Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad

Acceptance of Novel Perimetry Methods in Germany: Virtual Reality Perimetry and Tablet-based Perimetry in Glaucoma Patients

PURPOSE

The aim of this study was to investigate the acceptance of innovative perimetry methods such as virtual reality perimetry (VRP) and tablet-based perimetry (TBP) in comparison to conventional hemisphere perimetry (HP) in glaucoma patients for the first time in Germany.

PATIENTS AND METHODS

We examined 204 glaucoma patients using the 30 - 2 TOP algorithm (Octopus, Haag-Streit) followed by one of the two new methods: Group 1 (VRP; n = 101) and Group 2 (TBP using the Melbourne Rapid Fields Glaucoma App; n = 103). Subsequently, patients were asked to fill out a questionnaire on their experience with the new examination compared to the conventional examination.

RESULTS

More than three-quarters of patients at 77% in Group 1 (VR) and 89.9% of patients in Group 2 (TBP) found the respective new examination method "easier" or "much easier" than the conventional HP. An overwhelming majority of patients in Group 1 and Group 2 found the new method more comfortable at 86% and 90.9%, respectively. Examination durations were: 2.67 ± 0.98 min for HP, 6.26 ± 1.88 min for VR perimetry, and 4 ± 0.71 min for the tablet method; figures given as means ± standard deviation. Just over half the patients at 51% found HP and VR headset to be similar for duration with 54% preferring the tablet over conventional hemisphere perimetry. By far the most patients in Groups 1 and 2 at 80% and 81.8%, respectively, reported willingness to use the new perimetry method regularly in future follow-up examinations.

CONCLUSION

Most glaucoma patients surveyed consistently responded favourably to VR headset and tablet-based perimetry, preferring these examinations to conventional hemispherical perimetry.

Diagnosing glaucoma in primary eye care and the role of Artificial Intelligence applications for reducing the prevalence of undetected glaucoma in Australia

Glaucoma is the commonest cause of irreversible blindness worldwide, with over 70% of people affected remaining undiagnosed. Early detection is crucial for halting progressive visual impairment in glaucoma patients, as there is no cure available. This narrative review aims to: identify reasons for the significant under-diagnosis of glaucoma globally, particularly in Australia, elucidate the role of primary healthcare in glaucoma diagnosis using Australian healthcare as an example, and discuss how recent advances in artificial intelligence (AI) can be implemented to improve diagnostic outcomes. Glaucoma is a prevalent disease in ageing populations and can have improved visual outcomes through appropriate treatment, making it essential for general medical practice. In countries such as Australia, New Zealand, Canada, USA, and the UK, optometrists serve as the gatekeepers for primary eye care, and glaucoma detection often falls on their shoulders. However, there is significant variation in the capacity for glaucoma diagnosis among eye professionals. Automation with Artificial Intelligence (AI) analysis of optic nerve photos can help optometrists identify high-risk changes and mitigate the challenges of image interpretation rapidly and consistently. Despite its potential, there are significant barriers and challenges to address before AI can be deployed in primary healthcare settings, including external validation, high quality real-world implementation, protection of privacy and cybersecurity, and medico-legal implications. Overall, the incorporation of AI technology in primary healthcare has the potential to reduce the global prevalence of undiagnosed glaucoma cases by improving diagnostic accuracy and efficiency.