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Jo JJ, Pasquale LR. Recent developments of telemedicine in glaucoma. Curr Opin Ophthalmol 2024; 35:116-123. [PMID: 38295153 DOI: 10.1097/icu.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW Telemedicine has an increasingly significant role in the fields of ophthalmology and glaucoma. This review covers recent advancements in the development and optimization of teleglaucoma techniques and applications. RECENT FINDINGS Glaucoma monitoring and diagnosis via remote tonometry, perimetry, and fundus imaging have become a possibility based on recent developments. Many applications work in combination with smart devices, virtual reality, and artificial intelligence and have been tested in patient populations against conventional "reference-standard" measurement tools, demonstrating promising results. Of note, there is still much progress to be made in teleglaucoma and telemedicine at large, such as accessibility to internet, broadband, and smart devices, application affordability, and reimbursement for remote services. However, continued development and optimization of these applications suggest that the implementation of remote monitoring will be a mainstay for glaucoma patient care. SUMMARY Especially since the beginning of the COVID-19 pandemic, remote patient care has taken on an important role in medicine and ophthalmology. Remote versions of tonometry, perimetry, and fundus imaging may allow for a more patient-centered and accessible future for glaucoma care.
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Affiliation(s)
- Jason J Jo
- Department of Medical Education
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Louis R Pasquale
- Department of Medical Education
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Behera G, Waghmare SV, Ramasamy A. Comparison of the visual field test of Glaufield Lite with Humphrey Field Analyser. Int Ophthalmol 2023; 43:557-565. [PMID: 35947251 DOI: 10.1007/s10792-022-02457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare visual field test results of Glaufield Lite AP901 CTS 133 (Appasamy Associates, Mannadipet Commune, Thirubhuvanai, Puducherry, India, hereafter Glaufield Lite) with Humphrey Field Analyser (HFA, Carl Zeiss Meditec, Dublin, California, USA, hereafter HFA). METHODS A pilot study at a tertiary eye centre involving 23 normal and 24 glaucoma patients who underwent two consecutive visual field tests on (i) HFA 24-2 SITA Fast and (ii) Glaufield Lite Quick Central program. RESULTS The mean testing time on HFA was significantly shorter than Glaufield Lite (normals: HFA: 2.75 ± 0.49 min, Glaufield Lite: 6.85 ± 0.86 min, p < 0.001; glaucoma patients: HFA: 3.45 ± 1.08 min, Glaufield Lite: 6.95 ± 0.54 min, p < 0.001). Reliability criteria were similar, but false-positivity was lower with Glaufield Lite. Bland-Altman analysis showed poor agreement for mean deviation (MD), [~ 2.69 units less for HFA], and acceptable agreement for pattern standard deviation (PSD) [~ 0.426 units more for HFA] between the two devices. CONCLUSION Both perimetric techniques showed reliable test results though test duration was longer with Glaufield Lite perimetry. The MD showed poor agreement, likely due to different scales and principles used for perimetry. The PSD showed acceptable agreement, making it valid for use in glaucoma, though a direct comparison of fields from the two devices is not possible. We recommend using the same perimetry device for follow-up evaluation.
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Affiliation(s)
- Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Shradha Vijay Waghmare
- Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute (IGGGH&PGI), Puducherry, India
| | - Amala Ramasamy
- Department of Biostatistics, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, India
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Abdulhussein D, Abdul Hussein M, Szymanka M, Farag S. A systematic review of the current availability of mobile applications in eyecare practices. Eur J Ophthalmol 2022; 33:11206721221131397. [PMID: 36199266 PMCID: PMC9999269 DOI: 10.1177/11206721221131397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 09/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an increasing shift towards non-communicable eye diseases (NCEDs) because of a demographic transition. Incorporation of telemedicine into everyday clinical practice is becoming increasingly popular. We sought to carry out a systematic review to look at which applications on portable devices are available for use in eyecare practices for patients with NCEDs, specifically refractive error, diabetic retinopathy, age-related macular degeneration (AMD) and glaucoma. METHODS Pubmed, EMBASE, Medline, PsychInfo databases were systematically searched using keywords and MeSH terms. Eligible articles included peer-reviewed, original full text articles evaluating apps for use on portable devices aimed at patients with NCEDs. RESULTS The initial search yielded 100 studies. Nine studies met the inclusion criteria, and an additional eight studies were identified through reference screening. Of the included studies, 29.4%% (n = 5) evaluated applications aimed for use to identify refractive errors, 35.3% (n = 6) aimed at patients with glaucoma, 23.5% (n = 4) for use by patients with AMD, 11.7% (n = 2) for the non-specific monitoring of visual acuity/fields. 76.5% (n = 13) of the studies showed that the application evaluated was an effective and reliable tool compared to clinical standards. CONCLUSIONS Portable device applications in patients with NCED have been shown to be effective. The use of these apps for patients is limited to either diagnostic or monitoring use. There is scope for apps which encompass other aspects of patient care that have been used in other specialties that may be applied to ophthalmic patients, including those with an educational aim which have a role in increasing compliance.
