Clustered home assessment of visual fields in patients with glaucoma

项目摘要/摘要 青光眼是美国人不可逆转的视力丧失的第二大原因。有效的治疗需要 患者进行一段时间的视野测试，以监测视野丧失的进展。在许多患者中 没有进展，但当它发生时，必须尽快检测到，以挽救视力 通过使用更具侵略性的治疗。视力稳定的患者不知道这一点，所以他们担心 不必要的。 测量视野的常规测试太难进行了。他们疲惫不堪，装备齐全 他们使用的是昂贵和笨重的，仍然需要熟练的周边检查员来培训患者如何参加测试和 监测眼球运动和患者疲劳感。因此，青光眼患者通常会有一个视野 一年只检测一到三次。不幸的是，这些测试的结果具有很高的可变性，因为 测试的持续时间必然较短。因此，在估计疾病进展速度时存在很大的误差 从青光眼患者的视野来看，迫切需要在家里做额外的测试，以克服 数据限制。 我们开发了一种名为Vivid Vision视野检查(VVP-10)的测试，它显著增加了 患者可以收集的视野数据。患者在家中通过低成本的虚拟现实(VR)耳机使用VVP-10。 我们使用了一种新的任务，使测试变得更加用户友好。VVP-10使患者可以自由活动 他们的眼睛，并确切地知道什么时候会出现刺激。它在每次刺激后向患者提供反馈， 并使测试更像是一个视频游戏。患者可以选择猜测或不猜测，因为猜测 不会影响测试结果。在这个项目的第一阶段，我们通过展示 老年青光眼患者可以在家中进行测试，而无需面对面的培训。计算结果与实验结果吻合较好。 传统的考试，我们的数学模型建议一年四次进行10次考试 可以将检测快速进展所需的月数减少一半以上。在本指南中，直接指向 在第二阶段项目中，我们将使测试更容易执行，优化收集的数据质量，以及 确认VVP-10可以将检测快速进展所需的月数减少一半。 这项新测试是由Vivid Vision，Inc.开发的，Vivid Vision，Inc.是一家总部位于旧金山、成立七年的公司。 加州。该公司销售一种双目视觉治疗产品，全球350家诊所使用。它在以下方面拥有专业知识 心理物理学，VR游戏的软件工程，符合HIPAA的远程医疗，知识产权保护，市场营销， 和销售量。加州大学旧金山分校医学院和纽约大学医学院的领先青光眼专家 加入了该团队，在65名青光眼患者中开展了一项为期一年的多点VVP-10研究。

Project summary/abstract Glaucoma is the second leading cause of irreversible vision loss in Americans. Effective treatment requires the patient to take visual field tests over time, to monitor for progression of visual field loss. In many patients there is no progression, but when it occurs it must be detected as quickly as possible in order to save vision by using a more aggressive treatment. Patients whose vision is actually stable don’t know it, so they worry unnecessarily. Conventional tests to measure visual fields are too difficult to take. They are fatiguing and the equipment they use is expensive and bulky A skilled perimetrist is still required to train the patient how to take the test and to monitor for eye movements and patient fatigue. As a result, glaucoma patients typically have a visual field test only one to three times a year. And unfortunately, the results of these tests have high variability due to the necessarily short duration of the test. Thus, there is large error when estimating the rate of disease progression from visual fields in a patient with glaucoma, and an urgent need to do additional testing at home to overcome the data limitation. We developed a test, called Vivid Vision Perimetry (VVP-10), that substantially increases the quantity of visual field data a patient can collect. Patients take VVP-10 at home on a low-cost virtual reality (VR) headset. We have made the test much more user-friendly, using a novel task. VVP-10 allows the patient to freely move their eyes and to know exactly when stimuli will appear. It gives feedback to the patient after every stimulus , and makes the test more like a video game. Patients have the option of guessing or not, because guessing does not affect the test outcome. During Phase I of this project, we demonstrated feasibility by showing that elderly glaucoma patients can perform the test at home without in-person training. The results agreed well with conventional tests, and our mathematical models suggest that taking a cluster of 10 tests four times a year could reduce by more than half the number of months needed to detect rapid progression. In this Direct to Phase II Project, we will make the test still easier to perform, optimize the quality of the data collected, and verify that VVP-10 can reduce by half the number of months needed to detect rapid progression. The new test is being developed by Vivid Vision, Inc., a seven-year-old company based in San Francisco, CA. The company sells a binocular vision treatment product used by 350 clinics worldwide. It has expertise in psychophysics, software engineering for VR games, HIPAA-compliant telemedicine, IP protection, marketing, and sales. Leading glaucoma specialists at the UCSF School of Medicine and the NYU School of Medicine have joined the team to carry out a one-year, multi-site study of VVP-10 in 65 patients with glaucoma.