Application of Virtual Visual Fields Yvonne Ou, MD Associate - - PDF document
Application of Virtual Visual Fields Yvonne Ou, MD Associate Professor of Ophthalmology Co-Director, Glaucoma Service Vice Chair for Postgraduate Education Department of Ophthalmology, UCSF Disclosures: None Since intertest
Application of Virtual Visual Fields
Yvonne Ou, MD
Associate Professor of Ophthalmology Co-Director, Glaucoma Service Vice Chair for Postgraduate Education Department of Ophthalmology, UCSFDisclosures: None
“Since intertest (long-term) fluctuation is common, it is wise not to undertake a major therapeutic intervention based on a single examination.”
Slide about Medeiros study
“…evidence-based guidance on the frequency of testing required to accurately distinguish the presence of progressive visual field losses from measurement variability remains elusive, but would be of immense benefit for the clinical management of patients with glaucoma.”
Ophthalmology 2017;124:786-792.Smaller gains in the time to detect progression when testing increased from 2 to 3 times a year
Ophthalmology 2017;124:786-792. Slide about Medeiros study
“..obtaining 2 reliable tests at baseline followed by semiannual testing and confirmation of progression through repeat testing in the initial years of follow-up may provide a good compromise for detecting progression, while minimizing the burden on health care resources in clinical practice.”
Ophthalmology 2017;124:786-792.Do we really need to compromise?
New Yorker, published July 23, 2001“You want a child, I want a dog. Can’t we compromise?”
Me: “Mr. Smith, how are you doing? Sorry for the wait.”
“I HATE visual field testing!”
But what happens in reality?
https://giphy.com/gifs/kHU8W94VS329yHigh fixation losses – inability to suppress foveation reflex High false positives Ergonomic limitations Need for highly skilled examiner High cost Individual tests are noisy Lack of portability Controlled lighting environment
Limitations of traditional VF testing methods
Okulokinetic perimetry
As developed by Bertil Damato, MD, PhD
Courtesy of Bertil DamatoThursday, 13 October 1983, 1 pm Hospital Library
OKP Glaucoma Screener: Version I
Courtesy of Bertil Damato Okulokinetic perimetry
16Virtual Reality - OKP
How to perform the test On the fly customizability
Mean Test Duration Range
4 minutes 37 seconds to 5 minutes 53 seconds
Sensitivity in detecting blind spot User-friendliness Safety Outcome Demographics
In normal patients, how sensitive is VR-OKP for detecting the blind spot?
18 12 60
Eyes Male FemaleMean Age Range
31 years
19 to 50 years
5 minutes 19 seconds
0%
98.3%
(59/60 eyes)
Discomfort and fatigue rated little to none
adverse events
78 year-old female
78yo female
covered
“Areas of existing damage are far more likely to demonstrate progressive loss, either by scotomatous enlargement or deepening, than undamaged areas. Therefore, it is useful to examine these areas more carefully when examining a series of visual fields.”
What the future holds…
more detail
subtypes
Home testing is feasible
Utilizes foveation reflex No need for highly skilled examiner Overcomes ergonomics Home testing Low cost Frequent testing may
variability Very portable Built-in lighting environment
Potential benefits of VR-oculokinetic perimetry
Thank you!
UCSF
Vivid Vision