VRVF And HVF Perimeters - Advancing Eyecare

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The Role of Virtual Reality in Visual Field Testing when Standard Automated Perimetry is Not Available Grossman, AL; Savatovsky, E; Feuer, W; Javitt, MJ; Ziff, M; Chang, TC; Grajewski, A. Bascom Palmer Eye Institute VRVF and HVF Perimeters Synopsis Visual field monitoring is crucial in monitoring glaucoma progression. While standard automated perimetry remains the gold standard, portable VRVF devices may be a reasonable and practical alternative screening tool for actionable visual field changes when automated perimetry is not available or feasible. In addition, VRVF may become a useful tool in remote telehealth model of glaucoma care. The purpose of this study was to assess the utility of using a portable virtual reality visual field (VRVF) device when access to standard automated perimeters is limited. Materials and Methods Glaucoma patients at the Bascom Palmer Eye Institute who had automated perimetry within the past 6 months and at least 2 previous tests on record were offered portable VRVF testing at routine clinic visits. Data collection and patient enrollment occurred between November of 2019 and October of 2020. VRVF test results were compared to most recent Humphrey visual field (HVF) results for each patient. Agreement between VRVF and HVF was quantified with weighted kappa. Weighted kappa may be interpreted as follows: 0.4 poor; 0.4 - 0.75 fair to good; 0.75 excellent1 .

Outcome Measures VRVF vs HVF OD OS

The Role of Virtual Reality in Visual Field Testing when Standard Automated Perimetry is Not Available Grossman, AL; Savatovsky, E; Feuer, W; Javitt, MJ; Ziff, M; Chang, TC; Grajewski, A. Bascom Palmer Eye Institute Number of eyes Mild Moderate Severe Results 18 A total of 60 eyes of 33 patients were tested. The distribution of HVF HAP scores in this cohort was 25 (42%) mild, 13 (22%) moderate, and 22 (37%) severe. This chart compares HAP scores between VRVF and HVF revealing a good kappa of 0.69 with exact agreement of 62% between instruments and agreement within 1 category of 37%. A single eye had complete disagreement between VRVF and HVF. VRVF had 77% sensitivity and 77% specificity in detecting HVFS with severe HAP scores2. 16 14 12 10 Severe 8 6 Moderate 4 2 Mild 0 Mild Moderate VRVF HAP Severe HVF HAP

The Role of Virtual Reality in Visual Field Testing when Standard Automated Perimetry is Not Available Grossman, AL; Savatovsky, E; Feuer, W; Javitt, MJ; Ziff, M; Chang, TC; Grajewski, A. Bascom Palmer Eye Institute HVF ONL PATIENTS VRVF RESULTS General reduction of sensitivity 13% WNL 2% Borderline 4% Results The distribution of HVF GHTs in this cohort was: 4 (7%) WNL; 9 (15%) Borderline; 46 (77%) ONL; 1 (2%) General reduction of sensitivity. Because of the predominance of ONL results this cohort is not well suited for assessing agreement of GHT results. While the overall exact agreement was 65% and the agreement within 1 category was 23%, the weighted kappa was nearly zero, 0.05. ONL 81%

The Role of Virtual Reality in Visual Field Testing when Standard Automated Perimetry is Not Available Grossman, AL; Savatovsky, E; Feuer, W; Javitt, MJ; Ziff, M; Chang, TC; Grajewski, A. Bascom Palmer Eye Institute Conclusion Based on HAP criteria VRVF has the potential to detect moderate to severe visual field defect with acceptable sensitivity and specificity when standard automated perimetry testing is unavailable or infeasible. The increased accessibility and affordability of virtual reality headset makes it a suitable platform for visual field testing.

The Role of Virtual Reality in Visual Field Testing when Standard Automated Perimetry is Not Available Grossman, AL; Savatovsky, E; Feuer, W; Javitt, MJ; Ziff, M; Chang, TC; Grajewski, A. Bascom Palmer Eye Institute References 1. Fleiss JL. Statistical methods for rates and proportions, 2ed. John Wiley & Sons. NY. P223-4 2. Budenz DL, Rhee P, Feuer WJ, McSoley J, Johnson CA, Anderson DR. Comparison of Glaucomatous Visual Field Defects Using Standard Full Threshold and Swedish Interactive Threshold Algorithms. Arch Ophthalmol. 2002;120(9):1136–1141. doi:10.1001/archopht.120.9.1136 3. Suzumura H, Yoshikawa K, Kimura T, Yamazaki S. [Anderson criteria in early glaucomatous visual field defects with the SITA Standard]. Nippon Ganka Gakkai Zasshi. 2011 May;115(5):435-9. Japanese. PMID: 21706836. 4. Hodapp E, Parrish II R, Anderson D. Clinical Decisions in Glaucoma. St. Louis: Mosby-Year Book, Inc.; 1993.

Glaucoma patients at the Bascom Palmer Eye Institute who had automated perimetry within the past 6 months and at least 2 previous tests on record were offered portable VRVF testing at routine clinic visits. Data collection and patient enrollment occurred between November of 2019 and October of 2020. VRVF test

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