Home Visual Fields Screening App Has Inadequate Accuracy

An iPad-based perimetry application (app) designed to detect visual field defects does not have adequate diagnostic accuracy to be used as a screening tool for glaucoma, according to research published in Eye.

Researchers conducted a prospective cross-sectional study of patients undergoing their first Humphrey Field Analyzer (HFA) visual field test using 24-2 SITA standard HFA testing and iPad-based perimetry with the app at a glaucoma clinic in South India. 

The researchers evaluated diagnostic accuracy by comparing the tablet-based app at various test thresholds using the area under receiver-operating characteristic curve (AUROC) with the consensus of 2 ophthalmologists.

A total of 203 eyes of 115 participants (58% men and 42% women) were included in the study. The researchers classified participant eyes as having no glaucoma (45%), mild glaucoma (15%), moderate glaucoma (16%), advanced glaucoma (12%), and severe glaucoma (12%).

The researchers found that the iPad-based perimetry had an AUROC of 0.64 (95% confidence interval [CI], 0.57-0.71) for detection of any visual field defect relative to HFA and 0.68 (95% CI, 0.59-0.76) for detection of moderate or worse glaucoma relative to ophthalmologist consensus. 

When they set the specificity at 90%, indicating ≥19 missed points per hemifield, the sensitivity of the iPad-based perimetry for detection of moderate or worse glaucoma was 35% (95% CI, 22-48%).

“Better screening tests, further software improvements, and development of normative databases for perimetry tools are needed for glaucoma detection, particularly in resource-limited settings,” the researchers explain.