Portable hardware & software technologies for addressing ophthalmic health disparities: A systematic review

Evaluating the Diagnostic Accuracy of a Portable, Motorized, and Remotely Controlled Slit Lamp Imaging Adaptor Prototype for Head-Mounted Displays

Purpose

The purpose of this study was to validate the performance of a portable and remotely controlled slit lamp imaging adaptor.

Methods

Twenty patients with anterior eye segment conditions participated in a randomized masked clinical trial. Imaging was performed using a Haag-Streit AG, BX 900 slit lamp biomicroscope and a new slit lamp prototype. Three ophthalmologists independently reviewed masked and randomized 2D images from both instruments and conducted physical eye examinations based on these images. Inter- and intra-grader reliability were assessed using kappa statistics, and sensitivity and specificity were determined with reference to the clinical eye examinations performed during the patients' visits.

Results

The sensitivity and specificity of the evaluations with the prototype were 47.8% and 64.1%. Similarly, the evaluations from the conventional system obtained a sensitivity and specificity of 49.5% and 66.2%. The differences in the sensitivity and specificity between imaging modalities were not statistically significant (P > 0.05). The intra-grader reliability showed moderate to substantial agreement between the systems (κ = 0.522-0.708). The inter-grader reliability also indicated moderate agreement for the evaluations with the conventional system (κ = 0.552) and the prototype (κ = 0.474).

Conclusions

This study presents a new prototype that exhibits diagnostic accuracy on par with conventional slit lamps and moderate reliability. Further studies with larger sample sizes are required to characterize the prototype's performance. However, its remote functionality and accessibility suggest the potential to extend eye care.

Translational Relevance

The development of portable and remotely controlled eye imaging systems will enhance teleophthalmology services and broaden access to eye care at the primary care level.

Virtual Reality Hemifield Measurements for Corrective Surgery Eligibility in Ptosis Patients: A Pilot Clinical Trial

Purpose

We developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis.

Methods

In a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients' Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities.

Results

VR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = -0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P < 0.05; MCHT P < 0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P < 0.01), speed (P < 0.001), and overall experience (P < 0.01).

Conclusions

This pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment.

Translational Relevance

In this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.