Evaluation of a Virtual Reality-Based Eye Tracker for Neuro-Ophthalmic Assessment: A Feasibility, Reliability and Reproducibility Study

Abstract Virtual Reality (VR) eye trackers provide portable and objective tools for neuro-ophthalmic testing. This study assessed the feasibility, reproducibility, and clinical utility of a VR-based eye tracker (BulbiCAM) compared to wearable eye-tracking glasses (PupilLabs Neon). Thirty-nine healthy participants underwent BulbiCAM testing across two visits, with inter-visit reproducibility evaluated using intra-class correlation coefficients. Pupillary light reflex assessments were conducted with both devices, allowing paired comparisons. Participant feedback (n=27) demonstrated high acceptability, with 89% reporting the test as comfortable and 81.5% experiencing no eye strain or fatigue. BulbiCAM showed high reproducibility for pupil and pursuit tests (ICC=0.76–0.88), though saccade reproducibility was lower (best ICC=0.62). Key pupillometric parameters showed strong agreement between devices, with minimal bias observed in baseline diameter (-0.48 mm), peak constriction (-0.56 mm), constriction velocity (0.22 mm/s), and duration (-0.052 s). These findings support the clinical feasibility and reliability of BulbiCAM for both research and patient testing, offering a promising alternative for neuro-ophthalmic assessment.