Circular Contrast Perimetry via Web Application: A Patient Appraisal and Comparison to Standard Automated Perimetry

Glaucoma Home Monitoring Using Online Circular Contrast Perimetry Over 6 Months: Performance and Patient Attitudes in the Developing World Setting

Purpose

Online circular contrast perimetry (OCCP) provides perimetry on any computer or tablet without additional hardware. This study assessed the longitudinal performance and user feedback of home OCCP in an Asian population.

Methods

Twenty glaucoma and fifteen healthy participants underwent a comprehensive ocular examination and visual field tests in clinic, using OCCP and standard automated perimetry. Within a week, participants were asked to repeat OCCP at home. OCCP was then repeated after 3 months and 6 months at home, followed by a user-experience survey.

Results

No significant difference between clinic and home OCCP for test duration, false negative (FN) and fixation loss (FL) rates was found. False positive (FP) rate of home OCCP was slightly higher than that of clinic OCCP (p = 0.04). Bland-Altman plots indicated a small difference between Mean Deviation (MD) (1.26 dB, p = 0.0087) and good agreements between Pattern Standard Deviation (PSD) and Visual Index (VI) of clinic OCCP and home OCCP with insignificant difference of PSD and VI (p > 0.05). Intraclass correlation coefficient (ICC) analysis demonstrated good correlation of MD & VI and poor correlation of PSD between clinic OCCP and home OCCP. Over 6 months, home OCCP indicated moderate to excellent correlation of indices. Participants reported a positive attitude toward home OCCP; however, a high dropout rate was noted for the 3- and 6-month at-home testing.

Conclusion

Comparable results were observed between clinic and home OCCP at baseline. Acceptable consistency of home OCCP findings over 6 months was recognized. Patients may require additional support to achieve desired adherence to at-home monitoring protocols.

Evaluating the Consistency of Online Circular Contrast Perimetry Across Different Computer Monitors: A Cross-sectional Study

Aim and background

The aim of this study is to evaluate the agreement between perimetric findings of a novel 24°, 52-loci online circular contrast perimetry (OCCP) application on three different computer monitors to determine its stability of testing across varying displays.

Materials and methods

Sixty-one participants (19 healthy controls, 42 with glaucoma) underwent SAP testing followed by OCCP testing on three uncalibrated computer monitors in randomized order: a large-screen (24-inch) desktop personal computer (DPC) (Dell, Texas, US), a 17-inch laptop (LPC) (Dell), and a 14-inch MacBook Pro (MP) (Apple, California, US).

Results

Agreement of mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)/visual index (VI) values between MP, DPC, and LPC OCCP were strong, with intraclass correlations and Deming's coefficients ranging from 0.96 to 1.00 and 0.93 to 1.03, respectively. When OCCP tests were compared to SAP, ICCs and Deming's coefficients were less strong, ranging from 0.89 to 0.95 and 0.72 to 0.89. Bland-Altman analyses revealed higher biases (2.90 to 3.59 dB) and wider limits of agreement when comparing OCCP to SAP than when comparing OCCP on different monitors. Bland-Altman bias of contrast sensitivities for each 24-2 testing location revealed stronger relationships between OCCP tests on different monitors (-0.82 to 0.78) than between OCCP and SAP tests (-1.53 to 1.32).

Conclusion

OCCP demonstrates strong levels of test-retest agreement when performed on computer monitors of varying display and moderate to strong levels of correlation to SAP perimetric indices.

Clinical significance

With further enhancements, OCCP could potentially be used on different personal computers, which could help address current challenges in glaucoma care, such as limited access to traditional perimetric testing. This has the potential to expand the scope of glaucoma detection and monitoring, particularly in remote and underserved areas of our community.

How to cite this article

Gong A, Busija L, Skalicky SE. Evaluating the Consistency of Online Circular Contrast Perimetry Across Different Computer Monitors: A Cross-sectional Study. J Curr Glaucoma Pract 2025;19(1):15-27.

Glaucoma Clinic Monitoring Over 6 Months Using Online Circular Contrast Perimetry in Comparison with Standard Automatic Perimetry: The Developing-World Setting

Purpose

Online circular contrast perimetry provides visual field testing on any computer or tablet without additional hardware. This study compared outcomes of online circular contrast perimetry (OCCP) and standard automated perimetry (SAP) in a developing world setting.

Methods

The longitudinal and observation study was conducted on patients sampled during 2023 at Hanoi Medical University Hospital. Participants were either healthy volunteers as controls or stable glaucoma patients with either primary angle closure or primary open-angle glaucoma. They underwent a comprehensive ocular examination, retinal nerve fiber layer optical coherence tomography scan, and visual field tests performed at baseline and after 3 months and 6 months, using OCCP and SAP in clinic.

Results

The current study was carried out in 168 eyes of 87 patients at baseline, 133 eyes of 69 patients at 3 months, and 121 eyes of 63 patients at 6 months. At baseline, OCCP mean deviation (MD) (R2 = 0.804, p < 0.001) and visual index (VI) (R2 = 0.892, p < 0.001) were strongly correlated with SAP MD and visual field index (VFI) respectively. There was strong agreement and correlation between MD and VI/VFI for SAP and OCCP on repeated testing after 6 months. At 6 months AUC of SAP VFI (0.79) was superior to AUC of OCCP VI (0.67, p = 0.036); otherwise there was no difference in AUC of MD or VI/VFI at baseline, 3 and 6 months, when comparing OCCP and SAP.

