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Berneshawi AR, Shue A, Chang RT. Glaucoma Home Self-Testing Using VR Visual Fields and Rebound Tonometry Versus In-Clinic Perimetry and Goldmann Applanation Tonometry: A Pilot Study. Transl Vis Sci Technol 2024; 13:7. [PMID: 39102241 PMCID: PMC11309035 DOI: 10.1167/tvst.13.8.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/22/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose This pilot study aimed to assess the feasibility, accuracy, and repeatability of unsupervised, at-home, multi-day glaucoma testing using the Olleyes VisuALL Virtual Reality Platform (VRP) and the iCare HOME handheld self-tonometer. Methods Participants were trained to use two U.S. Food and Drug Administration-registered or approved devices before conducting self-tests at home over 3 consecutive days. The iCare HOME intraocular pressure (IOP) measurements were collected four times daily per eye, and VRP visual field tests were performed once daily. The results were compared with one in-clinic Humphrey Field Analyzer (HFA) visual field test performed on the day of device training, iCare HOME measurements by the trainer, and the last five Goldmann applanation tonometer (GAT) results. Results Of 15 enrolled participants, nine of them (60%) completed the study. The six excluded participants could not self-measure using iCare HOME. There was significant correlation between the average mean deviation (MD) values of the at-home VRP tests and in-clinic HFA test (r2 = 0.8793, P < 0.001). Additionally, the average of the sensitivities in five of six Garway-Heath sectors were significantly correlated. VRP test duration was also shorter than in-clinic HFA testing (P < 0.001). Finally, at-home tonometry yielded statistically similar values compared to trainer-obtained iCare HOME values. The mean and range of at-home tonometry were also statistically similar to those for in-clinic GAT, but at-home tonometry demonstrated higher maximum IOP values (P = 0.0429). Conclusions Unsupervised, at-home, multi-day glaucoma testing using two devices resulted in the capture of higher maximum IOPs than in the clinic and good MD correlation of VRP with HFA. However, 40% of participants could not self-measure IOP using iCare HOME. Translational Relevance The study findings suggest that at-home remote glaucoma monitoring correlates with in-office testing and could provide additional information for glaucoma management, although patients had more difficulty with the iCare HOME than the VRP.
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Affiliation(s)
- Andrew R. Berneshawi
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Shue
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert T. Chang
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
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Garba F, Kyari F, Nolan W, Burton MJ, Gordon I, Evans JR, Hu VH. Portable devices for diagnosis and monitoring of glaucoma: a scoping review protocol. BMJ Open 2024; 14:e082375. [PMID: 38471693 PMCID: PMC10936509 DOI: 10.1136/bmjopen-2023-082375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Glaucoma is the leading cause of irreversible blindness in the world. The need to diagnose glaucoma early in its natural history before extensive sight loss occurs cannot be overemphasised. However, glaucoma is largely asymptomatic in the early stages of the disease making it complex to diagnose clinically and requires the support of technology. The objective of this scoping review is to determine the nature and extent of the evidence for use of portable devices in the diagnosis of glaucoma. METHODS We will consider studies conducted in all healthcare settings using portable devices for the detection of all type of adult glaucoma. We will also include any systematic reviews or scoping reviews, which relate to this topic. Searches will be conducted in MEDLINE, Embase, CENTRAL on the Cochrane Library and Global Health databases, from their inception to the present. Reference lists from publications identified in the searches will also be reviewed. Two authors will independently screen titles and abstracts, followed by full-text screening to assess studies for inclusion. Any disagreements will be discussed and resolved with a third author. Tables accompanied by narrative descriptions will be employed to discuss results and show how it relates to review questions. ETHICS AND DISSEMINATION Ethical approval is not required in this review. Only published and publicly accessible data will be used. We will publish our findings in an open-access, peer-reviewed journal and develop an accessible summary of results and recommendations.
