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

Abstract

Précis: Monitoring visual fields via virtual reality device proved to have good inter-test and test-retest reliability as well as easy usability when self-administered by individuals with and without visual field defects in a remote setting. Purpose: To assess the reliability of remote, self-administered visual field monitoring using a virtual reality visual field (VRVF) device in individuals without ocular disease and with stable visual field defects. Methods: Individuals without ocular disease and with stable defects were recruited. All participants had a baseline standard automated perimetry (SAP) test. Participants tested remotely on a VRVF device for four weeks (exams V1, V2, V3, V4), with the last three unassisted. The mean sensitivities of VRVF results were compared to each other and to SAP results for reliability. Results: A total of 42 eyes from 21 participants were tested on the VRVF device. Participants tested consistently although external factors impacted outcomes. VRVF results were in reasonable agreement with the baseline SAP. Exams performed by the cohort with stable defects evinced better agreement with SAP exams (V2, P = 0.79; V3, P = 0.39; V4, P = 0.35) than those reported by the cohort without ocular disease (V2, P = 0.02; V3, P = 0.15; V4, P = 0.22), where the null hypothesis is that the instruments agree. Fixation losses were high and variable in VRVF exams compared to those of SAP, particularly in certain test-takers. Participants considered the device comfortable and easy to use. Conclusions: Self-administered, remote VF tests on a VRVF device showed satisfactory test-retest reliability, good inter-test agreement with SAP, and acceptability by its users. External factors may impact at-home testing and age and visual impairment may hinder fixation. Future studies to expand the sample size and understand inconsistencies in fixation losses are recommended.