Detection of Relative Afferent Pupillary Defects Using Eye Tracking and a VR Headset.

Area of Science:

• Ophthalmology
• Neuroscience
• Medical Technology

Background:

• Relative afferent pupillary defects (RAPDs) are crucial indicators of optic nerve or retinal dysfunction.
• Current methods for RAPD detection, like the swinging flashlight test, are subjective and qualitative.
• There is a need for objective and quantitative methods to assess RAPDs.

Purpose of the Study:

• To evaluate the feasibility of using a virtual reality (VR) headset with eye-tracking for detecting RAPDs.
• To compare the diagnostic performance of a novel computerized RAPD test against the traditional clinical standard.

Main Methods:

• A cross-sectional study involving 82 participants.
• A VR headset presented alternating bright/dark stimuli to each eye.
• An eye-tracker recorded pupil size changes, analyzed by an algorithm to detect RAPDs.
• Comparison with the swinging flashlight test and a post hoc clinical impression.

Main Results:

• The computerized method achieved 90.2% sensitivity and 84.4% accuracy for RAPD detection.
• Clinical evaluation showed 89.1% sensitivity and 88.3% accuracy.
• The VR-based method's performance was non-inferior to that of senior neuro-ophthalmologists.

Conclusions:

• The VR-based computerized method provides an accurate, objective, and rapid way to measure RAPDs.
• This technology offers a quantitative alternative to current subjective clinical practices.
• The study demonstrates the potential of VR and eye-tracking for ophthalmic diagnostics.