Using VR to investigate the relationship between visual acuity and severity of simulated oscillopsia

Purpose: Oscillopsia is a debilitating symptom resulting from involuntary eye movement most commonly associated with acquired nystagmus. Investigating and documenting the efects of oscillopsia severity on visual acuity (VA) is challenging. This paper aims to further understanding of the efects of oscillopsia using a virtual reality simulation.

Methods: Fifteen right-beat horizontal nystagmus waveforms, with diferent amplitude (1°, 3°, 5°, 8° and 11°) and frequency (1.25 Hz, 2.5 Hz and 5 Hz) combinations, were produced and imported into virtual reality to simulate diferent severities of oscillopsia. Fifty participants without ocular pathology were recruited to read logMAR charts in virtual reality under stationary conditions (no oscillopsia) and subsequently while experiencing simulated oscillopsia. The change in VA (logMAR) was calculated for each oscillopsia simulation (logMAR VA with oscillopsia – logMAR VA with no oscillopsia), removing the inluence of diferent baseline VAs between participants. A one-tailed paired t-test was used to assess statistical signiicance in the worsening in VA caused by the oscillopsia simulations.

Results: VA worsened with each incremental increase in simulated oscillopsia intensity (frequency x amplitude), either by increasing frequency or amplitude, with the exception of statistically insigniicant changes at lower intensity simulations. Theoretical understanding predicted a linear relationship between increasing oscillopsia intensity and worsening VA. This was supported by observations at lower intensity simulations but not at higher intensities, with incremental changes in VA gradually levelling of. A potential reason for the diference at higher intensities is the inluence of frame rate when using digital simulations in virtual reality.

Conclusions: The frequency and amplitude were found to equally afect VA, as predicted. These results not only consolidate the assumption that VA degrades with oscillopsia but also provide quantitative information that relates these changes to amplitude and frequency of oscillopsia.