Latest / Glaucoma, Vision & Longevity: Supplements & Science / Patient Education to Improve VF Performance and Reduce Anxiety

Transcript

Patient Education to Improve VF Performance and Reduce Anxiety · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Patient education to improve visual field test performance and reduce anxiety.
• 0:05
  SPEAKER_00: Visual field testing, also called perimetry, is essential for detecting and monitoring glaucoma, optic nerve disease, retinal disease, and some neurological conditions.
• 0:16
  SPEAKER_00: During standard automated perimetry, one eye is tested at a time while the patient looks at a central target and presses a button whenever a light is seen in the surrounding area.
• 0:26
  SPEAKER_00: The test estimates how sensitive different parts of the visual field are.
• 0:30
  SPEAKER_00: Because the test depends on attention, understanding, fixation, and timely responses, patient education can directly affect the quality of the result.
• 0:38
  SPEAKER_00: Anxiety, fatigue, unfamiliarity, incorrect responses, and difficulty maintaining fixation may lead to unreliable findings or unnecessary repeat testing.
• 0:49
  SPEAKER_00: In a prospective study, higher pretest anxiety was associated with greater visual field unreliability, while patients who had completed more than 10 previous tests reported substantially less anxiety.
• 1:02
  SPEAKER_00: Why patient education matters?
• 1:05
  SPEAKER_00: A patient does not need to see every light to perform well.
• 1:08
  SPEAKER_00: The goal is to respond accurately to the lights that are visible and to avoid pressing the button simply because a light is expected.
• 1:16
  SPEAKER_00: Education helps patients understand that the lights vary in brightness.
• 1:21
  SPEAKER_00: Some lights will be too dim to see.
• 1:23
  SPEAKER_00: Missing occasional lights is expected.
• 1:26
  SPEAKER_00: The patient should look at the central fixation target rather than chase peripheral lights.
• 1:31
  SPEAKER_00: Blinking is allowed.
• 1:32
  SPEAKER_00: A short pause can usually be requested if the patient becomes tired or uncomfortable.
• 1:37
  SPEAKER_00: The test is not an examination that can be failed through one or two missed responses.
• 1:43
  SPEAKER_00: A learning curve is common.
• 1:45
  SPEAKER_00: Repeated testing can improve attention, response timing, and understanding of the procedure, although a better result after practice does not necessarily mean that the eye itself has improved.
• 1:57
  SPEAKER_00: Educational interventions that improve performance.
• 2:01
  SPEAKER_00: Short educational videos.
• 2:03
  SPEAKER_00: A 3-5 minute video can show the patient what the instrument looks like, where to look, how the button works, and what the flashes will feel like during the test.
• 2:12
  SPEAKER_00: A randomized study of 244 patients undergoing their first automated visual field test used a 4.5-minute educational video.
• 2:21
  SPEAKER_00: Reliable results in both eyes were obtained in 75.9% of patients who watched the video, 61.4% of patients who received usual instruction without the video.
• 2:33
  SPEAKER_00: This was an absolute improvement of 14.5% points.
• 2:37
  SPEAKER_00: The main benefit occurred in the second eye tested.
• 2:40
  SPEAKER_00: Reliability was 86.6% with the video versus 73.5% without it.
• 2:46
  SPEAKER_00: A later quality improvement audit used a 4.5 minute video in patients with no previous experience of standard automated perimetry.
• 2:53
  SPEAKER_00: Reliability increased from 66.7% before the intervention to 87.5% afterward, an improvement of 20.8% points.
• 3:03
  SPEAKER_00: The video explained fixation, blinking, the changing brightness of the lights, and when to request a pause.
• 3:09
  SPEAKER_00: The video should be short enough to watch immediately before testing, available in the patient's preferred language, demonstrated from the patient's viewpoint, focused on behavior rather than disease terminology, followed by an opportunity to ask questions.
• 3:25
  SPEAKER_00: Interactive demonstrations.
• 3:28
  SPEAKER_00: An interactive demonstration can be more effective than spoken instructions alone because it allows the patient to see and rehearse the exact task.
• 3:36
  SPEAKER_00: A useful demonstration may include a central fixation target, a simulated peripheral flash, a button response.
