VISTA: Visual-Field Integration of Sound to Target Attention and Fixation in Perimetry

Purpose: Accurate fixation is essential for reliable visual field testing in perimetry. However, individuals with central vision loss, such as those with age-related macular degeneration, often struggle to maintain fixation, leading to unreliable results or test failure. To address this challenge, we developed VISTA (Visual-Field Integration of Sound to Target Attention), a novel gaze-contingent auditory feedback system implemented in a virtual reality perimetry environment. Methods: Participants with normal vision performed two types of perimetry: thresholding and suprathresholding. Both tests were conducted with and without gaze-contingent music feedback. In the feedback condition, background music volume dynamically increased when gaze remained within a 2-degree window around the fixation target and decreased when gaze deviated, providing an intuitive, nonverbal cue to maintain fixation. The experiments were performed using a Pico Neo 3 headset. Simulated central vision defects (3, 9, and 18 degrees eccentricities) were introduced to evaluate performance under impaired fixation conditions.Results: Results showed that gaze-contingent auditory feedback significantly improved fixation stability across both perimetric strategies (p < 0.0001) and under simulated impairment levels. The improvement persisted throughout the testing session, suggesting sustained attentional engagement. Conclusion: These findings demonstrate that gaze-contingent music can effectively guide fixation behavior during perimetry, enhancing test reliability and accessibility for individuals with central vision loss.