Comparison of Olleyes Virtual Reality and Humphrey Visual Field Testing in Detecting Visual Field Defects in Patients...

Virtual reality-based visual field testing may offer an alternative to traditional Humphrey visual field testing, but the performance of such tests in detecting visual field abnormalities for patients with neurosurgical diagnoses has not previously been established.

Patients presenting to neuro-ophthalmology clinic for visual field testing for neurosurgical diagnoses completed both the Humphrey Visual Field Analyzer (HVF) 30-2 SITA fast test and the Olleyes Advanced Vision Analyzer-Virtual Reality Perimeter (OE) 30-2 fast test during the same visit. Pearson correlation was used to compare mean deviation (MD) and pattern standard deviation (PSD) between the HVF and OE tests. A Bland-Altman analysis was performed, and 95% limits of agreement (LOA) were calculated to compare agreement of MD and PSD between OE and HVF tests. The sensitivity, specificity, positive predictive value, and negative predictive value of the OE test were calculated for detecting a clinically significant abnormal test on HVF testing.

Of 47 subjects recruited, the mean (SD) age was 54 (15) years, with 25 men. HVF testing resulted in 24 clinically significant abnormal findings. The R-squared for the Pearson correlation of MD and PSD between the HVF and OE tests were 0.45 and 0.79, respectively. Bland-Altman analysis of 95% LOA of HVF and OE tests were -10.42 to 11.16 (bias 0.37) for MD and -4.48 to 4.30 (bias -0.09) for PSD. The OE test had a sensitivity of 83.8% (95% CI 65.5%-92.4%) and specificity of 94.4% (95% CI 74.2%-99.7%) for detecting a clinically significant abnormal visual field finding on HVF testing. The positive predictive value of a clinically significant abnormal finding on OE testing was 96% (95% CI 80.5%-99.8%), for finding a clinically significant abnormal finding on HVF testing. The negative predictive value of no clinically significant abnormal finding on OE testing was 77.3% (95% CI 56.6%-89.9%).

The OE device provides visual field results that correlate well with HVF testing and can be used as a screening test for visual field defects in patients with brain tumors. However, the moderate sensitivity for detecting a clinically relevant field deficit for the Olleyes tests warrants clinical discretion and potential repeat visual field testing with the gold standard HVF in patients with a high suspicion for visual field loss.