Diagnostic Accuracy and Reliability of Portable Visual Field-Testing Devices for Glaucoma Monitoring: A Systematic Review and Meta-Analysis

Background Portable visual-field (VF) testing devices have emerged as accessible alternatives to standard automated perimetry (SAP) for glaucoma screening and monitoring. Their diagnostic accuracy and clinical reliability, however, remain uncertain due to heterogeneous study designs, variable thresholds, and inconsistent performance metrics. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy, test duration, and correlation of all portable VF devices compared with SAP, across multiple device categories and glaucoma severities. Methods A comprehensive search of PubMed, Scopus, Web of Science, Cochrane Central, ClinicalTrials.gov, WHO ICTRP, and Google Scholar was conducted from inception through December 2024, without language restrictions. Eligible studies included diagnostic-accuracy or cohort designs comparing portable VF devices—virtual reality, tablet-based, web-based, or paper-based—against SAP as the reference standard. Two reviewers independently extracted data and assessed quality using QUADAS-2. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated using bivariate random-effects models, with heterogeneity and publication bias evaluated via I², τ², and Deeks’ funnel asymmetry tests. Secondary outcomes included test duration and correlation coefficients for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). Results From 639 screened records, 21 studies involving 2,254 participants (1,362 glaucoma, 892 controls) were included. Pooled sensitivity and specificity were each 86% (95% CI, 80–90 and 80–93, respectively), with an overall DOR of 28.6 (95% CI, 14.3–57.2). Virtual-reality and tablet-based devices achieved the highest accuracy, while paper-based tools showed greater variability. Testing times were significantly shorter than SAP (SMD − 3.86; 95% CI, − 4.72 to − 2.99), and global index correlations were strong (r = 0.82; 95% CI, 0.75–0.88). Conclusions Portable VF devices demonstrate diagnostic accuracy equivalent to SAP with markedly reduced testing time, supporting their integration into tele-ophthalmology, community screening, and home-monitoring programs. These technologies represent validated, scalable tools for improving global glaucoma detection and ongoing disease management.