Wenner Yaroslava, Schneider Johann, Drisser Timo, Yang Yu Yi, Demeter Thilo, Fronius Maria, Lorenz Birgit, Kohnen Thomas, Müller Michael, Triesch Jochen
Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany.
Graefes Arch Clin Exp Ophthalmol. 2025 May;263(5):1435-1442. doi: 10.1007/s00417-024-06724-2. Epub 2025 Jan 6.
Our study presents a virtual reality-based tangent screen test (VTS) to measure subjective ocular deviations including torsion in nine directions of gaze. The test was compared to the analogous Harms tangent screen test (HTS).
We used an Oculus Go controller and head-mounted-display with rotation sensors to measure patient's head orientation for the VTS. The software was developed with Unity. We assessed subjective squint angles of adult patients with eye motility disorders of different origin in nine positions of gaze by means of HTS and VTS. We calculated mean difference, 95% limits of agreement and intraclass correlations (ICC) for horizontal, vertical and torsional deviations.
We included 85 patients. Measured horizontal and vertical deviations showed very good agreement between the two methods in all gaze directions (horizontal and vertical ICC: 0.93-0.98). Agreement was lower for torsional deviations (ICC: 0.79-0.93). The mean difference in primary position was 1.5° (95% limits of agreement -3.5° to 6.5°) for horizontal, 0° (-2,7° to 2,7°) for vertical, and 0.3° (-4.0° to 3.0°) for torsional deviations. The average examination time was 6 min with the VTS compared to 15 min with the HTS.
Vertical and horizontal deviations showed good agreement between both tests measuring a slightly higher esodeviation with VTS probably due to an increased vergence demand. Measurement of torsional misalignment would benefit from a controller with more holding stability, such as a PC-mouse with central wheel, facilitating fine adjustments. VTS allowed automatic documentation, required less time and was easier to use than HTS.
What is known The incidence of neurogenic diplopia increases in the ageing population. The Harms tangent screen test (HTS) reliably measures subjective ocular deviations in patients with diplopia. The HTS requires staff well-trained in orthoptics limiting its use. What is new A novel virtual reality-based tangent screen test (VTS) enables measurement of horizontal, vertical and torsional ocular misalignment and shows a good comparability to the HTS. VTS uses commercially available head-mounted-display and controller, and specifically developed software, requires less time than HTS and allows automatic documentation. VTS administration does not require orthoptic training and can eventually be implemented in a clinical setting to provide a wider availability of subjective squint angle measurements.
我们的研究提出了一种基于虚拟现实的切线屏测试（VTS），用于测量包括九个注视方向扭转在内的主观眼位偏差。将该测试与类似的哈姆斯切线屏测试（HTS）进行比较。
我们使用Oculus Go控制器和带有旋转传感器的头戴式显示器来测量VTS中患者的头部方向。该软件是用Unity开发的。我们通过HTS和VTS评估了不同病因的成人眼球运动障碍患者在九个注视位置的主观斜视角度。我们计算了水平、垂直和扭转偏差的平均差异、95%一致性界限和组内相关性（ICC）。
我们纳入了85名患者。在所有注视方向上，两种方法测得的水平和垂直偏差显示出非常好的一致性（水平和垂直ICC：0.93 - 0.98）。扭转偏差的一致性较低（ICC：0.79 - 0.93）。在初始位置，水平偏差的平均差异为1.5°（95%一致性界限为 - 3.5°至6.5°），垂直偏差为0°（ - 2.7°至2.7°），扭转偏差为0.3°（ - 4.0°至3.0°）。VTS的平均检查时间为6分钟，而HTS为15分钟。
垂直和水平偏差在两种测试之间显示出良好的一致性，VTS测得的内斜视偏差略高，可能是由于聚散需求增加。扭转斜视的测量将受益于具有更高握持稳定性的控制器，如带有中心滚轮的电脑鼠标，便于精细调整。VTS允许自动记录，所需时间更少，且比HTS更易于使用。
已知内容：神经源性复视的发病率在老年人群中增加。哈姆斯切线屏测试（HTS）能可靠地测量复视患者的主观眼位偏差。HTS需要受过斜视训练的工作人员，限制了其使用。新内容：一种新型的基于虚拟现实的切线屏测试（VTS）能够测量水平、垂直和扭转性眼位不正，并且与HTS具有良好的可比性。VTS使用市售的头戴式显示器和控制器，以及专门开发的软件，比HTS所需时间更少，并允许自动记录。VTS的实施不需要斜视训练，最终可在临床环境中实施，以提供更广泛的主观斜视角度测量服务。
