VR simulations can help evaluate glaucoma-related visual disability
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Researchers found that evaluating vision impairment in patients with glaucoma through the use of virtual reality simulations correlated with results from the NEI 25-item Visual Function Questionnaire Rasch score.
“Although functional assessment of the optic nerve in glaucoma currently relies on measurement of visual field (VF) sensitivity, VF testing does not adequately inform disability experienced by patients in real-world situations,” Alexander K. N. Lam, PhD, from the Chinese University of Hong Kong, and colleagues wrote. “This study investigated the application of virtual reality (VR) technology for evaluation and measurement of vision-related disability via simulating activities of daily living relevant to patients’ real-world experience.”
Lam and colleagues designed five interactive VR environments for display in a VR headset, including supermarket shopping, stair navigation in daytime and in nighttime, and city navigation in daytime and in nighttime.
The study included 98 patients with glaucoma, 94 of whom had visual field defects in at least one eye, and 50 healthy volunteers.
Compared with the healthy volunteers, patients with glaucoma required 34.1% more time to identify 10 items in the shopping simulation, 33.8% more time to complete the nighttime stair navigation with more collisions and 30.8% more time to complete the nighttime city navigation with more collisions. Results from the daytime simulations were often comparable.
To determine the association between the NEI VFQ-25 Rasch score and the overall performance in the VR simulations, Lam and colleagues derived an overall disability score including the duration to complete the simulation, the number of incorrect selections in shopping simulation, the number of collisions in the four navigation simulations and age.
From this, they found that the NEI VFG-25 Rasch score was significantly lower in patients with vision-related disability compared with those without vision-related disability and significantly associated with VR disability score (R2 = 0.207; P < .001).
Additionally, a worse binocular VF sensitivity, worse visual acuity in the better eye, worse contrast sensitivity and worse NEI VFG-25 Rasch score correlated with a higher odds ratio for vision-related disability.
The researchers wrote that patients with glaucoma performed worse in VR simulation compared with real-world simulation, such as selected items while shopping. However, the association in duration to complete selecting 10 shopping items between VR simulation and real-world simulation remained significant. – by Talitha Bennett
Disclosures: Lam reports grants from the Innovation and Technology Commission, the Government of Hong Kong Special Administration Region and the Chinese University of Hong Kong during the conduct of the study, and U.S. Non-Provisional Application No. 15/466,348 pending, related to the virtual reality technology used in this study. Please see the full study for all other authors’ relevant financial disclosures.
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Carl H. Jacobsen, OD, FAAO
I’ve recently started helping with in-home care for an aging relative. Sadly, their physical state was much worse than expected, with near nightly falls during trips to the rest room. Like finding cells in uveitis, you don’t see what you are not looking for. Are we similarly unaware of disability in our glaucoma population?
While generally poorly understood in our clinics, the literature is replete with evidence of glaucoma-related disability. However, this disability is hard to characterize and quantify when patients themselves may be unaware. Lam and colleagues have used an ingenious VR system to test real-world abilities. Their findings? Glaucoma patients have more difficulty with certain tasks and are challenged by low light environments.
There are several things I learned from this study. First, we should discuss the challenge of low-light conditions with our glaucoma patients and encourage them to limit night-time activities. Second, certain tasks may be more difficult for our glaucoma patients. Encourage them to take their time and exercise care. Finally, a VR-based evaluation system could be put to good use in low vision clinics. These data should be replicated and expanded upon, but it’s easy to imagine VR technology playing an increasing role in vision care.
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