Can Home Perimetry Make Glaucoma Trials Faster?

On the Feasibility of Accelerating Glaucoma Clinical Trials Using Portable Perimetry

Tan JCK, Montesano G, Crowston J, Bell K, Crabb DP, Jones PR¹
Industry support for this study: None

ABSTRACT SUMMARY

This cross-sectional study sought to determine whether more frequent portable (ie, home) perimetry could detect glaucomatous progression more quickly than traditional perimetry in a clinical trial setting.

Forty participants (78 eyes) performed interleaved visual field testing with the portable Eyecatcher 3.0 smartglasses perimeter (Irida Health) and the Swedish Interactive Threshold Algorithm Fast (Humphrey Field Analyzer [HFA], Carl Zeiss Meditec). Test-retest variability for global and pointwise sensitivity was quantified and used in statistical simulations modeling longitudinal progression detection according to prior precedents² under different testing schedules.

Although test-retest precision was lower with the Eyecatcher than the HFA (coefficient of repeatability for mean deviation, 6.37 vs 4.25 dB), simulations suggested that monthly testing with the Eyecatcher offset this limitation and detected a greater proportion of eyes experiencing slow disease progression than HFA testing performed every 4 months. More frequent testing schedules were also predicted to reduce the sample sizes required to detect treatment effects.

DISCUSSION

What is the ideal frequency of visual field testing?

The simulations modeled in this study indicated that, the more frequently testing is performed, the sooner glaucomatous progression is detected, even if the portable device used is less precise than standard clinic-based perimeters. Prior studies, however, have reported decreased rates of patient adherence with weekly compared to monthly testing frequencies.^3,4 The optimal testing frequency remains to be determined and would balance statistical power with patient adherence.

How does the Eyecatcher 3.0 compare to other head-mounted portable perimeters?

This study did not directly compare portable perimeters. The reported 95% coefficient of repeatability for mean deviation, however, was 6.37 dB. This value represents the range within which differences between repeated tests may reflect measurement noise rather than true disease progression. For comparison, Tan et al cited prior studies reporting coefficients of repeatability of approximately 10.75 dB for the VisuAll S (Olleyes) and 7.64 to 8.56 dB for the Imo perimeter (Crewt Medical Systems).^5,6 The Eyecatcher 3.0 also uses a smaller test grid (32 points arranged in a 4 x 8 pattern), which might influence both test duration and variability compared with other perimetric tests.

Is the Eyecatcher 3.0 device commercially available?

The Eyecatcher 3.0 is an investigational device currently under development and is not yet commercially available.

FIELDS FROM HOME: DEVICE- INDEPENDENT ONLINE PERIMETRY WITH MELBOURNE RAPID FIELDS

Montesano G, Nathwani N, Yu J, et al⁷
Industry support for this study: None

ABSTRACT SUMMARY

This cross-sectional study evaluated the short-term reliability of home visual field testing using a web-based version of the Melbourne Rapid Fields (MRF) software and its agreement with standard perimetry using the HFA.

One hundred adult participants from the Laser in Glaucoma and Ocular Hypertension (LIGHT) trial with prior perimetric testing experience performed two series of home visual field tests using the web-based MRF platform on their personal computers; they completed the second series 1 week after the first. Agreement with HFA perimetry was assessed using each participant’s two most recent HFA tests recorded before study enrollment, and individuals with evidence of unstable fields during the preceding year were excluded.

The MRF demonstrated greater test-retest variability than the HFA and showed proportional bias. The MRF demonstrated a tendency to underestimate visual field deficits in patients with advanced disease. Modeling, however, suggested that more frequent MRF testing could offset the lower precision and potentially allow earlier detection of visual field progression compared with HFA testing performed every 6 months.

DISCUSSION

Which patients might be the best candidates for portable or home perimetry?

These technologies may be most useful for patients with moderate glaucoma or suspected disease progression who require closer monitoring between clinic visits. Given the potential adherence challenges with frequent testing, home monitoring might be most valuable when a need for closer surveillance is identified clinically. Successful use also requires that patients be comfortable testing themselves without supervision.

What are the practical barriers to implementing home perimetry in routine glaucoma care?

Remote testing introduces several limitations. Environmental factors such as ambient lighting and viewing distance cannot be standardized, and screen display characteristics vary across personal devices. In addition, differences in testing strategies make directly comparing results between home-based and conventional perimetry inadvisable. Cost considerations and the absence of clear reimbursement pathways are additional significant barriers to widespread adoption.

Is the web-based MRF test available for use?

Although the test can be accessed online, its use is tied to research studies and clinician-supervised home monitoring programs.