• 3:44
  SPEAKER_00: Examples of lights that are easy to see and lights that are barely visible.
• 3:48
  SPEAKER_00: A brief example showing that the patient should not move the eyes toward the flash, a demonstration of normal blinking and pausing.
• 3:56
  SPEAKER_00: Direct research on a separate interactive perimetry simulator is still limited.
• 4:00
  SPEAKER_00: However, studies comparing video and spoken instruction consistently suggest that visual explanation improves understanding and confidence.
• 4:09
  SPEAKER_00: In one prospective study of 120 patients with no previous experience of the test, patients receiving video instruction had better reported relaxation and motivation than those receiving verbal instruction alone.
• 4:23
  SPEAKER_00: Teach back and short practice questions.
• 4:26
  SPEAKER_00: After a video or demonstration, the technician can ask the patient to explain the procedure in their own words.
• 4:32
  SPEAKER_00: This is called teach back.
• 4:34
  SPEAKER_00: Useful questions include: where will you look during the test?
• 4:38
  SPEAKER_00: When should you press the button?
• 4:40
  SPEAKER_00: What should you do if you do not see a light?
• 4:43
  SPEAKER_00: Are you allowed to blink?
• 4:44
  SPEAKER_00: What should you do if you become tired?
• 4:47
  SPEAKER_00: In the 2022 Educational Video Audit, patients completed a seven-question assessment.
• 4:53
  SPEAKER_00: Among patients with unreliable tests, 76.9% scored fewer than four correct answers.
• 5:00
  SPEAKER_00: Every patient who scored more than four correct answers had a reliable result.
• 5:04
  SPEAKER_00: This finding shows a strong association between understanding and test quality, although it does not prove that the quiz alone caused the improvement.
• 5:13
  SPEAKER_00: Practice tests.
• 5:15
  SPEAKER_00: A short practice exercise can reduce the unfamiliarity that makes the first test stressful.
• 5:20
  SPEAKER_00: A practice exercise should be clearly labeled as training only, not as a clinical result.
• 5:26
  SPEAKER_00: In a study of 55 healthy adults with no previous perimetry experience, the median test duration decreased from 5.7 minutes during the first test, 5.3 minutes during the second test.
• 5:39
  SPEAKER_00: False negative responses also decreased from a median of 2% to 0%.
• 5:43
  SPEAKER_00: Sensitivity increased during the second test, particularly in peripheral locations.
• 5:48
  SPEAKER_00: Practice should be brief.
• 5:50
  SPEAKER_00: A full additional threshold test may create fatigue and may alter the patient's performance through learning.
• 5:56
  SPEAKER_00: For most patients, a short demonstration or practice block is preferable to repeatedly performing a complete clinical test before the actual measurement.
• 6:06
  SPEAKER_00: Combined video and verbal instruction.
• 6:09
  SPEAKER_00: Video appears to work best when it reinforces rather than replaces a clear explanation from the technician.
• 6:16
  SPEAKER_00: In a study of 90 patients, three instruction methods were compared.
• 6:20
  SPEAKER_00: Verbal instruction alone, video instruction alone, video followed by verbal instruction.
• 6:26
  SPEAKER_00: The combined video and verbal approach resulted in the fewest repeat tests.
• 6:30
  SPEAKER_00: Both video instruction and combined instruction produced more reliable fields than verbal instruction alone.
• 6:37
  SPEAKER_00: The technician should use a consistent script.
• 6:40
  SPEAKER_00: Instructions that are too strict may cause patients to withhold responses.
• 6:44
  SPEAKER_00: Instructions that encourage excessive guessing may increase false positive responses.
• 6:50
  SPEAKER_00: The patient should follow the instructions for the specific instrument and testing algorithm being used.
• 6:56
  SPEAKER_00: Quantified effects on reliability and test duration.
• 7:00
  SPEAKER_00: The available studies show a clearer improvement in reliability than in test duration.
• 7:05
  SPEAKER_00: For the full table, please open this article on visualfieldtest.com.
• 7:09
  SPEAKER_00: Important limitations.
• 7:11
  SPEAKER_00: These percentages should not be combined as if they came from one large trial.
