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Visual Field Testing on the Envision Head-Mounted Perimeter with and without Gaming Elements
Emmanouil Tsamis1, Iván Marín-Franch2, William H Swanson3
1Department of Ophthalmology, Columbia University, New York, New York.
Objective:
To evaluate a new virtual reality head-mounted perimeter (Envision) with 2 test modes-a standard test (ENV) and a gaming-based test (ENVg)-by assessing their test-retest variability, comparing their results to the Humphrey Field Analyzer (HFA), and evaluating test duration and patient preferences.
Design:
This was a 2-part clinical trial. Part 1 involved data collection from the Envision and HFA from all participants. Part 2 was a test-retest variability study, where a subset of healthy participants (HCs) performed each Envision test twice.
Participants:
Thirty HCs and 30 glaucoma patients with varying disease severity.
Methods:
In Part 1, all 60 participants underwent visual field testing with the HFA, ENV, and ENVg tests. Patient preference surveys were also administered. In Part 2, HCs were retested with the ENV and ENVg to assess repeatability. Test-retest variability analysis was conducted on 19 HCs and 25 glaucoma participants who had reliable test results. Function-function and structure-function concordance were also evaluated in the glaucoma cohort, based on 2 approaches: (1) a clinician's evaluation and (2) a Reading Center approach.
Main Outcome Measures:
Key measures included: test-retest variability of pointwise total deviation (TD) and unweighted mean deviation (MD) values, comparison of TD/MD values between devices, test duration, concordance evaluation, and patient preference.
Results:
Both the ENV and ENVg tests demonstrated low test-retest variability (mean ± standard deviation TD: 0.05 ± 3.58 dB and 0.21 ± 3.70 dB, respectively, in HCs; 0.15 ± 4.81 dB, ENV only, in glaucomas), comparable to the HFA. TD and MD values were similar between ENV, ENVg, and HFA. The Envision tests had shorter and more consistent durations for patients with moderate and advanced glaucoma as compared to HFA. Function-function concordance was high, while both ENV and HFA had similar levels of structure-function agreement. Patient surveys indicated a strong preference for the ENVg test, which was perceived as more engaging and shorter in duration.
Conclusions:
The Envision virtual reality perimeter shows high repeatability and is comparable to the HFA. The ENVg was strongly preferred by patients, suggesting a promising avenue for improving patient engagement and compliance. The system's portability and consistent test duration make it a viable alternative for visual field testing in various clinical and nontraditional settings.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
