Evaluation of Virtual Reality-Based Diagnostic Devices in Tertiary Care Ophthalmology

Abstract

The integration of virtual reality (VR) technologies into clinical ophthalmic practice has accelerated in recent years. VR-based diagnostic platforms have the potential to provide comparable diagnostic performance relative to conventional ophthalmic testing while offering advantages in portability, cost-effectiveness, standardized test administration, and accessibility. This comparative cross-sectional study evaluated the validity and diagnostic utility of two commercially available VR headsets integrated with two novel diagnostic applications, (i) Order of Magnitude (OM) and (ii) Retinalogik ©, for visual field and pupillary assessment relative to the current standards of care at the University of Ottawa Eye Institute. Primary visual field outcome measures included test duration, mean deviation (MD), and pattern standard deviation (PSD). Agreement between the VR-based systems and the reference standards was evaluated using Pearson correlation and Bland–Altman analysis, while pointwise threshold agreement was assessed through heatmap visualizations and spatial analyses. Pupillary assessment focused on the detection and categorical grading of a relative afferent pupillary defect (RAPD), with diagnostic concordance evaluated through a contingency table analysis. The VR-based diagnostic platforms demonstrated diagnostic performance comparable to the standard of care testing methods, supporting their diagnostic validity relative to conventional clinical methods. Overall, this study demonstrated the feasibility and diagnostic validity of integrating VR-based diagnostic platforms into tertiary eye care settings, while highlighting their potential to expand access through remote and decentralized clinical workflows.