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Editors Selection IGR 15-2

Clinical Examination Methods: Tele-Perimetry: reliability and Compliance

Comment by Chris Johnson on:

104766 Test Reliability and Compliance to a Twelve-Month Visual Field Telemedicine Study in Glaucoma Patients, Prea SM; Vingrys AJ; Kong GYX, Journal of clinical medicine, 2022; 11:

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The use of computers, tablets and virtual reality headsets to perform remote visual function testing, including visual acuity, contrast sensitivity, glare disability, visual fields and other ophthalmic diagnostic tests is now possible. Developing countries find this technology to be useful because it is portable, inexpensive and internet compatible. Additionally, in this time of COVID infections, these devices are easy to sanitize, do not require a special testing room, and can be performed at sites other than ophthalmic clinical centers. The current paper by Prea, Vingrys and Kong describes the use of an iPad to perform home visual field testing over a twelve month period of time as a means of determining its reliability and compliance, as well as its relationship to clinical perimetry conducted in the eye clinic. The authors found that the tablet test produced mostly reliable results that were consistent with clinical test results. However, only about one third of the participants in this study were able to complete the investigation.

Only about one third of the participants in this study were able to complete the investigation

Compliance and adherence have been difficult issues for successful administration of glaucoma medications (even with email and smartphone reminders), and it appears that this may also be the case for home visual field testing.

The results of this study are promising and suggest that remote visual field testing is feasible. Advantages include portability, reduced equipment cost, ease of operation, effective sanitation, access to other telemedicine sources and other useful features. However, there are also some disadvantages. The remote devices have a smaller dynamic range than clinical perimeters, use a stimulus size that increases at greater eccentricities rather than employing a fixed size, tablets do not perform direct eye tracking, fixation must be redirected during certain phases of testing, and testing distance and alignment are variable. Although tablets require less instrumentation than virtual reality headsets, the headsets have a fixed testing distance, a larger field of view, are less susceptible to ambient illumination and potential glare sources and some have accurate and rapid eye tracking. We are currently in early stages of remote testing, which means that there are still many questions. What is the best device for home testing? Is visual field testing the only procedure to be offered, or will other functional tests be available as well? How often do patients need to perform visual function testing? Can remote testing results be appropriately combined with standard clinical tests? How will these devices be integrated with electronic medical records, maintain high level security along with selective access? There are many, many other questions that are also pending. This is reminiscent of the transition many years ago from manual to automated visual field testing. The current investigation by Prea, Vingrys and Kong indicates that longitudinal remote testing is feasible, but there are still many aspects that require refinement. I would strongly encourage all ophthalmic clinicians and scientists interested in this technology to actively pursue it so that we can have a larger database with long term follow-up, and various new approaches for enhancing this technology.

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