Feasibility of portable perimeters in an eye emergency department setting

 

‘Best-practice care and diagnosis must take into account clinic workflow as well as patient comfort and understanding. Although established diagnostic units may be considered the ‘gold standard’, this project gave us a valuable opportunity to use and review several new models which may contribute to the care of our glaucoma patients. Funding from Future Vision Foundation was central to gaining access to the equipment and providing the time to develop the project.’

– Dr Jason Cheng, Co-investigator

 

Project status

Complete

Project overview

Visual field testing is central in the diagnosis and management of glaucoma, as well as other optic nerve and visual pathway disorders.

Conventional automated perimetry requires expensive machinery, trained operators and a relatively large machine footprint, and depends on adequate instructions, patient positioning and supervision. Patients often dislike their experience of perimetry.

Ideally, perimetry would be adaptable to different settings, have short test durations and be comfortable and easy for patients while maintaining accuracy. There have been continued advances in software and hardware to achieve this goal.

This project reviewed three new devices which were either laptop-based or VR-based programs.

Key learnings

  1. Technical staff and patients preferred the virtual reality (VR) model as it provided clear instructions and required less manipulation. It also did not appear to be dependent on patient positioning, which is a requirement of both laptop-based models and existing ‘gold standard’ units.
  2. By contrast, non-technical staff found the VR model difficult to use and some patients described motion-related discomfort.
  3. The use of a cloud-based program allowed easy transfer of data and more collaborative opportunities between ophthalmology and optometry.
  4. No single device is yet to represent an absolute advantage. The focus group identified several key requirements for any unit including the integration within the clinic’s workflow.

Research findings

  • All three tested devices had relative advantages and disadvantages.
  • The project has outlined these for clinicians and may expedite the introduction of viable alternatives, which could represent a further benefit to the ongoing care of glaucoma patients globally.
  • This project serves as a platform for further analysis and review.

Presentations/publications

  • Utility of portable perimetry in ophthalmic emergency: A pilot study on usability and integration into workflow, Clin Exp Ophthalmol. Read poster abstract
  • Australia and New Zealand Glaucoma Society (ANZGS) meeting 2024 (Dr Jain won the award for best trainee presentation)
  • Testing 3 new visual field devices in an emergency department setting, Optometry Connection magazine (March 2024). Read article

Research team

Heashot of Dr Neera Jain in a charcoal blazer and black and white lace blouse.

Dr Neera Jain

Registrar, Sydney Eye Hospital

Dr Neera Jain is a current fourth year ophthalmology registrar within the Sydney Eye Training Network.

Papers

Wang X, Neely A, Jain NS, Lueck C. (2022) Biomechanics of human optic chiasmal compression: ex vivo experiment and finite element modelling. Medicine in Novel Technology and Devices. 13:100113

Jain NS, Ruan CW, Symes RJ. (2021) Psychotropic Drug-induced glaucoma: A practical guide to diagnosis and management. CNS drugs. 35(2)

Jain NS, Kersten H, Watson S, Danesh-Meyer, H. (2019) Gender differences in Australasian Ophthalmologists’ Experiences of the Workplace. Clin Experimental Ophthalmol 47(6)

Jain NS, Kam AW, Chong C, Francis KE, Kalani YS, Francis IC. (2019) Anterior visual pathway compression by the Internal Carotid Artery (AVCIC), the Anterior Cerebral Artery, the Ophthalmic Artery or the Basilar Artery. Neuro-Ophthalmology. 43(3):1-10

Research awards

Neuro-Ophthalmology Society of Australia (NOSA) Annual Clinical and Scientific Meeting Best Oral Presentation Prize (prize was funded trip to the North American Neuro-Ophthalmology Society Meeting in Washington)

Private Practice Fund Research Scholarship at The Canberra Hospital for research project investigating the microanatomy of the optic chiasm

Headshot of Dr Jason Cheng in a grey suit and white shirt

Dr Jason Cheng

Ophthalmologist, Vision Eye Institute

Dr Jason Cheng is a fellowship-trained glaucoma specialist. He is an experienced surgeon who performs complex glaucoma surgery, including trabeculectomy, tube implant, angle surgery and minimally invasive glaucoma surgery (MIGS). He is a highly skilled cataract surgeon and frequently combines cataract surgery and glaucoma surgery. Dr Cheng has strong research interests – he has been awarded over 14 research grants since 2012 – and is part of several commercial and multicentre trials as both principal and co-investigator.

Headshot of Dr Jessica Li in a black blazer.

Dr Jessica Li

Registrar, Liverpool Hospital

Dr Jessica Li is a Junior Medical Officer at Liverpool Hospital.

Papers

Li JXL, Wang X, Henry A, Anderson CS, Hammond N, Harris K, Liu H, Loffler K, Myburgh J, Pandian J, Smyth B, Venkatesh B, Carcel C, Woodward M. Sex differences in pain expressed by patients across diverse disease states: individual patient data meta-analysis of 33,957 participants in 10 randomized controlled trials. Pain. 2023.

Li JXL, Chan F, Johansson CYM. Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review. Aust N Z J Obstet Gynaecol. 2022.

Posters

Li J, Tong J, Tumuluri K. (2023). Orbital Apex Syndrome in Herpes Zoster Ophthalmicus: Case Series and Literature Review. Poster presentation for the 2023 RANZCO NSW Branch Congress. Awarded 2nd prize.