Ophthalmology Science (Mar 2025)
Virtual Reality Portable Perimetry and Home Monitoring of Glaucoma: Retention and Compliance over a 2-year Period
Abstract
Purpose: To evaluate long-term retention, compliance, and performance of glaucoma patients using a virtual reality portable perimeter to monitor visual fields (VFs) at home. Design: Prospective, longitudinal, cohort study. Subjects: Twenty-five glaucoma patients with stable and reliable VFs (average age 67.4 years) were recruited at Toronto Western Hospital, Ontario, Canada. Methods: Participants were instructed to perform bilateral home VF tests fortnightly for 2 years using the Toronto Portable Perimeter (TPP). Based on empirical home monitoring data, simulation analyses were conducted to evaluate the progression detection performance of high-frequency TPP testing. Main Outcome Measures: Retention rates were calculated as the percentage of participants who performed ≥1 home VF test. Compliance rates measured the percentage of participants adhering to the recommended test frequency of every 2-month period. Visual field indices, test reliability, intertest variability, and the precision of estimating progression rate with TPP were compared to those with the Humphrey Field Analyzer (HFA). After 6 months, participants completed a questionnaire to evaluate their experiences and preferences. The years required to detect progression were also compared between HFA and TPP tests. Results: Eighteen of the 25 participants (72%) completed ≥1 unsupervised VF test at home, with an average test frequency of 1.6 tests/month. Compliance decreased as the monitoring duration progressed, dropping from 83% (initial 2 months) to 11% (final 2 months). Unfamiliarity with technology and time constraints were identified as the main barriers to regular testing. Visual field indices of TPP home tests were strongly correlated with clinical results (r > 0.900). Home testing significantly reduced intertest variability (P < 0.001) and improved the precision of progression rate estimates (P < 0.010). Participants overwhelmingly preferred home testing over clinic VF follow-ups (P < 0.001). Simulations showed that TPP tests can significantly shorten the time to detect progression for different progression rates compared with clinical VF follow-up, even with compromised compliance. Conclusions: Despite the small sample size, our study demonstrated that glaucoma patients could reliably perform VF tests at home over a 2-year period. However, issues with retention rate and compliance with long-term VF monitoring were observed in some participants. Nevertheless, high-quality VF data from home tests can provide supplementary information to improve the timely detection of VF progression. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
