Remote Perimetry in a Virtual Reality Metaverse Environment for Out-of-Hospital Functional Eye Screening Compared Against the Gold Standard Humphrey Visual Fields Perimeter: Proof-of-Concept Pilot Study

Virtual Reality Visual Field Testing in Glaucoma: Benefits and Drawbacks

Importance

Virtual reality-assisted visual field testing (VRVFT) is a novel modality for evaluating glaucoma progression, offering potential advantages over standard automated perimetry (SAP). To date, no narrative literature review has comprehensively discussed the benefits and drawbacks of VRVFT for glaucoma patients.

Observations

A narrative literature review was conducted using PubMed and MEDLINE via EBSCOhost, covering articles published from 2014 to October 2023. The search terms used were "virtual reality visual field" AND "glaucoma". Filters applied included "Free full text", "Full text", and "Peer Reviewed." Inclusion criteria encompassed studies evaluating VRVFT in relation to glaucoma. Exclusion criteria included duplicates, meta-analyses, literature not discussing glaucoma or VRVFT, and other literature reviews. Sixteen studies met the inclusion criteria, comprising various study designs. VRVFT showed comparable reliability and efficacy to SAP in detecting glaucomatous visual field defects. Benefits of VRVFT included improved accessibility, patient comfort, and resource optimization. Drawbacks included technical limitations such as restricted luminance range, lack of sophisticated eye-tracking in some devices, and implementation challenges like patient technology familiarity and access to equipment.

Conclusion

VRVFT presents several benefits, making it a promising alternative or complement to conventional glaucomatous visual field testing in outpatient clinics and remote settings. Addressing technical limitations and standardizing protocols are essential for broader clinical adoption.

Diagnosing Cataracts in the Digital Age: A Survey on AI, Metaverse, and Digital Twin Applications

PURPOSE

The study explores the evolving landscape of cataract diagnosis, focusing on both traditional methods and innovative technological integrations. It aims to address challenges with subjectivity in traditional cataract grading and to evaluate how new technologies can enhance diagnostic accuracy and accessibility.

METHODS

The research introduces and examines the use of Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) in automating and improving cataract screening processes. It also explores the role of the Metaverse, Digital Twins, and Teleophthalmology for immersive patient education, real-time virtual replicas of eyes, and remote access to specialized care.

RESULTS

Various ML and DL techniques demonstrated significant accuracy in cataract detection. The integration of these technologies, along with the Metaverse, Digital Twins, and Teleophthalmology, provides a comprehensive framework for accurate and accessible cataract diagnosis.

CONCLUSION

There is a notable paradigm shift toward individualized, predictive, and transformative eye care. The advancements in technology address existing diagnostic challenges and mitigate the shortage of ophthalmologists by extending high-quality care to underserved regions. These developments pave the way for improved cataract management and broader accessibility.

Validation of a Wearable Virtual Reality Perimeter for Glaucoma Staging, The NOVA Trial: Novel Virtual Reality Field Assessment

Purpose

Compare estimated sensitivities of SITA-Standard to the RATA-Standard algorithm of the Radius virtual reality perimeter (VRP), and measure concordance in glaucoma staging.

Methods

One hundred adult glaucoma patients-half with suspect or mild glaucoma, and half with moderate or severe-from five clinics performed four 24-2 visual field tests during a single visit, two with the Humphrey Field Analyzer (HFA) and two with Radius, in randomized order: HRHR or RHRH. Only one eye was tested per participant. We used the Wilcoxon rank sum test with Bonferroni correction to compare distributions of estimated sensitivities across all 54 test locations over the 15 to 40 dB measurement range of the Radius. Weighted kappa measured concordance in glaucoma staging between two masked glaucoma experts using Medicare definitions of severity.

Results

A total of 62 OD and 38 OS eyes were tested. Estimated sensitivities for SITA-Standard and RATA-Standard were not significantly different for OD, but were for OS-likely because of SITA-Standard OD and OS being significantly different in our sample, but not for RATA-Standard. Low agreement was observed between 15 to 22 dB. Concordance in glaucoma staging was high for both graders: kappa = 0.91 and kappa = 0.93. Average test duration was 298 seconds for RATA-Standard and 341 seconds for SITA-Standard. The correlation in mean deviation was 0.94.

Conclusions

Estimated sensitivities of RATA-Standard are comparable to SITA-Standard between 23 to 40 dB with high concordance in glaucoma staging.

Translational Relevance

Radius VRP is statistically noninferior to HFA when staging glaucoma using Medicare definitions.

Interpretation of the Visual Field in Neuro-ophthalmic Disorders

PURPOSE OF REVIEW

In this review, we will describe current methods for visual field testing in neuro-ophthalmic clinical practice and research, develop terminology that accurately describes patterns of field deficits, and discuss recent advances such as augmented or virtual reality-based perimetry and the use of artificial intelligence in visual field interpretation.

RECENT FINDINGS

New testing strategies that reduce testing times, improve patient comfort, and increase sensitivity for detecting small central or paracentral scotomas have been developed for static automated perimetry. Various forms of machine learning-based tools such as archetypal analysis are being tested to quantitatively depict and monitor visual field abnormalities in optic neuropathies. Studies show that the combined use of optical coherence tomography and standard automated perimetry to determine the structure-function relationship improves clinical care in neuro-ophthalmic disorders. Visual field assessment must be performed in all patients with neuro-ophthalmic disorders affecting the afferent visual pathway. Quantitative visual field analysis using standard automated perimetry is critical in initial diagnosis, monitoring disease progression, and guidance of therapeutic plans. Visual field defects can adversely impact activities of daily living such as reading, navigation, and driving and thus impact quality of life. Visual field testing can direct appropriate occupational low vision rehabilitation in affected individuals.

Clinical report: Virtual reality enables comparable contrast sensitivity measurements to in-office testing (pilot study)

SIGNIFICANCE

Vision health disparities largely stem from inaccessibility to vision specialists. To improve patient access to vision tests and to expedite clinical workflows, it is important to assess the viability of virtual reality (VR) as a modality for evaluating contrast sensitivity.

PURPOSE

This study aimed to assess the validity of a VR version of the Pelli-Robson contrast sensitivity test by comparing its results with those of the corresponding in-office test.

METHODS

Twenty-eight participants (mean ± standard deviation age, 37.3 ± 20.5 years) with corrected vision were recruited for testing on a voluntary basis with randomized administration of the in-office test followed by the VR analog or vice versa. Nineteen participants took each test twice to assess test-retest consistency in each modality. Virtual reality tests were conducted on a commercial Pico Neo Eye 2 VR headset, which has a 4K screen resolution. The environment for both tests was controlled by the participant for location and lighting.

RESULTS

Similar sensitivity scores were obtained between testing modalities in both the right (n = 28 participants; Wilcoxon match-paired signed rank [SR], p=0.7) and left eyes (n = 28 participants; Wilcoxon match-paired SR, p=0.7). In addition, similar test-retest scores were found for VR (n = 19 participants; Wilcoxon match-paired SR, p=1.0) or in-office (n = 19 participants; Wilcoxon match-paired SR, p=1.0) tests. Virtual reality Pelli-Robson results correlated well with in-office test results in variably diseased participants (n = 14 eyes from 7 participants, R2 = 0.93, p<0.0001).

CONCLUSIONS

In this pilot trial, we demonstrated that VR Pelli-Robson measurements of corrected vision align with those of in-office modalities, suggesting that this may be a reliable method of implementing this test in a more interactive and accessible manner.