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. 2016 Aug 26;11(8):e0161974.
doi: 10.1371/journal.pone.0161974. eCollection 2016.

Visual Field Testing with Head-Mounted Perimeter 'imo'

Chota Matsumoto  1 , Sayaka Yamao  1 , Hiroki Nomoto  1 , Sonoko Takada  1 , Sachiko Okuyama  1 , Shinji Kimura  2 , Kenzo Yamanaka  2 , Makoto Aihara  3 , Yoshikazu Shimomura  1
Affiliations

Visual Field Testing with Head-Mounted Perimeter 'imo'

Chota Matsumoto et al. PLoS One. .

Abstract

Purpose: We developed a new portable head-mounted perimeter, "imo", which performs visual field (VF) testing under flexible conditions without a dark room. Besides the monocular eye test, imo can present a test target randomly to either eye without occlusion (a binocular random single eye test). The performance of imo was evaluated.

Methods: Using full HD transmissive LCD and high intensity LED backlights, imo can display a test target under the same test conditions as the Humphrey Field Analyzer (HFA). The monocular and binocular random single eye tests by imo and the HFA test were performed on 40 eyes of 20 subjects with glaucoma. VF sensitivity results by the monocular and binocular random single eye tests were compared, and these test results were further compared to those by the HFA. The subjects were asked whether they noticed which eye was being tested during the test.

Results: The mean sensitivity (MS) obtained with the HFA highly correlated with the MS by the imo monocular test (R: r = 0.96, L: r = 0.94, P < 0.001) and the binocular random single eye test (R: r = 0.97, L: r = 0.98, P < 0.001). The MS values by the monocular and binocular random single eye tests also highly correlated (R: r = 0.96, L: r = 0.95, P < 0.001). No subject could detect which eye was being tested during the examination.

Conclusions: The perimeter imo can obtain VF sensitivity highly compatible to that by the standard automated perimeter. The binocular random single eye test provides a non-occlusion test condition without the examinee being aware of the tested eye.

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Conflict of interest statement

The authors have the following interests: this study was funded by CREWT Medical Systems. SK and KY are employees of CREWT Medical Systems. SK and KY are directors and have proprietary interests with CREWT Medical Systems. This is the first study exploring the diagnostic abilities of this new instrument developed by the authors and CREWT Medical Systems. There are no products under development that are relevant to the materials presented in this article, except for the ongoing development of imo. There are patent applications issued by CM and CREWT Medical Systems. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. The head-mounted perimeter imo.
The perimeter imo consists of a main perimeter unit, a user control tablet, and a patient response button.
Fig 2
Fig 2. The perimeter unit.
The perimeter imo has completely isolated optical systems for the right and left eyes. Stimulus presentation is also independently performed for each eye.
Fig 3
Fig 3. A cross-section image showing the structure of the perimeter unit.
A test target is displayed on the full HD transmissive liquid crystal displays with high intensity LED backlights for the two eyes. Both pupils are illuminated by near infrared LEDs and these images are monitored by the SXVGA resolution CMOS image sensor.
Fig 4
Fig 4. Target presentation and the examinee’s view during the binocular random single eye test.
The test target was presented randomly to either eye under a non-occlusion condition and the patient was not aware of which eye was being tested. To better demonstrate this test with visible targets, target size V is used in this figure although target size III was the actual size used in this study.
Fig 5
Fig 5. Description of the glaucomatous VF defects by grey scale and actual values for a 61-year-old male with POAG.
(A) A deep lower nasal sensitivity loss in the right eye, a lower arcade scotoma and an upper small scotoma near the fixation point in the left eye were detected by the HFA. (B) Similar defects were detected using the imo binocular random single eye test.
Fig 6
Fig 6. Correlations between the MS values by the HFA and the imo tests.
(A) The MS values for the right eye by the HFA highly correlated with the values by the imo monocular test (the solid regression line: r = 0.96, P < 0.001) and the binocular random single eye test (the dotted regression line: r = 0.97, P < 0.001). The slopes of the Deming regression lines were 1.12 (95% confidence interval [CI], 1.01 to 1.37) for the solid line and 1.08 (95% CI, 0.97 to 1.32) for the dotted line. The intercepts were -2.82 (95% CI, -8.48 to -0.37) for the solid line and -1.64 (95% CI, -7.67 to 1.12) for the dotted line. (B) Similarly, the MS values for the left eye by the HFA highly correlated with the values by the imo monocular test (the solid regression line: r = 0.94, P < 0.001) and the binocular random single eye test (the dotted regression line: r = 0.98, P < 0.001). The slopes of the Deming regression lines were 0.88 (95% CI, 0.70 to 0.98) for the solid line and 1.37 (95% CI, 0.87 to 1.11) for the dotted line. The intercepts were -2.88 (95% CI, 0.92 to 7.24) for the solid line and -0.71 (95% CI, -2.65 to 3.34) for the dotted line.
Fig 7
Fig 7. Correlations between the MS values for the right and left eyes by the two imo tests.
The MS values by the two imo tests highly correlated for the two eyes (R: r = 0.96, L: r = 0.95, P < 0.001). The slopes of the Deming regression lines were 1.04 (95% CI, 0.89 to 1.26) for the right eye and 0.85 (95% CI, 0.71 to 0.95) for the left eye. The intercepts were -1.09 (95% CI, -6.30 to 2.66) for the right eye and 3.47 (95% CI, 0.92 to 6.35) for the left eye.
Fig 8
Fig 8. Bland-Altman plots of the MS differences for the right and left eyes between the two imo tests.
Bland-Altman plots revealed MS differences of 0.21 dB (95% limits of agreement between -3.6 dB and 4.04 dB) for the right eye and -0.11 dB (95% limits of agreement between -4.39 dB and 4.17dB) for the left eye between the two imo tests.
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