Effect of Pre-Training Patients Using Self-Directed Slideshow Presentation on Visual Field Reliability in First-Time Test Takers

Authors

• Derek Zahnleuter
• Lillian Centlivre
• Rahul Babu
• Chaeski Kim
• Kaitlin Ziadeh
• Hanna Simmons
• Vivian Rajeswaren
• Parker Williams
• Jacob Im
• Aleksey Mlshulin
• Brittany Hodges
• Faisal Ridha Al-Timimi, Corewell Health East
• Hassan Tokko

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : Visual field (VF) testing is essential for diagnosing and monitoring glaucoma, yet reliability is limited by inexperience and poor fixation. Reported reliability is 59–82%, with 41% of unreliable tests due to fixation loss in VF-naïve patients. Although training videos have improved reliability in VF-naïve patients, the impact of self-directed pre-test education remains unknown. This study evaluated whether a self-directed slideshow improves VF test reliability in VF-naïve adults with glaucoma or glaucoma suspicion.

Methods : In this randomized controlled trial, we enrolled VF-naïve adults (≥18 years old) from April 2022 to November 2025 who had a visual acuity (VA) ≥20/200, a diagnosis of glaucoma or glaucoma suspect, and a false-positive rate (FPR) ≤20%. Participants were randomized to either an experimental group with a self-directed slideshow before VF testing or a control group with no intervention. Demographic and clinical variables included age, sex, ethnicity, VA, intraocular pressure (IOP), fixation loss (FL), FPR, mean deviation (MD), pattern standard deviation (PSD), glaucoma severity, cup-to-disc (CD) ratio, and ocular comorbidities. VF reliability was defined as FL < 20%. Paired t-tests and chi-squared analyses were performed between groups.

Results : A total of 208 patients (101 intervention, 107 control) were included. Groups did not differ in age (p=0.70), sex (p=0.18), ethnicity (p=0.96), VA (p=0.27), IOP (p=0.23), MD (p=0.39), PSD (p=0.73), glaucoma severity (p=0.95) or CD ratio (p=0.92). Reliable VF tests occurred in 69.31% of the experimental group versus 59.81% of controls (p=0.15). Patients aged ≥65 demonstrated a lower test reliability (p=0.059).

Conclusions : A self-directed slideshow did not yield a statistically significant improvement in VF reliability compared with standard instruction. There was a non-significant increase in reliability between groups and a trend toward reduced reliability in patients over 65. These results highlight the need for continued investigation of patient-directed training for different age groups to determine optimal instructional methods and potential clinical impact.

Volume

67

Issue

7

First Page

4989

Comments

Association for Research in Vision and Ophthalmology (ARVO), May 3-7, 2026, Denver, CO

Last Page

4989

Recommended Citation

Zahnleuter D, Centlivre L, Babu R, Kim C, Ziadeh K, Simmons H, et al. [Ridha Al-Timimi F]. Effect of pre-training patients using a self-directed slideshow presentation on visual field reliability in first-time test takers. Invest Ophthalmol Vis Sci. 2026 Jun;67(7):4989.