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Measuring Visual Fields in Children With Glaucoma Using a Portable Tablet
Viney Gupta1, George X Y Kong2, Abhishek Singh1
1Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Insights
An iPad perimetry app (Melbourne Rapid Fields) showed results comparable to the Humphrey Field Analyser for children with glaucoma. This visual field testing was preferred by children and is suitable for clinical evaluation.
Area of Science:
- Ophthalmology
- Medical Technology
- Pediatric Glaucoma
Background:
- Pediatric glaucoma management requires accurate visual field assessment.
- Traditional perimetry methods like the Humphrey Field Analyser (HFA) can be challenging for children.
- Novel, patient-friendly approaches to visual field testing are needed.
Purpose of the Study:
- To compare the perimetric outcomes of an iPad-based perimetry application, Melbourne Rapid Fields (MRF), with the Humphrey Field Analyser (HFA) in children with glaucoma.
- To assess the concordance and repeatability of MRF and HFA in evaluating visual field defects in pediatric glaucoma patients.
Main Methods:
- Sixteen children with glaucoma underwent visual field testing using both MRF and HFA over two visits.
- Mean deviation (MD) and pattern deviation indices were primary outcome measures.
- Regression, intraclass correlation coefficient, and Bland-Altman analyses were used to assess concordance and repeatability.
Main Results:
- MRF demonstrated strong concordance with HFA for mean deviation (intraclass correlation coefficient = 0.91).
- Repeatability coefficients were comparable for normal fields but larger for glaucomatous defects in both MRF and HFA.
- MRF test times were similar to HFA's SITA Fast and significantly faster than SITA Standard.
Conclusions:
- The Melbourne Rapid Fields app provides comparable perimetric outcomes to the HFA in children with glaucoma.
- MRF is a suitable and preferred method for visual field evaluation in this pediatric population.
- iPad-based perimetry offers a promising alternative for assessing visual fields in children with glaucoma.
Purpose:
To compare perimetric outcomes of an iPad perimetry app (Melbourne Rapid Fields [MRF]) with those of the Humphrey Field Analyser (HFA) testing children with glaucoma.
Methods:
Sixteen children diagnosed and treated for glaucoma were recruited to evaluate their perimetric performance over two visits. At each visit, they undertook visual field assessment using the MRF application as well as the HFA. The HFA test was part of their usual clinical work up and a clinical assistant judged which test format (24-2 SITA standard or SITA fast) might be suited to the testing of that child. The primary outcome measure was the association and repeatability of mean deviation (MD) for the MRF and HFA tests, by way of regression, intraclass correlation coefficient and Bland-Altman analysis. Secondary measures were comparisons of pattern deviation indices, test times as well as an indication of participant test preference. Summary data show means ± standard deviation.
Results:
The age for our cohort was 7 to 15 years of age (mean, 10.0 ± 2.4 years of age). The MRF MD was in close concordance to HFA MD with an intraclass correlation coefficient of 0.91 (95% confidence interval, 0.82-0.95). Bland-Altman analysis found little bias (-0.6 dB) and a 95% coefficient of repeatability of 2.1 dB in eyes having a normal HFA MD. In eyes with glaucomatous visual field defects the 95% coefficient of repeatability at retest was much larger for both the MRF (10.5 dB) as well as for the HFA (10.0 dB). Average MRF test times (5.6 ± 1.2 minutes) were similar to SITA Fast (5.4 ± 1.9 minutes) with both being significantly faster than SITA standard (8.6 ± 1.4 minutes; P < 0.001). All children chose testing with the MRF as their preference.
Conclusions:
MRF correlated strongly with HFA and was preferred by the children over the HFA. MRF is suitable for perimetric evaluation of children with glaucoma.
Translational Relevance:
This study finds that an iPad based visual field test can be used with children having glaucoma to yield outcomes similar to SITA-fast. Children indicate a preference for such testing.
