June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Comparison of Virtual Reality Device vs. Standard Automated Perimetry in the Assessment of Superior Visual Field Prior to Functional Upper Eyelid Surgery
Author Affiliations & Notes
  • Annika J Patel
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • Wendy W Lee
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • Hounsh Munshi
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • Ta Chen Chang
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • Alana L Grajewski
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • David T Tse
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • Brian C Tse
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, United States
  • Footnotes
    Commercial Relationships   Annika Patel None; Wendy Lee None; Hounsh Munshi None; Ta Chang None; Alana Grajewski Virtual Vision, Code O (Owner), Virtual Vision, Code P (Patent); David Tse None; Brian Tse None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 606 – A0307. doi:
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    • Get Citation

      Annika J Patel, Wendy W Lee, Hounsh Munshi, Ta Chen Chang, Alana L Grajewski, David T Tse, Brian C Tse; Comparison of Virtual Reality Device vs. Standard Automated Perimetry in the Assessment of Superior Visual Field Prior to Functional Upper Eyelid Surgery. Invest. Ophthalmol. Vis. Sci. 2022;63(7):606 – A0307.

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

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Abstract

Purpose : Insurance coverage (IC) eligibility for functional eyelid surgery requires visual field (VF) exams demonstrating constriction of superior field of vision with improvement after taping the upper eyelids to simulate surgery. Limited access to standard automated perimetry (SAP) machines and the need for a skilled technician produce a bottleneck effect which slows clinic flow. We compared the results of a Superior-64 VF test between a virtual reality (VR) device and SAP in patients with ptosis, brow ptosis, and dermatochalasis.

Methods : Patients undergoing non cosmetic eyelid surgery evaluation had the eyelids in their natural state (unT) and taped (T) assessed by a Superior-64 VF test strategy using VR and SAP in random order. The percentage of grid seen was calculated for both eyelid positions using the devices. Fulfillment of IC criteria for blepharoplasty, defined as a 30% or 12-degree increase in grid seen from unT to T, was assessed for agreement between VR and SAP.

Results : 39 eyes (20 OD, 19 OS) from 20 (15 female, 5 male) patients were tested using SAP and VR (Figure 1). There was significant improvement in the percentage of grid seen from the unT to T state using VR (36% to 75%; t(38)=-8.94, p<0.001) and SAP (34% to 64%; t(38)=-7.16, p<0.001). SAP and VR IC results agreed in 29 (74%) eyes (Table 1). A diagnosis of dermatochalasis was significantly associated with meeting IC qualification using SAP (X2(1, N=39)=4.18, p=0.041) and approached significance using VR (X2(1, N=39)=3.39, p=0.066). However, this association did not exist for subjects diagnosed with ptosis or brow ptosis. Of subjects with disagreement, there was no association between order of test administration and fulfillment of IC criteria (X2(1, N=10)=0.28, p=0.598).

Conclusions : VR Superior-64 VF test showed reliable agreement with SAP in meeting IC criteria and may offer a more accessible alternative to SAP in eyelid functional VF evaluation. Patients diagnosed with dermatochalasis have greater ability to demonstrate improvement in VF exam from the unT to T state on both devices than those with ptosis or brow ptosis. Further studies should focus on understanding test-retest variability of superior VF testing and the cause of disagreement between SAP and VR.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Figure 1: Example of VF results on SAP (A, unT; B, T) and VR (C, unT; D, T)

Figure 1: Example of VF results on SAP (A, unT; B, T) and VR (C, unT; D, T)

 

Table 1: IC Criteria met on SAP and VR

Table 1: IC Criteria met on SAP and VR

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