Superior Field Vision Screening in Ptosis Patients using Alternative Technologies

Abstract

Purpose : With a rapidly aging population, there is an increasing prevalence of ophthalmic pathologies, however, epidemiological studies demonstrate limited ocular care in the form of early screening, which results in disease progression and its associated economic burden. Vision screening barriers have been attributed to the high costs of technological equipment, which influence the adoption of rapidly emerging alternative technologies. In this study, we tested the viability of using portable, low-profile technologies such as Virtual Reality (VR) as an alternative method of perimetry.

Methods : We measured the superior field in ptosis patients and compared VR results with those from a 30-2 HVFA at the New York Eye and Ear Infirmary of Mount Sinai. The primary outcome measure being non-inferiority regarding the percent difference of superior field in taped versus untapped ptosis eyes with an effect size of N=25 eyes. Superior perimetry is a standard used in obtaining insurance coverage for ptosis repair surgeries, and at least a 30% improvement is required to qualify for repair surgery.

Results : These measurements intend to evaluate the ability of VR to provide results that would allow a patient to qualify for surgery in the same manner as a HVFA. Percent change between taped and un-taped eyes were measured using HVFA and VR in 4 ptosis eyes. Both utilities found >30% change in superior visual field in these patients.

The qualitative surveys recorded for N=8 participants (ptosis patients & healthy controls) show that 87.5% preferred VR over HVFA. For the perceived speed parameter, the average score from 1 to 5, where 1 is the lowest score and 5 if the highest, was 4.8 for VR versus 3.3 for Humphrey (p=0.002; Wilcoxon). Comfort was rated at 4.25 out of 5 for the VR and 4 out of 5 for HVFA (p=0.28; Wilcoxon), and 100% of users rated their general experience at 5/5 for VR compared to 50% for HVFA (p=0.04; Wilcoxon).

Conclusions : Our preliminary data suggests no clinically significant difference between the accuracy of the HVFA and a head-mounted display with regards to changes in superior visual field in ptosis eyes before and after taping. The patients reported significantly higher levels of satisfaction with the VR across speed and experience measures. This interim analysis supports the validation of other vision screening tests in the virtual reality environment, which could also be expanded to other ocular conditions.

This is a 2020 ARVO Annual Meeting abstract.