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 raise an important question for clinicians:
“Does VR perimetry measure meaningful functional loss that corresponds with the structural damage seen on OCT?”
The current evidence is encouraging.
Research has demonstrated significant relationships between VF2000 visual field measurements and OCT-derived structural measurements, including retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters. Studies have also reported meaningful agreement between VF2000 and conventional visual field testing for key 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 demonstrate that VF2000 visual field measurements correlate with established structural biomarkers of glaucomatous damage. Notably, the researchers also found that VF2000 and conventional automated perimetry demonstrated similar correlations with OCT measurements across most anatomical sectors, further supporting the clinical relevance of VR-based visual field testing.
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 showed comparable structure–function correlations across most of the anatomical sectors evaluated.
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 |
Note: These correlation coefficients are based on the paired VF2000 and conventional perimetry dataset, which included 129–143 eyes depending on the OCT measurement. As a result, some values differ slightly from those reported in the broader analysis above.
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 presented at the 2026 European Glaucoma Society Congress evaluated an MMD VR-based perimeter against a conventional Optopol stationary perimeter, examining how visual field measurements from both devices correlated with OCT-derived RNFL and GCC measurements.
The study included 57 patients who underwent visual field testing using both devices, along with OCT imaging. Researchers also evaluated results based on visual field test reliability.
Among patients with high test reliability, VR perimetry demonstrated stronger correlations with several OCT measurements compared with 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
These findings suggest that MMD’s VR-based perimeter can produce clinically meaningful structure–function correlations, particularly when visual field tests meet established reliability criteria. Although the results are encouraging, additional research is needed to determine whether these differences are consistent across larger patient populations.
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?
Beyond clinical performance, patient comfort is an important consideration when evaluating visual field testing technologies.
A pilot study conducted by researchers at the University of Waterloo, presented at the 2024 European Glaucoma Society Congress, compared patient satisfaction with the PalmScan VF2000-G2 and the Humphrey Visual Field Analyzer.
The study included 10 patients who had previously undergone Humphrey visual field testing.
Researchers evaluated patient comfort, fatigue, apprehension, and overall testing preference.
The findings showed:
- Significantly higher patient comfort scores with VF2000 (p < 0.01)
- Significantly less reported fatigue (p < 0.05)
- Significantly less apprehension during testing (p < 0.03)
- Overall patient preference for VF2000 (p < 0.01)
Although the sample size was small, these findings suggest that VR-based perimetry may offer a more comfortable testing experience for patients.
This is particularly relevant in glaucoma care, where patients often undergo repeated visual field examinations over time.
Why Patient Comfort Matters in Glaucoma Testing
Visual field testing requires concentration and sustained attention. Patient discomfort and fatigue can make examinations more challenging, particularly for individuals who require repeated testing to monitor glaucoma progression.
The University of Waterloo pilot study provides encouraging evidence regarding the patient experience with VF2000, with participants reporting greater comfort and less fatigue and apprehension compared with conventional Humphrey testing.
While further studies involving larger patient populations are needed, these findings highlight the potential value of VR-based perimetry in making routine visual field examinations more comfortable for patients.
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 studies have also examined the diagnostic performance of PalmScan VF2000 in glaucoma detection and severity classification.
A 2022 study involving 166 eyes from 97 participants reported 100% sensitivity and specificity for distinguishing glaucoma from non-glaucoma eyes within the study population. However, agreement with conventional perimetry was less consistent when classifying the severity of glaucoma.
Another study involving 51 eyes found 86.3% agreement in glaucoma severity classification between VF2000 and standard automated perimetry (SAP), with a mean difference in mean deviation (MD) of +0.62 ± 0.26 dB.
These findings should be interpreted carefully. Although the devices agreed on glaucoma severity classification in most cases, agreement was less consistent in certain disease severity categories. The Stanford researchers also cautioned that the smartphone-based VF2000 configuration evaluated in their study may not fully reproduce the results of conventional automated perimetry.
These results highlight the importance of evaluating glaucoma detection and disease severity classification separately. They also underscore the need for continued clinical validation, particularly as newer generations of VR perimetry technology become available.
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 demonstrates comparable structure–function relationships to conventional perimetry
The University Hospital Cologne study found that VF2000 and conventional automated perimetry demonstrated similar correlations with OCT-derived structural measurements across most anatomical sectors evaluated.
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 also highlights the importance of test reliability, with its reported structure–function correlations based on patients whose visual field examinations met high-reliability criteria.
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.
Emerging clinical research suggests that VR-based systems can provide meaningful functional measurements that correlate with established structural biomarkers on OCT, while offering practical advantages in portability and patient experience.
For the PalmScan VF2000, the available evidence includes:
- Significant correlations with OCT-derived structural measurements, including RNFL thickness and BMO-MRW.
- Comparable structure–function relationships with conventional automated perimetry across most anatomical sectors evaluated.
- Strong agreement in key global visual field indices, including mean deviation (MD) and pattern standard deviation (PSD), in a study comparing VF2000 with conventional bowl perimetry.
- Improved patient comfort, with a University of Waterloo pilot study reporting less fatigue, less apprehension, and an overall preference for VR-based testing.
- Encouraging evidence supporting its potential role in glaucoma assessment, while recognizing that further clinical validation remains important.
Taken together, these findings support the continued development of VR perimetry as a portable approach to functional visual field testing, with growing clinical evidence supporting its use in eye care.
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?
Research comparing VF2000 with conventional visual field testing has produced encouraging results. A University of Waterloo pilot study involving 10 patients found that VF2000-G2 offered a more comfortable testing experience than the Humphrey Visual Field Analyzer, with participants reporting less fatigue, less apprehension, and an overall preference for VR-based testing.
Separately, research from University Hospital Cologne demonstrated that VF2000 produced meaningful structure–function correlations with OCT measurements, comparable to conventional automated perimetry across most anatomical sectors evaluated.
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.
Interested in exploring VF2000 for your practice?
Discover how VF2000 can support your visual field testing needs. Contact Micro Medical Devices to learn more about our available models or request a 30-day trial.
