A recent study published in Ophthalmology Science suggests that visual field telemedicine (VFTM) could be a valuable tool for monitoring glaucoma patients remotely. The 12-month trial assessed the reliability and compliance of glaucoma patients using weekly visual field tests via telemedicine, and its concordance with in-clinic outcomes.
The study, led by researchers at the University of Melbourne, Australia, involved 47 participants with stable glaucoma in at least one eye. Participants were tasked with weekly home monitoring using the Melbourne Rapid Fields (MRF-home) iPad application over a 12-month period, with routine clinical reviews every six months. Compliance to the weekly VFTM schedule (defined as 7 ± 1 days) and test reliability (false positives and fixation loss <33%) were key measures.
Compliance and Reliability
The VFTM uptake was 85%, with 75% compliance to weekly home monitoring observed in the analyzed group (n = 20) who also had five reliable in-clinic HFA examinations and submitted a minimum of 10 MRFh examinations from home. Of the 757 home examinations returned, approximately two-thirds were deemed reliable. However, the test reliability of VFTM was significantly lower than that of the in-clinic Humphrey Field Analyzer (HFA) (MRFh: 65% vs. HFA: 85%, p < 0.001).
Concordance with In-Clinic Measures
Despite the lower reliability, the VFTM results showed good concordance with in-clinic measures. The HFA-guided progression analysis (GPA) showed little bias from the MRFh slope (bias: 0.05 dB/yr, p > 0.05). Notably, the VFTM successfully detected clinical progression in two eyes, which aligned with the HFA findings.
Clinical Implications
"VFTM over 12 months returned good compliance (75%) to weekly testing with good concordance to in-clinic assays," the authors stated. "VFTM is a viable option for monitoring patients with glaucoma for visual field progression in between clinical visits."
The study suggests that VFTM could help bridge the gap between clinic visits, allowing for more frequent monitoring of glaucoma patients and potentially earlier detection of disease progression. However, the lower test reliability compared to in-clinic assessments highlights the need for careful interpretation of VFTM results and integration with traditional clinical evaluations.
