Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad

Mark A Chia; Edward Trang; Ashish Agar; Algis J Vingrys; Jenny Hepschke; George Yx Kong; Angus W Turner

doi:10.5005/jp-journals-10078-1312

Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad

J Curr Glaucoma Pract. 2021 Sep-Dec;15(3):125-131. doi: 10.5005/jp-journals-10078-1312.

Authors

Mark A Chia¹, Edward Trang², Ashish Agar³, Algis J Vingrys⁴, Jenny Hepschke³, George Yx Kong⁵, Angus W Turner¹

Affiliations

¹ Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia.
² Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
³ Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia.
⁴ Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia.
⁵ Department of Glaucoma, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Eye Research Australia, East Melbourne, Victoria, Australia.

Abstract

Aim and objective: Developing improved methods for early detection of visual field defects is pivotal to reducing glaucoma-related vision loss. The Melbourne Rapid Fields screening module (MRF-S) is an iPad-based test, which allows suprathreshold screening with zone-based analysis to rapidly assess the risk of manifest glaucoma. The versatility of MRF-S has potential utility in rural areas and during infectious pandemics. This study evaluates the utility of MRF-S for detecting field defects in non-metropolitan settings.

Materials and methods: This was a prospective, multicenter, cross-sectional validation study. Two hundred and fifty-two eyes of 142 participants were recruited from rural sites through two outreach eye services in Australia. Participants were tested using MRF-S and compared with a reference standard; either Zeiss Humphrey Field Analyzer or Haag-Streit Octopus performed at the same visit. Standardized questionnaires were used to assess user acceptability. Major outcome measures were the area under the curve (AUC) for detecting mild and moderate field defects defined by the reference tests, along with corresponding performance characteristics (sensitivity, specificity).

Results: The mean test duration for MRF-S was 1.88 minutes compared with 5.92 minutes for reference tests. The AUCs for mild and moderate field defects were 0.81 [95% confidence interval (CI): 0.75-0.87] and 0.87 (95% CI: 0.83-0.92), respectively, indicating very good diagnostic accuracy. Using a risk criterion of 55%, MRF-S identified moderate field defects with a sensitivity and specificity of 88.4 and 81.0%, respectively.

Conclusion and clinical significance: The MRF-S iPad module can identify patients with mild and moderate field defects while delivering favorable user acceptability and short test duration. This has potential application within rural locations and amidst infectious pandemics.

How to cite this article: Chia MA, Trang E, Agar A, et al. Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad. J Curr Glaucoma Pract 2021;15(3):125-131.

Keywords: Computers; Cross-Sectional study; Glaucoma; Handheld; Mass screening; Visual field tests; Visual fields.