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Editors Selection IGR 25-3

Clinical Examination Methods: Portable perimetry outside the clinic: ready to detect progression?

Comment by Rupert Bourne on:

127953 On the feasibility of accelerating glaucoma clinical trials using portable perimetry, Tan JCK; Montesano G; Crowston J et al., Ophthalmology. Glaucoma, 2026; 9: 106-116

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Portable perimetry, where visual field (VF) data is collected outside of the traditional clinic setting, may carry advantages in terms of patient access and the volume of VF data that can be collected. If portable perimetry could provide reliable data that independently or in combination with clinic-based current reference standard devices, was able to detect progression earlier then this may have significant benefits for glaucoma care and in particular clinical trials for glaucoma, which are lengthy and expensive. In this paper, Tan et al invited 3 groups of volunteers (no ocular pathology affecting visual fields, ocular hypertensives and those with suspected or manifest glaucoma) to perform 8 standard automated perimetry assessments with conventional bowl-based perimetry (Humphrey Field Analyzer, HFA) or portable head-mounted perimetry (Eyecatcher 3.0, EC3; with smart glasses that have magnetic clip-on lenses to correct for refractive errors and speakers embedded that provide verbal encouragement via a speech synthesizer).1 Sequence of testing was varied and patient experience measured. The authors used test-retest repeatability to predict the proportion of progressors over ∼3 years that would be detected by either device, in the context of an ongoing clinical trial, when tested 4 monthly by HFA and/or weekly, fortnightly, monthly, 4 monthly using the EC3. They reported no significant difference in test duration (noting that the HFA tests twice as many test locations) and high test-retest variability for both devices, although EC3 had worse measurement repeatability. By modeling change in standard error for estimated progression as a function of test frequencies, this poorer repeatability could be offset by greater frequency of testing, with monthly testing by EC3 detecting at least as many mild progressors as clinic-based HFA testing once every 4 months. Higher frequency of testing needs to be balanced against testing burden and patient acceptability, although a higher proportion of the study participants preferred the EC3 over the HCA. The study has important implications for clinical trial design, demonstrating that incorporating home-based VF testing would reduce clinic attendances and follow-up duration while also increasing frequency of testing. The authors also argue that home monitoring may improve equity of access to trials, improving inclusivity and representativeness that can often be lacking.2 The use of the EC3 was supervised and the authors note that finding an optimal trade-off between test frequency and adherence is still needed, 3 yet this study further provides evidence for the role of home perimetry in both clinical and research glaucoma practice.

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