Abstract
Purpose: To examine an image remapping method for peripheral visual field (VF) expansion with novel virtual reality digital spectacles (DSpecs) to improve visual awareness in glaucoma patients. Design: Prospective case series. Methods: Monocular peripheral VF defects were measured and defined with a head-mounted display diagnostic algorithm. The monocular VF was used to calculate remapping parameters with a customized algorithm to relocate and resize unseen peripheral targets within the remaining VF. The sequence of monocular VF was tested and customized image remapping was carried out in 23 patients with typical glaucomatous defects. Test images demonstrating roads and cars were used to determine increased awareness of peripheral hazards while wearing the DSpecs. Patients' scores in identifying and counting peripheral objects with the remapped images were the main outcome measurements. Results: The diagnostic monocular VF testing algorithm was comparable to standard automated perimetric determination of threshold sensitivity based on point-by-point assessment. Eighteen of 23 patients (78%) could identify safety hazards with the DSpecs that they could not previously. The ability to identify peripheral objects improved with the use of the DSpecs (P = .0.024, chi-square test). Quantification of the number of peripheral objects improved with the DSpecs (P = .0.0026, Wilcoxon rank sum test). Conclusions: These novel spectacles may enhance peripheral objects awareness by enlarging the functional field of view in glaucoma patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 125-135 |
| Number of pages | 11 |
| Journal | American journal of ophthalmology |
| Volume | 210 |
| DOIs | |
| State | Published - Feb 2020 |
ASJC Scopus subject areas
- Ophthalmology
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Expansion of Peripheral Visual Field with Novel Virtual Reality Digital Spectacles. / Sayed, Ahmed M.; Abdel-Mottaleb, Mostafa; Kashem, Rashed; Roongpoovapatr, Vatookarn; Elsawy, Amr; Abdel-Mottaleb, Mohamed; Parrish, Richard K.; Abou Shousha, Mohamed.
In: American journal of ophthalmology, Vol. 210, 02.2020, p. 125-135.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Expansion of Peripheral Visual Field with Novel Virtual Reality Digital Spectacles
AU - Sayed, Ahmed M.
AU - Abdel-Mottaleb, Mostafa
AU - Kashem, Rashed
AU - Roongpoovapatr, Vatookarn
AU - Elsawy, Amr
AU - Abdel-Mottaleb, Mohamed
AU - Parrish, Richard K.
AU - Abou Shousha, Mohamed
N1 - Funding Information: A technology was developed and tested to benefit patients with peripheral visual field defects by expanding their functional fields of view and potentially improving performance in their visually intense life activities. 28 , 29 Previous computer processing techniques designed to aid vision were first developed by Loshin and Juday 30 in 1989. Their study described a remapping algorithm based on image warping that can aid peripheral VF defects associated with retinitis pigmentosa. However, they studied no patients with this algorithm, and continued their studies focusing on central defects by testing with TV screen reading experiments. 30 , 31 Although the benefit of this technology was hypothesized, no visual aid was developed owing to technological barriers. Other, available commercial devices 11 , 16 , 17 , 32 apply general image enhancements, such as magnification and brightness without taking into account the specific VF defect. These improved performances were based on central VF defects but provided very limited benefits for activities that depend on the peripheral VF. 11 , 12 , 17 Peli and associates 14 , 33 reported a visual aid to expand the field of view for patients with tunnel vision due to retinitis pigmentosa by providing a minified contours of the patient surroundings. 34–36 Their approach was limited to displaying expanded contours and edges of objects that were captured with a camera. This was implemented on a number of commercial HMDs; however, even though it increased the field of view, it was not effective in improving patients' ability to avoid collisions. 34 Recently, they reported the use of peripheral prisms to help patients with peripheral VF losses to detect pedestrians, and tested their visual aid with a VR simulator. Despite the significant improvement of peripheral detection, the small apertures of the visual aid and the inevitable optical confusion and overlap were major shortcomings. 