# Patient Comfort, Acceptance, and Tolerability of Virtual Reality (VR) Headsets with Real-Time Eye Tracking for Remote Visual Field Testing

## TL;DR

This study shows that using VR headsets with eye tracking for vision tests at home is comfortable and well accepted by users, with only mild side effects.

## Contribution

The study introduces a novel approach to remote visual field testing using VR headsets with real-time eye tracking, demonstrating its tolerability and user acceptance.

## Key findings

- Home-based VR visual field testing was reported as highly comfortable with a mean score of 8.75 out of 10.
- Real-time eye tracking showed strong correlation with traditional reliability markers like false negative responses.
- Most subjects (91.7%) found the VR device easy to use and would be willing to repeat the test at home.

## Abstract

Objectives: Visual field (VF) testing is key to assessing functional loss in glaucoma. Despite its clinical value, traditional VF testing has a number of limitations, including its dependency on medical equipment and posturing requirements. The present study examines the acceptance, tolerability, and comfort of home-based VF testing using a virtual reality (VR) headset. Method: Healthy subjects were prospectively enrolled to undergo VF examination in a non-clinical setting using a commercially available stereoscopic VR headset and SORS (sequentially optimized reconstruction strategy) on the VisionOne platform. Subjects were supervised and wore their own spectacles within the headset. After the VR VF test, they were asked about their comfort, side effects, and readiness to repeat the examination at home. Results: Of the 12 subjects enrolled, 7 were female (58.3%) and 5 were male (41.7%). Mean age was 45 years (range: 30–68). While none of the subjects suffered from glaucoma, their medical histories included severe arthritis, refractive surgery, high myopia, amblyopia, and esotropia. The mean self-reported comfort score was 8.75 out of 10 (range: 8–10), with some subjects taking the test in the dorsal decubitus position. Eleven subjects (91.7%) considered the device to be easy to use, and 100% responded that they would be willing to repeat the test at home, of which 41.7% stated they would prefer to be supervised by a clinician. Overall, three subjects reported mild side effects, namely light asthenopia, epiphora, and periocular flushing. All side effects were mild and self-limited. The mean perceived duration of the test (187 s) correlated strongly with the mean actual duration (166 s; Pearson correlation coefficient r = 0.76, p-value = 0.007). In all, 58.3% of perceived durations were shorter than the actual test durations. Mean false negative and false positive responses were 3.75% and 4.7%, respectively. Central fixation recorded by real-time eye tracking was maintained on average 73.23% of the time and showed a strong correlation with false negative responses (r = 0.75; p = 0.026). Conclusions: While the present study did not examine the test algorithm itself, it suggests that home-based VF testing using a VR headset is well tolerated and accepted, with high levels of self-reported comfort and only mild side effects. While all subjects welcomed the opportunity to perform clinical tests from home, over a third expressed a preference for supervision. Real-time eye tracking correlated well with traditional reliability markers, suggesting potential clinical value.