VR Perimetry - What’s the Verdict?
I am what is called an “early-adopter”. I was one of the first to pull the trigger on an all-electric vehicle. It was exhilarating to hit the pedal and go so fast and also fun to drive past gas stations when prices were sky-high. However, after a while, I realized we had to use our old Suburban to go on trips of any distance and I had purchased an expensive commuter car. Now the excitement has died down and the market has fallen off for all-electric vehicles. Such is the case of the VR perimeter.
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.
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 Meta.
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. (The new Topcon Tempo does not have this issue, see below).
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 $10,000.00 – $20,000.00, 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 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.
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.
Speaking of cost, one might ask, if I can buy the latest Oculus Meta Quest 3 for $499.00, why is a VR visual field priced at thousands more?
In the case of the Oculus, one of the reasons is that Meta 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.
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.
VR Hybrid
Topcon has recently released the “Topcon Tempo” perimeter, manufactured by a Japanese company called Crewt Medical Systems. The Tempo is essentially a VR perimeter with a headrest and chinrest for patient comfort. It is small and easy to use, but still an expensive screening device with no progression analysis nor peripheral testing. The price point is in the $20,000.00 range, making it an expensive screener.
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 Topcon Tempo, 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 or less.
Remember a good rule of business…it’s OK to be on the cutting edge of technology, just not the “bleeding edge”.
