A Californian-made virtual-reality visual field device has been on the wish list of many Australian optometry practice owners thanks to its compact design and impressive battery of tests. A big departure from conventional designs, how does it stack up?
Mr Michael Young is an optometrist who takes space saving to the extreme. That’s because his service model differs significantly from that of your run-of-the mill practice.
In fact, you’d be hard pressed to find his shopfront because it doesn’t exist. Instead, the mobile optometrist bases himself in public hospital rooms and community facilities, travelling around 70,000km per year to service regional towns in-land from Bundaberg, Queensland.
Places like Charleville and Monto, known as citrus and cattle towns, that he visits monthly. Towns that don’t have a population big enough to support a permanent optometrist.
Providing a full-scope optometry service, seeing around 20 patients each visit, means a full suite of equipment is hauled across the state in his SUV.
Until recently, this included squeezing in a bulky perimeter to perform visual field tests on glaucoma patients and suspects. But practising optometry this way often requires thinking outside the box, and even sourcing equipment that challenges the status quo.
He believes he has found that with the VF2000 NEO. It’s a device available through BOC Instruments incorporating complete visual field analysis and progression in a virtual realty headset, plus a host of other tests and features.
For Young, this compact, portable device is a step above conventional visual field testers in terms of space and set-up time. Importantly, it can quickly run visual field protocols and performs just as well as gold standard equipment.
Plus, it is unaffected by lighting in the room, a big advantage for someone working out of impermanent facilities shared with other visiting health professionals.
“When I saw the VF2000 Neo, I thought this is the device that ticks all the boxes,” he says.
“Its portability is the big advantage for me, plus it performs all the tests you’d expect from a normal perimeter. I mostly use it for the 24-2 protocol, the standard test used for glaucoma, but importantly when I get a result from this device, it talks the same language as the ophthalmologists I refer to. There’s no question about the validity of the results.”
Equipped with the latest internal optics, the VF2000 Neo can quickly run visual field protocols and a variety of added self-guided vision tests in rich, full-colour 4K-resolution.
But perimetry isn’t its only function, also offering visual acuity testing, contrast sensitivity, colour testing (Ishihara), D15 and advanced colour tests, stereopsis testing, eye mobility and strabismus, and with more in development.
After launching in Australia in 2023, the device has been popular among independent optometrists seeking to upgrade their technology, save space and improve the patient experience. It also took out the Optical Distributors and Manufacturers Association (ODMA) 2023 Awards of Excellence in the Optical Equipment category at O=MEGA23.
When Young performs the test – taking around two and half minutes per eye – the data is sent to a tablet PC using Bluetooth, removing the need for a WiFi connection. Test results are stored and accessed from the tablet and automatically uploaded to the cloud, meaning they can be retrieved on any PC through the Micromedinc portal.
Battery-powered, the device can also operate independently from wiring.
Young keeps it plugged into the battery charger all day. He hasn’t run it flat and doesn’t want to risk being caught short, but another optometrist previously told Insight one charge can last several days after continuous use.
Young marvels at how far perimetry has come with the VF2000 Neo, but also at the skills of optometrists who are much more critical of the optic disc and other tell-tale glaucoma signs.
“We’ve got better tools for analysing, we now have better knowledge and understanding, and we’re looking harder and smarter and finding things earlier,” he says.
“I completed my therapeutics endorsement a couple of years ago, and the more you study, the more you realise how much glaucoma is out there. I’m finding about one new case a day, and that’s scary because I wonder what have I’ve missed in the past? What have we all missed in the past?”
Young uses the VF2000 NEO when clinically indicated, either diagnosing potential glaucoma patients and referring them on, or monitoring confirmed cases referred to him from ophthalmology who are on treatment plans. While many newly diagnosed patients are glaucoma suspects, he recently came across an advanced case and had to revoke their driver licence on the spot.
The VF2000 NEO also came in handy with another patient with a severe disability who sat in an electric wheelchair operated by a hand controller.
“She couldn’t move her head, but I could stick this device on her and perform a full visual field test as she sat in a chair. It would have been very difficult to get her onto the chinrest of a conventional perimeter,” he says.
“It’s also been great to use in home visits and nursing homes, places that you just can’t set up a normal perimeter in.”
The convenience factor
New South Wales optometrist Mr Lawrence Kao has also been impressed with the way the manufacturers of the VF2000 NEO, California’s Micro Medical Devices, has achieved visual field testing quality that’s just as good than his previous system, without the ergonomic hassle.
While it has been shown to perform a reliable standard of visual field analysis, the system is also ‘Gold Standard’ Visual Field compliant with identical report format, a big plus for eyecare professionals seeking consistent test results in a progressive disease like glaucoma.
Its battery of visual field tests include full and fast threshold VF, frequency doubling technology (FDT), neuro, kinetic, ptosis and Esterman tests. And a non-fixating eye can be tested without issues because there is an option to select bilateral fixation.
Eye Tracking is also an important feature. The test pauses when patient fixation drifts and alerts both patient and operator. It then resumes once the patient re-fixates correctly, ensuring accurate test results.
Plus, AI virtual assistance can guide the patient and enables communication in multiple languages.
“Putting all these benefits together, that’s why I was happy to move into the VF2000 Neo when my old visual field system broke down, and it’s really not let me down; it does exactly as BOC promised me,” Kao says.
“It’s providing a new level of convenience. It’s not bulky, in fact it’s very high tech, patients feel very happy and are glad to do the test.
“For us as optometrists, we also don’t need to monitor if the patient isn’t complying with the test – falling asleep for example – because the machine itself reminds the patient of the need to stay alert or keep focusing by looking at the fixation target. I’m very impressed.”
His previous system didn’t have a chin rest, making it difficult to keep the patient aligned for an accurate test.
“But with the VF2000 Neo, I can see the computer is doing most of the work,” Kao says.
Beyond visual field testing, Kao has also used the Esterman test to confirm if patients can still drive, and has confirmed colour deficiencies with the VF2000 Neo.
By reinventing the way perimetry is done, it’s clear the engineers at Micro Medical Devices have captured an increasingly captive audience of Australian eyecare professionals, beyond Young and Kao.
They’re finding that it is improving every aspect of testing, from the patient experience and clinical results, to practice efficiency without compromising the accuracy of results.
For Young, it’s appealing to see a manufacturer thinking differently, with perimetry devices largely maintaining the same design since he graduated from optometry school in the 1980s.
“I’ve been in practice by myself since 1996, and I joke that I’m able to do a good job today because I’ve made just about every mistake possible – and I’ve had to pay for them,” he says.
“You learn and develop things as you go, and you make it happen, and that comes down to the equipment you carry. Visual field testing is one of them – it’s one of those things you take for granted in a fixed practice, but it makes you think hard with an optometry business like mine, and it’s great to have access now to something like the VF2000 NEO.
“The price tag isn’t insignificant, but it does a very consistent job – and I’m very pleased with what I’ve got.”
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