VR Perimetry - A Ball of Confusion.

Virtual reality was designed for games and entertainment, but how about as a multi-functional diagnostic eye care device?

There are a growing number of companies urging you to consider the idea of “VR Perimetry”, visual fields performed with a Virtual Reality (VR) headset. Price points are all over the place and there is no general agreement on the best value and where it should fit into your practice. To take a phrase from the Temptations, it’s a Ball of Confusion at the moment.

Should you consider VR perimetry for your practice?

The answer is….it depends.

There are several different types of VR headsets, starting with the original devices on the Oculus Quest 2 , a consumer device now owned by Facebook. 

If you still haven’t tried one, you should experience it. It is mostly used for games and entertainment, but it is easy to see how this technology can evolve into a multi-functional diagnostic eye care screening device.

Can it replace your current perimeter? 

First, if you are using a conventional bowl perimeter (such as the HFA, Octopus or Optopol) and are looking to replace it with a newer one, this is probably not your ideal new perimeter. 

VR perimeters are not conventional visual field devices, but more of a mobile screening tool.  If space is somewhat an issue in your practice but you still want a conventional perimeter for a similar price, look for the newer models such as the Optopol PTS 925, which is a compact, full-field perimeter.

However, if you do not have any room for a conventional device or if you are looking for a complementary device that allows you to test those with limited mobility, pediatrics or set up off-site screenings, VR perimeters may be a good fit.

“I have to put that on my head?”

The non-conventional part of the equation is that some of your patients that need visual fields have never experienced a VR device and at first, it can be uncomfortable and intimidating. 

Despite the cost savings and mobility factor, if you have a practice with many older patients, having to force this learning curve on them is probably not worth the benefit.

There are limitations to the current technology.

These limitations have led to a significant device return rate from customers with higher expectations.
Some of the devices have eye tracking, but they do not provide a live video eye monitor to allow the operator to witness alignment and fixation. Most cannot perform peripheral testing outside of 30 degrees or progression analysis. Also, some eye care professionals that you refer to may not be comfortable with VR based fields.

Of course, for the more complex testing such as kinetic, blue/yellow, larger stimulus sizes for low vision, peripheral testing such as for ptosis, etc., you will need to use a conventional perimeter.

What is the cost for a Visual Field VR headset?

The pricing for these units ranges between $8,000.00 – $15,000.00, yes, this is a wide swing that adds to the market confusion. 

The low end is somewhat reasonable, the same or more than some smaller screening devices such as the Zeiss FDT, Oculus Easyfield, etc. 

However, the higher priced devices are hitting a price point of a more conventional perimeter such as the Optopol PTS 925 or Octopus Model 600 basic. 

You need to ask yourself if the mobility of the VR device makes up for what you will miss with a conventional visual field unit.

One might ask, if I can buy the latest Oculus Quest 2 for $299.00, why is a VR visual field priced at thousands more?

In the case of the Oculus Quest, one of the reasons is that Facebook wants their users to use the technology for games and cares about the broader consumer market. For this reason, they charge vendors who use the unit for specific niche applications a large premium in order to do this.

VR or AR based systems?

In the current market, some now offer a higher end android unit manufactured by PICO that offers eye alignment and additional screening features for contrast sensitivity, acuity, red/green testing, etc. Others such as HERU offer an “augmented reality” (AR) device based on the Magic Leap One manufactured by Magic Leap.
These AR systems allow for more features not available using strictly VR technology. With these new technologies and additional features come even higher price points.

Which vendors sell VR based perimeters?

Most major distributors have a VR unit that they offer and the list is growing. One reason for this is that there is a very low barrier to entry. The patent situation for VR based perimetry is murky and the technology is not difficult to develop, thus, several vendors with different products creates more confusion for the Eye Care Professional.
Currently, no conventional perimetry manufacturer (Zeiss, Haag-Streit, Optopol) is offering a VR option, although most distributors have a model they are offering, such as the M&S offered by Walman, the Virtual Field offered by Lombart and the OllEYES VisuALL VR perimeter offered by Marco.

Here’s the bottom line…

VR technology is very exciting and will lead to multi-functional diagnostic devices for eye care professionals in the coming years.
The current units are great for screening in practices with primarily younger patients and also give you a tool for remote screening if that makes sense to drive business to your practice.
For the lower priced units, it is suggested these be used as screeners for all your patients and at events in which you can test patients remotely to uncover pathology.
For the higher priced units such as OllEYES VisuALL and HERU, you need to carefully weigh the additional benefits of portability and added screening tests to that of purchasing a new conventional perimeter for the same price.

Remember a good rule of business…it’s OK to be on the cutting edge of technology, just not the bleeding edge.

Bob Padula

Bob Padula

President | Optopol USA

One of the leading experts in the U.S. ophthalmic device industry.

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