Editors Selection IGR 21-1

Clinical Examination Methods: Virtual-Reality Perimetry

Chris Johnson

Comment by Chris Johnson on:

84653 Validation of a Head-mounted Virtual Reality Visual Field Screening Device, Mees L; Upadhyaya S; Kumar P et al., Journal of Glaucoma, 2020; 29: 86-91

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Perimetry and visual field testing have undergone many changes throughout history, from confrontational visual field testing to the development of standardized testing and methodology with arc perimeters and tangent screens, continuing on to full hemispherical perimeter bowls that have a uniform background adaptation level and the ability to vary many properties of the test stimulus superimposed on the background. A major advance was realized approximately 40-45 years ago with the advent of automated visual field testing. Since that time, there have been many innovations that have improved the efficiency, accuracy and reliability of visual field evaluations, although it recently appears to have reached an asymptote.

As current approaches become further refined it appears that a new paradigm shift in perimetry and visual function testing is emerging

Current technological developments now make it possible to perform visual function testing on many small, portable, inexpensive devices (tablets, virtual reality headsets, smartphones, internet web sites) that allow testing to be performed in a variety of settings for population-based screening, home testing, and evaluation at eye care centers prior to examination by a practitioner. Although this new approach still needs refinement of methods and procedures, it opens up the potential for many new opportunities for providing ophthalmic services from a much broader spectrum. The current manuscript describes the use of a virtual reality headset to perform visual field screening, and demonstrates its performance for assessing a group of healthy normal controls and glaucoma patients in comparison to results obtained using a Humphrey Field Analyzer. The study was performed in a careful and thorough manner with excellent methodology, analysis and interpretation of results. The findings for this study were impressive and are highly similar to those that were obtained previously using a tablet-based visual field screening test in Nepal.1 This provides additional support for the use of these approaches for performing perimetry in a variety of settings. A limitation of this study is that it is currently a screening procedure. Quantitative threshold sensitivity assessment would be more desirable. It is encouraging that in addition to this work, there are many investigators and clinical research teams that are at work in this area, quantitative threshold sensitivity procedures are available, eye and head tracking has been incorporated into the test procedure, and new improvements are emerging at a rapid pace. Given the current activity in this area, it is clear that many colleagues see this as the wave of the future. As current approaches become further refined it appears that a new paradigm shift in perimetry and visual function testing is emerging.


  1. Johnson CA, Thapa S, Kong, YXG, Robin AL. Performance of an iPad application to detect moderate and advanced visual field loss in Nepal. Am J Ophthalmol. 2017;182:147-154.

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