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. 2024 Mar 1;13(3):10.
doi: 10.1167/tvst.13.3.10.

Validation of a Wearable Virtual Reality Perimeter for Glaucoma Staging, The NOVA Trial: Novel Virtual Reality Field Assessment

Chris Bradley  1 , Iqbal Ike K Ahmed  2   3 , Thomas W Samuelson  4 , Michael Chaglasian  5 , Howard Barnebey  6   7 , Nathan Radcliffe  8 , Jason Bacharach  9
Affiliations

Validation of a Wearable Virtual Reality Perimeter for Glaucoma Staging, The NOVA Trial: Novel Virtual Reality Field Assessment

Chris Bradley et al. Transl Vis Sci Technol. .

Abstract

Purpose: Compare estimated sensitivities of SITA-Standard to the RATA-Standard algorithm of the Radius virtual reality perimeter (VRP), and measure concordance in glaucoma staging.

Methods: One hundred adult glaucoma patients-half with suspect or mild glaucoma, and half with moderate or severe-from five clinics performed four 24-2 visual field tests during a single visit, two with the Humphrey Field Analyzer (HFA) and two with Radius, in randomized order: HRHR or RHRH. Only one eye was tested per participant. We used the Wilcoxon rank sum test with Bonferroni correction to compare distributions of estimated sensitivities across all 54 test locations over the 15 to 40 dB measurement range of the Radius. Weighted kappa measured concordance in glaucoma staging between two masked glaucoma experts using Medicare definitions of severity.

Results: A total of 62 OD and 38 OS eyes were tested. Estimated sensitivities for SITA-Standard and RATA-Standard were not significantly different for OD, but were for OS-likely because of SITA-Standard OD and OS being significantly different in our sample, but not for RATA-Standard. Low agreement was observed between 15 to 22 dB. Concordance in glaucoma staging was high for both graders: kappa = 0.91 and kappa = 0.93. Average test duration was 298 seconds for RATA-Standard and 341 seconds for SITA-Standard. The correlation in mean deviation was 0.94.

Conclusions: Estimated sensitivities of RATA-Standard are comparable to SITA-Standard between 23 to 40 dB with high concordance in glaucoma staging.

Translational relevance: Radius VRP is statistically noninferior to HFA when staging glaucoma using Medicare definitions.

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Conflict of interest statement

Disclosure: C. Bradley, Radius XR (C, P); I.I.K. Ahmed, Radius XR (C), Heru (C), Carl Zeiss Meditec (C, R); T.W. Samuelson, None; M. Chaglasian, Radius XR (F); H. Barnebey, Radius XR (I); N. Radcliffe, Radius XR (C, I), Carl Zeiss Meditec (C, R); J. Bacharach, Radius XR (C, F, I), Carl Zeiss Meditec (C)

Figures

Figure 1.
Figure 1.
The Radius headset, hand controller and tablet.
Figure 2.
Figure 2.
Example outputs for the same eye for the (A) HFA using the SITA-Standard algorithm and the (B) Radius using the RATA-Standard algorithm.
Figure 3.
Figure 3.
Mean absolute differences in dB for each 24-2 test location for OS (left column), OD (right column), Radius versus HFA (top row), HFA test versus retest (middle row), and Radius test versus retest (bottom row).
Figure 4.
Figure 4.
(A) Deming regression (red line) applied to all sensitivity data combined, with <15 dB set to 15 dB. The area of each data point (blue circles) is proportional to the number of occurrences; (B) Deming regression when ignoring all <15 dB data; (C) Deming regression on MD data; (D) Comparison of test duration.
Figure 5.
Figure 5.
Confusion matrices for grader 1 and grader 2.
See this image and copyright information in PMC

References

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