June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Investigating Phoria Measures and Visual Discomfort Symptoms of Low Vision Patients Using a Head-Mounted Electronic Low Vision Enhancement System (eLVES)
Author Affiliations & Notes
  • Rob Chun
    Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Ashley Deemer
    Optometry, Southern California College of Optometry, Fullerton, California, United States
  • Kyoko Fujiwara
    Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Micaela R Gobeille
    Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • James Deremeik
    Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Chris Bradley
    Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Frank S Werblin
    IrisVision, California, United States
  • Robert W Massof
    Ophthalmology, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Rob Chun, None; Ashley Deemer, None; Kyoko Fujiwara, None; Micaela Gobeille, None; James Deremeik, None; Chris Bradley, None; Frank Werblin, IrisVision Global (I), IrisVision Global (P), IrisVision Global (S), IrisVision Global (R); Robert Massof, IrisVision Global (C), IrisVision Global (P)
  • Footnotes
    Support  NEI Grants EY026617 and EY028077
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3563. doi:
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      Rob Chun, Ashley Deemer, Kyoko Fujiwara, Micaela R Gobeille, James Deremeik, Chris Bradley, Frank S Werblin, Robert W Massof; Investigating Phoria Measures and Visual Discomfort Symptoms of Low Vision Patients Using a Head-Mounted Electronic Low Vision Enhancement System (eLVES). Invest. Ophthalmol. Vis. Sci. 2021;62(8):3563.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Limitations in the technical designs of commercially available eLVES may cause some users to experience visual discomfort for a number of reasons including binocular vision and vestibulo-ocular deficits. One possible reason for reported symptoms of visual discomfort using such devices is the decentration of the pupils within the optical viewing systems of these head-mounted displays (HMDs). Thus, we aimed to investigate the impact of pupil decentration (including heterophoria measures) on reported symptoms of visual discomfort in the IrisVision eLVES.

Methods : Fifty low vision patients (BCVA≤20/60 and at least 70° of visual field) completed phoria testing with Maddox Rod. Interpupillary distances were obtained with a pupillometer and through the IrisVision eLVES in order to derive heterophoria (eso vs exo) measures through the HMD using Prentice’s Rule. All subjects took the device home for a 2-4 week trial period. A revised version of the simulator sickness questionnaire (SSQ) was administered twice during the trial period by telephone. Person measures and item measures, for responses to SSQ items relating to visual discomfort, were estimated by Rasch analysis. Deming regression normalized by standard deviation was used to compare 1) distance phoria measurement methods (Maddox Rod vs HMD) 2) phoria vs SSQ person measures (symptoms).

Results : Twenty-one of the 50 subjects were able to complete horizontal phoria testing using the HMD and with the Maddox Rod (mean age = 65.3 years). Deming regression comparing measured Maddox Rod values to predicted HMD phoria values shows the data (prism diopters) are centered around zero (mean = -0.6, stdev = 3.77). When person measures are anchored to item measures, only one participant showed significant symptoms. Pseudo R2 was 0.490 between SSQ person measure and Maddox Rod phoria, and 0.435 between SSQ person measure and HMD-derived phoria.

Conclusions : To our knowledge, this is the first study to investigate the impact of heterophoria testing and visual discomfort using a head-mounted eLVES among low vision patients. There was no significant correlation to phoria measures on either the HMD test or Maddox Rod to suggest higher simulator sickness symptoms with higher measures of esophoria or exophoria. In addition, predicted phoria measures using the HMD correlates well to Maddox Rod findings.

This is a 2021 ARVO Annual Meeting abstract.

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