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WO1999027842A1 - Test du champ visuel par telemedecine - Google Patents

Test du champ visuel par telemedecine Download PDF

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Publication number
WO1999027842A1
WO1999027842A1 PCT/US1998/025485 US9825485W WO9927842A1 WO 1999027842 A1 WO1999027842 A1 WO 1999027842A1 US 9825485 W US9825485 W US 9825485W WO 9927842 A1 WO9927842 A1 WO 9927842A1
Authority
WO
WIPO (PCT)
Prior art keywords
local
responses
remote
patient
visual field
Prior art date
Application number
PCT/US1998/025485
Other languages
English (en)
Inventor
Johannes Braeuning
Stefan Schueller
Richard J. Mcclure
Dariusz Wroblewski
R. Kemp Massengill
Original Assignee
Virtual-Eye.Com
Orincon Corp.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US09/179,112 external-priority patent/US6027217A/en
Application filed by Virtual-Eye.Com, Orincon Corp. filed Critical Virtual-Eye.Com
Priority to CA002312924A priority Critical patent/CA2312924A1/fr
Publication of WO1999027842A1 publication Critical patent/WO1999027842A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
    • A61B5/6813—Specially adapted to be attached to a specific body part
    • A61B5/6814—Head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/02—Subjective types, i.e. testing apparatus requiring the active assistance of the patient
    • A61B3/028—Subjective types, i.e. testing apparatus requiring the active assistance of the patient for testing visual acuity; for determination of refraction, e.g. phoropters
    • A61B3/032—Devices for presenting test symbols or characters, e.g. test chart projectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
    • A61B5/7267—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems involving training the classification device

