Virtual Reality–Based and Conventional Visual Field Examination Comparison in Healthy and Glaucoma Patients

Abstract

Purpose Clinically evaluate the noninferiority of a custom virtual reality (VR) perimetry system when compared to a clinically and routinely used perimeter on both healthy subjects and glaucoma patients. Methods We use a custom-designed VR perimetry system tailored for visual field testing. The system uses Oculus Quest VR headset (Facebook Technologies, LLC, Bern, Switzerland), that includes a clicker for participant response feedback. A prospective, single center, study was conducted at the Department of Ophthalmology of the Bern University Hospital (Bern, Switzerland) for 12 months. Of the 114 participants recruited 70 subjects (36 healthy and 34 glaucoma patients with early to moderate visual field loss) were included in the study. Participants underwent perimetry tests on an Octopus 900 (Haag-Streit, Köniz, Switzerland) as well as on the custom VR perimeter. In both cases, standard dynamic strategy (DS) was used in conjunction with the G testing pattern. Collected visual fields (VFs) from both devices were then analyzed and compared. Results High mean defect (MD) correlations between the two systems (Spearman, ρ ≥ 0 . 75) were obtained. The VR system was found to slightly underestimate VF defects in glaucoma subjects (1.4 dB). No significant bias was found with respect to eccentricity or subject age. On average, a similar number of stimuli presentations per VF was necessary when measuring glaucoma patients and healthy subjects. Conclusions This study demonstrates that a clinically used perimeter and the proposed VR perimetry system have comparable performances with respect to a number of perimetry parameters in healthy and glaucoma patients with early to moderate visual field loss. Translational Relevance This suggests that VR perimeters have the potential to assess VFs with high enough confidence, whereby alleviating challenges in current perimetry practices by providing a portable and more accessible visual field test.

Application and Validation of LUXIE: A Newly Developed Virtual Reality Perimetry Software

“…Smartphone-based head-mounted perimeters were later introduced in 2017 and 2018 and showed promising results [ 3 , 9 , 10 ]. Perimeters based on VR technique were developed rapidly in recent years [ 11 , 12 , 13 , 14 ]. Another study using the Oculus Quest VR headset to simulate a standard visual field test was compared with the Octopus 900 and showed that the performance of the two was comparable [ 13 ].…”

“…Perimeters based on VR technique were developed rapidly in recent years [ 11 , 12 , 13 , 14 ]. Another study using the Oculus Quest VR headset to simulate a standard visual field test was compared with the Octopus 900 and showed that the performance of the two was comparable [ 13 ]. In their study, correlation coefficients were 0.77, 0.50, and 0.70 for all, healthy, and glaucoma patients, respectively.…”

The Open Perimetry Initiative: A framework for cross-platform development for the new generation of portable perimeters

“…Thousands of tests are conducted every day. Although there have been many interesting advances in perimetry ( Greenfield, Deiner, Nguyen, Wollstein, Damato, Backus, Wu, Schuman, & Ou, 2022 ; Jones, 2020 ; Prager, Kang, & Tanna, 2021 ; Prince, Thompson, Mwanza, Tolleson-Rinehart, & Budenz, 2021 ; Stapelfeldt, Kucur, Huber, Höhn, & Sznitman, 2021 ; Turpin, Myers, & McKendrick, 2016 ), the community pursuing clinical visual field research remains relatively small. To many newcomers, perimetry first appears as something of a black art, with a specialist terminology somewhat at odds with mainstream psychophysics.…”

New Strategies for Automated Perimetry: Historical Perspective and Future Innovations

“…In addition, though electronics are developing at a rapid rate, there remain technical limitations on how luminance is translated to bits on a monitor. 16 At the high end of the logarithmic dB range (very dim stimulus), it is nearly impossible to distinguish the low luminance values with adequate confidence intervals. 17 For example, a 30-dB diminution of a standard 255-bit stimulus target requires the illumination of less than a single (0.25) bit.…”