Diagnostic performance of pupil perimetry in detecting hemianopia under standard and virtual reality viewing conditions

Brendan Portengen; Saskia Imhof; Marnix Naber; Giorgio Porro

doi:10.1007/s00417-024-06641-4

Diagnostic performance of pupil perimetry in detecting hemianopia under standard and virtual reality viewing conditions

Brendan Portengen^*, Saskia Imhof, Marnix Naber, Giorgio Porro

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Purpose: To determine the diagnostic performance and reliability of two pupil perimetry (PP) methods in homonymous hemianopia.

Methods: This cross-sectional monocenter cohort study performed gaze-contingent flicker PP (gcFPP) and a virtual reality version of gcFPP (VRgcFPP) twice on separate occasions in all patients suffering from homonymous hemianopia due to neurological impairment. The main outcomes were (1) test accuracy and (2) test–retest reliability: (1) was measured through area under the receiver operating characteristics curve (AUC) calculation of (VR)gcFPP results with comparators being SAP and healthy controls, respectively; (2) was evaluated by comparing tests 1 and 2 of both methods within patients.

Results: Both gcFPP and VRgcFPP were performed in 15 patients (12 males, M_Age = 57, SD_Age = 15) and 17 controls (6 males, M_Age = 53, SD_Age = 12). Mean test accuracy was good in separating damaged from intact visual field regions (gcFPP: M_auc = 0.83, SD_auc = 0.09; VRgcFPP: M_auc = 0.69, SD_auc = 0.13) and in separating patients from controls (gcFPP: M_auc = 0.92, SD_auc = 0.13; VRgcFPP: M_auc = 0.96, SD_auc = 0.15). A high test–retest reliability was found for the proportion intact versus damaged visual field (gcFPP: r = 0.95, P <.001, VRgcFPP: r = 1.00, P <.001).

Conclusions: Overall, these results can be summarized as follows: (1) the comparison of pupil response amplitudes between intact versus damaged regions per patient indicate that gcFPP allows for cleaner imaging of intact versus damaged visual field regions than VRgcFPP, (2) the comparisons of average differences in intact versus damaged amplitudes between patients and controls demonstrate high diagnostic performance of both gcFPP and VRgcFPP, and (3) the test–retest reliabilities confirm that both gcFPP and VRgcFPP reliably and consistently measure defects in homonymous hemianopia.

Key messages:
What is known
• Standard automated perimetry is the current gold standard for visual field examination, but not always suited for the evaluation of the VF in neurologically impaired patients.
• Pupil perimetry consists of the measurement of pupillary responses to light stimuli as a measure of visual sensitivity.
What is new
• This study reports the highest diagnostic accuracy of pupil perimetry so far in patients with homonymous hemianopia.
• Gaze-contingent flicker pupil perimetry reliably and consistently measures defects in homonymous hemianopia under standard and virtual reality viewing conditions.

Original language	English
Pages (from-to)	537–546
Number of pages	10
Journal	Graefe's Archive for Clinical and Experimental Ophthalmology
Volume	263
Issue number	2
Early online date	18 Sept 2024
DOIs	https://doi.org/10.1007/s00417-024-06641-4
Publication status	Published - 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Funding

This study was funded by: the ODAS foundation (grant number 2017-03), the Rotterdamse Stichting Blindenbelangen (grant number B20170004), the F.P. Fischer Foundation (grant number 170511]) and a grant from the Janivo Foundation (grant number 2017170). M.N. is supported by a grant from UitZicht (grant 2018-10, fund involved: Rotterdamse Stichting Blindenbelangen).

Funders	Funder number
ODAS foundation	2017-03
Rotterdamse Stichting Blindenbelangen	B20170004
F.P. Fischer Foundation	170511
Janivo Foundation	2017170
UitZicht	2018-10

