WRITER Associate Professor George Kong

Despite advances in diagnostic imaging and treatment, up to half of glaucoma cases go undiagnosed, mainly due to limited access to reliable visual field testing, inadequate community screening, and a lack of convenient platforms for routine checks of visual function.

Those with unstable or progressive glaucoma are often unable to access the urgent care they need because a significant portion of clinical resources in public hospitals and ophthalmology clinics are used to monitor patients with stable disease. This leads to bottlenecks, delayed treatment, and avoidable vision loss.

These issues highlight an urgent need for validated, scalable, and accessible diagnostic technologies that help clinicians reach more patients, prioritise cases more efficiently, and maintain continuity of care outside traditional clinics. Melbourne Rapid Fields (MRF) (mrfvision.com), an Australian innovation, is emerging as a leading solution to this global challenge.

AN AUSTRALIAN INNOVATION WITH A GLOBAL MISSION

MRF was developed by me, Associate Professor George Kong, a glaucoma specialist and clinician-scientist, together with Professor Algis Vingrys, an internationally recognised vision scientist at the University of Melbourne. We both aimed to enhance global access to validated visual field testing and envisioned a future where glaucoma could be monitored at home, reducing unnecessary hospital visits and easing clinic workloads.

Within a commercial structure known as GLANCE Optical, founded in 2016, the first iteration of MRF was launched as an iPad app, allowing clinicians to conduct perimetry with a simple, portable device instead of a costly, immobile perimeter.

The COVID pandemic accelerated MRF’s development. Responding to lockdowns and restricted clinic access, the team transitioned the platform from a tablet app to a browser-based system, enabling visual field testing on any mainstream device – laptops, desktops or tablets – found in most homes and clinics. During this shift, the team determined that a forward-facing camera would improve test reliability. We designed and patented an artificial intelligence (AI) system that analyses the webcam feed in real time, monitoring viewing distance, gaze stability, and lighting conditions to ensure tests are done under clinical standards. This innovation remains globally unique and is central to MRF’s reliable home-testing capability.

VALIDATION AND SCIENTIFIC EVIDENCE

Since its inception, MRF has built a strong evidence base for clinical validity and reliability. To date, the technology has been evaluated in 20 peer-reviewed publications, including seven independent studies, reinforcing confidence in its use across diverse environments. MRF applies the principles of traditional white-on-white automated perimetry, the current gold standard for glaucoma diagnosis, but increases efficiency with Bayesian inference and neighbourhood logic. This approach enables rapid and precise threshold estimation, reducing test duration without sacrificing diagnostic accuracy.

Comparisons with the Humphrey Field Analyzer (HFA) have shown that MRF achieves very strong concordance. Studies in the American Journal of Ophthalmology have reported intraclass correlation coefficients above 0.90 for key indices, such as mean deviation and pattern standard deviation, consistently across both cross-sectional and longitudinal cohorts.1,2 A multi-centre trial led by Tiang and colleagues in 2025 confirmed that the browser-based MRF maintains robust performance across devices and clinics in both urban and rural settings, demonstrating resilience to environmental variability.3 Over time, MRF has expanded its clinical toolset to include validated protocols for 24-2, 30-2, and 10-2 testing patterns, as well as a binocular visual field test, demonstrating validity of the software device in clinical practice.

PIONEERING HOME-BASED VISUAL FIELD TESTING

Melbourne Rapid Fields was among the first platforms to recognise the vast potential of home-based visual field testing. Early research published in Ophthalmology by the team showed that increasing testing frequency, by enabling patients to conduct visual field assessments at home, would allow clinicians to detect glaucoma progression much earlier than with standard review schedules.4 Building on this, the team led one of the first large home-monitoring trials for glaucoma, published in the American Journal of Ophthalmology in 2020.5 This pivotal study found patients could independently perform visual field tests at home and the resulting data were clinically meaningful and reliable for management decisions.

Subsequent studies extended these findings to longer periods, confirming patients maintained good compliance and steady test reliability over 12 months. This validated the feasibility of including home testing in chronic disease management. During the COVID-19 pandemic, MRF collaborated with Dr Hari Jayaram and Dr Giovanni Montesano at Moorfields Eye Hospital to support remote testing for 100 participants in the LiGHT trial.6 With only telephone guidance from research staff, patients successfully completed visual field tests using their own home computers. The results, recently published by the British Journal of Ophthalmology, show that two-monthly home testing with MRF provided superior clinical information to six-monthly in-clinic HFA testing. This was a significant advance in tele-ophthalmology, reinforcing MRF’s reputation as a leader in validated home-based perimetry.

