Optometry and Vision Sciences - Theses
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ItemThe role of home monitoring in chronic eye disease using smart devices.( 2023-03)Chronic eye disease affects millions of people worldwide and requires ongoing specialist care. Ever-increasing patient numbers has created pressure on the healthcare system, an issue that has been intensified by the COVID-19 pandemic. There is a pressing need to develop new models of eyecare to prevent vision loss. Home monitoring (HM) of vision in-between scheduled clinical visits could help prioritise valuable hospital chair time to those with the highest risk. Smart devices, such as desktops, laptops, tablets, and smartphones are ubiquitous in the community making them an ideal platform for HM due to familiarity of use. Most older individuals use smart devices to access the internet and it is this age group that is at a higher risk for developing chronic eye disease. This thesis considers the role of HM with the Melbourne Rapid Fields (MRF) vision testing application (for the Apple iPad) in the context of two common chronic eye diseases; glaucoma and age-related macular degeneration (AMD). MRF is new technology without a proven clinical record. Chapter 2 reports the clinical application of MRF as a routine and regular test of visual field (VF) by comparing 2-monthly VF testing to that found using the Humphrey Field Analyzer (HFA) for glaucoma patients in-clinic. We find the MRF has a strong correlation to the HFA with excellent medium-term repeatability (6-month period). This means that MRF can produce the same outcomes as the HFA when performed under supervision in the clinic. Chapters 3 and 4 apply the MRF to a weekly HM regime where participants tested themselves at home under application generated audio instructions and in the absence of clinical supervision. HM was undertaken for 12-months, and all participants had access to a clinical assistant who could be contacted to resolve technical difficulties. Chapter 3 finds that glaucoma participants had an uptake of 88% to HM and a weekly compliance of 72% with same-day reminders. A strong correlation was observed between the MRF at-home and the HFA in-clinic, and progression was detected in two participants using MRF home monitoring. Chapter 5 reports the HM uptake to be 85% in patients with intermediate AMD (iAMD) with a weekly compliance of 61% in the absence of reminders. Here, the HM included visual acuity as well as macula visual field sensitivity. Good correlation was observed between MRF and clinical measures with the Early Treatment Diabetic Research Study (ETDRS) letter chart and the Macular Integrity Assessment (MAIA) microperimeter. The overall findings of this thesis are that patients with chronic eye disease are receptive to the concept of HM with smart devices due to promising uptake. The finding of moderate compliance to weekly testing can be considered as a reduced number of tests received from home but, can still provide valuable information for clinical decision making. A survey of participant perceptions reveals that the MRF is easy to use and more comfortable than clinical perimeters. Larger, randomised, clinical trials are required to expose the true ability of MRF to detecting progression before it can be implemented as a new model of patient eye care.