Performance of iPad-based threshold perimetry in glaucoma and controls

Angela M. Schulz, Elizabeth C. Graham, Yuyi You, Alexander Klistorner, Stuart L. Graham

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Importance: Independent validation of iPad visual field testing software Melbourne Rapid Fields (MRF). Background: To examine the functionality of MRF and compare its performance with Humphrey SITA 24-2 (HVF). Design: Prospective, cross-sectional validation study. Paricipants: Sixty glaucomas mean deviation (MD:-5.08±5.22); 17 pre-perimetric, 43 HVF field defects and 25 controls. Methods: The MRF was compared with HVF for scotoma detection, global indices, regional mean threshold values and sensitivity/specificity. Long-term test-retest variability was assessed after 6months. Main Outcome Measures: Linear regression and Bland Altman analyses of global indices sensitivity/specificity using ROC curves, intraclass correlations. Results: Using a cluster definition of three points at <1% or two at 0.5% to define a scotoma on HVF, MRF detected 39/54 abnormal hemifields with a similar threshold-based criteria. Global indices were highly correlated between MRF and HVF: MD r2 = 0.80, PSD r2 = 0.77, VFI r2 = 0.85 (all P<0.0001). For manifest glaucoma patients, correlations of regional mean thresholds ranged from r2 = 0.45-0.78, despite differing array of tested points between devices. ROC analysis of global indices showed reasonable sensitivity/specificity with AUC values of MD:0.89, PSD:0.85 and VFI:0.88. MRF retest variability was low with ICC values at 0.95 (MD and VFI), 0.94 (PSD). However, individual test point variability for mid-range thresholds was higher. Conclusions and Relevance: MRF perimetry, despite using a completely different test paradigm, shows good performance characteristics compared to HVF for detection of defects, correlation of global indices and regional mean threshold values. Reproducibility for individual points may limit application for monitoring change over time, and fixation monitoring needs improvement.

LanguageEnglish
Pages346-355
Number of pages10
JournalClinical and Experimental Ophthalmology
Volume46
Issue number4
Early online date2017
DOIs
Publication statusPublished - Jun 2018

Fingerprint

Visual Field Tests
Glaucoma
Scotoma
Sensitivity and Specificity
ROC Curve
Validation Studies
Visual Fields
Area Under Curve
Linear Models
Software
Cross-Sectional Studies
Outcome Assessment (Health Care)
Equipment and Supplies

Keywords

  • iPad perimetry
  • Perimetry
  • Visual field

Cite this

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title = "Performance of iPad-based threshold perimetry in glaucoma and controls",
abstract = "Importance: Independent validation of iPad visual field testing software Melbourne Rapid Fields (MRF). Background: To examine the functionality of MRF and compare its performance with Humphrey SITA 24-2 (HVF). Design: Prospective, cross-sectional validation study. Paricipants: Sixty glaucomas mean deviation (MD:-5.08±5.22); 17 pre-perimetric, 43 HVF field defects and 25 controls. Methods: The MRF was compared with HVF for scotoma detection, global indices, regional mean threshold values and sensitivity/specificity. Long-term test-retest variability was assessed after 6months. Main Outcome Measures: Linear regression and Bland Altman analyses of global indices sensitivity/specificity using ROC curves, intraclass correlations. Results: Using a cluster definition of three points at <1{\%} or two at 0.5{\%} to define a scotoma on HVF, MRF detected 39/54 abnormal hemifields with a similar threshold-based criteria. Global indices were highly correlated between MRF and HVF: MD r2 = 0.80, PSD r2 = 0.77, VFI r2 = 0.85 (all P<0.0001). For manifest glaucoma patients, correlations of regional mean thresholds ranged from r2 = 0.45-0.78, despite differing array of tested points between devices. ROC analysis of global indices showed reasonable sensitivity/specificity with AUC values of MD:0.89, PSD:0.85 and VFI:0.88. MRF retest variability was low with ICC values at 0.95 (MD and VFI), 0.94 (PSD). However, individual test point variability for mid-range thresholds was higher. Conclusions and Relevance: MRF perimetry, despite using a completely different test paradigm, shows good performance characteristics compared to HVF for detection of defects, correlation of global indices and regional mean threshold values. Reproducibility for individual points may limit application for monitoring change over time, and fixation monitoring needs improvement.",
keywords = "iPad perimetry, Perimetry, Visual field",
author = "Schulz, {Angela M.} and Graham, {Elizabeth C.} and Yuyi You and Alexander Klistorner and Graham, {Stuart L.}",
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Performance of iPad-based threshold perimetry in glaucoma and controls. / Schulz, Angela M.; Graham, Elizabeth C.; You, Yuyi; Klistorner, Alexander; Graham, Stuart L.

In: Clinical and Experimental Ophthalmology, Vol. 46, No. 4, 06.2018, p. 346-355.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Performance of iPad-based threshold perimetry in glaucoma and controls

AU - Schulz, Angela M.

AU - Graham, Elizabeth C.

AU - You, Yuyi

AU - Klistorner, Alexander

AU - Graham, Stuart L.

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AB - Importance: Independent validation of iPad visual field testing software Melbourne Rapid Fields (MRF). Background: To examine the functionality of MRF and compare its performance with Humphrey SITA 24-2 (HVF). Design: Prospective, cross-sectional validation study. Paricipants: Sixty glaucomas mean deviation (MD:-5.08±5.22); 17 pre-perimetric, 43 HVF field defects and 25 controls. Methods: The MRF was compared with HVF for scotoma detection, global indices, regional mean threshold values and sensitivity/specificity. Long-term test-retest variability was assessed after 6months. Main Outcome Measures: Linear regression and Bland Altman analyses of global indices sensitivity/specificity using ROC curves, intraclass correlations. Results: Using a cluster definition of three points at <1% or two at 0.5% to define a scotoma on HVF, MRF detected 39/54 abnormal hemifields with a similar threshold-based criteria. Global indices were highly correlated between MRF and HVF: MD r2 = 0.80, PSD r2 = 0.77, VFI r2 = 0.85 (all P<0.0001). For manifest glaucoma patients, correlations of regional mean thresholds ranged from r2 = 0.45-0.78, despite differing array of tested points between devices. ROC analysis of global indices showed reasonable sensitivity/specificity with AUC values of MD:0.89, PSD:0.85 and VFI:0.88. MRF retest variability was low with ICC values at 0.95 (MD and VFI), 0.94 (PSD). However, individual test point variability for mid-range thresholds was higher. Conclusions and Relevance: MRF perimetry, despite using a completely different test paradigm, shows good performance characteristics compared to HVF for detection of defects, correlation of global indices and regional mean threshold values. Reproducibility for individual points may limit application for monitoring change over time, and fixation monitoring needs improvement.

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