“Virtual reality (VR) is the biggest change in 50 years when it comes to diagnostics for glaucoma,” Michelle R. Butler, MD, ABO, told the audience at a session highlighting advances in glaucoma technology during this weekend’s ASCRS meeting in Boston.

Dr. Butler, a surgeon with Glaucoma Associates of Texas, highlighted a number of benefits of VR headsets that can be used for visual field tests: the headset eliminates issues with positioning as both of the patient’s eyes can be tested at the same time; the devices are easier for children and non-English speakers to use; and, because they are portable, these devices can facilitate glaucoma screening for patients who live in remote areas, she said. Physicians like the devices because they are affordable, user-friendly, don’t take up much room, and are less technician-dependent than a standard perimetry test, Dr. Butler added.

There are some disadvantages as well, Dr. Butler acknowledged. Data from a VR headset test cannot be directly compared to a previous test on a traditional perimeter. “For glaucoma screening, they are excellent, but for staging glaucoma, they are not as good,” she said. In addition, VR headset results are not accepted in clinical trials, and some of the devices require an internet connection to function, which can limit their utility outside of the office.

Despite this, she said that advances in VR, possibly coupled with artificial intelligence for data analysis, “combines for a really exciting future for glaucoma.”

In another presentation, Inder Paul Singh, MD, reviewed the use of intraoperative optical coherence tomography (iOCT), showing several videos that demonstrated how this can assist surgeons. “iOCT allows us to visualize what’s actually happening while we’re in the eye,” he said. “You can actually see in real time what’s going on in the canal, trabecular meshwork and the collector channels.”

Dr. Singh, president of the Eye Centers of Racine and Kenosha in Wisconsin, said that iOCT can help to guide where certain minimally invasive glaucoma surgery (MIGS) devices, such as the Hydrus Microstent (Alcon) or iStent (Glaukos), should be placed for maximum effectiveness. “It’s nice to make sure our stents are placed in the right spot,” he said.

Alessandro A. Jammal, PhD, MD, a glaucoma research scientist at Bascom Palmer Eye Institute in Miami, discussed how measuring corneal hysteresis (CH) may be an accurate predictor of future visual field deterioration in patients who have apparently well-controlled IOP — so-called normal-tension glaucoma (NTG). “Approximately one-quarter of eyes with well-controlled IOP may show visual field progression over time,” Dr. Jammal explained. “Thin cornea and low CH are main risk factors.” According to a study he co-authored in Ophthalmology, each 1 mm Hg reduction in CH is equal to a 21% greater likelihood of glaucoma, he said.¹

Reference

1. Susanna BN, Ogata NG, Jammal AA, Susanna CN, Berchuck SI, Medeiros FA. Corneal biomechanics and visual field progression in eyes with seemingly well-controlled intraocular pressure. Ophthalmology. 2019;126(12):1640-1646.