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Editors Selection IGR 17-4
Clinical Examination Methods: Tablet perimetry
Comment by Yvonne Buys on:
70552 A Comparison of Perimetric Results from a Tablet Perimeter and Humphrey Field Analyzer in Glaucoma Patients, Kong YX; He M; Crowston JG et al., Translational vision science & technology, 2016; 5: 2
Perimetry plays a major role in glaucoma diagnosis and management. The Humphrey Field Analyzer (HFA) is the most commonly employed device, however, it has limitations of cost and portability both of which impact access. Tablet-based perimeters developed in response to these issues are challenged by small screen size and dynamic range of stimulus intensity. The Melbourne Rapid Fields perimetry software (MRF) addresses these by changing fixation position during testing and increasing stimulus size based on eccentricity.
The Melbourne Rapid Fields perimetry software addresses perimetry limitations by changing fixation position during testing and increasing stimulus size based on eccentricity.
This study compares perimetry performed on an Apple iPad using MRF to HFA 24-2 SITA standard in 90 individuals with a range of glaucoma severity. The authors report a strong correlation for MD and good correlation for PD and PSD between these two technologies, specifically for those with moderate-severe disease (MD £ -6 dB). Overall MD values were 1.4 dB higher with MRF. Test-retest reliability was similar to HFA. MRF test duration was on average one minute less in those with moderate-severe defects. Fixation losses, however, were six times higher with MRF (36 versus 6%).
One must use caution when translating this study's findings to real-life scenarios. Firstly, these subjects were 'experts' with HFA and the study was conducted in an environment where tabletto- eye distance was regularly monitored and luminance controlled. Secondly, there was no mention in this study about software for progression analysis and the testing strategy was limited to a spatial pattern similar to the 24-2.
Limitations notwithstanding, a tablet-based platform to perform perimetry is very exciting since this technology is readily available and could have widespread applications including remote testing, home based visual field testing, improving access for those unable to position on the HFA due to physical limitations and reducing burden on clinics. This study demonstrates that central perimetry with the MRF software correlates well to HFA and is a promising future technology.
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