Definitions

  • This invention is in the field of visual field screening.
  • glaucoma is one of the leading causes of blindness. Unlike cataract blindness, which is correctable with modern surgical techniques, blindness from glaucoma is permanent.
  • the target organ of glaucoma is the optic nerve, which transmits signals of light from the retina to the brain. No known method is available for repairing, or transplanting, an injured optic nerve. Millions upon millions of patients throughout the world have glaucoma and are completely unaware of this.
  • the particularly sad aspect of glaucoma blindness is that it is generally preventable with proper diagnosis and treatment.
  • Glaucoma which causes absolute, total blindness when untreated, is no exception.
  • a second major diagnostic problem is that visual loss from glaucoma is, almost without exception, painless.
  • the patient is unaware of the ravages of glaucoma until it is too late.
  • a "tonometer" to measure the intraocular pressure
  • the diagnosis can be made whenever the pressure within the eye is significantly elevated.
  • tonometry is not available in many parts of the world; and many patients have the "low-tension" form of glaucoma in which the intraocular pressure is completely normal. Therefore, reliance upon tonometry, in areas of the world where this is available, frequently leads to a blatantly false sense of security.
  • the patient is told that glaucoma is not present, when, in reality, the disease is insidiously attacking the patient's optic nerve, causing irreversible neurological damage to the visual system.
  • the present invention provides an extremely inexpensive vehicle for addressing the serious problem of glaucoma blindness throughout the world.
  • Screening software programs can be accessed by the patient's personal computer (or by any computer available to the patient, such as that of a friend or of a local clinic) from the Internet or other telemetric vehicle.
  • a computer monitor, a television screen, or some other local video display system may be used, with the software programs being operated entirely on a remote computer to generate the desired stimuli on the local video display system. Therefore, the entire testing process can be performed via long-distance transmission vehicles, such as, but not limited to, the Internet, or an optical fiber network, thus providing, telemetrically, not only essentially instantaneous auto interpretation, but also telemetric monitoring of the patient's performance of the test in real time.
  • At least gross telemetric monitoring is available by monitoring the speed of the patient's responses, as well as the response itself and whether it makes rational sense, based upon nomograms of typical patient visual behavior.
  • Computers or systems available to the patient with audio capability such as an audio card, can provide audio feedback stimuli, such as voice, or a tone or series of tones, to monitor the test performance in real-time and provide interactive feedback to the patient.
  • a patient can receive a "grade" correlated with demonstrated responsiveness and concentration ability, thus indicating whether the patient's performance is satisfactory for meaningful autointerpretation.
  • a central world-wide monitoring and data collection station can link the system and provide multiweb-like integration.
  • the Internet provides virtually instantaneous, extremely affordable, world-wide access.
  • the present telemedicine system is "intelligent," in that ongoing data accumulation and analyses thereof improve the computational model and provide, over time, increasingly more accurate identification of more subtle disease processes.
  • Figure 1 is a schematic diagram of the information flow in the system of the present invention.
  • Figure 2 is a schematic diagram of the automatic interpretation portion of the system of the present invention.
  • the present invention provides a quick and easy world-wide visual field screening system via the Internet, or via some other long-distance telemedicine vehicle. All that is required is for the patient to access the software programs which in real-time interactively present, monitor, and instantaneously autointerpret the visual field screening test.
  • the software programs can be accessed via telemedicine, such as "going on-line" on the Internet.
  • the proposed invention utilizes "frequency doubling” and “noise-field campimetry” software programs for quick and efficient visual screening of the patient on his or her own display system. These two types of programs are well known in the art.
  • An alternative embodiment of the proposed invention includes flicker and temporal modulation perimetry, as described in work published by Lachenmayr, and work published by Casson.
  • High temporal flicker frequencies stimulate, on a preferential basis, ganglion cells projecting to the magnocellular layers of the lateral geniculate body. These axons are called M-cell fibers, and it is these nerve fibers which are postulated to be preferentially damaged in glaucoma. Detection of damage to M-cell fibers, then, helps make the diagnosis of glaucoma in its earlier stages.
  • Flicker perimetry is an excellent tool with patients who also have cataract formation.
  • the Lachenmayr method uses the highest frequency of flicker, called the "critical flicker frequency", which is detected for a 100 per cent contrast flicker target.
  • the Casson method employs a group of frequencies, such as temporal frequencies of 2, 8, and 16 Hz.
  • Another alternative embodiment of the proposed invention employs color-on- color visual field strategies. This embodiment requires that the patient have access to a color video monitor or color television.
  • One such strategy currently known in the art, is called "short wavelength automated perimetry". The advantage of this strategy is that defects are believed to become apparent several years before being noted on standard automated perimetry visual field tests.
  • Still another alternative embodiment of the proposed invention employs motion, or "kinetic" perimetry strategies, which are currently well known in the art.
  • the system of the present invention includes a local visual field test apparatus 5, which can include a display screen, such as a television or a computer monitor.
  • the local apparatus may also include a local computer. It is recognized that using the patient's display system may not provide quite the degree of accuracy of the best available perimeter systems. Extremely subtle visual field changes are more difficult to notate on a computer or television display. Deficiencies include the fact that ambient lighting conditions will vary from one person's home to another. The "texture" and luminosity of one person's display screen will vary from that of another person. Some display screens have adjustable "brightness,” and some do not.
  • “Gamma calibration” a procedure well known in the art, is one strategy which can be used in the software incorporated in the present invention, as a standardization aid.
  • Visual field testing utilizing a video display as the visual fixation source may not equal the accuracy attainable with a full threshold first-class globe perimeter; nevertheless, the present invention can achieve an initial accuracy level of 75 to 80 per cent, and maybe more.
  • Providing this degree of test accuracy via a world- wide telemetric system, such as the Internet, for interactive real-time performance and for instantaneous autointerpretation of visual screening test results, will play a major role in eliminating world-wide glaucoma blindness.
  • a screening "preliminary" diagnosis can be then be confirmed, and, if glaucoma is present, proper glaucoma treatment can be instituted.
  • the proposed invention may well spare millions and millions of patients throughout the world blindness and the ravages of undiagnosed glaucoma.
  • visual field testing with the present invention can also be used to test for a variety of neurological disorders, including cerebrovascular accidents ("strokes"), trauma, brain tumors, and other diseases.
  • strokes cerebrovascular accidents
  • trauma trauma, brain tumors, and other diseases.
  • brain tumors Generally speaking, strokes and major neurological brain diseases cause quite large visual field deficits, and the proposed invention will readily help make the diagnosis of these disorders.
  • Some of the inventors of the present invention have also developed a method and an apparatus for automatic, computerized interpretation of the visual function test parameters obtained in a head-mounted display virtual realty testing system.
  • the data produced by the testing system are automatically reviewed and correlated with previously-determined patterns recognized to be "normal” or "abnormal,” and clinical diagnoses for pathological conditions are thereby suggested to the clinician.
  • Telemedicine can be utilized to receive test data from the patient and to transmit the test inte ⁇ retation, including the suspected diagnosis, or diagnoses, and recommendations for further clinical correlation or for further ancillary tests.
  • Telemedicine can be employed to monitor interactively and automatically, in real time, the patient's performance of the visual field test.
  • the system of the present invention similarly uses clustering algorithms, linear and non-linear mapping algorithms, and pattern recognition algorithms, either individually or as a combination thereof.
  • the remote computing system consists of a central processing system and data repository 18, as shown in Figure 1.
  • a database of empirical, semi-empirical, or simulated visual field test data is used to build a model of the visual field test data.
  • This model when applied to previously unseen test results, is capable of automatically interpreting and classifying the test data in terms of the presence and/or severity of abnormal (diseased) regions and states.
  • the data processing portion of the system provides not only the classification of the visual field test data in terms of presence or absence of all disease, or any particular disease (e.g., glaucoma), but also may assign a probability of detection and/or a numerical value indicating the severity of the disease. This provides a tool for monitoring disease progression.
  • the automatic inte ⁇ retation portion of the system may be a binary classification system, which will indicate the presence or absence of a particular disease, such as glaucoma, or a multi-class system, which provides recognition and classification of a large variety of possible visual field disorders, including, but not limited to, neurological tumors, cerebrovascular accidents and strokes, optic nerve disorders, compression syndromes of the optic nerve or optic chiasm, demyelinating diseases, and diseases of the retina.
  • a binary classification system which will indicate the presence or absence of a particular disease, such as glaucoma
  • a multi-class system which provides recognition and classification of a large variety of possible visual field disorders, including, but not limited to, neurological tumors, cerebrovascular accidents and strokes, optic nerve disorders, compression syndromes of the optic nerve or optic chiasm, demyelinating diseases, and diseases of the retina.
  • the system of the present invention utilizes the results of visual stimuli consisting of dots, symbols, shapes, or patterns, etc., with or without color, depending upon the capability of the patient's display screen. These are presented to the patient in the form, preferentially, of such visual screening programs as frequency doubling and noise-field campimetry, but also including standard automated perimetry visual testing schemes such as those used by the Humphrey Field Analyzer.
  • Noise-field campimetry can be used to present visual stimuli to the patient utilizing the entire display screen, called “full-field” noise-field campimetry.
  • a completely new technique called “focal” or “segmental” noise-field campimetry can also be employed as a visual testing strategy in the proposed invention.
  • focal area of the display screen is utilized to test visual function responses of the patient.
  • these visual stimuli are converted into numerical representation for data processing.
  • Other inputs resulting from standard pre-processing of the test data, such as visual field indices, can also be employed by the inte ⁇ retation system. Inclusion of all available individual components of perimetric examination is useful for proper clinical inte ⁇ retation of the visual test examination.
  • the information provided to the automated inte ⁇ retation system may include: ancillary data, such as pupil size during testing (as estimated or measured by an independent observer of the patient), the patient's age, and visual acuity (which can be measured for near vision by the testing program); reliability indices, such as fixation behavior and accuracy, and response fluctuation; visual field indices, such as average deviation of sensitivity at each test location from age-adjusted normal population values, the index of the degree of irregularity of visual field sensitivity about the normal slope, and sensitivity analysis of clusters of points; results of point-by-point comparison of test results with age- matched normal population values; results of high-pass resolution perimetry (with resolution limitations ascribed, among other considerations, to the innate quality and performance capabilities of the patient's computer system and display monitor); results of flicker and temporal modulation perimetry; results of color-on-color perimetry testing strategies, using a color video monitor or television; results of motion, or "kinetic", perimetry visual field testing strategies
  • the implementation may be in the form of a single-level system or a hierarchical system.
  • the single-level system all the input data which are deemed relevant for the inte ⁇ retation task, are inputted and processed simultaneously.
  • the hierarchical system different input data types are modeled by dedicated separate sub-systems, and these outputs are subsequently fused through a suitable computational architecture, such as a neural network, to produce the final classification result.
  • the automatic inte ⁇ retation system can consist of the following modules: clustering/data reduction module 22, which may employ singular value decomposition, principal component analysis, learning vector quantization, or other clustering or data size reduction methods; data normalization module 24; data classification module 26, which performs pattern recognition, classification, and quantification of the visual field test data through nonlinear or linear mapping.
  • This function may be accomplished through the use of multilayer perceptron neural network and other neural network architectures, or through non-linear, multivariate, or linear regression of the data, or by multivariate statistical classifiers or discriminators (such as Bayesian classifiers); output module 28, creating a graphical representation of the visual field test data, such as isopter/scotoma plots, or gray scale or color-coded plots, with superimposed identification of the regions that the system classified as abnormal.
  • the automatic inte ⁇ retation system is an expert system automatically trained on a set of empirical, semi-empirical, and/or simulated data.
  • the construction of a proper training database is essential for achieving good performance of the inte ⁇ retation system, including good sensitivity and specificity.
  • the training database may contain all, or any, of the following types of visual field data: empirical data, i.e., data obtained for patients with normal and abnormal visual fields; semi-empirical data, i.e., data obtained by modification of the empirical data, as described above, by: emphasizing or de-emphasizing certain aspects of the visual field test to bring out the characteristic features of certain diseased states; adding noise or measurement uncertainty component(s) which may be associated with a real visual field examination; any other modification of the visual field test data and their associated classification; and, simulated data, i.e., data that are constructed to simulate the real- world results of a visual field test for both normal and abnormal visual fields.
  • empirical data i.e., data obtained for patients with normal and abnormal visual fields
  • semi-empirical data i.e., data obtained by modification of the empirical data, as described above, by: emphasizing or de-emphasizing certain aspects of the visual field test to bring out the characteristic features of certain diseased states; adding noise or measurement
  • Telemedicine is utilized to receive test data from the patient and to transmit the test inte ⁇ retation, including the suspected diagnosis, or diagnoses, and recommendations for further clinical correlation or for further ancillary tests. Telemedicine is also employed to monitor interactively and automatically, in real time, the patient's performance of the visual field test.
  • the content of the software is dictated by the need to provide technically acceptable protocols, such as for examining the field of view and deficiencies thereof, utilizing measurements of thresholds for pattern discrimination, sensitivity to light intensity, or, if desired and available on the patient's display monitor, color.
  • the preferred embodiment includes frequency doubling and noise-field campimetry (both "full field” campimetry, and "focal” noise-field campimetry), as these are very amenable to testing on a display monitor screen.
  • Active feedback sensing can alert the system to patient loss of attention, for notation and reiteration of test stimuli. Individual test points are reiterated when a result is found to be inconsistent with a predetermined norm.
  • Audio feedback stimuli can present a voice, or a tone or series of tones, to monitor the test performance in real-time and to provide interactive feedback. Each eye is tested individually by occluding the non-tested eye.
  • Specific instructions are given to the patient to establish the proper geometric conditions for test performance, such as the recommended distance from the eyes to the patient's display screen, and head placement relationhip thereto. It is important that the dimensions of the patient's display screen be known. These dimensions, as well as the display screen's manufacturer and model number, can be readily transmitted to the central station computer, so that the software can provide necessary viewing distance instructions and other pertinent recommendatons. Widening the field of view is easily accomplished by simply decreasing the distance from the patient's eyes to the display monitor.

