Agreement, Reliability, and Feasibility of Melbourne Rapid Fields Tablet Perimetry Compared with Humphrey Field Analyzer in Glaucoma

Objectives: We aimed to evaluate the agreement, test–retest reliability, test duration, and patient acceptability of Melbourne Rapid Fields (MRF) tablet perimetry compared with Humphrey Field Analyzer (HFA) 24-2 SITA-Standard perimetry in glaucoma patients. Methods: This cross-sectional study evaluated 64 eyes of 64 patients with primary or secondary glaucoma. Participants underwent both HFA and MRF perimetry in a non-randomized sequence. Agreement was analyzed using intraclass correlation coefficients (ICC) and Bland–Altman analysis. Test–retest reliability of MRF was evaluated in 47 participants after 4 weeks. Acceptability was assessed via questionnaires. Results: MRF demonstrated comparable reliability indices to HFA (p > 0.05), although these findings do not establish equivalent clinical reliability due to differences in platform-specific definitions. MRF demonstrated excellent test–retest reliability for MD (ICC 0.993), PD (ICC 0.992), and VC (ICC 0.992; all p < 0.001). Compared with HFA, MRF produced significantly less negative MD (−6.27 ± 5.55 vs. −8.32 ± 5.47 dB, p < 0.001) and higher PSD/PD (7.48 ± 3.26 vs. 6.33 ± 4.11 dB, p < 0.001), while VFI/VC did not differ significantly (p = 0.808). Overall agreement was good-to-excellent MD (ICC 0.949), PSD/PD (ICC 0.880), and VFI/VC (ICC 0.930). However, exploratory severity-stratified Bland–Altman analysis suggested greater variability in moderate and severe glaucoma. MRF was significantly faster than HFA (4.22 ± 0.81 vs. 5.46 ± 1.33 min, p < 0.001). All patients reported it was easy and comfortable. Conclusions: MRF provides excellent test–retest reliability, shorter testing duration, and high patient acceptability. While overall agreement is high, systematic differences and greater advanced-stage variability prevent direct interchangeability with HFA. Instead, MRF serves as a practical, complementary platform for accessible, frequent testing.