GLOBAL REACH AND REGULATORY MILESTONES

Today, MRF stands as one of the most extensively approved and widely distributed digital perimetry platforms. It holds regulatory clearances from the Therapeutic Goods Administration (Australia), MedSafe (New Zealand), CE Mark (European Union), UKCA (United Kingdom), Central Drugs Standard Control Organisation (India), and ANVISA (Brazil). This broad regulatory portfolio enables the technology to be deployed across diverse regions. Clinically, MRF is now used in more than 370 practices globally, and continues to experience rapid adoption. In 2025, it surpassed 100,000 completed visual field tests, highlighting strong real-world usage. In Australia, MRF has been implemented by several large optometry groups, including Bailey Nelson, Optical Co, 1001 Optical, and Zoom Optics, as well as many other optometry and ophthalmology clinics. Its browser-based design allows clinics to efficiently scale up visual field testing without the need for dedicated perimetry hardware.

SUPPORTING GLOBAL PUBLIC HEALTH PROGRAMS

To tackle the widespread underdiagnosis of glaucoma, MRF is now a vital element of multiple screening initiatives worldwide. The platform has been adopted by community screening programs in India, Nepal, Cambodia, China, and across Africa. In many cases, MRF is used alongside on-site clinical exams and emerging AI–assisted fundus imaging tools to deliver comprehensive assessments for those who would otherwise miss out on early detection. By enabling fast, portable and reliable visual field assessments outside traditional clinics, MRF is expanding glaucoma detection to underserved populations.

PUSHING THE FRONTIER OF VISUAL FIELD ASSESSMENT

MRF continues to evolve, adopting advanced computational techniques to enhance performance and streamline clinical workflows. A recent development is the MRF 24-2 Rapid protocol, which leverages spatial and temporal prediction algorithms to accelerate threshold estimation. This protocol matches the diagnostic capability of the widely used SITA-Standard algorithm but completes testing in 60% less time. Such efficiency is crucial for high-volume screening, clinics with limited capacity, and patients who find long tests challenging. In addition to faster testing, MRF is introducing integrated communication tools so optometrists can easily share results with ophthalmologists. These upgrades are designed to enable smoother referrals, especially in areas with uneven eye care access. By simplifying clinical information exchange and reducing administrative hurdles, MRF helps support more coordinated and efficient patient care.

MRF’s rapid visual field test solution being used for a glaucoma screening program in China.

The MRF team Prof Algis Vingrys (left) and Assoc Prof George Kong (centre) with research team members from WenZhou, China.

BEYOND GLAUCOMA

While glaucoma is MRF’s main focus, the platform has shown value in other clinical areas. Collaborating with Melbourne-based neurologist Dr Tissa Wijeratne, optometrist and PhD candidate Chamini Wijesundera has used MRF to assess visual field function in bedridden stroke patients. Their research found that MRF identified previously undiagnosed visual field defects in 40% of stroke patients in hospital. These results underscore the importance of visual field assessment in neurological rehabilitation and highlight MRF’s potential for functional testing where standard equipment is unavailable.

MRF has also demonstrated promise in assessing macular disease. Studies comparing the MRF 10° macular protocol to standard macular integrity assessment (MAiA) microperimetry showed strong agreement, suggesting MRF may be valuable for home monitoring of geographic atrophy, intermediate age-related macular degeneration, and treated neovascular macular degeneration. As functional monitoring remains a significant gap in managing these conditions, MRF’s accessibility positions it well to help address this need.

BUILDING ON MILESTONES

2026 looks promising for MRF having experienced pivotal growth in 2025. The platform achieved its milestone of 100,000 completed tests, reflecting its expanding global footprint. MRF was recognised by the InnovationAus Awards as a finalist in the HealthTech category, a distinction that highlights its contribution to the Australian innovation landscape. Scientifically, the team published nine peer-reviewed papers within a single year, reinforcing its leadership in clinical validation and the development of new perimetric methodologies.2,6,7-13

Organisationally, MRF has strengthened its leadership by appointing Dr Anabela Corria as interim Chief Executive Officer, bringing additional commercial and operational expertise to the company. Additionally, Associate Professor Mo Dirani has joined the Board, adding depth to its strategic and global health mission. Together, these developments position MRF well for accelerated international expansion.