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Affiliation(s)
- Farouk Garba
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Fatima Kyari
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Winifred Nolan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- NHIR Biomedical Reserach Centre, Moorfields and UCL Institute of Ophthalmology, London, UK
| | - Matthew J Burton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| | - Iris Gordon
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| | - Jennifer R Evans
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| | - Victor H Hu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
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Reeves BC, Wickens R, O'Connor SR, Gidman EA, Ward E, Treanor C, Peto T, Burton BJL, Knox PC, Lotery A, Sivaprasad S, Donnelly M, Rogers CA, Hogg RE. Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home. BMJ Open 2024; 14:e077196. [PMID: 38453199 PMCID: PMC10921518 DOI: 10.1136/bmjopen-2023-077196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack). DESIGN Diagnostic Test Accuracy study. SETTING Six UK hospitals. METHODS The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges. RESULTS Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers. CONCLUSIONS Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose. TRIAL REGISTRATION NUMBER ISRCTN79058224.
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Affiliation(s)
- Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robin Wickens
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eleanor Alma Gidman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - E Ward
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlene Treanor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Tunde Peto
- Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - Ben J L Burton
- James Paget University Hospitals NHS Trust, Liverpool, UK
| | | | | | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Chen Z, Shen X, Zhang Y, Yang W, Ye J, Ouyang Z, Zheng G, Yang Y, Yu M. Development and Validation of an Internet-Based Remote Perimeter (Perimouse). Transl Vis Sci Technol 2024; 13:16. [PMID: 38506801 PMCID: PMC10959190 DOI: 10.1167/tvst.13.3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/13/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose We sought to validate the feasibility of Perimouse, an internet-based remote perimeter that allows for natural fixation and can be performed on most computers via a web page. Methods In this cross-sectional study, Perimouse evaluated the visual field of 45 healthy people and 27 patients with primary open-angle glaucoma on a laptop. Participants used a mouse cursor to locate new dots on the screen that were determined by preset saccade vectors. A "click and confirm" strategy was used to eliminate the unwanted visual search. Dot brightness was either fixed at 12 dB in the suprathreshold program (screening program) or variable in the threshold program. We compared Perimouse outcomes with the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Testing Algorithm standard program. Results In the screening program, Perimouse showed moderate to high concordance with HFA. The intraclass coefficient ranged from 0.58 to 0.86 in different areas of Garway-Heath mapping. In the threshold program, normal subjects had threshold ranging from 19 to 16 dB, presenting sensitivity changes according to the "hill of vision". The test-retest difference was 0.09 dB. Habitual spectacle correction and environmental luminance (2-337 lux) had little impact on the central or peripheral threshold (P > 0.05). The correlation between Perimouse and HFA threshold sensitivity was strong (R = 0.950), although Perimouse mean defect was 4.40 dB higher than the HFA mean defect. Conclusions Perimouse is a reliable visual field test that correlates strongly with HFA. It shows potential for population screening and monitoring visual field defects. Translational Relevance Perimouse assesses the visual field using saccade vectors without eye trackers, enhancing its accessibility via a web page.
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Affiliation(s)
- Zidong Chen
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Xiaoyuan Shen
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Yuning Zhang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Wenxin Yang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Jiexin Ye
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Zhiqiang Ouyang
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Guifeng Zheng
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Yangfan Yang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Minbin Yu
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
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Chen YX, Meyerov J, Skalicky SE. Online Circular Contrast Perimetry via a Web-Application: Establishing a Normative Database for Central 10-Degree Perimetry. Clin Ophthalmol 2024; 18:201-213. [PMID: 38269363 PMCID: PMC10807269 DOI: 10.2147/opth.s440964] [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: 10/16/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024] Open
Abstract
Purpose To establish a normative database using a central 10-degree grid pattern for the online circular contrast perimetry (OCCP) application. Participants Fifty participants with mean age 65 ± 13 years were selected for this study. One eye from each participant that met inclusion criteria was randomly included in the cohort. Methods The web-application delivered online 52-loci perimetry in a central 10-degree pattern using circular flickering targets. These targets consist of concentric sinusoidal alternating contrast rings. Users were guided by the application to the correct viewing distance and head position using in-built blind spot localization and webcam monitoring. A spinning golden star was used as the fixation target and patients performed the test in a darkened room following standard automated perimetry (SAP). Results The reliability rates and global indices for OCCP were similar to SAP. OCCP mean sensitivity reduced with age at a similar rate to SAP. Mean sensitivity per loci of 10-degree OCCP was greater than SAP by 1.24 log units (95% CI 1.23 to 1.26) and obeyed a physiological hill of vision. Small differences existed in mean sensitivities between OCCP and SAP which increased with increasing spot eccentricity. Mean deviation (MD) displayed good agreement between the two tests. Conclusion Central 10-degree online circular contrast perimetry via a computer-based application has comparable perimetric results to standard automated perimetry in a normal cohort.
