Performance of virtual reality game–based automated perimetry in patients with childhood glaucoma

Abstract

To evaluate VisuALL, a game-based automated perimetry device, utilizing virtual reality (VR) goggles, in a cohort of patients with childhood glaucoma. In this prospective series, the results of consecutive patients with childhood glaucoma performing both VisuALL VR field (VRF) and Humphrey visual field (HVF) 24-2 testing were compared. A masked ophthalmologist graded both VRF and HVF tests for field defects (three clustered abnormal points in total or pattern deviation plot). VRF testing was performed binocularly and with the child's own spectacles. The two devices were assessed with respect to agreement of (1) global indices, such as mean deviation (MD) and pattern standard deviation (PSD), (2) point-by-point sensitivity, and (3) the ability to detect visual field defects determined by a grader. A total of 39 children (77 eyes) were enrolled, with mean age 14.1 ± 3.6 years; 3 patients (5 eyes) could not complete the HVF. Average HVF MD was -6.3 ± 6.4 dB. There was strong correlation between VRF and HVF for MD (R = 0.68, P < 0.001), PSD (R=0.78, P < 0.001), and point-by-point sensitivity (R = 0.63, P < 0.001). Bland Altman analysis showed no systematic difference between VRF and HVF in assessing MD and PSD. Of 72 eyes having results for both modalities, 63 (87.5%) had agreement between VRF and HVF with respect to the presence/absence of any field defect, and 52 (72.2%) had agreement regarding the presence/absence of fixation-threatening field loss. VRF is comparable to the gold standard HVF in both identification and quantification of visual field deficits in pediatric glaucoma patients and may offer a valuable supplement or alternative to standard automated perimetry.