Comparison Of AVirtualReality Visual Field Program To The Zeiss .
Comparison of a Virtual Reality Visual FieldProgram to the Zeiss Humphrey 24-2 SitaStandard in a ComprehensiveOphthalmology PracticeHomer Chiang, MD1; Ansel Hoang, BS2; Corey Waldman, MD1; Jay M Rubin, MD31.2.3.University Health San Antonio San Antonio, TXLong School of Medicine, University of Texas San Antonio, San Antonio, TXEye Clinics of South Texas, San Antonio, TX
Financial DisclosuresDr. Rubin owns private shares of Virtual Field. No funding supportwas received for this work
BackgroundHumphrey automated perimetry is considered the gold standard of visual fieldtesting in patients with glaucoma. Recently, a new form of virtual visual fieldtesting was introduced. This study describes the new method of automatedperimetry and compares results to the Humphrey-Zeiss 24-2 Sita Standard in acomprehensive practice
MethodsThis study aims to compare automated perimeter results in established glaucomapatients with known scotomas, who are returning for their regularly scheduledvisual fields. The patient completed their scheduled visual field testing using theHumphrey-Zeiss 24-2 Sita Standard format, followed by the virtual visual fieldwithin 5 minutes of completing the Humphrey-Zeiss test.The results were then analyzed by the author for similarities or differencesbetween the two tests by comparing the following parameters: fixation losses,false positives, false negatives, visual field index (VFI), mean deviation (MD), andpattern deviation (PD). Statistical significance was calculated using the MannWhitney U test. Correlations were calculated using the Pearson correlationcoefficient and the interclass correlation coefficient (ICC).
Results61 eyes from 31 patients were tested. 50 eyes were included in the finalanalysis.Virtual field (VVF) demonstrated no difference in ratio of fixation losses (meandifference -0.02, p 0.45) or number of false negatives (mean difference 2.13%,p 0.051), but had significantly fewer false positives (mean difference -1.29%,p 0.00086) compared to Humphreys (HFA)Virtual field demonstrated significantly lower visual field index and meandeviation (mean difference -2.66, p 0.0033; mean difference -3.03, p 0.00001)respectively. Mean difference in patter deviation was -0.11 which was notstatistically significant (p 0.47).Pearson's correlation coefficient for virtual field index, mean deviation, andpattern deviation were 0.93 (p 0.00001), 0.85 (p 0.00001) and 0.79 (p 0.00001),respectively. Interclass correlation coefficient for virtual field index, meandeviation, and pattern deviation were 0.99, 0.74, and 0.81, respectively.
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ConclusionsVirtual field demonstrated good to excellent correlation with Humphreys withregard to visual field index, mean deviation, and pattern deviation in pairedanalysis. Virtual field shows promise in increasing mobility, efficiency and costreduction in many practice settings while maintaining testing accuracy comparedto the Humphreys standard.
DiscussionOverall patient performance had lower VFI and MD on the virtual field compared toHumphreys while trending toward greater false negatives. This may be due to fatigue aspatients were tested 5 minutes after completing the Humphreys SITA Standard protocol usingthe full threshold exam on the virtual field, unfamiliarity with the virtual field testing, ordifferences in machine strategies. However, compared to Humphreys, Virtual field hadsignificantly fewer false positives and trended toward fewer fixation losses.Virtual field testing offers potential advantages over Humphrey, including smaller footprint,portability, and the possibility of increasing clinic throughput if multiple units are usedsimultaneously. Potential pitfalls include lack of real-time “coaching” from clinic staff anddistortions due to the multifocal virtual headset lenses if patients were to move the headsetduring examination.Critically, future studies would evaluate inter-test reproducibility of visual field defects andthe virtual field’s ability to monitor progression. Fatigue may be mitigated by using thevirtual field’s BOLT exam, which has similar testing time to SITA standard. Further, patientswith visual field deficits secondary to other ocular pathologies should be tested.
Standard in a Comprehensive Ophthalmology Practice Homer Chiang, MD1; Ansel Hoang, BS2; Corey Waldman, MD1; Jay M Rubin, MD3 1. University Health San Antonio San Antonio, TX 2. Long School of Medicine, University of Texas San Antonio, San Antonio, TX 3. Eye Clinics of South Texas, San Antonio, TX
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