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Virtual reality oculokinetic perimetry is low cost, has high patient acceptance
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WAIKOLOA, Hawaii — Based upon oculokinetic perimetry developed by ocular oncologist Bertil Damato, MD, PhD, in the 1980s and using virtual reality technology, a new visual field test overcomes some of the challenges of the gold standard of perimetry, according to a speaker here.
“This type of perimetry is called oculokinetic perimetry because instead of the stimulus moving the patient’s eye is moving,” Yvonne Ou, MD, said here at Hawaiian Eye 2019. “Now oculokinetic perimetry (OKP) has been combined with a virtual reality platform in collaboration with Vivid Vision.”
Challenges of the traditional visual field testing process include high cost, noise and distraction, lack of portability, controlled lighting environment, ergonomic limitations, “high fixation losses because patients have difficulty suppressing their natural foveation reflex,” the need for a highly skilled examiner and high false positives, Ou said.
Virtual reality OKP is portable, self-paced, wireless and uses suprathreshold testing, she said, adding it has automated instruction and there is no need to control the lighting.
“The way the test is performed is [the patient] moves the head cursor into the fixation target,” she said. “And once the head cursor is within the fixation target a stimulus is shown and then that becomes the fixation target for the next stimulus and so on and so forth.”
The virtual reality OKP has on-the-fly customization including laterality, test duration, layout, fixation target type and size and stimulus time among many other variables.
“We should be able to develop ‘smart’ algorithms that test previous scotomas in more detail,” she said. Threshold testing is being developed for the Vivid Vision Perimeter.
“Of course, the ideal of home testing is quite appealing or even testing in underserved populations or remote locations with such a portable test. My lab is interested in understanding whether certain ganglion subtypes are susceptible in early glaucoma, so we can design stimuli to challenge those particular subtypes.”
The virtual reality OKP “is still a research tool,” Ou said. “There have been some studies throughout the years looking at its ... sensitivity and specificity compared to Humphrey Visual Field as the ground truth and ... the version that I showed is still a suprathreshold testing stimulus so there is definitely some optimization that, I think, can be done to improve the sensitivity and specificity.”– by Joan-Marie Stiglich, ELS
Reference: Ou Y. Virtual reality and visual fields. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.
Disclosures: Ou reports she is a consultant for Merck.