Perimetric Outcomes of Melbourne Rapid Field Perimetry in Patients with Glaucoma: A Systematic Review and Meta-Analysis
Andres Inzunza, Edgar Alejandro Moreno-Diaz, Deborah Goss, David FriedmanPrécis:
MRF had shorter test durations than HFA, high agreement with HFA global indices, modest bias in MD and PSD measurements, and comparable concordance and repeatability. MRF had poorer reliability indices, while maintaining good diagnostic performance.
Purpose:
The Humphrey Field Analyzer (HFA) is the most widely used perimeter in glaucoma, but its cost and low portability limit its use in resource-constrained settings. Melbourne Rapid Fields (MRF) is a low-cost, tablet-based perimeter system that enables at-home testing and testing in low-resource environments. Despite growing evidence that the MRF can obtain reliable estimates of the visual field, no study has synthesized its perimetric performance through meta-analysis and compared it with HFA.
Methods:
Following PROSPERO registration, we conducted a systematic review to compare MRF with HFA in patients with glaucoma. Searches were performed using controlled vocabulary related to perimetry assessment with these devices. Meta-analyses and narrative synthesis were conducted to summarize their performance.
Results:
Of 290 studies screened, 9 were included, aggregating data from 777 eyes. Pooled data comparing MRF to HFA, MRF had faster testing (–1.33 min), less-negative MD (+2.08 dB), and higher PSD (+0.77 dB). Global agreement with HFA was high (MD ICC=0.94; MD R²=0.85; PSD ICC=0.85). Test–retest reliability was similar between devices (MRF ICC=0.96; HFA ICC=0.95). AUCs were comparable for MD (0.84 vs 0.85) but lower for PSD (0.81 vs 0.93). MRF had higher fixation losses, false positives, and false negatives.
Conclusion:
MRF had shorter test durations, high global agreement with HFA, excellent repeatability, and a bias toward less negative global results. MRF showed greater pointwise variability at certain thresholds and worse reliability measures. Despite these differences, MRF returned diagnostic information comparable to HFA.