Visual field testing remains a fundamental part of glaucoma diagnosis and monitoring.
Traditionally, clinicians have relied on stationary automated perimetry systems to evaluate functional vision loss. However, virtual reality (VR) visual field testing is emerging as a more portable and patient-friendly approach.
Recent studies involving the PalmScan VF2000 provide an increasingly important question for clinicians:
““Does VR perimetry measure meaningful functional loss that corresponds with the structural damage seen on OCT?
The answer from the current evidence is encouraging.
Studies have found that VF2000 visual-field measurements demonstrate significant relationships with OCT-derived retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and optic nerve head measurements. Research has also demonstrated meaningful agreement between VR perimetry and conventional visual field testing, particularly for important global indices such as mean deviation (MD) and pattern standard deviation (PSD).
Why the Structure–Function Relationship Matters in Glaucoma
Glaucoma is both a structural and functional disease.
OCT provides structural information about tissues such as the retinal nerve fiber layer and neuroretinal rim, while visual field testing evaluates functional vision.
That means clinicians often need to interpret two different types of information:
- OCT: What structural damage is present?
- Visual field testing: How is that damage affecting visual function?
A visual field technology becomes more clinically meaningful when its functional measurements demonstrate a relationship with established structural biomarkers.
This is why recent research into VR perimetry and OCT is particularly important.
VF2000 and OCT: Evidence of a Meaningful Structure–Function Relationship
A 2026 study from the University Hospital of Cologne investigated the relationship between PalmScan VF2000 visual field sensitivity and OCT-derived optic nerve head measurements in patients with open-angle glaucoma.
The study included 147 eyes from 86 patients with reliable visual field tests and adequate OCT quality.
Researchers compared VR visual field sensitivity with two important OCT measurements:
- Bruch’s membrane opening–minimum rim width (BMO-MRW)
- Peripapillary retinal nerve fiber layer (pRNFL) thickness
The results showed statistically significant correlations across multiple anatomical sectors.
For BMO-MRW, correlations with VF2000 mean sensitivity reached:
- Inferotemporal: r = 0.581
- Superotemporal: r = 0.485
- Temporal: r = 0.471
- Inferonasal: r = 0.416
- Superonasal: r = 0.520
The global BMO-MRW correlation was r = 0.492.
The relationship with pRNFL was also significant. The strongest sectoral correlation was observed in the superotemporal sector (r = 0.695), followed by the inferotemporal sector (r = 0.658). Global pRNFL thickness showed a correlation of r = 0.584 with mean visual-field sensitivity.
These findings are important because they connect the functional information generated by VR perimetry with established structural biomarkers of glaucomatous damage.
How Does VF2000 Compare With Conventional Perimetry?
One of the most important questions is whether VR visual field testing produces information comparable to conventional standard automated perimetry (SAP).
The 2026 Germany study directly addressed this question.
Researchers compared the correlations between OCT measurements and:
- PalmScan VF2000 VR perimetry
- Conventional SAP
The results were remarkably similar across most sectors.
For example:
| OCT measurement | VF2000–OCT | SAP–OCT |
| Global BMO-MRW | 0.506 | 0.524 |
| Global RNFL | 0.587 | 0.633 |
| Inferotemporal RNFL | 0.664 | 0.647 |
| Superotemporal RNFL | 0.702 | 0.652 |
| Inferotemporal MRW | 0.581 | 0.562 |
With the exception of the superonasal RNFL sector, the differences between VR–OCT and SAP–OCT correlation strengths were not statistically significant.
This distinction matters.
The research does not demonstrate that VF2000 universally outperforms conventional perimetry. Instead, it suggests that the functional information captured by VF2000 can show a comparable structure–function relationship to conventional SAP.
That is a clinically meaningful finding for an alternative visual field technology.
Another Study Found Stronger OCT Correlations With VR Perimetry
A separate observational study involving 57 patients compared VR-based perimetry with a conventional stationary perimeter and OCT-derived RNFL and GCC measurements.
The researchers analyzed mean deviation (MD), pattern standard deviation (PSD), and other visual-field parameters.
Among patients with reliable visual-field testing, VR perimetry showed stronger correlations with several OCT measurements than conventional stationary perimetry.
For example:
MD vs. RNFL
- VR: r = 0.40, p = 0.02
- Conventional: r = 0.30, p = 0.08
MD vs. GCC
- VR: r = 0.55, p = 0.0001
- Conventional: r = 0.50, p = 0.0002
PSD vs. RNFL
- VR: r = −0.35, p = 0.03
- Conventional: r = −0.27, p = 0.09
PSD vs. GCC
- VR: r = −0.60, p = 0.0001
- Conventional: r = −0.50, p = 0.0003
The authors concluded that VR perimetry was non-inferior to stationary perimetry and demonstrated stronger structure–function correlations with OCT-derived RNFL and GCC measurements in patients with high test reliability.
This provides an important second piece of evidence: when the visual field test is reliable, VR-generated functional measurements can show strong relationships with objective retinal structure.
VF2000 and Humphrey: What Does the Research Show?
The OCT findings are not the only evidence supporting VF2000.
A University of Waterloo pilot study directly compared the PalmScan VF2000 with the Humphrey Visual Field Analyzer in 22 patients who were glaucoma suspects or had early primary open-angle glaucoma.
The study found:
- Good agreement for mean deviation (MD)
- Good agreement for pattern standard deviation (PSD)
- Moderate agreement for fixation loss
- Moderate correlation for MD and PSD
The researchers also found a significant difference in examination time.
Average test duration was approximately:
VF2000: 271 seconds
versus
Humphrey: 391 seconds
The VF2000 test was therefore approximately 120 seconds shorter in this study.
