(AGS) Value-Cost Analysis and Comparison: Standard Automated Perimetry vs. Virtual Reality Visual Field (VRVF)

McLaughlin D, Munshi H, Grossman A, Grajewski A.

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

Conference: 32nd AGS Annual Meeting, Nashville, TN. March 3-6, 2022.




To compare the value and efficiency of in-clinic visual field (VF) testing between Standard Automated Perimetry (SAP) (Humphrey Field Analyzer) and a Virtual Reality Visual Field device (VRVF) (Virtual Vision) as measured by required time, space, and equipment cost.


This study was performed at an academic eye hospital’s glaucoma clinic. Visual Field times are defined as time elapsed from the start of wait time for Visual Field to the start of waiting for the next visit event and include patient relocation time, wait time, and test time.  Measurements were collected for the months of February 2021 and May 2021, pre- and post- introduction of Virtual Reality Visual Fields for selected patients. Specifications as to physical footprints for SAP and Virtual Reality Visual Fields were quoted from the manufacturers. Equipment, software, licensing, and maintenance costs were provided by the hospital’s purchasing department.  Equipment portability and technician skill were compared between the two testing modalities.


Visual Field time using Virtual Vision’s Virtual Reality Visual Field device was 26% shorter than SAP time: 60.22 ± 27.27 minutes for SAP and 44.56 ± 13.53 minutes for VRVF (P= 0.01). The physical footprint of the SAP model is 46 L x 52 W x 58 H (cm)1 and the physical footprint of the Virtual Reality Visual Field model is 18 L x 13 W x 10 H (cm). SAP costs $102,400 and Virtual Reality Visual Field costs $36,000 per device over an estimated 20 years.


Data comparing wait times, patient relocation times, and test time using different perimetry modalities in an academic glaucoma clinic has not been previously reported.  Incorporating a head-mounted perimetry device for selected patients in a glaucoma clinical practice decreased the length and variability of Visual Field time and reduced equipment costs and spatial requirements. These changes have the potential to optimize Visual Field scheduling. Implementing the elective use of Virtual Reality Visual Field in a glaucoma specialty practice overall appears cost effective and time efficient. The portability and predictability of Virtual Reality Visual Field testing permit the simultaneous use of Virtual Reality Visual Field and SAP within a given clinic day.

While the authors feel there will always be a need for SAP device in clinic, incorporating an alternative head-mounted perimetry for some patients’ Visual Field testing was space and cost effective and significantly reduced Visual Field times and Visual Field time variability. This has the potential to lead to greater clinical efficiency and possible patient satisfaction for in-clinic glaucoma evaluation.

Layman Abstract: