Hello I’m Dr. David Richardson, a cataract and glaucoma surgeon in Southern California. During my morning commutes, I like to discuss those topics that there’s just not enough time to discuss in a typical exam room situation.
Now I’ve been talking about visual fields. And my most recent video was about the exciting possibility of using virtual reality or VR headsets to test visual fields.
Now, as exciting as that technology is, or maybe, it’s still limited. In the sense that a response is still required from the individual taking the test. So, either clicking on a handheld device or moving the head to indicate to the testing unit that the stimulus has indeed been seen. Now, what if that was not necessary? What if all somebody had to do was to place his or her head in a field device and watch? Sound like science fiction? I certainly thought so. But the technology exists and is in development that could allow this to occur. So, let’s talk about that.
At a recent national meeting, I had the opportunity to test out a device made by Konan. This device called the objectiveFIELD™ is a tabletop device, so unlike virtual reality headsets, it’s not at all portable. That being said, it’s really an amazing piece of technology because it allows one to simply place the head up against a chin rest in a headrest and watch. And as one watches, a visual field is being performed.
Now, this technology is not yet available. But if it does become available in the next year, which is what they’re anticipating, and it’s affordable, I would certainly like to have one in my office because the experience of taking the visual field was actually quite relaxing. During the exam, multiple colored petal-shaped patterns are displayed in front of the eyes. And all that’s required of the individual is just to sit there. The technology uses the pupil response, so whenever light hits the retina signals sent back into a nucleus in the brain, it then results in pupil reaction. So bright lights result in the pupil constricting, dim lighting situations allow the people to dilate. So essentially, this device is able to measure that pupillary response to a stimulus, so if you don’t see something, there’s no pupil response; if you see something, there’s a pupil response. It’s really quite incredible how it works. And as I said, it’s really the furthest thing from a typical stressful visual field testing experience. It’s mesmerizing, really like looking at our kaleidoscope. So that is a very exciting technology, and I’m very hopeful that additional studies show that it is indeed on par or it’s perhaps even better than standard automated perimetry. And, hopefully, affordable.
Now the other thing I want to talk about today is a technology that’s not yet available and probably won’t be available for a couple of years, if ever, but hopefully, it will. And this technology combines the benefits of a virtual reality headset both the portability as well as the ability to change up the strategy, the software, the way one responds, and the lack of needing to press a button or otherwise indicate to the machine that you’ve seen something. So, this technology, which is called NGoggle so N (the letter N), then NGoggle actually combines a virtual reality headset with an EEG– so an electroencephalogram. And the way it works is that visual stimuli are projected onto the screen of the virtual reality headset. And the electrodes that would be on a cap, around to the individual’s head, then detect a response in the brain to the visual stimulus. So again, there’s no reaction necessary by the individual who’s being tested. Simply the EEG unit picks up the response that a stimulus that was presented has been detected by the retina. So again, this is early technology right now that’s not yet available but very, very exciting.
So, in summary, although currently available visual field testing has not significantly changed in the last half-century, we are right on the cusp of some very exciting things that could potentially address both the issue of poor quality reliability testing (as we’ve talked about), as well as the issue of the requirement for a patient response, which is both frustrating for the individual taking the test (and again as we’ve talked about before) because you just don’t always know whether you’ve seen something…and it’s boring and frustrating…as well as, the problem with reliability associated with requiring a patient response.
So, if we could—either with the tabletop unit (in the case of the Konan objectiveFIELD™) or with a combination virtual reality headset as well as the EEG (as would be available with the NGoggle)—this provides the potential for a better quality experience by the patient, a better quality result for the doctor reviewing the test results, and just an overall better experience.
So, I’m very excited about the potential, but it’s going to be a while before these things are available, and it’s going to probably be at least a decade before newer technologies are able to replace the older technologies if that even happens. But in any case, I find this very exciting, and again if it’s affordable and as reliable as it seems to be, I will certainly have it available for my patients. Because we’re all together looking for something better than the current automated perimetry. All right, I hope this was informative for you, and I look forward to my next commute together.
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- Visual Field Testing – Why We Do It | Driving with Dr. David Richardson – Series 2 Ep 01
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.