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Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
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Virtual reality-based Harms tangent screen test for strabismus measurement.
Yaroslava Wenner1, Johann Schneider2, Timo Drisser3
1Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. Yaroslava.Wenner@unimedizin-ffm.de.
Summary
A new virtual reality-based tangent screen test (VTS) accurately measures ocular deviations, including torsion, comparable to the traditional Harms tangent screen test (HTS). This VTS offers faster, automated documentation and requires less specialized training for clinical use.
Area of Science:
- Ophthalmology
- Medical Technology
- Virtual Reality Applications
Background:
- Neurogenic diplopia is increasingly prevalent in the aging population.
- The Harms tangent screen test (HTS) is a reliable method for measuring subjective ocular deviations in patients with diplopia.
- HTS requires specialized orthoptic training, limiting its widespread clinical application.
Purpose of the Study:
- To introduce and evaluate a virtual reality-based tangent screen test (VTS) for measuring subjective ocular deviations, including horizontal, vertical, and torsional misalignments.
- To compare the accuracy and efficiency of the VTS against the established Harms tangent screen test (HTS).
Main Methods:
- The VTS utilized an Oculus Go head-mounted display and controller with rotation sensors.
- Eighty-five adult patients with various eye motility disorders were assessed using both HTS and VTS across nine gaze directions.
- Statistical analysis included calculating mean differences and intraclass correlations (ICC) for horizontal, vertical, and torsional deviations.
Main Results:
- High agreement was found between VTS and HTS for horizontal (ICC: 0.93-0.98) and vertical (ICC: 0.93-0.98) deviations.
- Agreement for torsional deviations was lower (ICC: 0.79-0.93), potentially due to controller stability.
- VTS examination time averaged 6 minutes, significantly less than HTS's 15 minutes.
Conclusions:
- The VTS demonstrates good comparability with HTS for horizontal and vertical deviations, with a slight tendency towards higher esodeviation measurement possibly due to increased vergence demand.
- Improvements in controller design could enhance the accuracy of torsional deviation measurements.
- VTS offers advantages in automated documentation, reduced examination time, and ease of use, making it a potentially valuable tool for broader clinical implementation without requiring extensive orthoptic training.