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  • Life Sciences & Earth Sciences (AREA)
  • Health & Medical Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
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  • Animal Behavior & Ethology (AREA)
  • Physics & Mathematics (AREA)
  • Public Health (AREA)
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Abstract

Cette invention se rapporte à un procédé et à un appareil servant à la réalisation et à l'auto-interprétation, via l'Internet ou via un autre moyen de télémétrie, des paramètres d'un test de la vue, obtenus lors d'une détection interactive du champ visuel à l'aide d'un écran d'affichage local. Ce test interactif et l'auto-interprétation instantanée des performances du champ visuel à l'aide d'un écran d'affichage local (5) et d'un dépôt central de données/traitement de données (18) par télémédecine permettent de dépister les glaucomes et d'autres troubles neurologiques affectant l'organe de la vue. La télémédecine, par exemple via l'Internet, permet d'utiliser un tel système à l'échelle planétaire, y compris dans des régions où des médecins ne sont pas présents.
PCT/US1998/025485 1997-12-04 1998-12-02 Test du champ visuel par telemedecine WO1999027842A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CA002312924A CA2312924A1 (fr) 1997-12-04 1998-12-02 Test du champ visuel par telemedecine

Applications Claiming Priority (8)

Application Number Priority Date Filing Date Title
US6752197P 1997-12-04 1997-12-04
US60/067,521 1997-12-04
US8981798P 1998-06-19 1998-06-19
US60/089,817 1998-06-19
US9021498P 1998-06-22 1998-06-22
US60/090,214 1998-06-22
US09/179,112 US6027217A (en) 1996-07-31 1998-10-26 Automated visual function testing via telemedicine
US09/179,112 1998-10-26

Publications (1)

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WO1999027842A1 true WO1999027842A1 (fr) 1999-06-10

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WO (1) WO1999027842A1 (fr)

