Glaucoma home-monitoring using a tablet-based visual field test (Eyecatcher): An assessment of accuracy and adherence over six months

Abstract

Purpose: To assess accuracy and adherence of visual field (VF) home-monitoring in a pilot sample of glaucoma patients. Design: Prospective longitudinal observation. 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.

Evaluation of a 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 Smartphones can be used to measure visual acuity, 10 but a 2015 review of smartphone vision testing apps found poor agreement with conventional vision tests, particularly for people with severe vision impairment. 11 Further, more than 1 in 8 people in the UK do not use the internet, including 48% of those over 75 years of age, 12 all of whom are classified as being of at least moderate risk of complications from Covid-19.…”

Tablet‐based tests of everyday visual function in a diabetic macular oedema (DME) clinic waiting area: A feasibility study

“…52 The tests also have the potential to be used as a tool for home monitoring; this should be the subject of future studies. While there is a relatively large and growing body of literature on the use of technology for home monitoring of ophthalmological conditions such as glaucoma 53,54 and AMD, 55,56 home monitoring in DR/DME has very little mention in the existing research literature. This seems strange given DR/DME patients are likely ideal candidates for a home-monitoring programme as many will already be accustomed to self-monitoring other aspects of their condition.…”