Evaluation of a Novel Virtual Reality Simulated Alternate Cover Test to Assess Strabismus: A Prospective, Masked Study

A sensorimotor examination is the gold standard for strabismus diagnosis and quantification but requires a highly skilled examiner and may be limited by a child's cooperation. Virtual reality (VR) employs eye-tracking technology to monitor eye position and may be able to measure strabismus. The...

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Bibliographic Details
Published in:American journal of ophthalmology 2024-09
Main Authors: Mori, Diego Martinez, Kuchhangi, Ashika, Tame, Jessica, Cooper, Karen, Hajkazemshirazi, Leila, Indaram, Maanasa, Keenan, Jeremy, Oatts, Julius T.
Format: Article
Language:English
Subjects:
pediatric ophthalmology
sensorimotor examination
Strabismus
virtual reality
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Summary:A sensorimotor examination is the gold standard for strabismus diagnosis and quantification but requires a highly skilled examiner and may be limited by a child's cooperation. Virtual reality (VR) employs eye-tracking technology to monitor eye position and may be able to measure strabismus. The aim of this study was to assess a prototype VR-simulated alternate cover test to detect and measure strabismus. Prospective, masked diagnostic test study. Patients aged 5-18 years with visual acuity of 20/80 or better were prospectively enrolled to undergo strabismus measurements using a VR simulated alternate cover test (Olleyes, Inc., Summit NJ) followed by an alternate cover test performed by a masked pediatric ophthalmologist or orthoptist. The main outcome measure was correlation between gold standard and VR-obtained strabismus measurements (in prism diopters [PD]) in primary gaze at near using Pearson correlation coefficients and Bland-Altman analysis with limits of agreement (LOA). A secondary measure was the diagnostic accuracy for the VR headset to detect strabismus. A total of 85 participants were enrolled, mean ± standard deviation age was 10.8 ± 3.8 years, 45.9% (39/85) male. 40.0% (34/85) had strabismus: 17.7% (15/85) esotropia, 22.4% (19/85) exotropia, and 5.9% (5/85) vertical strabismus. 52.9% (18/34) of strabismus was intermittent. The overall correlation between VR and gold standard strabismus measurements was moderate but significant (r=0.42, 95% CI 0.22, 0.58, p
ISSN:0002-9394
1879-1891
1879-1891
DOI:10.1016/j.ajo.2024.08.042