Virtual reality field testing in children with normal eyes and glaucoma: comparison of game-based versus Humphrey...

Virtual reality-based field (VRF) perimetry presents an alternative to standard automated perimetry, offering both game-based and Humphrey-equivalent algorithms. Comparative performance of these two algorithms is not well-documented. We evaluated the performance of children with healthy eyes and those with known or suspected glaucoma using both VRF algorithms.

Pediatric patients (children with healthy eyes and with known or suspected glaucoma) were prospectively enrolled to take VisuALL VRF (Olleyes) using a game-based test and a Humphrey-equivalent test; a subset of 49 eyes were also tested with table-top Humphrey visual field (HVF) perimetry. The two algorithms were evaluated based on test duration, foveal sensitivity, mean deviation (MD), pattern standard deviation (PSD), and patient preference, assessed by means of a questionnaire.

A total of 71 eyes of 36 participants were included: 42 healthy control eyes, 4 glaucoma suspects, and 25 with known childhood glaucoma. Mean patient age was 10.9 ± 2.6 years (range, 6-17). For game-based versus Humphrey-equivalent algorithms, average MD (-2.78 ± 6.5 vs -3.41 ± 6.4 dB) and foveal sensitivity (30.3 ± 9.0 vs 31.3 ± 6.6 dB) were not statistically significantly different (P = 0.39 vs 0.79, resp.). Comparison using linear mixed-effects modeling showed a positive correlation between visual field parameters from the two VRF test types for both MD (P < 0.001) and PSD (P < 0.001). Test duration was longest for game-based VRF (5.7 min ± 1.8 min) compared with Humphrey-equivalent VRF perimetry (2.6 min ± 0.4 min) and HVF (4.2 ± 1.1 min), but most participants preferred it.

Game-based and Humphrey-equivalent VRFs showed good correlation with respect to one another for visual field parameters for both healthy eyes and those with known or suspected glaucoma. Most children preferred the game-based VRF despite its longer duration.