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.
Richardson QR, Kumar RS, Ramgopal B, et al. Diagnostic accuracy of an iPad application for detection of visual field defects. Eye (Lond). Published online September 5, 2022. doi:10.1038/s41433-022-02223-y