By Jane Ehrhardt  

Gaming has led to a new diagnostic tool for glaucoma. What normally has required a $35,000 to $50,000 machine to measure peripheral vision can now be done with a $10,000 piece of headgear. “ We&rsquo're starting to use virtual-reality headsets,” says ophthalmologist Lindsay Rhodes, MD, MSPH, with TriaVision. “It just takes a few minutes to check patients’ peripheral vision.”

For decades, the gold standard for measuring peripheral vision, where glaucoma strikes first, has been administered through a bulky desktop device. As the patient stares straight ahead with her head kept stationary in a chin support, it tests one eye at a time with flashes of light that go off in various areas of her peripheral vision. The patient presses a button each time she thinks she sees a light.

Called perimetry, the mapping of the peripheral threshold tests the functional behavior of the optic nerve to help determine the extent of glaucoma, along with some neurological and retinal diseases. “In the last five years, there has been a huge increase in companies trying to create these virtual reality headsets and goggles,” says Rhodes, who holds a fellowship in glaucoma.

The devices use the familiar gaming VR equipment, but are loaded with the perimetry software. The process is shorter, and the freedom of movement with the headset alleviates common physical problems for older or obese patients, or those with neck or back conditions, or mobility issues.

“With the old equipment, some people would fall asleep, because the test is long and boring,” Rhodes says. “But it only takes a few minutes to check their peripheral vision using the new headset. With the ease, speed, and affordability provided by VR, optometrists are now performing perimetry tests. I could see a primary care office wanting to get these.”

Screening by primary care physicians could be a game-changer for spotting glaucoma. “The biggest thing about glaucoma is that it’s often diagnosed late and when that happens, you can’t undo the damage or recover the vision that’s been lost,” Rhodes says.

Because it’s such a slow disease, patients rarely notice any problem with their vision until late in the disease course. That means questioning patients about their vision during routine exams by primary care physicians is unlikely to uncover potential glaucoma.

“The best thing primary care physicians can do is to ask their patient about the family history of eye diseases and glaucoma specifically,” Rhodes says. “Because if there’s a direct relative who has it, that increases the risk of glaucoma by four to nine times. People of African, Hispanic, or Asian descent all have six to eight times higher risk of glaucoma than Caucasians.

“Anyone over 60 of any race runs a six-time higher risk of harboring the disease as well. Most of the diseases of the eye are diseases of aging—cataracts, macular degeneration, glaucoma. So if your patient is 60 or older, I recommend they get an eye exam.”

The goggles do hold some limitations. There isn’t much long-term data on how well they perform in various stages of glaucoma. For early detection screening, the VR system works well, but has yet to prove itself in the more sensitive monitoring of people with severe glaucoma.

Treatments for glaucoma have also taken a new leap. “There have been some awesome five-year studies on the long-term effects of laser for glaucoma, and those are really exciting,” Rhodes says.

While daily eye drops to lower the fluid pressure in the eye have been the first line of long-term treatment for glaucoma, in recent studies the laser has been shown to outperform eye drops over a longer period. Laser procedures adjust the flow or production of fluid in the eye by changing the architecture of the drainage system, or trabecular meshwork, to maintain a consistent healthy pressure.

“There are also new procedures called minimally invasive glaucoma surgeries,” Rhodes says. “The various new options in diagnosing and treatment are particularly needed with glaucoma. There are little nuances with each person’s glaucoma. Every case is just totally different. That’s the art of treating glaucoma.”