Tesis

Kesesuaian Parameter Perimetri Melbourne Rapid Fields Terhadap Humphrey Field Analyzer Pada Pasien Glaukoma Derajat Sedang – Berat: Hubungan Tajam Penglihatan Dengan Akurasi Melbourne Rapid Fields = Agreement of Perimetric Melbourne Rapid Fields Parameters to Humphrey Field Analyzer in Patients with Moderate to Severe Glaucoma: Relationship between Visual Acuity and Accuracy of Melbourne Rapid Fields.

Latar Belakang: Glaukoma merupakan suatu kelompok neuropati optik progresif yang ditandai dengan kelainan struktural dan fungsi saraf optik. Fungsi penglihatan yang paling terganggu pada penderita glaukoma adalah lapang pandangan. Pemeriksaan perimetri berguna untuk mengidentifikasi dan mengukur defek lapang pandangan serta memperkirakan progresivitas glaukoma. Aplikasi perimetri berbasis tablet atau website sangat berguna untuk pemantauan pasien selama pandemi Covid19 dan dapat digunakan di daerah terpencil dengan keterbatasan alat Humphrey Field Analyzer (HFA). Perimetri Melbourne Rapid Fields (MRF) merupakan teknologi baru yang terjangkau, mudah dibawa dan andal, serta dapat memberikan manfaat yang sama dengan perimetri HFA. Tujuan: Menilai kesesuaian hasil perimetri MRF terhadap HFA pada pasien glaukoma derajat sedang – berat dengan tajam penglihatan terganggu. Metode: Penelitian observasional dengan desain potong lintang untuk menilai hubungan tajam penglihatan terhadap kesesuaian hasil perimetri MRF 24-2 dibandingkan dengan HFA 24-2 pada pasien glaukoma derajat sedang-berat. Dilakukan pengelompokan subjek ke dalam dua grup berdasarkan tajam penglihatan. Setiap subjek dilakukan pemeriksaan dengan dua macam alat, urutan pemeriksaan dilakukan randomisasi blok. Pemeriksaan perimetri HFA sebanyak satu kali dan pemeriksaan MRF sebanyak dua kali. Hasil pemeriksaan yang memenuhi kriteria dilakukan analisis komparatif, korelasi, kesesuaian, serta test-retest repeatability. Hasil: Total 64 mata dari 57 subjek terbagi dalam dua kelompok. Durasi pemeriksaan MRF lebih singkat dibanding HFA (265,7 ± 26,6 vs 384,4 ± 46,7, p < 0,001). Tidak terdapat perbadaan bermakna pada indeks reliabilitas kedua alat. MRF menunjukkan korelasi dan kesesuaian yang sangat kuat dan baik dengan HFA (R = 0,931, ICC = 0,957, p < 0,001 pada hasil mean deviation (MD) dan R = 0,941, ICC = 0,974, p < 0,001 pada hasil Visual Field Index (VFI)). Test-retest repeatability MRF menunjukkan korelasi dan kesesuaian yang sangat baik (R = 0,948, ICC = 0,989, p < 0,001 pada hasil MD dan R = 0,946, ICC = 0,989, p < 0,001 pada hasil Visual Capacity (VC)). Tidak didapatkan korelasi antara tajam penglihatan dengan Root Mean Squared Error (RMSE) hasil MRF, p > 0,05. Kesimpulan: Hasil perimetri MRF memiliki korelasi yang sangat kuat dnegan HFA. MRF juga menunjukkan hasil test-retest repeatability yang sebanding dengan HFA.Keakuratan hasil MRF tidak berkorelasi dengan perbedaan tajam penglihatan
Kata Kunci: Melbourne Rapid Fields; glaukoma derajat sedang-berat; kesesuaian hasil perimetri tablet dan Humphrey; tajam penglihatan dan lapang pandangan glaukoma.


Background: Glaucoma is a group of progressive optic neuropathy characterized by structural and functional abnormalities of the optic nerve. The most impaired visual function in glaucoma sufferers is the visual field. Perimetric examination is useful for identifying and measuring visual field defects and predicting the progression of glaucoma. Tablet or website-based perimetry applications are very useful for monitoring patients during the Covid-19 pandemic and can be used in remote areas with limited Humphrey Field Analyzer (HFA) perimetry. Melbourne Rapid Fields (MRF) is a new perimetry technology that is affordable, portable and reliable, also can provide the same benefits as HFA perimetry. Objective: To assess the concordance of MRF perimetry results with HFA in moderate to severe glaucoma patients with impaired visual acuity. Methods: Observational study with a cross-sectional design to assess the relationship of visual acuity to the concordance of perimetry MRF 24-2 versus HFA 24-2 in patients with moderate-to-severe glaucoma. Subjects were grouped into two groups based on visual acuity. Each subject was examined with two kinds of perimetry, the order of examination was randomized using block randomization. Participants were tested once on HFA and twice on MRF. Examination results that meet the criteria are analyzed for comparative, correlation, concordance, and test-retest repeatability. Results: A total of 64 eyes from 57 subjects were divided into two groups. MRF examination duration was shorter than HFA (265.7 ± 26.6 vs 384.4 ± 46.7, p < 0.001). There is no significant difference in the reliability index of the two perimetry. MRF showed a very strong and good correlation and concordance with the HFA (R = 0.931, ICC = 0.957, p < 0.001 in the mean deviation (MD) and R = 0.941, ICC = 0.974, p < 0.001 in the results of the Visual Field Index (VFI)). The MRF test-retest repeatability showed a very good correlation and concordance (R = 0.948, ICC = 0.989, p < 0.001 on the MD and R = 0.946, ICC = 0.989, p < 0.001 on the Visual Capacity (VC)). There was no correlation between visual acuity and Root Mean Squared Error (RMSE) MRF, p > 0.05. Conclusion: The perimetry results from MRF have a very stong correlation to the HFA outcomes. MRF reveals test-retest repeatability comparable to HFA. The accuracy of MRF results did not correlate with differences in visual acuity.
Keywords: Melbourne Rapid Fields; moderate-to-severe glaucoma; agreement of tablet perimetry and Humphrey outcomes; visual acuity and perimetry results in glaucoma