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Affiliation(s)
- Yang X Chen
- St Vincent’s Hospital Clinical School, University of Melbourne, Melbourne, VIC, Australia
| | - Joshua Meyerov
- Department of Surgery Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Simon E Skalicky
- Department of Surgery Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
- Glaucoma Investigation and Research Unit, the Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
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Lima DDS, Ventura DF. A review of experimental task design in psychophysical eye tracking research. Front Hum Neurosci 2023; 17:1112769. [PMID: 37662635 PMCID: PMC10469886 DOI: 10.3389/fnhum.2023.1112769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
While eye tracking is a technique commonly used in the experimental study of higher-level perceptual processes such as visual search, working memory, reading, and scene exploration, its use for the quantification of basic visual functions (visual acuity, contrast sensitivity, color vision, motion detection) is less explored. The use of eye movement features as dependent variables in a psychophysical investigation can serve multiple roles. They can be central in studies with neurological patients or infants that cannot comply with verbal instructions, understand task demands, and/or emit manual responses. The technique may also serve a complementary role, determining the conditions under which a manual or verbal response is given, such as stimulus position in the visual field, or it can afford the analysis of new dependent variables, such as the time interval between oculomotor and manual responses. Our objective is to review the literature that applied the eye tracking technique to psychophysical problems. The two questions our review raises are: can eye movements (reflex or voluntary) be an objective index of stimulus detection in psychophysical tasks? If so, under what conditions, and how does it compare with traditional paradigms requiring manual responses? Our (non-systematic) methodological review selected studies that used video-oculography as the technique of choice and had a basic visual function as their primary object of investigation. Studies satisfying those criteria were then categorized into four broad classes reflecting their main research interest: (1) stimulus detection and threshold estimation, (2) the effects of stimulus properties on fixational eye movements, (3) the effects of eye movements on perception, and (4) visual field assessment. The reviewed studies support the idea that eye tracking is a valuable technique for the study of basic perceptual processes. We discuss methodological characteristics within each of the proposed classification area, with the objective of informing future task design.
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Affiliation(s)
- Diego da Silva Lima
- Laboratory of Clinical Visual Psychophysics and Electrophysiology, University of São Paulo, São Paulo, Brazil
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González-Vides L, Hernández-Verdejo JL, Cañadas-Suárez P. Eye Tracking in Optometry: A Systematic Review. J Eye Mov Res 2023; 16:10.16910/jemr.16.3.3. [PMID: 38111688 PMCID: PMC10725735 DOI: 10.16910/jemr.16.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
This systematic review examines the use of eye-tracking devices in optometry, describing their main characteristics, areas of application and metrics used. Using the PRISMA method, a systematic search was performed of three databases. The search strategy identified 141 reports relevant to this topic, indicating the exponential growth over the past ten years of the use of eye trackers in optometry. Eye-tracking technology was applied in at least 12 areas of the field of optometry and rehabilitation, the main ones being optometric device technology, and the assessment, treatment, and analysis of ocular disorders. The main devices reported on were infrared light-based and had an image capture frequency of 60 Hz to 2000 Hz. The main metrics mentioned were fixations, saccadic movements, smooth pursuit, microsaccades, and pupil variables. Study quality was sometimes limited in that incomplete information was provided regarding the devices used, the study design, the methods used, participants' visual function and statistical treatment of data. While there is still a need for more research in this area, eye-tracking devices should be more actively incorporated as a useful tool with both clinical and research applications. This review highlights the robustness this technology offers to obtain objective information about a person's vision in terms of optometry and visual function, with implications for improving visual health services and our understanding of the vision process.