Keywords

Perimetry
Pupillometry
Scotoma
Virtual reality
Visual field

Access to Document

10.1007/s00417-024-06641-4Licence: CC BY

s00417-024-06641-4Final published version, 1.64 MBLicence: CC BY

Cite this

@article{39b88d38c4324a2c86b3f588db1ba0ed,

title = "Diagnostic performance of pupil perimetry in detecting hemianopia under standard and virtual reality viewing conditions",

abstract = "Purpose: To determine the diagnostic performance and reliability of two pupil perimetry (PP) methods in homonymous hemianopia. Methods: This cross-sectional monocenter cohort study performed gaze-contingent flicker PP (gcFPP) and a virtual reality version of gcFPP (VRgcFPP) twice on separate occasions in all patients suffering from homonymous hemianopia due to neurological impairment. The main outcomes were (1) test accuracy and (2) test–retest reliability: (1) was measured through area under the receiver operating characteristics curve (AUC) calculation of (VR)gcFPP results with comparators being SAP and healthy controls, respectively; (2) was evaluated by comparing tests 1 and 2 of both methods within patients. Results: Both gcFPP and VRgcFPP were performed in 15 patients (12 males, MAge = 57, SDAge = 15) and 17 controls (6 males, MAge = 53, SDAge = 12). Mean test accuracy was good in separating damaged from intact visual field regions (gcFPP: Mauc = 0.83, SDauc = 0.09; VRgcFPP: Mauc = 0.69, SDauc = 0.13) and in separating patients from controls (gcFPP: Mauc = 0.92, SDauc = 0.13; VRgcFPP: Mauc = 0.96, SDauc = 0.15). A high test–retest reliability was found for the proportion intact versus damaged visual field (gcFPP: r = 0.95, P <.001, VRgcFPP: r = 1.00, P <.001). Conclusions: Overall, these results can be summarized as follows: (1) the comparison of pupil response amplitudes between intact versus damaged regions per patient indicate that gcFPP allows for cleaner imaging of intact versus damaged visual field regions than VRgcFPP, (2) the comparisons of average differences in intact versus damaged amplitudes between patients and controls demonstrate high diagnostic performance of both gcFPP and VRgcFPP, and (3) the test–retest reliabilities confirm that both gcFPP and VRgcFPP reliably and consistently measure defects in homonymous hemianopia. Key messages: What is known• Standard automated perimetry is the current gold standard for visual field examination, but not always suited for the evaluation of the VF in neurologically impaired patients. • Pupil perimetry consists of the measurement of pupillary responses to light stimuli as a measure of visual sensitivity. What is new • This study reports the highest diagnostic accuracy of pupil perimetry so far in patients with homonymous hemianopia. • Gaze-contingent flicker pupil perimetry reliably and consistently measures defects in homonymous hemianopia under standard and virtual reality viewing conditions.",

keywords = "Perimetry, Pupillometry, Scotoma, Virtual reality, Visual field",

author = "Brendan Portengen and Saskia Imhof and Marnix Naber and Giorgio Porro",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2025",

doi = "10.1007/s00417-024-06641-4",

language = "English",

volume = "263",

pages = "537–546",

journal = "Graefe's Archive for Clinical and Experimental Ophthalmology",

issn = "0721-832X",

publisher = "Springer Verlag",

number = "2",

}

TY - JOUR

T1 - Diagnostic performance of pupil perimetry in detecting hemianopia under standard and virtual reality viewing conditions

AU - Portengen, Brendan

AU - Imhof, Saskia

AU - Naber, Marnix

AU - Porro, Giorgio

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2025

Y1 - 2025

N2 - Purpose: To determine the diagnostic performance and reliability of two pupil perimetry (PP) methods in homonymous hemianopia. Methods: This cross-sectional monocenter cohort study performed gaze-contingent flicker PP (gcFPP) and a virtual reality version of gcFPP (VRgcFPP) twice on separate occasions in all patients suffering from homonymous hemianopia due to neurological impairment. The main outcomes were (1) test accuracy and (2) test–retest reliability: (1) was measured through area under the receiver operating characteristics curve (AUC) calculation of (VR)gcFPP results with comparators being SAP and healthy controls, respectively; (2) was evaluated by comparing tests 1 and 2 of both methods within patients. Results: Both gcFPP and VRgcFPP were performed in 15 patients (12 males, MAge = 57, SDAge = 15) and 17 controls (6 males, MAge = 53, SDAge = 12). Mean test accuracy was good in separating damaged from intact visual field regions (gcFPP: Mauc = 0.83, SDauc = 0.09; VRgcFPP: Mauc = 0.69, SDauc = 0.13) and in separating patients from controls (gcFPP: Mauc = 0.92, SDauc = 0.13; VRgcFPP: Mauc = 0.96, SDauc = 0.15). A high test–retest reliability was found for the proportion intact versus damaged visual field (gcFPP: r = 0.95, P <.001, VRgcFPP: r = 1.00, P <.001). Conclusions: Overall, these results can be summarized as follows: (1) the comparison of pupil response amplitudes between intact versus damaged regions per patient indicate that gcFPP allows for cleaner imaging of intact versus damaged visual field regions than VRgcFPP, (2) the comparisons of average differences in intact versus damaged amplitudes between patients and controls demonstrate high diagnostic performance of both gcFPP and VRgcFPP, and (3) the test–retest reliabilities confirm that both gcFPP and VRgcFPP reliably and consistently measure defects in homonymous hemianopia. Key messages: What is known• Standard automated perimetry is the current gold standard for visual field examination, but not always suited for the evaluation of the VF in neurologically impaired patients. • Pupil perimetry consists of the measurement of pupillary responses to light stimuli as a measure of visual sensitivity. What is new • This study reports the highest diagnostic accuracy of pupil perimetry so far in patients with homonymous hemianopia. • Gaze-contingent flicker pupil perimetry reliably and consistently measures defects in homonymous hemianopia under standard and virtual reality viewing conditions.