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Affiliation(s)
- D Abdulhussein
- The Imperial College Ophthalmic Research Group, Imperial College London, London, UK
| | | | - M Szymanka
- Faculty of Medicine, Imperial College London, London, UK
| | - S Farag
- Faculty of Medicine, Imperial College London, London, UK
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Ichhpujani P, Dhillon H. Spotlight on iPad Visual Field Tests Efficacy. Clin Ophthalmol 2022; 16:2179-2185. [PMID: 35818511 PMCID: PMC9270904 DOI: 10.2147/opth.s340508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Tablet based perimetry has the potential to be used as a low-cost, portable method for glaucoma screening. With the advent of tablets with large dynamic luminance range and high spatial resolution, perimetry applications can test visual field locations within the central 30 degrees, just like bowl perimetry. Tablet perimetry has garnered interest in this COVID era as it can be promptly done in the waiting room or even from the comfort of home. The current review focuses on evaluating glaucoma detection sensitivities, diagnostic abilities and correlation of each parameter and examination time of the iPad based perimetry applications with those of HFA.
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Affiliation(s)
- Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
- Correspondence: Parul Ichhpujani, Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, 160030, India, Tel +91-9501071591, Fax +91-172-2608488, Email
| | - Hennaav Dhillon
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Hughes MA, Ho JW, Keenlyside A, Sieradzki J, Statham PFX. The digital Cullen chart: a red colour perimetry aid for visual field examination. Br J Neurosurg 2021:1-5. [PMID: 34918606 DOI: 10.1080/02688697.2021.2014782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND 30 years ago, a paper chart was developed in Edinburgh by Cullen et al. and validated as a swift, supplementary method for perimetric evaluation of visual fields. We have re-developed this concept in digital form (on smartphone screen) and assessed its sensitivity and specificity in detecting visual field loss, by comparison with formal machine-based perimetry. METHODS Patients with sellar and parasellar tumours, being managed in a single neurosurgical centre, underwent formal visual field perimetry as part of standard care. They also underwent assessment using the smartphone-based Cullen chart. 37 eye testing episodes were assessed, incorporating pre- and post-treatment assessments for a range of potentially compressive pathologies (non-secretory and secretory pituitary adenoma, craniopharyngioma, and parasellar meningioma). The smartphone-based Cullen chart was compared with formal machine-based perimetry for concordance in detecting visual field loss. RESULTS The digital Cullen chart had a sensitivity of 75% and specificity of 98% compared with machine-based perimeters. The positive predictive value was 93% and the negative predictive value was 92%. CONCLUSIONS For the visual field assessment of patients with sellar/parasellar tumours, this simple and swift smartphone-based chart shows good concordance with machine-based perimeters. With amendments to the user interface, there may be potential for telemetric patient-led visual field monitoring.
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Affiliation(s)
- Mark Antony Hughes
- Edinburgh Translational Neurosurgery, Department of Clinical Neurosciences, BioQuarter, Edinburgh, UK
| | - Jen Wae Ho
- Edinburgh Translational Neurosurgery, Department of Clinical Neurosciences, BioQuarter, Edinburgh, UK
| | - Andrew Keenlyside
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Jake Sieradzki
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Patrick F X Statham
- Edinburgh Translational Neurosurgery, Department of Clinical Neurosciences, BioQuarter, Edinburgh, UK
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Stapelfeldt J, Kucur SS, Huber N, Höhn R, Sznitman R. Virtual Reality-Based and Conventional Visual Field Examination Comparison in Healthy and Glaucoma Patients. Transl Vis Sci Technol 2021; 10:10. [PMID: 34614166 PMCID: PMC8496417 DOI: 10.1167/tvst.10.12.10] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Clinically evaluate the noninferiority of a custom virtual reality (VR) perimetry system when compared to a clinically and routinely used perimeter on both healthy subjects and glaucoma patients. Methods We use a custom-designed VR perimetry system tailored for visual field testing. The system uses Oculus Quest VR headset (Facebook Technologies, LLC, Bern, Switzerland), that includes a clicker for participant response feedback. A prospective, single center, study was conducted at the Department of Ophthalmology of the Bern University Hospital (Bern, Switzerland) for 12 months. Of the 114 participants recruited 70 subjects (36 healthy and 34 glaucoma patients with early to moderate visual field loss) were included in the study. Participants underwent perimetry tests on an Octopus 900 (Haag-Streit, Köniz, Switzerland) as well as on the custom VR perimeter. In both cases, standard dynamic strategy (DS) was used in conjunction with the G testing pattern. Collected visual fields (VFs) from both devices were then analyzed and compared. Results High mean defect (MD) correlations between the two systems (Spearman, ρ ≥ 0.75) were obtained. The VR system was found to slightly underestimate VF defects in glaucoma subjects (1.4 dB). No significant bias was found with respect to eccentricity or subject age. On average, a similar number of stimuli presentations per VF was necessary when measuring glaucoma patients and healthy subjects. Conclusions This study demonstrates that a clinically used perimeter and the proposed VR perimetry system have comparable performances with respect to a number of perimetry parameters in healthy and glaucoma patients with early to moderate visual field loss. Translational Relevance This suggests that VR perimeters have the potential to assess VFs with high enough confidence, whereby alleviating challenges in current perimetry practices by providing a portable and more accessible visual field test.
