Testing equipment is vital to the proper diagnosis and subsequent treatment of eye diseases and debilitating visual complications. Clinical decisions surrounding glaucoma in particular are heavily reliant on perimetry results produced by visual field testing.

However, drawbacks with current perimeter technology were aggravated by the developing needs of patients during the COVID-19 pandemic: tighter office visit schedules, heavy safety precautions and the risk of coronavirus exposure preventing patients from venturing beyond their home or care facility.

These and other limiting factors caused many eye professionals to seek innovative solutions for the evaluation and treatment of glaucoma and neuro-ophthalmic diseases in their patients.

In searching for technology suited to the meet these needs, I discovered the answer in the form of the portable virtual reality visual fields technology.

ABOUT VR PERIMETRY

The practitioners in our glaucoma service utilize the VisuALL Virtual Reality Platform (Olleyes), though there are other options on the market (see page 50).

VisuALL is an FDA Class I virtual reality headset that delivers comprehensive perimetry screening and testing on patients through intuitive gaze-checking technology. The device features point patterns similar to the Humphrey Field Analyzer and conducts its tests independently of technician guidance, allowing the user to pause and resume interaction as necessary via a Bluetooth-connected response button. A pilot study our group conducted found the VisuALL’s data to be comparable to Humphrey visual fields. Additionally, patients may wear their glasses during examination rather than wear trial lenses.

EFFICIENCY AND COMFORT

The result of adding VisuALL to our practice has been a streamlined, autonomous and accessible method of perimetry and general eye evaluations for patients of all ages and backgrounds.

Previously, our technicians had to guide patients from their exam rooms to the visual field room and back. We now have the patient experience visual field testing in a doctor lane, saving about 5-10 minutes per patient in the clinic.

This improved flow and speed has an added safety benefit for those who have trouble moving, such as those patients who are wheelchair-bound or have musculoskeletal diseases. These patients are no longer required to meet the awkward designs of visual field chin rests, instead receiving comfortable testing while sitting in an exam chair or their wheelchair.

SAFETY

In addition, this technology may cut down on in-person time with patients thanks to home-based perimetry. The device is portable and easy to understand, so patients are capable of running their own visual field tests in their home, enabling a closer assessment of their condition. A study by Wills Eye Hospital Glaucoma Service is currently underway to measure the long-term viability of at-home testing. We are planning to mail a VisuALL to our patients along with a home tonometer and have them periodically monitor themselves over the course of a 2-year study. These will be patients who are capable of educating themselves on how to use the device via its built-in demo.

Additionally, with coronavirus precautions in mind, cleaning the VR headset between patients with alcohol wipes is fast and simple.

CONCLUSION

Cleanliness and efficiency became even larger considerations since COVID. Virtual reality-based perimetry helps to address both of those problems and has been a resounding success in my clinic. Other ophthalmologists may seek this technology to prepare their practices for operational challenges down the road. Though it may not happen overnight, I expect this technology to help us meet and address the shifting landscape of health care and the evolving expectations of patients over the next decade. OM

Reza Razeghinejad, MD, is director of the clinical glaucoma fellowship program at Wills Eye Hospital Glaucoma Service in Philadelphia, Pa., and an associate professor of ophthalmology at the Sidney Kimmel Medical College, Thomas Jefferson University. 
Dr. Razeghinejad disclosed a relationship with Olleyes.