McLaughlin D, Munshi H, Savatovsky E, Vanner E, Chang TCP, Grajewski A.
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
To determine the feasibility of remote visual field testing using a virtual reality visual field (VRVF, Virtual Eye) device with and without assistance.
Individuals without ocular disease (age ≥ 60) completed a standard automated perimetry (SAP) 24-2 SITA Standard strategy on a Humphrey Field Analyzer and on a Virtual Eye VRVF (V0) exam in random order on the same day in clinic with assistance. Participants were taught how to operate the VRVF equipment and given a device to take home. The following day, participants were telehealth-assisted to establish a remote testing environment, confirm proper use, and complete a VRVF exam (V1). Participants tested remotely and without assistance once a week for 3 weeks (V2-4). A pointwise mean absolute difference and SD between light sensitivity threshold values (LSTV) were calculated (V0 vs SAP and V1-4 vs V0). Using a normal perimetric database for SAP ages 60-69, the number of points below normal (OD) was graphed. Data input was validated by a second party. Reliability indices were analyzed.
7 participants (14 eyes) were enrolled and completed reliable VRVF exams in clinic and remotely as determined by mean reliability indices (fixation losses ≤ 0.15, false positives ≤ 0.05, false negatives ≤ 0.06). The mean absolute difference and SD of LSTV between exams appear in Table 1. Excluding an outlier (P2 V4) and missing data (P7 V4), the absolute mean difference between V0 and V1-4 generally decreased as the study progressed. The number of LSTV below normal (OD) decreased with weekly, remote self-testing (V2-4) and was greater in those who took V0 first (x̄V0=14.5) than SAP first (x̄V0=1.6).
Variability of LSTV from V0 and number of points below normal reduced with weekly testing, implying that experience with testing improves results. Initial exposure to SAP may be useful for VRVF testing and could confound comparisons between V0 and V1-4. Virtual Eye was generally reliable in a telehealth setting for individuals with normal eyes. Further research is needed to assess viability in a glaucoma patient population.
Telemedicine can expand glaucoma care in circumstances of rural access, rapid disease progression, or a global pandemic. Glaucoma progression may be monitored with visual field testing, which has traditionally been performed on a stationary, technician-assisted machine using standard automated perimetry (SAP). In this study, we assess the feasibility of remote visual field testing using a virtual reality visual field (Virtual Eye VRVF) device with and without assistance in individuals without eye disease. Our findings conclude that VRVF was generally reliable in a telehealth setting for individuals with normal eyes, yet further research is needed to assess viability in a glaucoma patient population.
