Virtual reality perimetry compared to standard automated perimetry in adults with glaucoma: A systematic review.

Purpose: The purpose of this systematic review was to consolidate and summarize available data comparing virtual reality perimetry (VRP) with standard automated perimetry (SAP) in adults with glaucoma. Understanding the utility and diagnostic performance of emerging VRP technology may expand access to visual field testing but requires evidence-based validation.

Methods: A systematic literature search was conducted in 3 databases (PubMed Central, Embase, and Cochrane Central Register of Controlled Trials) from the date of inception to 10/09/2024. Eligibility criteria included randomized controlled trials or prospective or retrospective cohort studies that compared different modalities of VRP to SAP in adults >18 years of age with glaucoma. Studies were excluded if they were review articles, letters, case reports, abstract-only papers, unavailable full text, or non-English language. Identified studies were formally evaluated for risk of bias using the Newcastle-Ottawa tool. The study protocol was prospectively registered with PROSPERO in May 2023 (registration number: CRD42023429071).

Results: The literature search yielded 1657 results. After deduplication, abstract and title screening, 14 studies met inclusion criteria and were included in the final systematic review. Compared to Humphrey Field Analyzer or Octopus 900, 10 different VRP devices were included in our study: Oculus Quest, Smartphone-based Campimetry, Toronto Portable Perimeter, VirtualEye, Advance Vision Analyzer, VisuALL, Vivid Vision Perimeter, C3 fields visual field analyzer, Radius, and Virtual Field. Overall, published studies of VRP are promising; however, more work is required to better evaluate these devices, namely test-retest repeatability.

Conclusions: VRP holds strong potential to evaluate visual fields in adults with glaucoma, though further data is needed to validate emerging technologies and testing protocols. Eye providers may consider using these devices to monitor certain adults with glaucoma.