The short-term compliance and concordance to in clinic testing for tablet-based home monitoring in age-related macular degeneration.

Abstract

PURPOSE: This study determines the short-term compliance to regular home monitoring of macular retinal sensitivity (RS) in intermediate age-related macular degeneration (iAMD). We also compare home-based outcomes with in-clinic outcomes determined using 1. the same tablet device under supervision and 2. the Macular Integrity Assessment (MaIA) microperimeter. DESIGN: Single-centre longitudinal compliance and reliability study. METHODS: Seventy-three participants with iAMD were trained to perform macular field testing with the Melbourne Rapid Fields-macular (MRF-m) iPad application. Volunteers were asked to retur 6 weekly tests from home, guided by audio instructions. We determined compliance to weekly testing and surveyed for factors that limited compliance. Test reliability (false positive, false negative) and retinal sensitivity (RS) were compared to in-clinic assays (MaIA). Data are shown as mean ±[standard deviation] or median[quartile 1-3 range]. Group comparisons were achieved with bootstrap to define the 95% confidence limits. RESULTS: Fifty-nine participants submitted 6 home exams with a median inter-test interval of 8.0 [7.0-17] days. Compliance to weekly testing (7 days ±24 hours) was 55%. The main barrier to compliance was IT logistic reasons. Of 694 home exams submitted, 96% were reliable (FP<25%). The mean RS returned by the tablet was significantly higher (+3.2 dB, p<0.05) compared to the MaIA. CONCLUSIONS: Home monitoring produces reliable results that differ from in-clinic tests due to test design. This should not impact self-monitoring once an at-home baseline is established, but these differences will affect comparisons to in-clinic outcomes. Reasonable compliance to weekly testing was achieved. Improved IT support might lead to better compliance.