Driven by advances in telehealth, Melbourne Rapid Fields (MRF) is making inroads around the world. The browser-based application, which enables patients with retinal disease to self-monitor and identify serious changes in their condition from their home and workplace, is now in use in 154 sites in Australia and New Zealand. A total of 30,100 MRF tests have been done throughout the world.
Professor Algis Vingrys, from the University of Melbourne’s Department of Optometry and Vision Sciences, who has led the development of MRF, described the application as inexpensive and portable, with a small footprint.
He said enabling evaluations to be undertaken by patients at home, rather than requiring them to come into your practice “allows practitioners to triage patients and identify those who need urgent attention. It can also save chair time because patients can complete screening tests before attending for a clinical exam.”
Professor Vingrys provided two case studies that demonstrate the efficacy of the MRF when used in the home.
Case One
A 65-year-old male was diagnosed with type 2 diabetes in 2003. In 2016, he had seen an ophthalmologist and had no signs of diabetic retinopathy. This was confirmed at the optometry visit one year later, in January 2017. In October 2019, the patient called complaining of recent vision loss (Figure 1). A home-based evaluation of visual acuity (VA) and MRF-diabetes was ordered for him to determine the urgency of his symptoms. Home testing found VA in his right eye was 6/12 (previous 6/6) and low-luminance, low-contrast (LL-LCVA) was 6/48. This difference was abnormal (VA and LL-LC VA differed by one to two lines) and likely indicated pre-retinal or macular disorder.
His visual field on MRF-diabetes showed a significant region of macular loss, confirming the presence of macular oedema.
Clinical review the next day, with fundus photos and optical coherence tomography (OCT), confirmed macular oedema (Figure 1). The patient was referred to a retinal specialist for treatment.
Figure 1. Fundus photo, OCT, and VF for a 65-year-old diabetic patient who developed DMO in October 2019. This VF was measured at home and took three minutes, 39 seconds to complete.
Case Two
A 72-year-old woman volunteered for Melbourne University’s age-related macular degeneration (AMD) clinical trial but was excluded due to her suspicious optical coherence tomography (OCT) scan. However, being highly motivated in her own medical care and owning a tablet device, she requested access to the MRF at home, to self-monitor her condition. She self-monitored weekly for the following 3.5 years.
Figure 2. A woman with intermediate AMD who developed nAMD and self-monitored with MRF for 3.5 years.
Figure 2 displays her MRF event analysis at the top. This identifies pointwise changes in the visual field in red (confirmed at least twice) or black (zero sensitivity).
The mean sensitivity for both MaiA (retina stabilised perimeter, large red circles), done in clinic, and MRF (small blue diamonds), done at home, is displayed on a weekly basis. Her VA measured clinic (6m ETDRS chart) at key time points, is shown on the x-axis. The blue-dotted vertical line identifies when her visual field MS started to change on both MaiA and MRF, and the red dashed vertical line identifies the time for intraocular anti-VEGF injection by her retinal specialist.
In March 2023, mivision published a CPD article on MRF technology. Visit: mieducation.com/melbourne-rapid-fields-expanding-yourpractice-with-modern-vision-testing-technology.
