Normative data using a virtual reality game-based visual field test
Reviewed by Lauren Hepworth

The authors present a prospective cross-sectional study involving healthy children to assess the use of a virtual reality game-based perimetry assessment. A single eye centre recruited through paediatric optometry and ophthalmology clinics over a 12-month period. Children aged <18 years with visual acuity of 6/12 or better, no ocular pathology or developmental delay were eligible for recruitment. Participants were not dilated for the purpose of the assessment; a darkened room was used and a reclined examination chair was employed for younger participants. A standard strategy (revised VisuALL AVA), published elsewhere, was used for a paediatric 24-2 protocol. Videos of the instructions given to participants are included as part of the published paper. The following data was recorded: foveal sensitivity, point sensitivities, mean deviation and pattern standard deviation. Demographics and medical history were also recorded. A total of 191 eyes (n=97) were analysed as part of the study; mean age was 11.9. The mean time taken to complete the assessment was less than six minutes per eye. Only 4% of participants had previously undertaken perimetry on the Humphrey Field Analyser (HFA). The findings outline the feasibility of visual field assessment using the VisuALL virtual reality perimetry assessment, with other benefits including being able to wear their own glasses. The study presents normative data for this testing method. Mean deviation and pattern standard deviation were both influenced by age and test duration but no other influencing factors were identified. The authors discuss the different lighting conditions between the VisuALL and HFA which could be responsible for the hill of vision not consistently being detected. A number of limitations are reported, including small sample size, no assessment of test-retest reliability and no comparison to gold-standard perimetry. This study outlines that virtual reality perimetry could be a more accessible assessment method for younger children but further development is required along with assessment of ocular pathology.

Performance of VisuALL virtual reality visual field testing in healthy children.
Alvarez-Falcon S, Wang B, Taleb E, et al.
JOURNAL OF THE AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2024;28:103802.