Diagnostic accuracy and reliability of portable visual field-testing devices for detecting manifest glaucomatous...

Portable visual-field testing devices have emerged as accessible approaches for detecting and monitoring manifest glaucomatous visual-field loss, particularly where standard automated perimetry is difficult to access. Their diagnostic accuracy and clinical reliability, however, remain uncertain due to heterogeneous study designs, variable thresholds, and inconsistent performance metrics. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy, test duration, and correlation of all portable VF devices compared with SAP, across multiple device categories and glaucoma severities.

A comprehensive search of PubMed, Scopus, Web of Science, Cochrane Central, ClinicalTrials.gov, WHO ICTRP, and Google Scholar was conducted from inception through December 2025, without language restrictions. Eligible studies included diagnostic-accuracy or cohort designs comparing portable VF devices, including virtual-reality, tablet-based, web-based, or paper-based against SAP as the reference standard. Two reviewers independently extracted data and assessed quality using QUADAS-2. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated using bivariate random-effects models, with heterogeneity and publication bias evaluated via I², τ², and Deeks' funnel asymmetry tests. Secondary outcomes included test duration and correlation coefficients for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI).

From 639 screened records, 21 studies involving 2,254 participants (1,362 glaucoma, 892 controls) were included. Pooled sensitivity was 86% (95% CI, 80-90) and pooled specificity 88% (95% CI, 80-93), with an overall DOR of 28.6 (95% CI, 14.3-57.2). Substantial heterogeneity was observed across studies and device categories. Virtual-reality/head-mounted devices showed the highest diagnostic performance, whereas tablet-based devices demonstrated the lowest pooled specificity; however, sensitivity did not differ significantly between device categories, and specificity differences were not statistically significant. Test durations were significantly shorter for portable perimetry overall (SMD - 1.60; 95% CI, - 2.63 to - 0.57), with the largest reductions for tablet-based and paper-based devices, whereas VR/head-mounted systems showed no significant difference. Global index correlations were strong (r = 0.82; 95% CI, 0.75-0.88).

In included validation studies, portable visual-field devices showed promising diagnostic performance relative to SAP for detecting manifest glaucomatous visual-field loss in validation-study settings, and most devices reduced testing time. However, because many studies used case-control designs, pooled accuracy estimates may be optimistic. Prospective, population-based studies in unselected cohorts are needed before these technologies are used as stand-alone diagnostic tools. These technologies represent potentially scalable tools requiring further validation for improving global glaucoma detection and ongoing disease management.