AB - Purpose: To determine the diagnostic performance and reliability of two pupil perimetry (PP) methods in homonymous hemianopia. Methods: This cross-sectional monocenter cohort study performed gaze-contingent flicker PP (gcFPP) and a virtual reality version of gcFPP (VRgcFPP) twice on separate occasions in all patients suffering from homonymous hemianopia due to neurological impairment. The main outcomes were (1) test accuracy and (2) test–retest reliability: (1) was measured through area under the receiver operating characteristics curve (AUC) calculation of (VR)gcFPP results with comparators being SAP and healthy controls, respectively; (2) was evaluated by comparing tests 1 and 2 of both methods within patients. Results: Both gcFPP and VRgcFPP were performed in 15 patients (12 males, MAge = 57, SDAge = 15) and 17 controls (6 males, MAge = 53, SDAge = 12). Mean test accuracy was good in separating damaged from intact visual field regions (gcFPP: Mauc = 0.83, SDauc = 0.09; VRgcFPP: Mauc = 0.69, SDauc = 0.13) and in separating patients from controls (gcFPP: Mauc = 0.92, SDauc = 0.13; VRgcFPP: Mauc = 0.96, SDauc = 0.15). A high test–retest reliability was found for the proportion intact versus damaged visual field (gcFPP: r = 0.95, P <.001, VRgcFPP: r = 1.00, P <.001). Conclusions: Overall, these results can be summarized as follows: (1) the comparison of pupil response amplitudes between intact versus damaged regions per patient indicate that gcFPP allows for cleaner imaging of intact versus damaged visual field regions than VRgcFPP, (2) the comparisons of average differences in intact versus damaged amplitudes between patients and controls demonstrate high diagnostic performance of both gcFPP and VRgcFPP, and (3) the test–retest reliabilities confirm that both gcFPP and VRgcFPP reliably and consistently measure defects in homonymous hemianopia. Key messages: What is known• Standard automated perimetry is the current gold standard for visual field examination, but not always suited for the evaluation of the VF in neurologically impaired patients. • Pupil perimetry consists of the measurement of pupillary responses to light stimuli as a measure of visual sensitivity. What is new • This study reports the highest diagnostic accuracy of pupil perimetry so far in patients with homonymous hemianopia. • Gaze-contingent flicker pupil perimetry reliably and consistently measures defects in homonymous hemianopia under standard and virtual reality viewing conditions.

KW - Perimetry

KW - Pupillometry

KW - Scotoma

KW - Virtual reality

KW - Visual field

UR - http://www.scopus.com/inward/record.url?scp=85204202525&partnerID=8YFLogxK

U2 - 10.1007/s00417-024-06641-4

DO - 10.1007/s00417-024-06641-4

M3 - Article

AN - SCOPUS:85204202525

SN - 0721-832X

VL - 263

SP - 537

EP - 546

JO - Graefe's Archive for Clinical and Experimental Ophthalmology

JF - Graefe's Archive for Clinical and Experimental Ophthalmology

IS - 2

ER -

Diagnostic performance of pupil perimetry in detecting hemianopia under standard and virtual reality viewing conditions

Abstract

Bibliographical note

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Cite this