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Yu Xiang George Kong, Colm McAlinden, Rachel Goh, John Liu, Jonathan G Crowston, Simon Skalicky; Objective Assessment of Activity Limitation in Glaucoma by Smart Phone Virtual Reality Goggle. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1966.
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© ARVO (1962-2015); The Authors (2016-present)
To assess activity limitation in patients with glaucoma using Virtual Reality (VR) delivered through a low-cost and readily portable smart phone platform in an attempt to better reflect real-world visual function. The test is a modified version of the Cambridge Visual Function Test (VR-CVFT) and consists of 12 stationary tests where time required to identify objects in virtual environment is recorded and 12 motion tests where reaction time to key events is recorded. An observational cross-sectional study was conducted to establish validity of the test.
52 patients (6 non-glaucoma, 22 mild, 14 moderate and 10 severe glaucoma) were included in the study with a mean age of 67.3 ±13.4 years. Sociodemographic information, visual field parameters, visual acuity, contrast sensitivity and the Rasch-analysed Glaucoma Activity Limitation-9 (GAL-9) questionnaire data were collected. High resolution PhotoSphere photography and videos were presented to patients using a Samsung Note 3 smart phone fitted on a low-cost Google Cardboard Project™ Virtual Reality Adaptor and controlled by linkage to a computer.
The total time taken to complete the 12 stationary tests is higher in patients with moderate to severe visual field defects (mean deviation, MD >-6.0) compared to those with none or mild defects (MD <-6.0) in their better eye (76.4±17.3 vs. 46.3±3.7 sec, p=0.016). Motion tests showed patients with moderate to severe defects in their better eye have greater a spread of responses to key events in videos, especially those taken in evening and night-time settings. Convergent validity was demonstrated by a moderate correlation between total stationary test time and GAL-9 scores (R=0.49, p<0.001) and between total stationary test time and better eye MD (R=0.30, p=0.033). There were no significant correlations between total stationary test time and binocular logMAR visual acuity (R=0.23) or contrast sensitivity (R=0.24). Divergent validity assessment showed that ethnicity, sex, marital status and education level of patients had no significant effect on outcomes measures.
Smart phone based Virtual Reality may be a portable method of assessing activity limitation related to glaucomatous visual loss.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Patient performing smartphone virtual reality assessment
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