At-home virtual reality visual field testing reliable in patients with stable defects
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Key takeaways:
- Researchers found that VRVF results were in reasonable agreement with baseline SAP.
- VRVF exams had higher fixation losses compared with SAP, particularly among pediatric or geriatric test-takers.
Self-administered, remote virtual reality visual field testing can reliably monitor ocular disease in individuals with stable visual field defects, according to research published in the Journal of Glaucoma.
“Remote, unsupervised monitoring of VFs in patients without ocular disease and those with stable defects appears feasible using a [virtual reality visual field (VRVF)] device as demonstrated by the consistent mean sensitivities among sequential exams and the comparable outcomes to the gold standard [standard automated perimetry (SAP)] instrument,” Danielle E. McLaughlin, MD, and colleagues from the Bascom Palmer Eye Institute at University of Miami Miller School of Medicine wrote.
They continued, “It is, however, important to recognize the impact that an in-home testing environment may have on exam results and to educate patients to optimize telehealth glaucoma practices.”
In a study of 42 eyes from 21 individuals, 20 had no ocular disease, and 22 had stable defects. The participants underwent a baseline SAP test and then tested remotely on a VRVF device for 4 weeks.
McLaughlin and colleagues compared the mean sensitivities of the VRVF results with each other and SAP results to determine reliability and found that VRVF results were in reasonable agreement with baseline SAP. They noted that participants with stable defects had better agreement with SAP than those without ocular disease.
In addition, researchers reported that VRVF exams had higher fixation losses compared with SAP, particularly among test-takers with defects or of pediatric or geriatric age.
“Overall, the adjunct use of a VRVF device to monitor VFs remotely and increase testing frequency is promising for the future of glaucoma care,” McLaughlin and colleagues wrote. “Expansion of the study sample size as well as further investigations into VRVF reliability and telemedicine optimization will be important for incorporating virtual testing in the standard of care.”
Perspective
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This study informs clinicians of precautions with VRVF. The benefits of VRVF include ease of use, reduced testing time, enhanced comfort, and availability of different patterns, strategies and stimuli sizes.
One of the precautions is reduced reliability in younger and older patients with reduced BCVA due to fixation loses, which may be alleviated by implementing monocular fixation. Additionally, utilizing VRVF in patients without ocular disease and VF-naive test takers may be unreliable as results were not in agreement with SAP and had lower sensitivities, respectively.
Also, external environmental factors may impact VRVF. Proper patient education about consistent noise level and testing time, along with minimizing distractions, may aid in obtaining reliable results.
It is recommended that clinicians use clinical judgment on whether testing supervision is needed for VRVF, based on patients’ VF testing history, age and socioeconomic and educational status.
One of the limitations of this study is using stimulus size III for the group without ocular disease but variable stimuli sizes for the group with stable defects. Future studies matching stimulus size for each participant with stable defect with that of the control participant is necessary to minimize confounding variables.
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