• 7:15
  SPEAKER_00: The studies use different patient populations, visual field instruments, testing algorithms, definitions of a reliable test, instruction methods, study designs.
• 7:27
  SPEAKER_00: Some studies were randomized, while others were audits or before and after comparisons.
• 7:32
  SPEAKER_00: Reliability indices such as fixation losses, false positive responses, and false negative responses are useful, but they should not be interpreted in isolation.
• 7:41
  SPEAKER_00: Modern interpretation also considers the gaze trace, the pattern of loss, test duration, disease severity, and whether the result makes clinical sense.
• 7:50
  SPEAKER_00: A practical structured coaching protocol.
• 7:53
  SPEAKER_00: A clinic can provide structured coaching in approximately five to eight minutes.
• 7:57
  SPEAKER_00: Step one, set expectations.
• 8:01
  SPEAKER_00: Use simple language.
• 8:02
  SPEAKER_00: This test measures how sensitive different parts of your vision are.
• 8:06
  SPEAKER_00: You will not see every light.
• 8:08
  SPEAKER_00: Missing some lights is normal.
• 8:10
  SPEAKER_00: This reduces the fear that a patient must respond perfectly.
• 8:13
  SPEAKER_00: Step two, show the procedure.
• 8:15
  SPEAKER_00: Use a video, tablet demonstration, or printed illustration to show the central fixation target, the surrounding flashes, the response button, the covered eye, how the patient should sit, how the technician monitors fixation.
• 8:29
  SPEAKER_00: Step 3.
• 8:30
  SPEAKER_00: Demonstrate the correct response.
• 8:32
  SPEAKER_00: Tell the patient, look steadily at the central target.
• 8:35
  SPEAKER_00: Press only when a light is seen.
• 8:37
  SPEAKER_00: Do not move the eyes toward the light.
• 8:39
  SPEAKER_00: Blink normally.
• 8:40
  SPEAKER_00: Do not try to predict when the next flash will appear.
• 8:43
  SPEAKER_00: Ask for a pause if needed.
• 8:45
  SPEAKER_00: The exact response instruction should match the instrument's protocol.
• 8:49
  SPEAKER_00: Step 4.
• 8:50
  SPEAKER_00: Use teachback.
• 8:52
  SPEAKER_00: Ask the patient to explain the procedure.
• 8:54
  SPEAKER_00: Correct misunderstandings before testing begins.
• 8:57
  SPEAKER_00: Step 5.
• 8:58
  SPEAKER_00: Offer a brief practice.
• 9:00
  SPEAKER_00: A short non-diagnostic practice sequence can familiarize the patient with the button and the changing brightness of the lights.
• 9:07
  SPEAKER_00: The practice result should not be used as the patient's clinical baseline.
• 9:11
  SPEAKER_00: Step 6.
• 9:12
  SPEAKER_00: Use neutral support during testing.
• 9:15
  SPEAKER_00: The technician should monitor the patient's position, alertness, and fixation without repeatedly giving performance-related comments.
• 9:22
  SPEAKER_00: Overly frequent prompts may distract the patient or alter responses.
• 9:27
  SPEAKER_00: A standardized script and consistent technician approach are preferable because technician instructions can influence perimetry results.
• 9:36
  SPEAKER_00: In-clinic tutoring versus application-based home modules.
• 9:40
  SPEAKER_00: What in-clinic tutoring does best.
• 9:43
  SPEAKER_00: In-clinic tutoring is strongest when the patient is taking the test for the first time.
• 9:48
  SPEAKER_00: The patient has previously produced unreliable results.
• 9:51
  SPEAKER_00: There is significant anxiety.
• 9:53
  SPEAKER_00: The patient has drooping eyelids, neck or shoulder problems, tremor, hearing difficulty, or cognitive impairment.
• 10:00
  SPEAKER_00: The test is being used for diagnosis, disability assessment, or an important treatment decision.
• 10:05
  SPEAKER_00: A technician can immediately correct head position, distance from the instrument, use of the corrective lens, eyelid obstruction, fixation problems, incorrect button responses, signs of fatigue or distress.
• 10:19
  SPEAKER_00: Traditional instruments such as the Humphrey Field Analyzer and Octopus Perimeter generally require oversight by experienced personnel.
