Hello I’m Dr. David Richardson. I’m a cataract and glaucoma surgeon in Southern California. On my morning commutes, I like to discuss those topics that there’s generally not enough time to discuss in the exam room.

We’ve been talking about visual field testing, and today I’d like to begin touching on what we can look forward to. And in particular, how virtual reality or VR headsets may actually revolutionize the way visual field testing is done. So, let’s go ahead.

So, as we’ve been talking about the currently available visual field testing units (it’s called automated perimetry) have a number of issues that make them challenging, difficult, or just plain inconvenient for those who need to be tested to have the testing done. These include things like limited testing locations, positioning requirements, requiring a response from the individual, and the fact that they’re just plain boring. So, all of these things are related to the way the visual field testing units are currently structured— in terms of the size of them, and you know, how the software is designed.

Virtual reality headsets or also known as VR headsets—the most common or the most well-known of which is the Oculus Rift for the Oculus Go—may change this. Virtual reality headsets essentially are headsets that are placed over the head and provide an experience in one’s visual field. So, there’s a screen in front of the eyes, and objects, movies, games, stimuli can be projected on the visual field of the individual who has the headset on. Now, traditionally these headsets have been tethered to large, powerful computers. But with headsets such as the oculus go, there are now portable headsets available that essentially allow the virtual reality headset to be worn anywhere by anyone who can sit upright. And this opens up an entire new set of possibilities for visual field testing.

Let’s talk about testing location. The current visual field units are rather large and cumbersome, and far from portable. They generally have to be placed on tables, and once they’re set up in a doctor’s office, they don’t move. So, portability is not an option. Because they’re generally in a physician’s office, it means that the individual to be tested has to find time in his or her schedule that matches the schedule of the physician’s office, drive to the office, or use public transportation, and then set aside the time for the testing. So, this involves a lot more than just the testing time itself.

So, it’s quite clear that if a virtual reality headset was available, on which visual field testing can be performed that, this could potentially be done at home, at a time and location convenient to the individual patient. With those patients who already have virtual reality headsets, it may someday be possible to actually just have the visual field program downloaded unto the individual’s headset and then have the data, the test results, uploaded to the physician’s office for review. Now what we’ve been talking about, so far, is just, you know, the physical reality of the headsets. We’ve not talked about the software itself. So, you know it’s certainly possible to just simply take the standard visual field testing and project it on to a virtual reality screen. And there are a number of companies that are already doing this. Much of this information has been validated already. And in that, it is possible to port similar testing on a virtual reality headset. But that still requires a patient response.
So generally, the patient holds a handheld controller, and when a stimulus is seen—whether it’s a regular visual field device or a virtual reality headset—it still requires pressing a button, which can be problematic for someone who is arthritic or has a slow response time. And as we age, our response time tends to decrease, as well as, you know there’s an issue with dementia. Not only visual field testing challenging for those with dementia but it worsens the reaction time.

So, one of the exciting things about VR headsets is it doesn’t necessarily require using a handheld device. Indeed, because these headsets track head movements, one could— and there are already devices that are being tested and may come to market that allow one to—simply look around and when a stimulus is presented in the visual field, the individual can look toward it with the head rather than clicking with a handheld device. Now, of course, this requires that ONE not have cervical disc disease or something that would make it difficult to spend time moving one’s head around. But it’s for many people, a huge advantage over a handheld controller.

Now, this also just gets to the issue of positioning. With the standard visual field devices that are available in doctors’ offices, it requires that an individual sit upright, place the chin against a chin rest, forehead against a forehead rest, and this can be quite challenging for those who are wheelchair-bound or have back or neck problems. With a light virtual reality headset, that essentially eliminates that issue for anyone whose neck musculature is strong enough to hold the head upright and tolerate the weight of the virtual reality headset. In theory, as long as one can sit upright, one could then take a visual field test on a VR headset. Even somebody whose bed-bound as long as the individual could sit upright. And it’s possible that a software could be created that could then be calibrated for someone in a supine or reclined position. No reason why that couldn’t be done, although currently, most VR headsets do require one to be upright for the unit to work well. Now, all of these things that I’ve talked about are possible just by (again) porting the software algorithms over to a virtual reality headset. But what’s really exciting is the possibility of testing the visual field using completely different algorithms. Currently, the algorithm that’s used is as I describe it to my patients, the world’s most boring video game. I mean, it really makes the old Pong look absolutely just as exciting as possible. It should be possible to create visual field testing algorithms that could essentially gamify the visual field test. So, it’d make it more interesting, more interactive, more challenging, and we just need to wait and see what those software developers come up with, and then it would, of course, need to be validated against current visual field testing.

So, what I’ve talked about today is just one aspect of the potential future of automated perimetry—in this case, just using virtual reality or VR headsets. And it really is quite exciting. It could potentially make visual field testing more affordable, more convenient…potentially allow the individual to have testing done at home, which would then allow for more repetitions of the field, which as we’ve talked about before, the repetitions are incredibly important in order to determine whether or not field to field fluctuation is just fluctuation or whether it’s actual progression of disease.

David Richardson, MD

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, M.D. is recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs MicroPulse P3™ "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from the University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Eye Institute. Dr. Richardson is also an Ambassador of Glaucoma Research Foundation.

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