Virtual Reality Elucidates Vision Impairment in Patients With Glaucoma

Investigators used virtual reality to better understand the particular vision difficulties of patients with glaucoma.

New research underscores the promise of virtual reality as a means of assessing vision-related disability in patients with glaucoma.

Writing in the journal JAMA Ophthalmology, corresponding author Christopher K.S. Leung, MD, MB, ChB, of the Hong Kong University of Science and Technology and colleagues write that lighting appears to play a significant role in the level of visual impairment among people with glaucoma.

“There are some published studies applying driving simulation in a designated research facility to evaluate driving performance in glaucoma patients,” Leung told The American Journal of Managed Care®. “To our knowledge, we provided the first account applying virtual reality to simulate different types of activities in different lighting conditions to determine visual disability in glaucoma patients.”

Leung and colleagues recruited 98 patients with glaucoma and 50 healthy controls. The enrollees were put through 5 virtual reality simulations, such as shopping in the supermarket and navigating stairs and a city. Along the way, investigators took measurements of visual acuity, contrast sensitivity, visual field, virtual reality disability scores, and Rasch scores from the National Eye Institute’s 25-item Visual Function Questionnaire. The team also took into account the length of time needed to complete the simulation, the number of items correctly identified, and the number of virtual “collisions” patients encountered.

The team found differences between the patients with glaucoma and those without, but not in every aspect. Most notably, patients with glaucoma needed more time for the nighttime stair and city navigation scenarios, but there was no statistically significant difference in the amount of time needed to do the same tasks in a daylight scenario. This was even true when the patient appeared to have normal vision.

“We were surprised by the fact that while many glaucoma patients were apparently normal with excellent central vision, they had tremendous difficulties to navigate at night,” Leung said. “We found that whereas only 8% of glaucoma patients had vision-related disability (ie, VR disability score outside the normal age-adjusted 95% confidence region) in city navigation simulated in daytime, 31% had vision-related disability in the same navigation simulated in nighttime.”

The idea to use virtual reality to assess glaucoma came to Leung and colleagues back in 2016, Leung said, when the Oculus Rift VR headset hit the market. The investigators used that device and its attendant development kit to create and validate different virtual reality environments through which they could assess the particular impairments of people with vision problems.

Leung said it’s often difficult for clinicians to fully appreciate the specific ways in which glaucoma affects the vision and daily function of patients. He said the simulations in the study help to lend context.

“VR simulations have bridged the disconnect between patients and clinicians, enabling both parties to understand the disparities of disability in daytime and nighttime conditions,” he said.

Leung and colleagues hope virtual reality will one day become a regular part of patient assessment. If it does, their technology could be at the forefront; the team has already filed a patent for the concept.


Lam AKN, To E, Weinreb RN, et al. Use of virtual reality simulation to identify vision-related disability in patients with glaucoma [published online March 19, 2020]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2020.0392.

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