Patients also reported less fatigue and apprehension during the VR examination.
A Shorter Test Can Matter Clinically
Visual field testing requires concentration and sustained attention. Longer examinations can contribute to fatigue, which can potentially affect the quality and reliability of testing.
This is one area where VR technology may have a practical advantage.
In the University of Waterloo study, VF2000 reduced testing time while also receiving better patient-experience scores for fatigue and apprehension.
The advantage isn’t simply that a VR headset is smaller.
The potential value is that a more portable and patient-friendly testing environment may make functional visual assessment easier to integrate into different clinical workflows.
The Strongest Correlations Occur in Anatomically Relevant Regions
The Germany study also provides an interesting insight into where VF2000 measurements correlate most strongly with OCT.
The strongest relationships were generally observed in the superotemporal and inferotemporal regions.
For example, pRNFL correlation reached:
- Superotemporal: r = 0.702
- Inferotemporal: r = 0.664
The study found a weaker relationship in the nasal sector. The researchers noted that this may be related to anatomical factors, including the location of the central retinal vessel trunk.
This sector-specific pattern is important because it resembles established structure–function relationships observed with conventional perimetry.
In other words, the results aren’t simply showing a random statistical association between a VR test and OCT. The pattern of correlations follows anatomical relationships that are already relevant to glaucoma assessment.
What About Diagnostic Accuracy?
Previous research cited in the 2026 study has also reported encouraging results for PalmScan VF2000 in glaucoma classification.
One cited study reported 100% agreement with SAP classification of glaucoma versus nonglaucoma eyes, although classification of glaucoma severity was less consistent.
Another study reported that PalmScan VF2000 correctly classified glaucoma severity in 86.3% of cases, with a mean difference in MD between SAP and PalmScan of +0.62 ± 0.26 dB.
These findings should be interpreted carefully. Detecting glaucoma and accurately staging its severity are different clinical tasks, and the available studies do not establish VF2000 as a universal replacement for conventional perimetry.
Instead, the evidence supports continued investigation of VR perimetry as a clinically relevant functional testing technology.
What the Research Says About Patient Experience
Conventional automated perimetry remains an important clinical reference standard, but it has well-known practical challenges.
Patients must maintain concentration, respond repeatedly to stimuli, and remain engaged throughout the examination.
The Germany study notes that conventional perimetry can be demanding in terms of patient concentration and time and that patient anxiety can influence testing.
VR perimetry may address some of these practical challenges.
The Waterloo study found that patients experienced:
- Less fatigue
- Less apprehension
- Shorter testing time
while still demonstrating good agreement for key global visual-field parameters.
What Do These Studies Mean for Eye Care Professionals?
Taken together, the research points toward several important conclusions.
1. VR perimetry can capture clinically meaningful functional information
The VF2000 measurements demonstrate significant relationships with OCT-derived RNFL, BMO-MRW, and other structural measurements.
2. VF2000 results can compare favorably with conventional perimetry
Studies have demonstrated good agreement between VF2000 and conventional visual field testing for important global measures such as MD and PSD.
3. The OCT relationship strengthens the clinical case for VR perimetry
Comparing two visual field devices tells us whether they produce similar functional measurements.
Comparing visual field measurements with OCT tells us something different: whether the functional results correspond with objective structural changes.
The recent VF2000 studies provide encouraging evidence on both fronts.
4. Reliability remains critical
The Pacwa study particularly highlights the importance of reliable testing. Stronger VR–OCT relationships were observed in patients with high visual-field test reliability.
VR does not eliminate the need for patient cooperation. Threshold perimetry still requires concentration, whether it is performed through a headset or a conventional perimeter.
The Future of Visual Field Testing
The development of VR perimetry represents more than a change in the physical form of a visual field analyzer.
The emerging research suggests that modern VR systems can produce functional measurements that relate meaningfully to established structural biomarkers on OCT while also offering potential advantages in portability, examination time, and patient experience.
For the PalmScan VF2000 specifically, the evidence now includes:
- Meaningful OCT correlations.
- Comparable structure–function relationships with conventional SAP.
- Good agreement with Humphrey testing for important global indices.
- Shorter examination times in a comparative pilot study.
- Reduced patient fatigue and apprehension in that study.
- Evidence supporting its potential role in glaucoma assessment.
Frequently Asked Questions
Is VR visual field testing accurate for glaucoma?
Current studies provide encouraging evidence that VR perimetry can produce clinically meaningful visual-field measurements and significant correlations with OCT-derived structural biomarkers. However, larger longitudinal studies are still needed before VR perimetry can be considered interchangeable with conventional standard automated perimetry.
How does VF2000 compare with Humphrey visual field testing?
A University of Waterloo study found good agreement between VF2000 and Humphrey for mean deviation and pattern standard deviation. The study also found a shorter average testing time with VF2000 and lower reported fatigue and apprehension.
Does VF2000 correlate with OCT?
Yes. Research has demonstrated significant correlations between VF2000 visual-field sensitivity and OCT-derived measurements including RNFL and BMO-MRW. In the 2026 Germany study, global correlations were r = 0.492 for BMO-MRW and r = 0.584 for pRNFL.
Is VR perimetry better than conventional perimetry?
The evidence does not justify a blanket statement that VR perimetry is better. Rather, current studies suggest that VF2000 can provide comparable functional information, meaningful OCT structure–function relationships, and potential workflow and patient-experience advantages.
Can VR perimetry replace OCT?
No. Visual field testing and OCT measure different aspects of glaucoma. OCT evaluates structural changes, while perimetry evaluates visual function. The research supports using these measurements as complementary sources of information rather than treating one as a replacement for the other.
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