Visual field testing (perimetry) involves testing the visual sensitivity of each eye’s entire field; assessing for any deficits in our peripheral vision. It is the most important way to detect glaucoma, and to monitor patients with glaucoma for its progression over time.
Currently visual field testing requires single-purpose, complex machines (see Figure 1). These machines are large, cumbersome and expensive. They require specialised knowledge to build, maintain and operate. They have a carbon footprint, access requires attendance at an eye care clinic, and one must place one’s head in a head rest within a bowl where others have been. This bowl is not able to be sterilised between users (as this would affect the finely tuned light parameters).
Figure 1. Conventional, machine-based visual field testing
As an Ophthalmologist, and busy glaucoma specialist in Melbourne, dozens of my patients are performing such testing daily. I am acutely aware of the limitations of machine-based visual field testing. It slows down the clinic, the machines are expensive to acquire and maintain, and require a great deal of staff involvement. Also, my patients are very commonly complaining about the experience: they do not enjoy perimetry using those machines. It was only until recently that this was the only option.
Not any more.
Working with experts from Microsoft, in 2020 I founded Australian health-tech company Eyeonic, with a vision to provide a more enjoyable and accessible experience in perimetry.
We believed online perimetry was possible, and we were right.
We have developed a means of performing online visual field testing that will work on any computer. All that is needed is a computer, mouse, and internet access; although volume and a webcam are preferable.
Online visual field testing has many advantages over perimetry locked into cumbersome machines.
Online perimetry is more enjoyable, accessible and less costly than machine-based perimetry.
As a Melbourne-based Ophthalmologist and glaucoma specialist, I am fortunate to have a wonderful cohort of glaucoma patients that see me regularly. Generally we have an honest and frank relationship. It was my patients telling me, time and time again, how they did not enjoy perimetry on the conventional machines, that motivated me to create a new way of doing it, the online Eyeonic visual field test.
Online I was amazed at the consistent positive feedback from patients, describing how much more enjoyable the online test was than machine-based perimetry.
We published their responses as a survey of 95 patients, in 2022 in the prestigious journal Ophthalmology Science.
We asked a 10-item survey about various aspects of the experience of visual field testing, and found preference to online perimetry in 10/10 items; 8 of these reached statistical significance.
When asked overall, which form of perimetry did they prefer; 84% preferred the online Eyeonic visual field test, 16% preferred neither, and 2% preferred the conventional machine. Not bad considering many had been familiar with the old machine, having used it for years, while this was their first experience with online perimetry!
One might ask: “What about older patients – do they have problems with the online test?” The answer is no: we specifically analysed for age (our eldest was 87 years old) and this did not influence their survey results.
Being able to perform testing on any computer, anywhere suddenly opens access for many. Many people either do not have the time to visit an eye care clinic (eg an Optometry or Ophthalmology practice) or are concerned about costs. Many remote or regional communities in Australia, and across the globe do not have access to eye care clinics or to dedicated visual field machinery. Providing the service online, bringing visual field testing into our living rooms is a game changer for glaucoma screening and detection. And it is desperately needed – 50% of glaucoma remains undetected in the developed world; 90% of glaucoma is undetected in the developing world. These eye-watering statistics represent people who are not accessing vital eye care services and are unnecessarily losing vision daily. Making the test more accessible will save sight globally.
It was during the Covid-19 pandemic we truly learnt the value of telemedicine; but even following on from the pandemic, telemedicine has become a critical aspect of healthcare delivery across the globe.
When visual field testing is performed on a dedicated machine at an eye clinic, the data is forever stored on the machine and owned by the clinic. If you the patient wish to change clinics (for example, move to a different location) you must ask permission to the clinic for the medical record, and if lucky are provided a printout of test results. Such a printout is useless when it comes to careful progression analysis over time, which requires data from now to be compared to past data on the machine. This is why when a patient moves between clinics, their progression analysis must begin again, and their previously performed tests are rendered almost useless for this task.
In comparison, an online system allows you the patient to be in control of your data. If you move from one clinic to another, simply unclick your old clinic clinician and find and click your new one; now the old data is still easily accessible, and ongoing data can be easily added and analysed for ongoing progression analysis. In this way the value of previous tests is not lost.
This is also very helpful in the shared care model between Optometrists and Ophthalmologists, which is becoming more common. If both clinicians have access to the same database, and contribute testing to the same database, this would provide more precise continuity of care; more careful monitoring as you move between the Optometrist’s and Ophthalmologist’s clinics.