(ARVO) Assessment of Superior Visual Field Prior to Functional Upper Eyelid Surgery: Comparison of Virtual Reality (Virtual Eye VRVF) Device without Eye-Tracking vs. Standard Automated Perimetry (SAP)

Patel A, Lee W, Munshi H, Chang TCP, Grajewski A, Tse D, Tse B.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL

Conference: The Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting 2022




Insurance coverage (IC) eligibility for functional eyelid surgery requires visual field (VF) exams demonstrating constriction of superior field of vision with improvement after taping the upper eyelids to simulate surgery. Limited access to standard automated perimetry (SAP) machines and the need for a skilled technician produce a bottleneck effect which slows clinic flow. We compared the results of a Superior-64 Visual Field test between a Virtual Reality Visual Field device without Eye-Tracking and SAP in patients with ptosis, brow ptosis, and dermatochalasis. ***Major Update: A Virtual Reality Visual Field device with Eye-Tracking will be reviewed in a future study.


Patients undergoing non cosmetic eyelid surgery evaluation had the eyelids in their natural state (unT) and taped (T) assessed by a Superior-64 Visual Field test strategy using a Virtual Reality Visual Field (Virtual Eye, Virtual Vision Health) and SAP in random order. The percentage of grid seen was calculated for both eyelid positions using the devices. Fulfillment of IC criteria for blepharoplasty, defined as a 30% or 12-degree increase in grid seen from unT to T, was assessed for agreement between Virtual Reality Visual Field and SAP.


39 eyes (20 OD, 19 OS) from 20 (15 female, 5 male) patients were tested using SAP and VR (Figure 1). There was significant improvement in the percentage of grid seen from the unT to T state using VR (36% to 75%; t(38)=-8.94, p<0.001) and SAP (34% to 64%; t(38)=-7.16, p<0.001). SAP and Virtual Eye IC results agreed in 29 (74%) eyes (Table 1). A diagnosis of dermatochalasis was significantly associated with meeting IC qualification using SAP (X2(1, N=39)=4.18, p=0.041) and approached significance using Virtual Eye (X2(1, N=39)=3.39, p=0.066). However, this association did not exist for subjects diagnosed with ptosis or brow ptosis. Of subjects with disagreement, there was no association between order of test administration and fulfillment of IC criteria (X2(1, N=10)=0.28, p=0.598).


Virtual Vision’s Virtual Eye Superior-64 Visual Field test showed reliable agreement with SAP in meeting IC criteria and may offer a more accessible alternative to SAP in eyelid functional Visual Field evaluation. Patients diagnosed with dermatochalasis have greater ability to demonstrate improvement in Visual Field exam from the unT to T state on both devices than those with ptosis or brow ptosis. Further studies should focus on understanding test-retest variability of superior Visual Field testing and the cause of any disagreements between SAP and Virtual Reality Visual Field.

Layman Abstract:


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