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Using an open-source tablet perimeter (Eyecatcher) as a rapid triage measure for glaucoma clinic waiting areas
  1. Pete R Jones1,
  2. Dan Lindfield2,
  3. David P Crabb1
  1. 1 Division of Optometry and Visual Sciences, City University of London, London, UK
  2. 2 Glaucoma Services, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
  1. Correspondence to Dr Pete R Jones, Division of Optometry and Visual Sciences, City University of London, London EC1V 0HB, UK; peter.jones{at}city.ac.uk

Abstract

Background Glaucoma services are under unprecedented strain. The UK Healthcare Safety Investigation Branch recently called for new ways to identify glaucoma patients most at risk of developing sight loss, and of filtering-out false-positive referrals. Here, we evaluate the feasibility of one such technology, Eyecatcher: a free, tablet-based ‘triage’ perimeter, designed to be used unsupervised in clinic waiting areas. Eyecatcher does not require a button or headrest: patients are simply required to look at fixed-luminance dots as they appear.

Methods Seventy-seven people were tested twice using Eyecatcher (one eye only) while waiting for a routine appointment in a UK glaucoma clinic. The sample included individuals with an established diagnosis of glaucoma, and false-positive new referrals (no visual field or optic nerve abnormalities). No attempts were made to control the testing environment. Patients wore their own glasses and received minimal task instruction.

Results Eyecatcher was fast (median: 2.5 min), produced results in good agreement with standard automated perimetry (SAP), and was rated as more enjoyable, less tiring and easier to perform than SAP (all p<0.001). It exhibited good separation (area under receiver operating characteristic=0.97) between eyes with advanced field loss (mean deviation (MD) < −6 dB) and those within normal limits (MD > −2 dB). And it was able to flag two thirds of false-positive referrals as functionally normal. However, eight people (10%) failed to complete the test twice, and reasons for this limitation are discussed.

Conclusions Tablet-based eye-movement perimetry could potentially provide a pragmatic way of triaging busy glaucoma clinics (ie, flagging high-risk patients and possible false-positive referrals).

  • diagnostic tests/Investigation
  • field of vision
  • glaucoma
  • psychophysics
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @petejonze, @eyesurgeondan, @crabblab

  • Presented at Elements of this work were presented at ARVO 2019.

  • Contributors PRJ, DL and DPC conceived the designed the study. PRJ developed the test materials and collected the data. PRJ analysed the data and wrote the manuscript. All the authors contributed towards finalising the draft.

  • Funding This study was funded by a Fight for Sight (UK) project grant (#1854/1855).

  • Disclaimer The funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the National Health Service Health Research Authority (IRAS ID: #230440) and was conducted in accordance with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The complete source code for Eyecatcher is available online at https://github.com/petejonze/Eyecatcher, and is free for non-commercial use.

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