Virtual Reality Takes the Field in Glaucoma

Daniel Vinson, MD; Shuchi B. Patel, MD


June 06, 2023

The COVID-19 pandemic made it clear that we need novel solutions for monitoring patients with chronic diseases such as glaucoma. One area that is particularly ripe for disruption is perimetry testing. Virtual-reality (VR) visual field monitoring could enable a pivot away from traditional in-office automated perimetry.

Some practices have already successfully implemented VR perimetry, reporting that patients prefer the comfort and portability of the headset. Office staff also found it easier to clean the equipment between patients. Another notable benefit is that by utilizing dynamic visual field mapping with eye tracking and head positioning information, test duration could be shortened while improving patient engagement and attentiveness.

Mobile or home-based testing could facilitate closer monitoring of visual field loss and alert physicians to patients who need further evaluation. It might even be possible for patients to perform preappointment visual field tests at home, allowing their physicians to review the results in advance, streamlining patient visits.

Whether attempting to duplicate traditional visual field testing in VR with a consistent fixation point and clicker or by utilizing a proprietary software package to map out a dynamic visual field, VR visual field testing is beginning to approach parity with the traditional perimetry methods. To date, a few studies have sought to prove noninferiority to conventional Humphrey Field Analyzer testing.

In one head-to-head study, VR visual field and traditional perimetry were shown to have high overall field correlation with consistent mean deviations and comparable reliability indices between the two methods. The VR headset had difficulty capturing and would at times underestimate more profound defects in the visual field or miss isolated defects. This was most likely a result of the technical limitations of the luminance of the headset used and can be rectified in future studies.

More definitive data comparing the new VR technology with gold-standard automated perimetry devices are needed.

We anticipate that visual field acquisition utilizing VR, either through the production of proprietary headsets or as licensed software that leverages the existing ecosystem of VR headsets, will revolutionize our approach to testing. We look forward to adding VR visual field testing to diagnostic offerings for our patients and anticipate that as more practices adopt this technology, the data collected will lead to the continued improvement and increased reliability of the results. While this is a promising application of a developing technology, it still needs refinement before it will fully replace the more traditional testing methods.

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