Assessment of the Feasibility of Remote Training, At-Home Testing, and Test-Retest Variability of Clustered Virtual Reality Perimetry

Abstract

Objective: To assess the feasibility of remotely training glaucoma patients to take a ten-session clustered virtual reality (VR) visual field test (VVP-10) at home, analyze results for test-retest variability, and assess correspondence with conventional perimetry. Design: Cross-sectional study. Subjects: 21 subjects with glaucoma were enrolled and included in the feasibility assessment of remote training. 36 eyes were used for test-retest analysis and determination of concordance with Humphrey Visual Field (HVF) testing. Methods: Subjects were provided with a mobile VR headset containing the VVP-10 test software and trained remotely via video conferencing. Subjects were instructed to complete ten sessions over a 14-day period. Main Outcome Measures: Feasibility was determined by the number of subjects who were able to independently complete VVP-10 over the 14-day period after one remote training session. Intraclass correlation coefficient (ICC) of average fraction seen across ten sessions and standard error (SE) for the mean were primary outcome measures for assessing test-retest variability. Correlation with HVF mean sensitivity (MS) across eyes, was a secondary outcome measure. Results: 20 subjects (95%) successfully completed the VVP-10 test series after one training session. ICC of VVP-10 was 0.95 (95% CI [0.92, 0.97]). Mean SE in units of fraction seen was 0.012. The Spearman correlations of VVP-10 average fraction seen versus HVF MS were 0.88 (95% CI [0.66, 0.99]) for moderate to advanced glaucoma eyes, and decreased to 0.68 (95% CI [0.29, 0.94]) when all eyes were included. Conclusions: Remote training of patients at home is feasible and subsequent remote clustered visual field testing using VVP-10 by patients on their own without any further interactions with caregivers or study staff was possible. At-home VVP-10 results demonstrated low test-retest variability. Future studies must be conducted to determine if VVP-10, taken at home as convenient for the patient, may be a viable supplement to provide equivalent or complementary results to that of standard in-clinic assessment of visual function in glaucoma.