37 In contrast to the previous studies, the present DSpecs approach has the advantage of customizing the vision augmentation based on patient's unique VF defect. VF augmentation is done by displaying real images that are processed and relocated into the remaining intact visual field. Our approach does not exhibit image overlap nor optical confusion artifacts, since the whole test image is being remapped. The DSpecs performs a diagnostic test before processing to ensure that what is displayed conforms with the personalized participant's VF geometrically. The purpose of our DSpecs VF measurement was to guide the image remapping algorithm by identifying the intact VF regions. These measurements are not directly comparable to those obtained with the standard automated perimetric analysis. These VF measurements had an acceptable error of 7.65% with the DSpecs compared with the commonly used testing strategy. Furthermore, the DSpecs is more case specific, as it has the potential to help various peripheral VF defects, including peripheral glaucoma defects. The results of this study have shown evidence that peripheral awareness can be improved using the DSpecs. The VF testing data with the DSpecs was incorporated to provide two advantages. First, with this technique no eye misorientation or calibration issues, such as lens rim artifact or head malpositioning occurred. Second, the diameter of the VF with the DSpecs was larger than the standard 24-2 or 30-2, which better approximates the area of display's field of view and covers more of the peripheral vision. To our knowledge, no similar visual aid can be used to diagnose a VF defect and apply a visual correction profile. Although the ability of most patients with peripheral VF defects to identify hazards was improved with DSpecs, not everyone benefitted. As shown in Figure 7 , some patients recognized the peripheral object without applying image remapping. Patients with minor peripheral defect cases did not appreciate the produced visual profile and some expressed minor improvements, such as the object being easier to find using the remapped images. These patients likely scanned the test images using eye movements and compensated for their VF defect. Another case had a severe VF defect in the left eye that even the produced remapped image was not beneficial, as the object was not seen because of the extremely narrow remaining VF to fit the image. It was also noted that the DSpecs algorithm was most effective with patients with moderate continuous peripheral field defects. Correlation analysis suggests that the MD, PDS, and VFI metrics might be predictive parameters for potential functional improvements with image remapping. Limitations of this proof of concept study include the usage of only static images for testing. Activities of daily living are normally based on responding to dynamic moving objects. Peripheral awareness is very important to sustain adequate mobility performance. 7 , 38 A dynamic testing environment with an adequate sample size is needed to ultimately prove the usefulness of this DSpecs to improve patient's ability to avoid moving obstacles. Real-time video image remapping will be necessary to conduct such an experiment. Other limitations are the subjective nature of VF testing and the accuracy of the produced visual augmentation profile consequently depends on the accuracy of the measured VF. Repetitive measurements and averaging strategies can be used to overcome this limitation. One more limitation of the study, is the utilization of subjective patients' responses to test images as the test scores, therefore patient factors such as their level of understanding of the test processes or familiarity with the VR headset could influence their responses. The minimized and shifted visual perception may affect hand and body movements while performing daily tasks. The authors believe that proprioception may play an important role in determining directional orientations, and only training will be needed to achieve good hand and body coordination with the modified spectacles visual perspective. Evaluation of the patients' ability to maintain stereopsis while the displayed images are being remapped for both eyes (i.e. binocular vision) is another point to investigate, and new remapping algorithms will be needed to eliminate the binocular rivalry effects. Driving is an important activity that many patients with peripheral VF defects cannot perform safely anymore, as they tend to miss peripherally projected stimuli. 39 Our spectacles may help these patients restore their awareness of the peripheral safety hazards associated with driving. Implementation of the DSpecs using an augmented reality (AR) platform would produce a visual aid that is more user friendly, light weight, and socially acceptable for the daily real-life usage. These points are all considered in our future studies. The authors believe that this new digital glasses technology may help patients with peripheral VF defects functionally restore a wider field of view. The glasses display algorithms allowed the test subjects to identify safety hazards that they could not do without their use. The glasses significantly allowed the recruited patients to quantify more objects in the periphery. This highlighted the positive impact of the DSpecs to potentially restore these patients' ability to perform many aspects of their visually intense activities. All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Funding/Support: This research has been partially supported by the National Institute of Health (NIH), United States, under Grant # K23 KEY026118A, NEI core center grant, United