Conclusion

OCCP parameters are significantly correlated with those of SAP. OCCP has the potential to provide a complementary role to SAP in glaucoma screening and monitoring.

Repeatability of Online Circular Contrast Perimetry Compared to Standard Automated Perimetry

PRCIS

Online circular contrast perimetry provides visual field assessment on any computer or tablet with no extra hardware. It has good test repeatability and reliability that is comparable with standard automated perimetry. It holds promise for use in disease screening and surveillance to expand the provision of glaucoma care.

PURPOSE

To evaluate the repeatability of online circular contrast perimetry (OCCP) compared to standard automated perimetry (SAP) in normal participants and patients with stable glaucoma over 18 weeks.

METHODS

Thirty-six participants (13 normal controls and 23 patients with open angle glaucoma) were recruited. OCCP and SAP perimetry tests were performed twice at baseline, then at 6, 12, and 18 weeks. Global perimetric indices were compared between perimetry types and analyzed for short-term and intermediate-term repeatability.

RESULTS

There were no statistically significant changes over time for both OCCP and SAP across all groups for mean deviation (MD), pattern standard deviation, and visual index/visual field index ( P >0.05). Test-retest intraclass correlation coefficients (ICCs) for OCCP MD were excellent at baseline (0.98, 95% CI: 0.89-0.99) and good at 18 weeks (0.88, 95% CI: 0.51-0.98). SAP test-retest ICCs were excellent at baseline (0.94, 95% CI: 0.70-0.99) and 18 weeks (0.97, 95% CI: 0.84-0.99). Inter-test ICCs were good, ranging from 0.84 to 0.87. OCCP testing time was shorter than SAP (5:29 ± 1:24 vs. 6:00 ± 1:05, P <0.001). OCCP had similar false-positive (3.84 ± 3.32 vs. 3.66 ± 4.53, P =0.48) but lower false-negative (0.73 ± 1.52 vs. 4.48 ± 5.00, P <0.001) and fixation loss responses (0.91 ± 1.32 vs. 2.02 ± 2.17, P <0.001).

CONCLUSIONS

OCCP allows visual field assessment on any computer screen with no additional hardware. It demonstrated good repeatability and reliability with similar performance indices to SAP in both the short term and intermediate term. OCCP has the potential to be utilized as a glaucoma screening and surveillance tool for in-clinic and at-home testing, expanding the provision of care.

Online Circular Contrast Perimetry via a Web-Application: Establishing a Normative Database for Central 10-Degree Perimetry

Purpose

To establish a normative database using a central 10-degree grid pattern for the online circular contrast perimetry (OCCP) application.

Participants

Fifty participants with mean age 65 ± 13 years were selected for this study. One eye from each participant that met inclusion criteria was randomly included in the cohort.

Methods

The web-application delivered online 52-loci perimetry in a central 10-degree pattern using circular flickering targets. These targets consist of concentric sinusoidal alternating contrast rings. Users were guided by the application to the correct viewing distance and head position using in-built blind spot localization and webcam monitoring. A spinning golden star was used as the fixation target and patients performed the test in a darkened room following standard automated perimetry (SAP).

Results

The reliability rates and global indices for OCCP were similar to SAP. OCCP mean sensitivity reduced with age at a similar rate to SAP. Mean sensitivity per loci of 10-degree OCCP was greater than SAP by 1.24 log units (95% CI 1.23 to 1.26) and obeyed a physiological hill of vision. Small differences existed in mean sensitivities between OCCP and SAP which increased with increasing spot eccentricity. Mean deviation (MD) displayed good agreement between the two tests.

Conclusion

Central 10-degree online circular contrast perimetry via a computer-based application has comparable perimetric results to standard automated perimetry in a normal cohort.

Online Circular Contrast Perimetry: A Comparison to Standard Automated Perimetry

PURPOSE

The aim was to validate and compare the diagnostic accuracy of a novel 24-degree, 52-loci online circular contrast perimetry (OCCP) application to standard automated perimetry (SAP).

DESIGN

Prospective cohort study.

METHODS

Two hundred and twenty participants (125 normal controls, 95 open angle glaucoma patients) were included. Agreement, correlation, sensitivity, specificity, and area under receiver operating curves (AUC) were compared for parameters of OCCP, SAP, and optical coherence tomography (OCT) for the retinal nerve fiber layer and macular ganglion cell complex inner plexiform layer.

RESULTS

Pointwise sensitivity for OCCP was greater than SAP by 1.02 log units (95% CI: 0.95-1.08); 95% limits of agreement 0.860 to 1.17. Correlation and agreement for global indices and regional zones between OCCP and SAP were strong. OCCP mean deviation (MD) AUC was 0.885±0.08, similar to other instruments' parameters with the highest AUC: SAP MD (0.851±0.08), OCT retinal nerve fiber layer inferior thickness (0.908±0.07), OCT ganglion cell complex inner plexiform layer inferior thickness (0.849±0.08), P>0.05. At best cutoff, OCCP MD sensitivity/specificity were comparable to SAP MD (90/74 vs 94/65%).

CONCLUSIONS

OCCP demonstrates similar perimetric sensitivities to SAP and similar AUC to SAP and OCT in distinguishing glaucoma patients from controls. OCCP holds promise as a glaucoma surveillance and screening tool, with the potential to be utilized for in-clinic and at-home perimetry and expand community testing.