Associate Professor George Kong

SHAPING THE FUTURE OF ACCESSIBLE EYE CARE

With the global burden of glaucoma rising, the need for accessible and efficient diagnostic tools is more urgent than ever. By changing where and how visual field testing is conducted, MRF is creating new opportunities for early detection, equitable access, and ongoing disease monitoring around the world.

Associate Professor George Kong MBBS BMedSci PhD FRANZCO is an Honorary Clinical Associate Professor at the University of Melbourne. He is a Director at GLANCE Optical, developer of Melbourne Rapid Fields.

References
1. Prea SM, Kong GYX, Vingrys AJ, et al. Six-month longitudinal comparison of a portable tablet perimeter with the Humphrey Field Analyser. Am J Ophthalmol. 2018; 190: 9-16. doi: 10.1016/j.ajo.2018.03.009.
2. Kong GYX, M He, Crowston JG, Vingrys AJ. A comparison of perimetric results from a tablet perimeter and Humphrey field analyzer in glaucoma patients. Trans Vis Sci Tech. 2016; 5(6):2, doi:10.1167/ tvst.5.6.2.
3. Tiang J, Vingrys AJ, Kong YXG, et al. Multi-centre comparison between device-independent web-browser perimetry (Melbourne Rapid Fields-web) and SITA-Faster for glaucoma. Front Ophthalmol (Lausanne). 2025 Feb 6;5:1485950. doi: 10.3389/fopht.2025.1485950.
4. Anderson AJ, Bedggood PA, Vingrys AJ, et al. Can home monitoring allow earlier detection of rapid visual field progression in glaucoma? Ophthalmology. 2017; 124: 1735-1742. doi: 10.1016/j.ophtha.2017.06.028.
5. Prea SM, Kong GYX, Guymer RH, Vingrys AJ. Uptake, persistence, and performance of weekly home monitoring of visual field in a large cohort of patients with glaucoma. Am J Ophthalmol. 2021; 223:286-95. doi: 10.1016/j.ajo.2020.10.023.
6. Montesano G, Nathwani N, Jayaram H, et al. Fields from home: device-independent online perimetry with Melbourne Rapid Fields. Br J Ophthalmol. 2026 Jan 6:bjo-2025-328016. doi: 10.1136/bjo-2025-328016.
7. Schrittenlocher S, Lüke V, Dietlein TS, et al. Acceptance of novel perimetry methods in Germany: Virtual reality perimetry and tablet-based perimetry in glaucoma patients. Klin Monbl Augenheilkd. 2025 Mar;242(3):219-227. English, German. doi: 10.1055/a-2511-4087.
8. Chen DF, Zhou W, Liang Y, et al. Comparative analysis of Melbourne Rapid Fields web-browser perimeter and Humphrey Field Analyzer in Chinese glaucoma patients. Transl Vis Sci Technol. 2025 Jul 1;14(7):18. doi: 10.1167/tvst.14.7.18.
9. Sugihara K, Kong YXG, Hosokawa M, Okanouchi T. Comparison of 10-2 visual field using Melbourne Rapid Fields online perimetry and Humphrey Field Analyzer. Transl Vis Sci Technol. 2025 Sep 2;14(9):14. doi: 10.1167/tvst.14.9.14.
10. Sugihara K, Kong YXG, Okanouchi T, et al. Comparison of 30-2 visual field using Melbourne Rapid Fields online perimetry and Humphrey Field Analyzer. J Glaucoma. 2025 Nov 1;34(11):970-978. doi: 10.1097/IJG.0000000000002625.
11. Bhartiya S, Kong YXG, Ambawata M, et al. Evaluating the ease of use and clinical applicability of the Melbourne Rapid Field for visual field testing: A real-world experience. Indian J Ophthalmol. 2026 Jan 1;74(1):117-122. doi: 10.4103/IJO.IJO_1461_25.
12. Kong GYX, Dirani M, Vingrys AJ, et al. Melbourne Rapid Fields online perimeter home visual field study for glaucoma: 3-month results. Ophthalmol Glaucoma. 2025 Nov 17:S2589-4196(25)00240-6. doi: 10.1016/j.ogla.2025.10.008.
13. Wijesundera CN, Crewther SG, Wijeratne T, Vingrys AJ. Persistent visual impairments following mild-to-moderate ischemic stroke. Front Ophthalmol (Lausanne). 2025 May 26;5:1505836. doi: 10.3389/fopht.2025.1505836.