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Christopher Kai-Shun Leung, Alexander Lam, Elaine To; Virtual reality (VR) for measurement of visual disability in glaucoma patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4744.
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© ARVO (1962-2015); The Authors (2016-present)
While visual field (VF) examination is crucial in the evaluation of glaucoma, translating VF results to visual disability experienced by patients has been difficult. There is no clinical test that can integrate different components of vision for measurement of visual disability experienced by patients relevant to their daily activities. This study investigated the application of VR simulation for measurement of visual disability in glaucoma patients.
We designed and developed VR environments using Unity (Unity Technologies, CA) and Oculus Rift (Oculus VR, CA) simulating common daily tasks including (1) navigating in a street; (2) walking up/down flights of stairs; and (3) locating objects from a supermarket rack for evaluation of visual performance in glaucoma patients (Fig.1). Tasks (1) and (2) were performed in simulated daylight and nightlight conditions (Fig.2). VR simulation, NEI VFQ-25, and perimetry were performed in the same visit. Associations between visual performance (measured as the time required to complete a simulation and no. of collisions/errors made in a simulation) and VFQ-25 score/binocular VF sensitivity were evaluated with univariable and multivariable regression analyses.
The mean age and VF MD of the 41 glaucoma patients (VA ≥20/40 for both eyes) were 50.0±9.8 years (26 to 68 years) and -15.8±7.5 dB (-2.33 to -32.81 dB), respectively. Time required to complete tasks (1) and (2) was significantly longer and the no. of collisions was significantly greater in simulated nightlight than daylight environments (p<0.001). Time required for task completion and no. of collisions were associated with binocular VF sensitivity and VFQ-25 score in all simulated nightlight conditions for tasks (1) and (2) (R2 range: 0.19-0.38; p≤0.004). Time required to complete task 3 was also associated with binocular VF sensitivity (R2=0.29, p<0.001) and VFQ-25 score (R2= 0.37, p<0.001). Binocular VF sensitivity and age explained up to 51% of visual performance measured in the VR environments (R2=0.51, p<0.001).
VR can provide a new paradigm to quantify and monitor visual performance/visual disability, which would empower clinicians to better understand from a patient’s perspective how visual impairment impacts activities of daily living and prescribe appropriate treatment and visual aids to improve patients’ quality of life.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Simulation of 3 daily tasks
Simulation in day and at night
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