• Home Monitoring to Detect Rapid Visual Field Decline

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, December 2017

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    Recent technologic advancements have allowed patients to monitor their central visual field (VF) at home with portable devices. Anderson et al. in­vestigated whether the greater test fre­quency afforded by home monitoring improves early detection of rapid VF loss in patients with glaucoma. They found it beneficial for this purpose, even if patient compliance is imperfect.

    This computer simulation study included 43 patients who were be­ing treated for glaucoma (open- or closed-angle), had ocular hypertension, or had suspected glaucoma. Series of VFs (n = 100,000) were simulated for those patients with stable glaucoma and for those with progressing glauco­ma for 2 in-clinic schedules (yearly and every 6 months) and 3 home-moni­toring schedules (monthly, fortnightly, and weekly), each lasting 5 years.

    To simulate reduced compliance, the researchers randomly omitted varying percentages of home-monitored fields and manipulated the variability of the home-monitored VFs. Previously pub­lished variability characteristics were used for perimetry, and their appro­priateness for home monitoring was confirmed by measuring the device’s retest variability at 2 months among the study group. The criterion for determining progression was a signifi­cant slope of the ordinary least-squares regression of a simulated patient’s mean deviation data.

    In the clinic, sensitivity of 0.8 for rapid VF loss was achieved by 2.5 years of semiannual testing, while the same level of sensitivity was attained by 0.9 years with weekly home monitoring, despite only moderate compliance (63%) with the schedule. The superiority of weekly home monitoring over in-clinic testing every 6 months remained even when home monitoring was assumed to pro­duce more variable test results or to be associated with low patient compliance.

    Although the cost-benefit of home monitoring was not evaluated, this approach likely would reduce health resource utilization by decreasing the frequency of in-clinic testing, the researchers said.

    The original article can be found here.