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Observational Study
. 2023 Oct 19:25:e45044.
doi: 10.2196/45044.

Remote Perimetry in a Virtual Reality Metaverse Environment for Out-of-Hospital Functional Eye Screening Compared Against the Gold Standard Humphrey Visual Fields Perimeter: Proof-of-Concept Pilot Study

Kang-An Wong #  1   2 , Bryan Chin Hou Ang #  2 , Dinesh Visva Gunasekeran  1   3   4   5 , Rahat Husain  3   5   6 , Joewee Boon  2 , Krishna Vikneson  6 , Zyna Pei Qi Tan  2 , Gavin Siew Wei Tan  3   5   7 , Tien Yin Wong  3   5   7   8 , Rupesh Agrawal  2   3   9
Affiliations
Observational Study

Remote Perimetry in a Virtual Reality Metaverse Environment for Out-of-Hospital Functional Eye Screening Compared Against the Gold Standard Humphrey Visual Fields Perimeter: Proof-of-Concept Pilot Study

Kang-An Wong et al. J Med Internet Res. .

Abstract

Background: The growing global burden of visual impairment necessitates better population eye screening for early detection of eye diseases. However, accessibility to testing is often limited and centralized at in-hospital settings. Furthermore, many eye screening programs were disrupted by the COVID-19 pandemic, presenting an urgent need for out-of-hospital solutions.

Objective: This study investigates the performance of a novel remote perimetry application designed in a virtual reality metaverse environment to enable functional testing in community-based and primary care settings.

Methods: This was a prospective observational study investigating the performance of a novel remote perimetry solution in comparison with the gold standard Humphrey visual field (HVF) perimeter. Subjects received a comprehensive ophthalmologic assessment, HVF perimetry, and remote perimetry testing. The primary outcome measure was the agreement in the classification of overall perimetry result normality by the HVF (Swedish interactive threshold algorithm-fast) and testing with the novel algorithm. Secondary outcome measures included concordance of individual testing points and perimetry topographic maps.

Results: We recruited 10 subjects with an average age of 59.6 (range 28-81) years. Of these, 7 (70%) were male and 3 (30%) were female. The agreement in the classification of overall perimetry results was high (9/10, 90%). The pointwise concordance in the automated classification of individual test points was 83.3% (8.2%; range 75%-100%). In addition, there was good perimetry topographic concordance with the HVF in all subjects.

Conclusions: Remote perimetry in a metaverse environment had good concordance with gold standard perimetry using the HVF and could potentially avail functional eye screening in out-of-hospital settings.

Keywords: HVF; digital health; eye; functional testing; glaucoma; metaverse; ophthalmologic; ophthalmology; perimetry test; remote care; screening; virtual reality; visual field; visual impairment; visually impaired.

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Conflict of interest statement

Conflicts of Interest: Authors KAW, DVG, GSWT, and TYW report equity interest in the company VISRE (Visual Reality), which developed the Perispace version 1.1 solution. Author DVG also reports investment in DoctorBell (acquired by MaNaDr, Mobile Health), AskDr, Healthlink, and Shyfts. He declares receipt of travel funding from a Mobile Health Education grant, Commonwealth Fellowship in Innovation award, and National Youth Fund award for clinical research training and collaborations at Oxford University and Stanford University. He reports serving as senior lecturer and faculty advisor to the medical innovation program of the National University of Singapore, and appointment as Head (Digital Health) at Northeast Health International postinvestment by parent company Sheares Health Care. Author GSWT also reports clinical research grants from Santen and fees from Zeiss, Leica, Topcon, Optos-Nikon, Allergan, Roche, Novartis, and Bayer, governed by the policies of the Singapore National Eye Centre, as well as start-up equity in EyRiS. Author TYW also reports clinical trial grants from Allergan, Bayer, Boehringer-Ingelheim, Genentech, Merck, Novartis, Oxurion, Roche, and Samsung Bioepis; travel support from Allergan, Bayer, Boehringer-Ingelheim, Genentech, Merck, Novartis, Oxurion, Roche, and Samsung Bioepis; and personal fees from Allergan, Bayer, Boehringer-Ingelheim, Genentech, Merck, Novartis, Oxurion, Roche, and Samsung Bioepis, governed by the policies of the Singapore National Eye Centre; TYW is also a cofounder of the start-up companies Plano and EyRis and reports a patent for a method of modifying a retina fundus image for a deep learning model issued to EyRiS (WO2019022663).

Figures

Figure 1
Figure 1
Point--wise concordance of Perispace v1.1 and Humphrey visual field (HVF) results with a 24-2 testing distribution. Corresponding perimetric topographic maps and point-wise concordance for automated classification of individual test points in all corresponding locations of the Swedish interactive threshold algorithm–fast testing distribution in the HVF results (left) and remote perimetry in a virtual reality–based metaverse environment using Perispace (right). If the concordance was good, then black areas of the HVF gray scale should appear as red areas of the Perispace topographic map. The letters A to J represent individual patients.
See this image and copyright information in PMC

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