Journal of Ophthalmic and Vision Research

ISSN: 2008-322X

The latest research in clinical ophthalmology and vision science

Diagnostic Performance of the PalmScan VF2000 Virtual Reality Visual Field Analyzer for Identification and Classification of Glaucoma

Published date: Jan 21 2022

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: January–March 2022, Volume 17, Issue 1

Pages: 33 - 41

DOI: 10.18502/jovr.v17i1.10168

Authors:

Vijay ShettyLaxmi Eye Institute, Panvel, Maharashtra, India

Prachi SankheLaxmi Eye Institute, Panvel, Maharashtra, India

Suhas S HaldipurkarLaxmi Eye Institute, Panvel, Maharashtra, India

Tanvi HaldipurkarLaxmi Eye Institute, Panvel, Maharashtra, India

Rita DhamankarLaxmi Eye Institute, Panvel, Maharashtra, India

Priyanka KashelkarLaxmi Eye Institute, Panvel, Maharashtra, India

Dhruven ShahLaxmi Eye Institute, Panvel, Maharashtra, India

Paresh MhatreLaxmi Eye Institute, Panvel, Maharashtra, India

Maninder Singh Setiamaninder.setia@karanamconsultancy.inLaxmi Eye Institute, Panvel, Maharashtra, India

Abstract:

Purpose: To evaluate the diagnostic test properties of the Palm Scan VF2000® Virtual Reality Visual Field Analyzer for diagnosis and classification of the severity of glaucoma.

Methods: This study was a prospective cross-sectional analysis of 166 eyes from 97 participants. All of them were examined by the Humphrey® Field Analyzer (used as the gold standard) and the Palm Scan VF 2000® Virtual Reality Visual Field Analyzer on the same day by the same examiner. We estimated the kappa statistic (including 95% confidence interval [CI]) as a measure of agreement between these two methods. The diagnostic test properties were assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: The sensitivity, specificity, PPV, and NPV for the Virtual Reality Visual Field Analyzer for the classification of individuals as glaucoma/non-glaucoma was 100%. The general agreement for the classification of glaucoma between these two instruments was 0.63 (95% CI: 0.56–0.78). The agreement for mild glaucoma was 0.76 (95% CI: 0.61–0.92), for moderate glaucoma was 0.37 (0.14–0.60), and for severe glaucoma was 0.70 (95% CI: 0.55–0.85). About 28% of moderate glaucoma cases were misclassified as mild and 17% were misclassified as severe by the virtual reality visual field analyzer. Furthermore, 20% of severe cases were misclassified as moderate by this instrument.

Conclusion: The instrument is 100% sensitive and specific in detection of glaucoma. However, among patients with glaucoma, there is a relatively high proportion of misclassification of severity of glaucoma. Thus, although useful for screening of glaucoma, it cannot replace the Humphrey® Field Analyzer for the clinical management in its current form.

Keywords: Glaucoma, Sensitivity, Specificity, Test Properties, Virtual Reality Perimetry

References:

1. Cook C, Foster P. Epidemiology of glaucoma: what’s new? Can J Ophthalmol 2012;47:223–226.

2. World Health Organization. Blindness and vision impairment [Internet]. WHO; 2019 [cited 2020 February 27]. Available from: https://www.who.int/news-room/factsheets/ detail/blindness-and-visual-impairment.

3. George R, Ve RS, Vijaya L. Glaucoma in India: estimated burden of disease. J Glaucoma 2010;19:391–397.

4. Kulkarni U. Early detection of primary open angle glaucoma: Is it happening? J Clin Diagn Res 2012;6:667– 670.

5. Alencar LM, Medeiros FA. The role of standard automated perimetry and newer functional methods for glaucoma diagnosis and follow-up. Indian J Ophthalmol 2011;59:S53–S58.

6. Wroblewski D, Francis BA, Sadun A, Vakili G, Chopra V. Testing of visual field with virtual reality goggles in manual and visual grasp modes. Biomed Res Int 2014;2014:206082.

7. Tsapakis S, Papaconstantinou D, Diagourtas A, Droutsas K, Andreanos K, Moschos MM, et al. Visual field examination method using virtual reality glasses compared with the Humphrey perimeter. Clin Ophthalmol 2017;11:1431–1443.

8. Kong YX, He M, Crowston JG, Vingrys AJ. A comparison of perimetric results from a tablet perimeter and humphrey field analyzer in glaucoma patients. Transl Vis Sci Technol 2016;5:2.

9. Anderson DR, Drance SM, Schulzer M, Collaborative Normal-Tension Glaucoma Study Group. Natural history of normal-tension glaucoma. Ophthalmology 2001;108:247– 253.

10. Nayak B, Dharwadkar S. Interpretation of autoperimetry. J Clin Ophthalmol Res 2014;2:31–59.

11. Hodapp E, Parrish RI, Anderson D. Clinical decisions in glaucoma. St. Louis, Mo: Mosby; 1993.

12. Cioffi G. Glaucoma. Basic and clinical science course (Book 10). USA: American Academy of Ophthalmology; 2011.

13. McManus JR, Netland PA. Screening for glaucoma: rationale and strategies. Curr Opin Ophthalmol 2013;24:144–149.

14. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med 2012;22:276–282.

15. Brusini P. OCT Glaucoma Staging System: a new method for retinal nerve fiber layer damage classification using spectral-domain OCT. Eye 2018;32:113–119.

16. Mees L, Upadhyaya S, Kumar P, Kotawala S, Haran S, S Rajasekar, et al. Validation of a head mounted virtual reality visual field screening device. J Glaucoma 2020;29:86–91.

17. Wall M, Wild J. Perimetry Update 1998/1999: Repeatability of abnormality and progression in glaucomatous standard and SWAP visual fields. Proceedings of the XIIIth International Perimetric Society Meeting; 1998. Gardone Riveira (BS), Italy: Kugler Publications.

18. Wall M, Woodward KR, Doyle CK, Artes PH. Repeatability of automated perimetry: a comparison between standard automated perimetry with stimulus size III and V, matrix, and motion perimetry. Invest Ophthalmol Vis Sci 2009;50: 974–979.

19. Prea SM, Kong YXG, Mehta A, He M, Crowston JG, Gupta V. Six-month longitudinal comparison of a portable tablet perimeter with the humphrey field analyzer. Am J Ophthalmol 2018;190:9–16.

20. Schulz AM, Graham EC, You Y-Y, Klistorner A, Graham SL. Performance of iPad-based threshold perimetry in glaucoma and controls. Clin Exp Ophthalmol 2018;46:346–355.

21. Ianchulev T, Pham P, Makarov V, Francis B, Minckler D. Peristat: a computer-based perimetry self-test for costeffective population screening of glaucoma. Curr Eye Res 2005;30:1–6.

22. Lowry EA, Hou J, Hennein L, Chang RT, Lin S, J Keenan, et al. Comparison of peristat online perimetry with the humphrey perimetry in a clinic-based setting. Transl Vis Sci Technol 2016;5:4.

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