Evaluating the Role of Virtual Reality Visual Fields (VRF) in the Diagnosis and Management of Pediatric Neuro-Ophthalmic Conditions.

Objective

Virtual reality field testing (VRF) is feasible and reliable in adults and in children with normal and glaucomatous eyes, but its role in pediatric neuro-ophthalmic conditions remains unexplored.

Purpose

To evaluate the feasibility of using VRF vs. standard automated perimetry (HVF) in children with neuro-ophthalmic conditions.

Design

Prospective reliability and validity comparison of diagnostic approaches.

Participants

Children (<18 years of age) with a known or suspected neuro-ophthalmic condition.

Methods

Children presenting to one pediatric neuro-ophthalmologist at Duke Eye Center between July 2022 to March 2023 were recruited. Participants attempted both HVF and VRF. A neuro-ophthalmologist predicted expected visual field (VF) abnormalities based on history, examination, magnetic resonance imaging, and optical coherence tomography of the retina and optic nerve. A masked ophthalmologist graded HVFs and VRFs with respect to global indices and VF abnormalities.

Main outcome measures

Comparison between clinically-predicted and observed visual field defects and visual field global indices between virtual reality fields (VRF) and Humphrey visual fields (HVF).

Results

One-hundred twenty-nine children (253 eyes) were included, mean age 11.1 ± 3.9 years. Fewer children successfully completed HVF than VRF (191 vs 240 eyes, p < .0001). Comparing HVF to VRF, average mean deviation (MD) was similar (-5.0 ± 6.3 vs -5.3 ± 6.2 dB, respectively, p = .782). When comparing global indices between HVF and VRF, moderate correlation was observed for both MD and pattern standard deviation (PSD). Sensitivity of HVF vs VRF to detect any clinically-predicted VF defect was 86.5% vs 88.6%, respectively, p = .861; specificity was 30.8% vs 33.5%, respectively, p = .725. HVF vs VRF concordance for presence/absence of any clinically-predicted VF defect was 52.0% vs 53.0%, respectively (p = .849).

Conclusion

HVF and VRF were comparable, with relatively high sensitivity and low specificity for the detection of clinically-predicted VF defects in children with known or suspected neuro-ophthalmic disease. However, more children were able to successfully perform VRF than HVF, suggesting VRF may provide valuable clinical assessment in this challenging population.