Structure–Function Relationship Between Optic Nerve Head Morphometry and Virtual Reality-Based Perimetry in Open-Angle Glaucoma

Purpose: To investigate the structure-function relationship between optical coherence tomography (OCT) parameters of the optic nerve head and corresponding sectorial mean sensitivity values obtained using virtual reality (VR) headset-based perimetry. Methods: In a post hoc analysis of a cross-sectional study, patients with suspected or confirmed glaucoma underwent examination with both VR-based perimetry (PalmScan VF2000; Micro Medical Device) and spectral-domain OCT (Spectralis) of the optic nerve head within an 8-week interval. Based on the Garway-Heath map, sensitivity points were assigned to the corresponding OCT sectors of the peripapillary retinal nerve fiber layer (pRNFL) and the Bruch's membrane opening-minimum rim width (BMO-MRW). Mean sensitivity values were converted to a linear scale. Structure-function correlations were assessed using Spearman's rank correlation coefficient. Results: A total of 147 eyes from 86 patients with reliable visual field tests and sufficient OCT quality were included in the analysis. VR-based perimetry showed significant correlations with the BMO-MRW in the nasal (r = 0.274; P < 0.001), inferotemporal (r = 0.581; P < 0.0001), superotemporal (r = 0.485; P < 0.0001), temporal (r = 0.471; P < 0.0001), inferonasal (r = 0.416; P < 0.0001), and superonasal (r = 0.520; P < 0.0001) sectors. For the pRNFL, significant correlations were also observed in the inferotemporal (r = 0.6581; P < 0.0001), superotemporal (r = 0.695; P < 0.0001), temporal (r = 0.473; P < 0.0001), inferonasal (r = 0.492; P < 0.0001), and superonasal (r = 0.496; P < 0.0001) sectors. The correlation in the nasal sector was also significant but weaker (r = 0.343; P < 0.0001). Conclusions: VR-based perimetry demonstrates a reliable structure-function relationship with optic nerve head morphometry. The strength of the structure-function correlation was comparable regardless of the OCT parameter used (BMO-MRW or pRNFL). This study highlights the potential of VR perimetry as an additional functional diagnostic tool in glaucoma. Translational Relevance: This study supports the clinical utility of VR-based perimetry by demonstrating its significant correlation with established OCT-derived structural biomarkers of glaucomatous damage. By bridging novel immersive diagnostic technologies with established imaging modalities, these findings lay the groundwork for more accessible, portable, and patient-friendly visual field testing in both clinical and teleophthalmology settings.