States, to the University of Miami (P30 EY014801), and Research to Prevent Blindness (RPB), United States. Research and its contents are solely the responsibility of the authors and do not necessarily represent the official view of the funding organizations. Financial Disclosures: United States Non-Provisional Pending Patent (Application No. 16/144,995) (MA) and United States Non-Provisional Filed Patents (Application No. 16/367,633, 16/367,687 and 16/367,751) (MA, AS). Patents and PCT are owned by University of Miami and licensed to Horus LLC. MA is an equity holder and sits on the Board of Directors for Horus LLC. Funding Information: All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest and none were reported. Funding/Support: This research has been partially supported by the National Institute of Health (NIH), United States, under Grant # K23 KEY026118A, NEI core center grant, United States, to the University of Miami (P30 EY014801), and Research to Prevent Blindness (RPB), United States. Research and its contents are solely the responsibility of the authors and do not necessarily represent the official view of the funding organizations. Financial Disclosures: United States Non-Provisional Pending Patent (Application No. 16/144,995) (MA) and United States Non-Provisional Filed Patents (Application No. 16/367,633, 16/367,687 and 16/367,751) (MA, AS). Patents and PCT are owned by University of Miami and licensed to Horus LLC. MA is an equity holder and sits on the Board of Directors for Horus LLC. Publisher Copyright: © 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Purpose: To examine an image remapping method for peripheral visual field (VF) expansion with novel virtual reality digital spectacles (DSpecs) to improve visual awareness in glaucoma patients. Design: Prospective case series. Methods: Monocular peripheral VF defects were measured and defined with a head-mounted display diagnostic algorithm. The monocular VF was used to calculate remapping parameters with a customized algorithm to relocate and resize unseen peripheral targets within the remaining VF. The sequence of monocular VF was tested and customized image remapping was carried out in 23 patients with typical glaucomatous defects. Test images demonstrating roads and cars were used to determine increased awareness of peripheral hazards while wearing the DSpecs. Patients' scores in identifying and counting peripheral objects with the remapped images were the main outcome measurements. Results: The diagnostic monocular VF testing algorithm was comparable to standard automated perimetric determination of threshold sensitivity based on point-by-point assessment. Eighteen of 23 patients (78%) could identify safety hazards with the DSpecs that they could not previously. The ability to identify peripheral objects improved with the use of the DSpecs (P = .0.024, chi-square test). Quantification of the number of peripheral objects improved with the DSpecs (P = .0.0026, Wilcoxon rank sum test). Conclusions: These novel spectacles may enhance peripheral objects awareness by enlarging the functional field of view in glaucoma patients.
AB - Purpose: To examine an image remapping method for peripheral visual field (VF) expansion with novel virtual reality digital spectacles (DSpecs) to improve visual awareness in glaucoma patients. Design: Prospective case series. Methods: Monocular peripheral VF defects were measured and defined with a head-mounted display diagnostic algorithm. The monocular VF was used to calculate remapping parameters with a customized algorithm to relocate and resize unseen peripheral targets within the remaining VF. The sequence of monocular VF was tested and customized image remapping was carried out in 23 patients with typical glaucomatous defects. Test images demonstrating roads and cars were used to determine increased awareness of peripheral hazards while wearing the DSpecs. Patients' scores in identifying and counting peripheral objects with the remapped images were the main outcome measurements. Results: The diagnostic monocular VF testing algorithm was comparable to standard automated perimetric determination of threshold sensitivity based on point-by-point assessment. Eighteen of 23 patients (78%) could identify safety hazards with the DSpecs that they could not previously. The ability to identify peripheral objects improved with the use of the DSpecs (P = .0.024, chi-square test). Quantification of the number of peripheral objects improved with the DSpecs (P = .0.0026, Wilcoxon rank sum test). Conclusions: These novel spectacles may enhance peripheral objects awareness by enlarging the functional field of view in glaucoma patients.
UR - http://www.scopus.com/inward/record.url?scp=85075985964&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075985964&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2019.10.006
DO - 10.1016/j.ajo.2019.10.006
M3 - Article
C2 - 31626763
AN - SCOPUS:85075985964
VL - 210
SP - 125
EP - 135
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
SN - 0002-9394
ER -