Clustered home assessment of visual fields in patients with glaucoma

Project summary/abstract
Glaucoma is the second leading cause of irreversible vision loss in Americans. Effective treatment requires
the patient to take visual field tests over time, to monitor for progression of visual field loss. In many patients
there is no progression, but when it occurs it must be detected as quickly as possible in order to save vision
by using a more aggressive treatment. Patients whose vision is actually stable don’t know it, so they worry
unnecessarily.
Conventional tests to measure visual fields are too difficult to take. They are fatiguing and the equipment
they use is expensive and bulky A skilled perimetrist is still required to train the patient how to take the test and
to monitor for eye movements and patient fatigue. As a result, glaucoma patients typically have a visual field
test only one to three times a year. And unfortunately, the results of these tests have high variability due to the
necessarily short duration of the test. Thus, there is large error when estimating the rate of disease progression
from visual fields in a patient with glaucoma, and an urgent need to do additional testing at home to overcome
the data limitation.
We developed a test, called Vivid Vision Perimetry (VVP-10), that substantially increases the quantity of
visual field data a patient can collect. Patients take VVP-10 at home on a low-cost virtual reality (VR) headset.
We have made the test much more user-friendly, using a novel task. VVP-10 allows the patient to freely move
their eyes and to know exactly when stimuli will appear. It gives feedback to the patient after every stimulus ,
and makes the test more like a video game. Patients have the option of guessing or not, because guessing
does not affect the test outcome. During Phase I of this project, we demonstrated feasibility by showing that
elderly glaucoma patients can perform the test at home without in-person training. The results agreed well with
conventional tests, and our mathematical models suggest that taking a cluster of 10 tests four times a year
could reduce by more than half the number of months needed to detect rapid progression. In this Direct to
Phase II Project, we will make the test still easier to perform, optimize the quality of the data collected, and
verify that VVP-10 can reduce by half the number of months needed to detect rapid progression.
The new test is being developed by Vivid Vision, Inc., a seven-year-old company based in San Francisco,
CA. The company sells a binocular vision treatment product used by 350 clinics worldwide. It has expertise in
psychophysics, software engineering for VR games, HIPAA-compliant telemedicine, IP protection, marketing,
and sales. Leading glaucoma specialists at the UCSF School of Medicine and the NYU School of Medicine
have joined the team to carry out a one-year, multi-site study of VVP-10 in 65 patients with glaucoma.

Grant Number: 5R44EY035203-02
NIH Institute/Center: NIH
Principal Investigator: James Blaha