Evaluating Increment and Decrement Stimuli Responses in Patients with Glaucoma Using Virtual Reality-Based Perimetry

Area of Science:

• Ophthalmology
• Visual Neuroscience
• Medical Technology

Background:

• Glaucoma diagnosis and monitoring rely on visual field testing.
• Conventional perimetry may have limitations in detecting subtle visual field changes.

Purpose of the Study:

• To evaluate responses to increment and decrement stimuli using virtual reality perimetry (VVP).
• To compare VVP findings with conventional perimetry (Humphrey Visual Field [HVF]).

Main Methods:

• A cross-sectional study involving 69 participants with glaucoma, preperimetric glaucoma, or glaucoma suspect/ocular hypertension.
• Vivid Vision Perimetry (VVP) tested increment and decrement stimuli at 12 locations per eye.
• Contrast sensitivities (CSs) were recorded and compared between VVP and HVF using cluster bootstrapping.

Main Results:

• Perimetric glaucoma eyes showed stronger CS correlation between VVP and HVF compared to earlier stages.
• Decrement testing generally yielded higher correlations than increment testing across all groups.
• Moderate to severe perimetric glaucoma showed greater CS to decrement stimuli, while preperimetric glaucoma favored increment stimuli.

Conclusions:

• Significant differences in visual stimuli responses exist between preperimetric and perimetric glaucoma.
• Early glaucoma exhibits OFF-pathway vulnerability (increment stimuli), shifting to ON-pathway vulnerability in severe glaucoma (decrement stimuli).