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.

Duke Scholars

Author Mays Antoine Dairi Ophthalmology, Neuro-Ophthalmology

Author Sharon Fridovich Freedman Ophthalmology