Evaluation of a Head-Mounted Virtual Reality Perimeter Compared with Stationary Perimeters across All Stages of Glaucoma.

OBJECTIVE

To evaluate agreement between a head-mounted virtual reality perimeter (VRP) and a conventional standard automated perimeter (SAP) in individuals with glaucoma across all stages of disease severity, including advanced visual field (VF) loss.

DESIGN

Prospective, single-center observational study.

PARTICIPANTS

Adults with glaucoma undergoing VF testing; 120 matched VFs from 73 participants met the inclusion criteria.

METHODS

Participants underwent VF testing using a VRP (VisionOne; PeriVision AG) and SAP (Octopus 900; Haag-Streit AG) during a single visit. Global indices (mean sensitivity [MS], mean defect [MD]), pointwise sensitivity, and total deviation (TD) were compared. Agreement and association were assessed using Pearson correlation and Bland-Altman analyses. Stage-wise analyses evaluated interdevice differences across mild, moderate, and severe glaucoma. Test duration, reliability indices, and simulator-related discomfort were also assessed.

MAIN OUTCOME MEASURES: Interdevice agreement for global VF indices (MS and MD), pointwise sensitivity and TD, and test performance measures (duration, reliability indices, and simulator-related discomfort).

RESULTS

Strong correlations were observed between VRP and SAP for global indices (MS and MD: ρ = 0.97; P < 0.0001) and for pointwise sensitivity and TD (sensitivity: ρ = 0.88; TD: ρ = 0.89; both P < 0.0001). Bland-Altman analyses demonstrated a small systematic pointwise sensitivity bias of -2.33 dB (95% limits of agreement [LoA]: -10.70 to +6.03 dB) and a TD bias of 0.98 dB (95% LoA: -6.36 to +8.33 dB), falling within known SAP test-retest variability parameters. Interdevice agreement remained consistent across glaucoma stages, including advanced VF loss. Test duration and reliability indices were comparable across devices. Simulator-related discomfort was generally low, with no test discontinuations.

CONCLUSIONS

The VisionOne head-mounted VRP demonstrated strong agreement with conventional SAP for VF assessment, including cases of significant VF loss, supporting its clinical validity.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.