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Uptake, Persistence, and Performance of Weekly Home Monitoring of Visual Field in Patients With Glaucoma
TAKE-HOME MESSAGE
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The use of the Melbourne Rapid Fields application on an iPad for weekly home testing of visual fields was shown to be accepted by patients and provided adjunct information that was useful in the management of glaucoma and ocular hypertension. Challenges to compliance with the testing protocol included IT logistic difficulties, fixation losses while testing, absence of viewing distance monitoring, and lack of motivation. Despite these issues, the results were considered reliable in many cases, with good patient acceptance.
- Patients are compliant with visual field home testing, and the results are comparable with in-clinic testing results.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPurpose
This study examines the short-term uptake, compliance, and performance of a tablet device used for home monitoring of visual field (VF-Home) by glaucoma patients.
Design
Single-centre, observational, longitudinal, compliance study.
Methods
Participants who were glaucoma suspects or had stable glaucoma in at least one eye were recruited during a regular clinic review. Baseline in-clinic visual field (VF) was recorded with the Humphrey Field Analyser (HFA, SITA standard) and repeated at 6-months. Participants were tasked with performing 6 VF examinations from home, at weekly intervals, using a loaned iPad tablet. Uptake was defined as returning at least one test from home. Reliability and global indices from VF-Home were compared to in-clinic outcomes. Data are shown as either mean ± [standard deviation] or median [quartile 1-3 range] and group comparisons were achieved with bootstrap.
Results
We recruited 186 eyes of 101 participants. VF-Home uptake was excellent with 88% of participants successfully completing ≥1 home exam and 69% completing all 6 exams. The median duration between tests was 7.0 [7.0-8.0] days. Barriers to uptake and compliance involved information technology (IT) issues, lack of motivation or competing life demands. VF-Home gave greater fixation loss but a similar level of False Positives (FP) as the HFA. A high correlation was found for the mean defect between in-clinic and at-home outcomes (R = 0.85).
Conclusions
VF-Home can return a high level of short-term compliance and results comparable to those found by in-clinic testing. IT logistic reasons and lack of motivation are barriers to uptake and compliance.
Additional Info
Disclosure statements are available on the authors' profiles:
Eye Care
Home monitoring is increasingly considered as a way of reducing the growing healthcare burden of glaucoma and of improving patient outcomes through more regular assessment. This interest has only accelerated in the wake of COVID-19. Until now, however, there has been scant evidence that home monitoring is actually feasible in practice.
In this timely paper by Prea and colleagues, 101 glaucoma patients (186 eyes) were given a copy of the authors’ “Melbourne Rapid Fields” iPad perimetry test, to use at home once a week for 6 weeks. The data showed good accuracy (R2 = 0.73 correlation with “gold standard” measurements made in clinic) and promising levels of adherence (88% of participants successfully completing at least one home exam, 69% completing all six exams). The authors also examine why some patients did not fully adhere to the monitoring regimen (eg, IT logistical reasons, lack of interest, competing life demands), and these data could be extremely valuable for guiding future developments in telemedicine more broadly.
Together with other recent pilots into ophthalmic home monitoring (Adams et al, TVST, 2018; Jones et al, AJO, in press), this important study by Prea and colleagues suggests that home monitoring is not just desirable but achievable. It also highlights that home monitoring must be approached with care and sensitivity to the needs and abilities of patients.