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2361374A (en) * 2000-04-14 2001-10-17 Anil Kumar Gupta Ophthalmic dispensing via the internet
WO2001087149A1 (fr) * 2000-05-15 2001-11-22 Boston Medical Technologies, Inc. Systeme de telemesure d'essai medical
WO2002000105A1 (fr) * 2000-06-28 2002-01-03 Aivision Pty Ltd Systeme de test de la vue
WO2001071636A3 (fr) * 2000-03-23 2002-03-14 Mitsubishi Chem Corp Systeme et procede d'etablissement de profils de sante personnalises
EP1216444A2 (fr) * 1999-09-28 2002-06-26 Sound ID Procedes d'evaluation audiologique sur l'internet
WO2002061526A3 (fr) * 2000-12-15 2004-02-26 Cybercare Technologies Inc Systeme et procede de groupe de support video correcteur
AU2001267152B2 (en) * 2000-06-28 2006-02-02 Aivision Pty Ltd Vision testing system
US10398304B2 (en) 2013-03-12 2019-09-03 Visibly, Inc. Computerized testing and determination of a visual field of a patient
WO2019169322A1 (fr) * 2018-03-02 2019-09-06 Ohio State Innovation Foundation Systèmes et procédés de mesure de cartes de la fonction visuelle
US10779733B2 (en) 2015-10-16 2020-09-22 At&T Intellectual Property I, L.P. Telemedicine application of video analysis and motion augmentation

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US5317405A (en) * 1991-03-08 1994-05-31 Nippon Telegraph And Telephone Corporation Display and image capture apparatus which enables eye contact
US5441047A (en) * 1992-03-25 1995-08-15 David; Daniel Ambulatory patient health monitoring techniques utilizing interactive visual communication
US5517021A (en) * 1993-01-19 1996-05-14 The Research Foundation State University Of New York Apparatus and method for eye tracking interface

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5317405A (en) * 1991-03-08 1994-05-31 Nippon Telegraph And Telephone Corporation Display and image capture apparatus which enables eye contact
US5441047A (en) * 1992-03-25 1995-08-15 David; Daniel Ambulatory patient health monitoring techniques utilizing interactive visual communication
US5517021A (en) * 1993-01-19 1996-05-14 The Research Foundation State University Of New York Apparatus and method for eye tracking interface

Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1216444A4 (fr) * 1999-09-28 2006-04-12 Sound Id Procedes d'evaluation audiologique sur l'internet
EP1216444A2 (fr) * 1999-09-28 2002-06-26 Sound ID Procedes d'evaluation audiologique sur l'internet
WO2001071636A3 (fr) * 2000-03-23 2002-03-14 Mitsubishi Chem Corp Systeme et procede d'etablissement de profils de sante personnalises
GB2361374A (en) * 2000-04-14 2001-10-17 Anil Kumar Gupta Ophthalmic dispensing via the internet
WO2001087149A1 (fr) * 2000-05-15 2001-11-22 Boston Medical Technologies, Inc. Systeme de telemesure d'essai medical
US6650932B1 (en) 2000-05-15 2003-11-18 Boston Medical Technologies, Inc. Medical testing telemetry system
US7367675B2 (en) 2000-06-28 2008-05-06 Aivision Pty Ltd. Vision testing system
WO2002000105A1 (fr) * 2000-06-28 2002-01-03 Aivision Pty Ltd Systeme de test de la vue
AU2001267152B2 (en) * 2000-06-28 2006-02-02 Aivision Pty Ltd Vision testing system
WO2002061526A3 (fr) * 2000-12-15 2004-02-26 Cybercare Technologies Inc Systeme et procede de groupe de support video correcteur
US10398304B2 (en) 2013-03-12 2019-09-03 Visibly, Inc. Computerized testing and determination of a visual field of a patient
US10517476B2 (en) 2013-03-12 2019-12-31 Visibly, Inc. Computerized testing and determination of a visual field of a patient
US11666211B2 (en) 2013-03-12 2023-06-06 Visibly, Inc. Computerized testing and determination of a visual field of a patient
US10779733B2 (en) 2015-10-16 2020-09-22 At&T Intellectual Property I, L.P. Telemedicine application of video analysis and motion augmentation
WO2019169322A1 (fr) * 2018-03-02 2019-09-06 Ohio State Innovation Foundation Systèmes et procédés de mesure de cartes de la fonction visuelle
US10925481B2 (en) 2018-03-02 2021-02-23 Ohio State Innovation Foundation Systems and methods for measuring visual function maps

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