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Johnson C, Sayed A, McSoley J, Durbin M, Kashem R, Nicklin A, Lopez V, Mijares G, Chen M, Shaheen A, Segarra S, Rady N, Duque CA, Opoku-Baah C, Abou Shousha M. Comparison of Visual Field Test Measurements With a Novel Approach on a Wearable Headset to Standard Automated Perimetry. J Glaucoma 2023; 32:647-657. [PMID: 37311012 PMCID: PMC10414153 DOI: 10.1097/ijg.0000000000002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/30/2023] [Indexed: 06/15/2023]
Abstract
PRCIS This study of inter-test comparability of a novel visual field application installed on an augmented-reality portable headset and Humphrey field analyzer Swedish interactive thresholding algorithm (SITA) Standard visual field test demonstrates the excellent correlation of mean deviation (MD) and mean sensitivity (MS). PURPOSE To determine the correlation between visual field testing with novel software on a wearable headset versus standard automated perimetry. PATIENTS AND METHODS Patients with and without visual field defects attributable to glaucoma had visual field testing in one eye of each patient with 2 methods: re:Imagine Strategy (Heru, Inc.) and the Humphrey field analyzer (Carl Zeiss Meditec, Inc.) SITA Standard 24-2 program. Main outcome measures included MS and MD, which were evaluated by linear regression, intraclass correlation coefficient (ICC), and Bland Altman analysis for assessment of the mean difference and limits of agreement. RESULTS Measurements from 89 eyes of 89 patients (18 normal and 71 glaucomas) were compared with both instruments. Linear regression analysis demonstrated an excellent Pearson correlation coefficient of r = 0.94 for MS and r = 0.95 for MD. ICC analysis demonstrated high levels of concordance (ICC = 0.95, P < 0.001 for MS and ICC = 0.94, P < 0.001 for MD). Bland-Altman analysis determined a small mean difference between the two devices (Heru minus Humphrey) of 1.15 dB for MS and 1.06 dB for MD. CONCLUSIONS The Heru visual field test correlated well with SITA Standard in a population of normal eyes and eyes with glaucoma.
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Affiliation(s)
- Catherine Johnson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Ahmed Sayed
- Heru, Inc., Miami, FL
- Biomedical Engineering Department, Helwan University, Cairo, Egypt
- EECS Department, MSOE University, Milwaukee, WI
| | - John McSoley
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | | | - Rashed Kashem
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Heru, Inc., Miami, FL
| | | | | | - Georgeana Mijares
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | | | - Abdulla Shaheen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Steven Segarra
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nadine Rady
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Christian Andres Duque
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Heru, Inc., Miami, FL
| | | | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Heru, Inc., Miami, FL
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Test Reliability and Compliance to a Twelve-Month Visual Field Telemedicine Study in Glaucoma Patients. J Clin Med 2022; 11:jcm11154317. [PMID: 35893408 PMCID: PMC9332101 DOI: 10.3390/jcm11154317] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Our primary aim is to quantify test reliability and compliance of glaucoma patients to a weekly visual field telemedicine (VFTM) schedule. A secondary aim is to determine concordance of the VFTM results to in-clinic outcomes. Methods: Participants with stable glaucoma in one eye were recruited for a 12 month VFTM trial using the Melbourne Rapid Fields (MRF-home, MRFh) iPad application. Participants attended routine 6 month clinical reviews and were tasked with weekly home monitoring with the MRFh over this period. We determined compliance to weekly VFTM (7 + 1 days) and test reliability (false positives (FPs) and fixation loss (FL) <33%). A secondary aim considered concordance to in-clinic measures of visual field (MRF-clinic (MRFc) and the Humphrey Field Analyzer (HFA)) in active participants (≥10 home examinations and 5 reliable HFA examinations). The linear trend in the MRFh mean deviation (MD) was compared to the HFA guided progression analysis (GPA) using Bland−Altman methods. Data are shown as the mean ± standard deviation. Results: Forty-seven participants with a mean age of 64 ± 14.6 years were recruited for the trial. The VFTM uptake was 85% and compliance to weekly home monitoring was 75% in the presence of weekly text reminders in the analysed group (n = 20). The analysed group was composed of test subjects with five reliable in-clinic HFA examinations (GPA analysis available) and who submitted a minimum of 10 MRFh examinations from home. Of the 757 home examinations returned, approximately two-thirds were reliable, which was significantly lower than the test reliability of the HFA in-clinic (MRFh: 65% vs. HFA: 85%, p < 0.001). The HFA-GPA analysis gave little bias from the MRFh slope (bias: 0.05 dB/yr, p > 0.05). Two eyes were found to have clinical progression during the 12 month period, and both were detected by VFTM. Conclusions: VFTM over 12 months returned good compliance (75%) to weekly testing with good concordance to in-clinic assays. VFTM is a viable option for monitoring patients with glaucoma for visual field progression in between clinical visits.
