Eyecatcher vs. Humphrey Field Analyzer (visual fields), and Remedio handheld fundus camera vs. slit lamp (optic discs). Agreement, diagnostic accuracy (AUC), completion rates, and patient preference were assessed.

RESULTS

Strong correlations were observed between iCare and GAT IOP (r = 0.96), Peek and LogMAR acuity (r = 0.82), and Remedio handheld fundus camera and slit lamp CDR (r = 0.82). The Remedio handheld fundus camera achieved the highest diagnostic accuracy (AUC = 0.91; sensitivity 82.4%, specificity 99.8%). Combining Remedio with Eyecatcher MD (AUC = 0.86) or iCare IOP (AUC = 0.83) also performed well. Portable devices were faster, had higher completion rates, and were strongly preferred by participants, particularly iCare and Eyecatcher.

CONCLUSIONS

Portable devices showed good agreement with standard tools and high acceptability, supporting their potential role in glaucoma screening in resource-limited settings. Further community-based validation is recommended.