Remote training and administration of a portable virtual reality-based visual field test for home testing during COVID-19

ABSTRACT

Purpose: To 1) determine the feasibility of remotely administering and training subjects at home on how to use Vivid Vision Perimetry (VVP-10), a portable virtual reality-based visual field test during COVID-19 shelter-in-place;2) assess the correlation between VVP-10 and standard automated perimetry (SAP) and the test-retest variability of VVP-10. Methods: Inclusion criteria included subjects 21 or older with glaucomatous visual field defects, and exclusion criteria included those with retinal diseases or significant cataracts. Virtual reality devices were given to subjects during clinic visits or mailed to them. Subjects were remotely trained using training software and coaching via Zoom and proceeded to take 10 tests at home over 14 days. Subject age and sex, test duration, response rate at each of the test points (fraction correct), and SAP results including mean deviation and individual test point sensitivities were recorded. The Pearson correlation coefficients of SAP mean sensitivity versus VVP-10 fraction correct for all eyes together and fraction correct of tests 6-10 versus tests 1-5 for individual eyes were calculated. A bootstrap analysis that resampled eyes with replacement was done to calculate the 95% confidence interval of the Spearman correlation coefficient between SAP sensitivity versus VVP-10 fraction correct for each point of the 54 test locations. Results: Of the 20 subjects enrolled, 11 (55%) were male and the average (SD) age was 62.9 (10.5) years. Eight (40%) subjects were Asian and 12 (60%) were Caucasian. In total, 37 glaucomatous eyes with an average (SD) mean deviation of-6.1 (6.1) dB were analyzed. The Pearson correlation coefficient of SAP mean sensitivity versus VVP-10 fraction correct for 37 eyes was 0.68. The Pearson correlation coefficient between fraction correct in tests 6-10 versus tests 1-5 for individual eyes ranged from 0.78-0.99 (median = 0.94). Spearman correlation coefficients of SAP sensitivity versus VVP-10 fraction correct at each point ranged from 0.008-0.85 (median = 0.58). Conclusions: We demonstrate good test-retest variability of VVP-10 and a strong correlation with SAP, both globally and in a pointwise manner. VVP-10 is portable, inexpensive, and can be used entirely remotely while producing results that are similar to the current gold standard for assessing glaucomatous visual fields.