Virtual Reality Visual Field Exam in Community Screenings During COVID-19

ABSTRACT

Purpose: 57.5 million people worldwide are affected by glaucoma. However, 50% of those with glaucoma are unaware, and 80% of those identified for follow-up in community screenings (CS) fail to do so. Current standards of visual field testing are usually limited to the clinic. As such, a wearable perimetry headset was used to perform Virtual Reality Visual Field Acuity (VRVFA) examination for suspected visual field loss in the community minimizing exposure to COVID-19 and the need for follow-up. Methods: 31 subjects from 4 CS were screened by an onsite certified telemedicine reader (CR) who considered family history, visual acuity, intraocular pressures, cup-to-disc ratio, nerve fiber layer defects, and ganglion cell complex captured by non-mydriatic photography and ocular coherence tomography (OCT-B). Cataracts were also graded. Supervised VRVFA testing with a multilingual Palmscan VF2000 Analyzer (Fig.1) was performed in 6 minutes on average. Eyes with fixation losses >20% or false positive/negative ratios >0.375 were excluded. Visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD), and mean sensitivity (MS) from VRVFA were compared to CR glaucoma referral and cataract grading. Descriptive statistics, independent samples t-tests, and Mood's median tests were performed. Subjects with positive findings underwent same-day robotic glaucoma specialist telepresence evaluation. Results: 37 eyes from 31 subjects met inclusion criteria (mean age 51.42 ± 14.57 years, 56.76% male, 94.59% Hispanic). 7 (18.92%) eyes were referred for glaucoma evaluation. Glaucoma referrals had significantly different VFI (66.86% vs 86.40%, p=0.027), MD (-9.60 vs -4.04, p=0.031), and MS (19.94 vs 26.01, p=0.027) (Fig. 2). 30 (81.08%) eyes were 0-1+ in cataract grading, 5 (13.51%) were 2-3+, and 2 (5.41%) were intra-ocular lenses (IOL);respectively, these subgroups were not significantly different in VFI (84.20% vs 92.80% vs 35.00%, p=0.147), MD (-4.70 vs -2.11 vs -18.41, p=0.147), PSD (3.52 vs 2.25 vs 9.69, p=0.053), or MS (25.38 vs 27.75 vs 9.91, p=0.147) (Fig. 2). Conclusions: VRVFA testing yielded valuable information on the extent of vision loss as a supportive screening tool for glaucoma congruent with referrals. Expanded testing is needed. Future studies may evaluate VRVFA utility in evaluating other peripheral vision threatening diseases.