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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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11
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Marín-Franch I, Turpin A, Artes PH, Chong LX, McKendrick AM, Alawa KA, Wall M. The Open Perimetry Initiative: A framework for cross-platform development for the new generation of portable perimeters. J Vis 2022; 22:1. [PMID: 35385053 PMCID: PMC8994165 DOI: 10.1167/jov.22.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Open Perimetry Initiative was formed in 2010 with the aim of reducing barriers to clinical research with visual fields and perimetry. Our two principal tools are the Open Perimetry Interface (OPI) and the visualFields package with analytical tools. Both are fully open source. The OPI package contains a growing number of drivers for commercially available perimeters, head-mounted devices, and virtual reality headsets. The visualFields package contains tools for the analysis and visualization of visual field data, including methods to compute deviation values and probability maps. We introduce a new frontend, the opiApp, that provides tools for customization for visual field testing and can be used as a frontend to run the OPI. The app can be used on the Octopus 900 (Haag-Streit), the Compass (iCare), the AP 7000 (Kowa), and the IMO (CREWT) perimeters, with permission from the device manufacturers. The app can also be used on Android phones with virtual reality headsets via a new driver interface, the PhoneHMD, implemented on the OPI. The use of the tools provided by the OPI library is showcased with a custom static automated perimetry test for the full visual field (up to 50 degrees nasally and 80 degrees temporally) developed with the OPI driver for the Octopus 900 and using visualFields for statistical analysis. With more than 60 citations in clinical and translational science journals, this initiative has contributed significantly to expand research in perimetry. The continued support of researchers, clinicians, and industry are key in transforming perimetry research into an open science.
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Affiliation(s)
- Iván Marín-Franch
- Computational Optometry, Atarfe, Spain.,Southwest Eye Institute, Tavistock, UK., www.optocom.es
| | - Andrew Turpin
- School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.,
| | - Paul H Artes
- Southwest Eye Institute, Tavistock, UK.,University of Plymouth, Plymouth, UK.,
| | - Luke X Chong
- School of Medicine (Optometry), Deakin University, Geelong, Australia.,
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia.,
| | - Karam A Alawa
- Departments of Neurology and Ophthalmology and Visual Sciences, University of Iowa, College of Medicine, Iowa City, Iowa, USA.,
| | - Michael Wall
- Departments of Neurology and Ophthalmology and Visual Sciences, University of Iowa, College of Medicine, Iowa City, Iowa, USA.,
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12
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Prince J, Thompson A, Mwanza JC, Tolleson-Rinehart S, Budenz DL. Glaucoma Screening Using an iPad-Based Visual Field Test in a West African Population. Ophthalmol Glaucoma 2021; 5:275-283. [PMID: 34537412 DOI: 10.1016/j.ogla.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate the performance of the Melbourne Rapid Fields (MRF) for use in clinic-based visual field testing in a low-resource setting. DESIGN Prospective cross-sectional study. PARTICIPANTS One hundred and three participants (66 patients with glaucoma and 37 control participants) attending a clinical appointment at the Tema Eye Center, Tema, Ghana. METHODS Patients with glaucoma and control participants underwent MRF and Humphrey Field Analyzer (HFA) testing. MAIN OUTCOME MEASURES Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS Mean MD was less negative and mean PSD was more positive on the MRF than the HFA in both groups (all P < 0.001). False-positive and false-negative rates were comparable between methods (P = 0.09 and P = 0.35, respectively). In patients with glaucoma, MD and PSD from the 2 devices were correlated strongly (r = 0.84; P < 0.001) and moderately (r = 0.61; P < 0.001), respectively. Agreement analysis revealed that MRF tended to generate significantly higher MD (bias, 3.3 ± 4.1 dB; P = 0.03) and PSD (bias, 1.9 ± 2.8 dB; P = 0.03) with wide limits of agreement. For detecting moderate to advanced glaucoma, the sensitivity was 60.9% for the MRF and 78.3% for the HFA (P = 0.10); respective specificities were 86.5% and 83.8% (P = 0.76). CONCLUSIONS The MRF underestimated MD and overestimated PSD values compared with the HFA. Agreement biases were significant, suggesting a weak agreement between the 2 devices. However, the MRF showed potential for screening in a low-resource setting, particularly for detecting moderate to advanced glaucoma.
