Virtual Reality Simulation to Identify Vision-Associated Disability in Patients With Glaucoma

Autor: Ken Wu, Timothy P H Cheng, Christopher Kai-Shun Leung, Xiu Juan Zhang, Alexander Lam, Robert N. Weinreb, Philip Yawen Guo, Gilda Lai, Vivian Chiu, Heather Kayew Mak, Elaine To, Marco Yu
Rok vydání: 2020
Předmět:
Male
Activities of daily living
Visual acuity
genetic structures
Cross-sectional study
Visual Acuity
Glaucoma
01 natural sciences
Disability Evaluation
0302 clinical medicine
Sickness Impact Profile
Surveys and Questionnaires
Activities of Daily Living
Original Investigation
Vision
Binocular
Stair climbing
Hazard ratio
Virtual Reality
Middle Aged
Female
medicine.symptom
Glaucoma
Angle-Closure
Glaucoma
Open-Angle
Adult
medicine.medical_specialty
Visual impairment
Vision Disorders
MEDLINE
Virtual reality
03 medical and health sciences
medicine
Humans
Computer Simulation
In patient
0101 mathematics
Intraocular Pressure
Decibel
Aged
business.industry
010102 general mathematics
medicine.disease
eye diseases
Ophthalmology
Cross-Sectional Studies
030221 ophthalmology & optometry
Physical therapy
Optometry
Visual Fields
Vision Disability
business
Zdroj: JAMA Ophthalmol
ISSN: 2168-6165
DOI: 10.1001/jamaophthalmol.2020.0391
Popis: Importance Clinical assessment of vision-related disability is hampered by the lack of instruments to assess visual performance in real-world situations. Interactive virtual reality (VR) environments displayed in a binocular stereoscopic VR headset have been designed, presumably simulating day-to-day activities to evaluate vision-related disability. Objective To investigate the application of VR to identify vision-related disability in patients with glaucoma. Design, Setting, and Participants In a cross-sectional study, 98 patients with glaucoma and 50 healthy individuals were consecutively recruited from a university eye clinic; all participants were Chinese. The study was conducted between August 30, 2016, and July 31, 2017; data analysis was performed from December 1, 2017, to October 30, 2018. Exposures Measurements of visual acuity, contrast sensitivity, visual field (VF), National Eye Institute 25-item Visual Function Questionnaire Rasch score, and VR disability scores determined from 5 VR simulations: supermarket shopping, stair and city navigations in daytime, and stair and city navigations in nighttime. Duration required to complete the simulation, number of items incorrectly identified, and number of collisions were measured to compute task-specific and overall VR disability scores. Vision-related disability was identified when the VR disability score was outside the normal age-adjusted 95% confidence region. Main Outcomes and Measures Virtual reality disability score. Results In the 98 patients with glaucoma, mean (SD) age was 49.8 (11.6) years and 60 were men (61.2%); in the 50 healthy individuals, mean (SD) age was 48.3 (14.8) years and 16 were men (32.0%). The patients with glaucoma had different degrees of VF loss (122 eyes [62.2%] had moderate or advanced VF defects). The time required to complete the activities by patients with glaucoma vs healthy individuals was longer by 15.2 seconds (95% CI, 5.5-24.9 seconds) or 34.1% (95% CI, 12.4%-55.7%) for the shopping simulation, 72.8 seconds (95% CI, 23.0-122.6 seconds) or 33.8% (95% CI, 10.7%-56.9%) for the nighttime stair navigation, and 38.1 seconds (95% CI, 10.9-65.2 seconds) or 30.8% (95% CI, 8.8%-52.8%) for the nighttime city navigation. The mean (SD) duration was not significantly different between the glaucoma and healthy groups in daytime stair (203.7 [93.7] vs 192.9 [89.1] seconds,P = .52) and city (118.7 [41.5] vs 117.0 [52.3] seconds,P = .85) navigation. For each decibel decrease in binocular VF sensitivity, the risk of collision increased by 15% in nighttime stair (hazard ratio [HR], 1.15; 95% CI, 1.08-1.22) and city (HR, 1.15; 95% CI, 1.08-1.23) navigations. Fifty-eight patients (59.1%) with glaucoma had vision-related disability in at least 1 simulated daily task; a higher proportion of patients had vision-related disability in nighttime city (27 of 88 [30.7%]) and stair (27 of 90 [30.0%]) navigation than in daytime city (7 of 88 [8.0%]) and stair (19 of 96 [19.8%]) navigation. The overall VR disability score was associated with the National Eye Institute 25-item Visual Function Questionnaire Rasch score (R2 = 0.207). Conclusions and Relevance These findings suggest that vision-related disability is associated with lighting condition and task in patients with glaucoma. Virtual reality may allow eye care professionals to understand the patients’ perspectives on how visual impairment imparts disability in daily living and provide a new paradigm to augment the assessment of vision-related disability.
Databáze: OpenAIRE
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