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Superior Visual Field Testing Using Virtual Reality With and Without Eye Tracking for Functional Upper Eyelid Surgery

Annika J Patel1, Wendy W Lee, Matteo Ziff

  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.

Ophthalmic Plastic and Reconstructive Surgery
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Summary

Virtual reality (VR) visual field testing shows promise as an alternative to standard automated perimetry for evaluating functional upper eyelid surgery coverage. VR testing demonstrated comparable sensitivity and specificity to traditional methods.

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Area of Science:

  • Ophthalmology
  • Medical Technology
  • Surgical Evaluation

Background:

  • Functional upper eyelid surgery, such as blepharoplasty, often requires objective visual field testing to meet insurance coverage criteria.
  • Standard automated perimetry (SAP) is the conventional method, but newer technologies like virtual reality (VR) with eye tracking (VR-ET) and without eye tracking (VR 0) are emerging.

Purpose of the Study:

  • To compare the sensitivity and specificity of VR-based visual field tests (with and without eye tracking) against SAP for assessing insurance eligibility for functional upper eyelid surgery.
  • To determine if VR testing can reliably meet established criteria for blepharoplasty coverage.

Main Methods:

  • A prospective, cross-sectional study involving 78 eyes from 41 patients evaluated for ptosis, brow ptosis, or dermatochalasis.
  • Participants underwent serial superior visual field testing using SAP and VR (VR 0 and VR-ET) in a randomized sequence.
  • Insurance coverage criteria were met if a 30% increase in the visual field was observed from the untaped to the taped state.

Main Results:

  • Virtual reality (VR) testing achieved a sensitivity of 84.1% and specificity of 67.6%, with no significant difference between VR with (VR-ET) and without (VR 0) eye tracking.
  • SAP results aligned with VR 0 in 71.8% of cases and with VR-ET in 82.1% of cases.
  • Diagnosis significantly impacted insurance coverage fulfillment rates with SAP (p=0.012) but not with VR (p=0.059).

Conclusions:

  • Virtual reality visual field testing presents a viable alternative to standard automated perimetry for functional upper eyelid surgery evaluations.
  • Further research is recommended to compare patient satisfaction, testing duration, and test-retest reliability between VR and SAP methods.