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Affiliation(s)
- Jamie Prince
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Atalie Thompson
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jean-Claude Mwanza
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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13
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Soans RS, Grillini A, Saxena R, Renken RJ, Gandhi TK, Cornelissen FW. Eye-Movement-Based Assessment of the Perceptual Consequences of Glaucomatous and Neuro-Ophthalmological Visual Field Defects. Transl Vis Sci Technol 2021; 10:1. [PMID: 34003886 PMCID: PMC7873497 DOI: 10.1167/tvst.10.2.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Assessing the presence of visual field defects (VFD) through procedures such as perimetry is an essential aspect of the management and diagnosis of ocular disorders. However, even the latest perimetric methods have shortcomings-a high cognitive demand and requiring prolonged stable fixation and feedback through a button response. Consequently, an approach using eye movements (EM)-as a natural response-has been proposed as an alternate way to evaluate the presence of VFD. This approach has given good results for computer-simulated VFD. However, its use in patients is not well documented yet. Here we use this new approach to quantify the spatiotemporal properties (STP) of EM of various patients suffering from glaucoma and neuro-ophthalmological VFD and controls. Methods In total, 15 glaucoma patients, 37 patients with a neuro-ophthalmological disorder, and 21 controls performed a visual tracking task while their EM were being recorded. Subsequently, the STP of EM were quantified using a cross-correlogram analysis. Decision trees were used to identify the relevant STP and classify the populations. Results We achieved a classification accuracy of 94.5% (TPR/sensitivity = 96%, TNR/specificity = 90%) between patients and controls. Individually, the algorithm achieved an accuracy of 86.3% (TPR for neuro-ophthalmology [97%], glaucoma [60%], and controls [86%]). The STP of EM were highly similar across two different control cohorts. Conclusions In an ocular tracking task, patients with VFD due to different underlying pathology make EM with distinctive STP. These properties are interpretable based on different clinical characteristics of patients and can be used for patient classification. Translational Relevance Our EM-based screening tool may complement existing perimetric techniques in clinical practice.
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Affiliation(s)
- Rijul Saurabh Soans
- Department of Electrical Engineering, Indian Institute of Technology - Delhi, New Delhi, India.,Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Alessandro Grillini
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Rohit Saxena
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Remco J Renken
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Tapan Kumar Gandhi
- Department of Electrical Engineering, Indian Institute of Technology - Delhi, New Delhi, India
| | - Frans W Cornelissen
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, The Netherlands
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14
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Jones PR, Campbell P, Callaghan T, Jones L, Asfaw DS, Edgar DF, Crabb DP. Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months. Am J Ophthalmol 2021; 223:42-52. [PMID: 32882222 PMCID: PMC7462567 DOI: 10.1016/j.ajo.2020.08.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023]
Abstract
Purpose To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma. 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 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye). Results All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .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 receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry 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 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320). Conclusions Home monitoring of VFs is viable for some patients and may provide clinically useful data.
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK; Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Tamsin Callaghan
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Lee Jones
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Daniel S Asfaw
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
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