• 10:27
  SPEAKER_00: What home modules do best?
• 10:29
  SPEAKER_00: A home module can reinforce information before the appointment and allow repeated low pressure exposure.
• 10:35
  SPEAKER_00: Useful features include a short video, voice instructions, a simulated test, a teach-back quiz, multiple language options, captions and large text reminders, a record of completed practice sessions, feedback that emphasizes steady fixation rather than speed.
• 10:52
  SPEAKER_00: However, the evidence is stronger for validated home visual field testing systems than for generic educational applications used alone.
• 11:00
  SPEAKER_00: In a six-month study of the eye catcher tablet perimeter, 20 patients completed monthly home testing with 98% adherence.
• 11:07
  SPEAKER_00: Home results correlated well with clinic results, and the median home test duration was 4.5 minutes.
• 11:14
  SPEAKER_00: Adding home tests reduced measurement variability in most eyes.
• 11:18
  SPEAKER_00: In a 12-month study using the Melbourne Rapid Fields home application, weekly testing compliance was 75% when weekly text reminders were used.
• 11:28
  SPEAKER_00: However, only about 65% of home tests met the study's reliability criteria, compared with 85% of supervised in-clinic Humphrey Field Analyzer tests.
• 11:39
  SPEAKER_00: The first nine home tests showed a learning phase, after which the correlation with in-clinic results improved.
• 11:46
  SPEAKER_00: A more recent home monitoring study using a web-enabled perimeter found that test duration decreased from 10.04 minutes to 8.31 minutes over six months, suggesting that repeated home exposure may improve efficiency.
• 12:00
  SPEAKER_00: Participants also rated the home system favorably for stress relief and visual comfort.
• 12:06
  SPEAKER_00: Summary Comparison.
• 12:07
  SPEAKER_00: For the full table, please open this article on VisualFieldTest.com.
• 12:12
  SPEAKER_00: The studies reviewed here do not provide a direct randomized comparison between an in-clinic tutor and an application-only educational module before the same clinic-based visual field test.
• 12:23
  SPEAKER_00: The most practical approach is therefore usually a hybrid model, provide initial instruction in the clinic, allow patients to review the same material at home, and use reminders or a short practice module before future testing.
• 12:37
  SPEAKER_00: Home results should not automatically be combined with Humphrey field analyzer results.
• 12:42
  SPEAKER_00: Different devices may use different screens, stimulus patterns, eye tracking methods, algorithms, and reference databases.
• 12:50
  SPEAKER_00: A recent systematic review found that tablet-based systems may have good agreement for some overall measures, but can also show measurement bias and poorer reliability indices than standard automated perimetry.
• 13:04
  SPEAKER_00: Pre-test preparation checklist, in-clinic visual field test, before the appointment.
• 13:09
  SPEAKER_00: Get adequate sleep and schedule the test when you are usually most alert.
• 13:13
  SPEAKER_00: Avoid alcohol before testing.
• 13:16
  SPEAKER_00: Tell the clinic about antihistamines, sedatives, sleep medicines, or other medicines that may make you drowsy.
• 13:22
  SPEAKER_00: Do not stop prescribed medicines unless your clinician specifically tells you to.
• 13:27
  SPEAKER_00: Bring your usual glasses or contact lens information.
• 13:30
  SPEAKER_00: Tell the technician if you have neck pain, tremor, arthritis, hearing difficulty, drooping eyelids, or difficulty keeping one eye covered.
• 13:39
  SPEAKER_00: Tell the clinic if you are worried about the test.
• 13:42
  SPEAKER_00: Anxiety is common and can be addressed before testing.
• 13:46
  SPEAKER_00: Ask whether a video or practice demonstration is available.
• 13:50
  SPEAKER_00: Fatigue, alcohol, central nervous systems, suppressing medicines, physical limitations, uncorrected refractive error, and eyelid problems can all affect visual field performance.
• 14:01
  SPEAKER_00: During the test, sit with your forehead and chin comfortably supported.
• 14:05
  SPEAKER_00: Keep looking at the central fixation target.
• 14:08
  SPEAKER_00: Press the button only when you see a light, following the instrument's specific instructions.
