Patients Prefer a Virtual Reality Approach Over a Similarly Performing Screen-Based Approach for Continuous Oculomotor-Based Screening of Glaucomatous and Neuro-Ophthalmological Visual Field Defects

Abstract

Standard automated perimetry (SAP) is the gold standard for evaluating the presence of visual field defects (VFDs). Nevertheless, it has requirements such as prolonged attention, stable fixation, and a need for a motor response that limit application in various patient groups. Therefore, a novel approach using eye movements (EMs) – as a complementary technique to SAP – was developed and tested in clinical settings by our group. However, the original method uses a screen-based eye-tracker which still requires participants to keep their chin and head stable. Virtual reality (VR) has shown much promise in ophthalmic diagnostics – especially in terms of freedom of head movement and precise control over experimental settings, besides being portable. In this study, we set out to see if patients can be screened for VFDs based on their EM in a VR-based framework and if they are comparable to the screen-based eyetracker. Moreover, we wanted to know if this framework can provide an effective and enjoyable user experience (UX) compared to our previous approach and the conventional SAP. Therefore, we first modified our method and implemented it on a VR head-mounted device with built-in eye tracking. Subsequently, 15 controls naïve to SAP, 15 patients with a neuro-ophthalmological disorder, and 15 glaucoma patients performed three tasks in a counterbalanced manner: (1) a visual tracking task on the VR headset while their EM was recorded, (2) the preceding tracking task but on a conventional screen-based eye tracker, and (3) SAP. We then quantified the spatio-temporal properties (STP) of the EM of each group using a cross-correlogram analysis. Finally, we evaluated the human–computer interaction (HCI) aspects of the participants in the three methods using a user-experience questionnaire. We find that: (1) the VR framework can distinguish the participants according to their oculomotor characteristics; (2) the STP of the VR framework are similar to those from the screen-based eye tracker; and (3) participants from all the groups found the VR-screening test to be the most attractive. Thus, we conclude that the EM-based approach implemented in VR can be a user-friendly and portable companion to complement existing perimetric techniques in ophthalmic clinics.

Reliability of Visual Field Testing in a Telehealth Setting Using a Head-Mounted Device: A Pilot Study

“…The VRVF device's usability and comfort, as reported by the participants, Hu et al's 28 conclusions that a virtual reality device is easy to use for home VF monitoring. Our findings also support those of a study by Soans et al, 56 which…”

“…The VRVF device’s usability and comfort, as reported by the participants, Hu et al’s 28 conclusions that a virtual reality device is easy to use for home VF monitoring. Our findings also support those of a study by Soans et al, 56 which determined that virtual reality is preferable for VF testing compared with the traditional perimeter. The reported comfort of at-home testing alludes to increased patient satisfaction, which has been seen in a study on telemedicine practice in glaucoma care 57 .…”

Pilot study comparing a new virtual reality–based visual field test to standard perimetry in children

“…VR-based testing has been associated with consistent patient satisfaction among adults, similar to our findings and those of the Olleyes VisuALL in children (Groth SL, et al IOVS 2021;62:ARVO eAbstract 3391). 11 For children, VR headsets offer some familiarity given the prevalence of these devices in the video game industry. 12 Even among children who have no experience with VR, their knowledge of this technology can be leveraged in clinical practice.…”

PTVR – A software in Python to make virtual reality experiments easier to build and more reproducible

“…It has become quite clear, especially in the last decade, that virtual reality (VR) is a valid and high-potential technology to build very sophisticated experiments in behavioral vision science and psychological research in general ( Cipresso, Giglioli, Raya, & Riva, 2018 ; de Gelder, Kätsyri, & de Borst, 2018 ; Huygelier, Schraepen, van Ee, Vanden Abeele, & Gillebert, 2019 ; Kourtesis, Collina, Doumas, & MacPherson, 2019 ; Parsons, 2015 ; Rizzo, Goodwin, De Vito, & Bell, 2021 ; Scarfe & Glennerster, 2015 ; Wilson & Soranzo, 2015 ). To cite without comprehensiveness a few recent examples related to vision science, experiments have been performed in fields as diverse as binocular vision and stereopsis ( Bankó et al, 2022 ; Levi, 2023 ), neuropsychological assessment of visual attention ( Foerster, Poth, Behler, Botsch, & Schneider, 2019 ), visual search ( David, Beitner, & Võ, 2021 ), visual perception with body/head-movements or with freely moving observers ( Bai, Bao, Zhang, & Jiang, 2019 ; Scarfe & Glennerster, 2015 ), self-location, and self-motion perception ( Luu, Zangerl, Kalloniatis, Palmisano, & Kim, 2021 ; Nakul, Orlando-Dessaints, Lenggenhager, & Lopez, 2020 ), visuo-motor control of reaching and pointing movements ( Karimpur, Eftekharifar, Troje, & Fiehler, 2020 ; Wiesing, Kartashova, & Zimmermann, 2021 ), and testing and training of different sensorimotor functions, such as mobility ( Bowman & Liu, 2017 ) or visuo-motor functions in low vision and ophthalmology ( Crossland, Starke, Imielski, Wolffsohn, & Webster, 2019 ; Soans et al, 2021 ).…”