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.