• 14:14
  SPEAKER_00: Do not move your eyes toward peripheral flashes, blink normally, do not worry about missing occasional lights.
• 14:21
  SPEAKER_00: Ask for a pause if you are tired, uncomfortable, or need to reposition.
• 14:26
  SPEAKER_00: Take a short break between the two eyes if permitted.
• 14:29
  SPEAKER_00: Tell the technician if the corrective lens, eyelid, or face position is uncomfortable.
• 14:35
  SPEAKER_00: Patient-friendly guidance commonly emphasizes normal blinking, steady fixation, and communicating when a pause is needed.
• 14:43
  SPEAKER_00: After the test, ask whether the technician reviewed the reliability indicators.
• 14:48
  SPEAKER_00: Ask whether the result is adequate for clinical interpretation.
• 14:52
  SPEAKER_00: If the test is unreliable, ask whether a repeat test is needed and what could be changed next time.
• 14:58
  SPEAKER_00: Do not assume that a darker grayscale area automatically means permanent worsening.
• 15:03
  SPEAKER_00: The clinician must interpret the entire result and compare it with previous tests.
• 15:09
  SPEAKER_00: Application-based home module or home visual field test.
• 15:13
  SPEAKER_00: Use only an application or device recommended by your eye care professional.
• 15:18
  SPEAKER_00: Confirm whether the application is for education only or whether it is a validated medical visual field test.
• 15:25
  SPEAKER_00: Use the same device, screen, viewing distance, and corrective lens each time.
• 15:30
  SPEAKER_00: Test in a quiet area without television, conversation, glare, or screen reflections.
• 15:36
  SPEAKER_00: Sit in a stable position and follow the application's instructions for covering the other eye.
• 15:42
  SPEAKER_00: Complete the tutorial and teach back questions before the first test.
• 15:46
  SPEAKER_00: Use one short practice session, but do not treat the practice result as a medical result.
• 15:51
  SPEAKER_00: Test when you are alert rather than immediately after strenuous activity or a poor night's sleep.
• 15:56
  SPEAKER_00: Use reminders if the program provides them.
• 16:00
  SPEAKER_00: Record unusual circumstances such as headache, dizziness, illness, poor sleep, or difficulty keeping the head still.
• 16:08
  SPEAKER_00: Stop and contact the clinic if the device causes significant dizziness, nausea, headache, or visual discomfort.
• 16:15
  SPEAKER_00: Upload or send the results as instructed.
• 16:18
  SPEAKER_00: Do not change glaucoma treatment or other medicines based only on a home application result.
• 16:24
  SPEAKER_00: The first several home tests may reflect learning rather than true change.
• 16:28
  SPEAKER_00: Clinicians should review trends over time instead of reacting to one isolated home result.
• 16:35
  SPEAKER_00: When extra coaching is especially important, ask for additional instruction or a supervised practice session if this is your first visual field test, you have had one or more unreliable results, you feel intense anxiety about failing the test, you have difficulty hearing or understanding spoken instructions, you have memory, attention, or neurological problems, you have a drooping eyelid or difficulty keeping your head still, you become tired during the second eye, your home test results are repeatedly inconsistent with clinic results.
• 17:08
  SPEAKER_00: Conclusion: Patient education is a low-cost way to improve visual field test performance.
• 17:13
  SPEAKER_00: The strongest evidence supports a brief educational video reinforced by clear verbal instruction, teachback, reassurance, and a short practice demonstration.
• 17:24
  SPEAKER_00: Across available studies, structured education improved the proportion of reliable tests by approximately 14.5 to 20.8 percentage points, while effects on test duration were smaller, generally a few seconds to less than one minute and not always statistically significant.
• 17:40
  SPEAKER_00: Practice and home testing can reduce unfamiliarity and anxiety, but home systems currently show variable reliability and should not automatically replace supervised clinical perimetry.
• 17:52
  SPEAKER_00: The most effective model is usually clinic-based coaching, plus optional home review and reminders, with the final interpretation made by an eye care professional.
• 18:02
  SPEAKER_00: All links to sources are available in the text version of this article.
• 18:06
  SPEAKER_00: You can find the full article at visualfieldtest.com.
• 18:10
  SPEAKER_00: Thanks for listening.
• 18:11
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.