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Affiliation(s)
- Jan Stapelfeldt
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Serife Seda Kucur
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nina Huber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René Höhn
- Department of Ophthalmology, Bern University Hopsital, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Jariyakosol S, Jaru-Ampornpan P, Manassakorn A, Itthipanichpong R, Hirunwiwatkul P, Tantisevi V, Somkijrungroj T, Rojanapongpun P. Sensitivity and Specificity of New Visual Field Screening Software for Diagnosing Hemianopia. Eye Brain 2021; 13:231-238. [PMID: 34512063 PMCID: PMC8412821 DOI: 10.2147/eb.s315403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia. Patients and Methods Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired t-test. Results The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53–85.96) and 93.94% (78.38–99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP. Conclusion The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.
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Affiliation(s)
- Supharat Jariyakosol
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Patcharaporn Jaru-Ampornpan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anita Manassakorn
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Rath Itthipanichpong
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Parima Hirunwiwatkul
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Visanee Tantisevi
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thanapong Somkijrungroj
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Prin Rojanapongpun
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Muñoz-Negrete F, Moreno-Montañés J, Rebolleda G. Perimetría en domicilio. ¿Es posible? ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:285-287. [PMID: 34629693 PMCID: PMC8123935 DOI: 10.1016/j.oftal.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muñoz-Negrete FJ, Moreno-Montañés J, Rebolleda G. Home perimetry. Is possible? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:285-287. [PMID: 34092281 DOI: 10.1016/j.oftale.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; OFTARED, Madrid, Spain.
| | - J Moreno-Montañés
- OFTARED, Madrid, Spain; Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcalá, Madrid, Spain; OFTARED, Madrid, Spain
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Ichhpujani P, Thakur S, Sahi RK, Kumar S. Response to comments on: Validating tablet perimetry against standard Humphrey Visual Field Analyzer for glaucoma screening in Indian population. Indian J Ophthalmol 2021; 69:1018-1019. [PMID: 33727492 PMCID: PMC8012978 DOI: 10.4103/ijo.ijo_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Sahil Thakur
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India; Research Fellow, Department of Ocular Epidemiology, Singapore Eye Research Institute, Singapore
| | - Roopjit K Sahi
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Kumar H, Thulasidas M. Comments on: Validating tablet perimetry against standard Humphrey Visual Field Analyzer for glaucoma screening in Indian population. Indian J Ophthalmol 2021; 69:1017-1018. [PMID: 33727491 PMCID: PMC8012962 DOI: 10.4103/ijo.ijo_3793_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Harsh Kumar
- Glaucoma Services, Centre for Sight, B-5/24, Safdarjung Enclave, New Delhi, India
| | - Mithun Thulasidas
- Glaucoma Services, Centre for Sight, B-5/24, Safdarjung Enclave, New Delhi, India
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Abstract
PURPOSE OF REVIEW Perimetry remains important for the diagnosis and management of glaucoma despite advances in imaging technology. The purpose of this review is to describe advances in the acquisition and analysis of visual field data and highlight novel techniques for performing perimetry. RECENT FINDINGS Studies have focused on improving the detection of patients at highest risk of severe vision loss and the development of innovative testing strategies that allow for more frequent testing. Artificial intelligence has been utilized in research settings to improve detection and characterization of glaucomatous field damage. Furthermore, tablet-based strategies and virtual reality headsets show promise for glaucoma screening and remote monitoring of patients with glaucoma. SUMMARY New testing strategies and research findings have improved our ability to identify patients with both paracentral and mid-peripheral visual field progression. New strategies have the potential to make visual field testing more efficient, reliable and accessible for patients with glaucoma.
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