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Home monitoring may allow earlier detection of visual field progression
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Home monitoring the visual field using portable devices may improve detection of progression and be a viable alternative to the increased frequency of tests performed in the clinic.
Researchers used simulation methods to evaluate the outcomes of home monitoring in addition to in-clinic visual field testing in 43 patients with glaucoma, ocular hypertension or glaucoma suspects.
The iPad tablet-based Melbourne Rapid Fields, or MRF, (Glance Optical) perimetry application was used under clinical supervision along with the Humphrey Visual Field Analyzer (Carl Zeiss Meditec). Three home-monitoring (monthly, every 2 weeks and weekly) and two in-clinic (yearly and monthly) schedules applied over a 5-year period were simulated.
To reproduce a more realistic scenario of variable compliance, possible inaccuracies and false positives, some home-monitored fields were excluded at random from the final evaluation, and the variability of results was manipulated, according to the study.
Within the simulation, increased frequency of visual field testing by home monitoring resulted in improved ability to detect visual field progression, even in situations of imperfect compliance and potential lesser accuracy of home-based devices as compared with clinical perimetry, the researchers reported.
“Our results suggest that home monitoring could lead to earlier intervention for rapidly progressing patients and improved patient outcomes,” the authors wrote.
Although the cost-benefit of home monitoring was not established, it is likely that combination of home-based and in-clinic testing could represent “a viable alternative to the increased in-clinic visual field testing advocated to ensure rapid visual field progression is not missed in the initial period after glaucoma diagnosis, thereby potentially reducing clinical loads,” the authors concluded. – by Michela Cimberle
Disclosure: Anderson reports no conflict of interest. Please see the study for the other authors’ financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Despite tremendous advancements in structural analysis, the assessment of function through regular visual field testing remains an integral part of glaucoma management.
While the majority of patients will progress relatively slowly, rapid progression (≥2 dB/year increase in mean deviation) must be identified and addressed as early as possible if vision-related quality of life is to be maintained. It has been suggested that this requires six visual field tests within 24 months of diagnosis.
Unfortunately, visual field assessment is often far less frequent: Patients dislike the test, and scheduling can present a logistical challenge for many clinics. Whatever the reason, infrequent testing can delay the detection of irreversible vision loss.
Through simulation, Anderson and colleagues have demonstrated that weekly tablet-based home monitoring can identify rapid visual field progression in less than 1 year, while in-office automated visual field testing every 6 months took nearly three times as long. Particularly (perhaps only) in high-risk patients, more frequent assessment in a comfortable and convenient environment that doesn’t necessitate an office visit is a win-win scenario.
Although the risk of information overload and identification of false positives is real, novel monitoring strategies (including 24-hour IOP assessment) appear poised to change the way we manage glaucoma.
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