Use of a Novel Virtual Reality-Based Pupillography Device for Glaucoma Management: Cross-Sectional Cohort Pilot Study

Area of Science:

• Ophthalmology
• Neuroscience
• Medical Technology

Background:

• Standard glaucoma monitoring tools like OCT and SAP have limitations.
• Automated pupillary light reflex (PLR) testing, including relative afferent pupillary defect (RAPD), offers objective alternatives.
• This study explored RAPD's potential for distinguishing asymmetrical glaucoma and monitoring progression.

Purpose of the Study:

• To evaluate if RAPD can sufficiently distinguish between eyes in asymmetrical glaucoma.
• To establish a foundation for using single-eye PLR measurements for longitudinal glaucoma progression monitoring.
• To correlate RAPD and SAP findings with optical coherence tomography (OCT) measurements.

Main Methods:

• Quantitative PLR measurements were performed using a virtual reality headset in 21 glaucoma patients.
• RAPD was calculated by comparing PLR amplitudes between the two eyes.
• RAPD and standard automated perimetry (SAP) mean defect (MD) were correlated with peripapillary retinal nerve fiber layer (RNFL) thickness measured by OCT.

Main Results:

• RAPD significantly correlated with RNFL thickness differences between eyes (r=0.79, p=0.05).
• SAP's mean defect (MD) correlated better with RNFL differences (r=0.87, p<0.05).
• Combining RAPD and MD improved RNFL difference prediction by 5% compared to MD alone.

Conclusions:

• RAPD measurements effectively identified optic nerve damage asymmetries in glaucoma.
• SAP showed a stronger correlation with OCT RNFL thickness than RAPD.
• The combination of SAP and RAPD enhanced prediction of RNFL thickness, suggesting future potential for longitudinal monitoring using PLR.