Fields from home: device-independent online perimetry with Melbourne Rapid Fields

To assess the short-term reliability and agreement of home-based visual field (VF) testing using web-based Melbourne Rapid Fields (MRF-web) software compared to standard in-clinic Humphrey Field Analyzer (HFA) perimetry. To evaluate the feasibility and patient acceptance of home VF monitoring and whether increased testing frequency with home monitoring could detect progression earlier.

Cross-sectional study with a repeated measures design of one eye of 100 adult participants from the Laser in Glaucoma and Ocular Hypertension trial with stable VFs with a questionnaire capturing participant feedback. Participants performed VF tests at home using MRF-web on their own computers. Each testing session included visual acuity, two 10-2 VFs and two 24-2 VFs. Analysis compared the MRF 24-2 with the two most recent HFA 24-2 from prior clinic visits. Bland-Altman plots and mixed linear models assessed test-retest variability and agreement, while simulations estimated the power to detect progression. Patient feedback was collected via online questionnaire.

MRF-web showed greater test-retest variability than HFA for point-wise values, with a significant learning effect. There was a significant proportional bias, with MRF underestimating damage compared to HFA. The SE for MTD progression was higher for MRF at a 6-month testing interval. Four-monthly MRF testing achieved similar progression detection power to 6-monthly HFA: more frequent testing enabling earlier detection of progression. Most participants preferred home monitoring due to convenience.

Home-perimetry produced more variable results than in-clinic testing, but the increased testing frequency enabled the potential earlier detection of progression compared to standard in-clinic testing.