A New Approach to Vision Therapy Based on Naturalistic 3-D Computer Gaming

描述（由申请人提供）：会聚障碍和屈光性弱视是一般验光临床实践中最常见且可治疗的视力问题。基于Oce和家庭的视力治疗（分别为OBVT和HBVT）是此类疾病的标准治疗方法。计算机视频治疗的最新进展，模拟视力治疗演习中进行的验光师的oce提供了一个更低的成本和更方便的替代OBVT。目前商业HBVT系统的缺点是，推荐的眼保健操是高度重复的，单调的，无趣的，这导致高水平的患者不依从性。这提出了一个问题，因为一致的性能和适当的技术是实现治疗效果的关键。 另一种方法是将视力治疗融入有趣的互动电脑游戏中，患者会更感兴趣，这对提高HBVT的成功率有很大的潜力。为了满足这一需求，巴伦协会提出开发一种新的计算机化虚拟现实HBVT系统，称为iCare，它将通过解决成功家庭治疗的三个障碍来克服现有系统的局限性：（1）患者依从性;（2）程序准确性;（3）验光师监测培训的能力。 所提出的方法利用了高级人机接口设备（HID）（例如，Wii遥控器）是为视频游戏市场开发的。由于视频游戏的流行，在最近的过去可能会非常昂贵的HID技术现在以低成本广泛可用（例如，< $40）。这些现成的HID允许在计算机显示器（用于近点视觉治疗）或等离子显示器（用于远距离视觉治疗）上创建虚拟三维（3-D）环境。基于“3D眼镜”的传统3D图形技术（即，红-蓝立体照片）相对于观看设备的框架是静态的;也就是说，不管观看者相对于监视器的位置如何，图像都是相同的。拟议中的iCare技术通过低成本跟踪患者的头部位置和方向来利用运动视差，从而创建动态视觉3D环境。在视觉上，该技术允许观看者感知物体，就好像它们是从屏幕中出来的，或者退回到屏幕中。这使得在近乎无限的3-D空间中创建虚拟的对象成为可能。用户甚至可以看到“背后”和操纵虚拟对象。 根据SBIR快速通道拨款申请，提议团队将使用上述技术为HBVT开发和测试原型计算机游戏环境，以提高治疗效果。第一阶段治疗的目的是治疗8-12岁儿童的屈光性弱视;第二阶段将重点治疗青少年和成人的屈光性弱视，以及两个人群的会聚性弱视。这些疾病显然适合视力治疗，在临床实践中很常见。对于这两种视力问题，将在儿童中进行最流行的计算机化HBVT程序与iCare系统游戏的比较有效性的临床研究，以评估iCare系统的有效性。 公共卫生相关性：会聚不足是最常见的双眼视觉障碍之一，屈光性弱视是一种非常高比例的患者寻求治疗的视觉障碍;这两种障碍影响数百万美国儿童和成人。这种视力异常会引起各种慢性症状，如果不加以治疗，往往会降低学习和工作成绩;在某些情况下，甚至可能导致学习障碍。计算机化家庭视力治疗（HBVT）提供了一种相对低成本和方便的治疗选择;然而，现有的商业HBVT程序高度重复和枯燥，导致依从性差。本研究的目的是通过将眼保健操融入有趣，有趣和互动的计算机视频游戏中，使HBVT成为基于海洋的视力治疗的更有效的替代方案，患者将更有吸引力，这将导致更好的依从性和改善的治疗结果。

DESCRIPTION (provided by applicant): Convergence disorders and refractive amblyopia are among the most common and treatable vision problems seen in general optometric clinical practice. Oce- and home-based vision therapy (OBVT and HBVT, respectively) are standard treatments for such disorders. Recent advances in computerized video therapies that emulate vision therapy exercises performed in the optometrist's oce provide a lower-cost and more convenient alternative to OBVT. The downside of current commercial HBVT systems is that the recommended eye exercises are highly repetitive, monotonous, and uninteresting, which leads to high levels of patient noncompliance. This presents a problem since consistent performance and proper technique are key to achieving therapeutic benet. An alternative approach, which oers strong potential to increase the success of HBVT, is to incorporate vision therapy into fun and interactive computer games that patients will nd more engaging. To address this need, Barron Associates proposes to develop a novel computerized virtual reality HBVT system called iCare that will overcome the limitations of present systems by addressing three obstacles to successful home treatment: (1) patient compliance; (2) procedural accuracy; and (3) the ability of the optometrist to monitor training. The proposed approach takes advantage of advanced human-interface devices (HIDs) (e.g., Wii Remote Controllers) that have been developed for the video gaming market. Due to the popularity of video gaming, HID technology that would have been prohibitively expensive in the recent past is now widely available at low cost (e.g., < $40). These o-the-shelf HIDs permit the creation of virtual three-dimensional (3-D) environments on computer monitors (for \near-point" vision therapy) or plasma displays (for \distance" vision therapy). Traditional 3-D graphics technology based on \3-D glasses" (i.e., red-blue anaglyphs) is static with respect to the frame of the viewing device; that is, the image is the same regardless of the viewer's position relative to the monitor. The proposed iCare technology exploits motion parallax via low-cost tracking of the patient's head position and orientation, creating a dynamic visual 3-D environment. Visually, the technology allows the viewer to perceive objects as if they are coming o of, or receding into, the screen. This enables the creation of virtual xation objects in a nearly innite 3-D space. Users can even see \behind" and manipulate virtual objects. Under this SBIR Fast Track grant application, the proposing Team will develop and test prototype computer gaming environments for HBVT using the technology outlined above to improve treatment eectiveness. Phase I therapy will be aimed at treating refractive amblyopia in children 8-12 years of age; Phase II will focus on treating refractive amblyopia in teens and adults, as well as convergence insuciency in both populations. These disorders are clearly amenable to vision therapy and are common in clinical practice. For both vision problems, clinical studies of the comparative eectiveness of the most popular computerized HBVT programs vs. the iCare system's games will be conducted in children to assess the ecacy of the iCare system. PUBLIC HEALTH RELEVANCE: Convergence insuciency is one of the most common binocular vision disorders, and refractive amblyopia a vision disorder for which a very-high percentage of patients seek treatment; both disorders aect millions of U.S. children and adults. Such vision anomalies can cause a variety of chronic symptoms which, left untreated, often degrade academic and work performance; they may even result in learning disabilities in some cases. Computerized home-based vision therapy (HBVT) provides a relatively low-cost and convenient treatment option; however, the available commercial HBVT programs are highly repetitive and dull, leading to poor compliance. The goal of this research is to make HBVT a more eective alternative to oce-based vision therapy by incorporating the eye exercises into fun, interesting, and interactive computer video games that patients will nd more engaging, which should lead to better compliance and improved therapeutic outcomes.