Systems and methods for visual field analysis

Abstract

To provide methods and systems for assessing a visual field of a person.SOLUTION: Information can be presented to a person undergoing a visual field testing in a manner that utilizes the person's natural tendency to look at an object that is displayed so that it attracts the person's attention. A fixation target can be displayed on a display viewed by a user. Once it is determined that the user has viewed the fixation target and the person's eye(s) location is determined, a test target is displayed on the display in a location corresponding to a location on the user's visual field. The test target is determined to be either detected or missed based on user input acquired as the user is viewing the display.SELECTED DRAWING: Figure 6E

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. patent application Ser. No. 62 / 586,151, entitled "SYSTEM AND METHOD FOR VISUAL ASSESSMENT," filed Nov. 14, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0002] Systems and methods are provided for visual field analysis to diagnose and monitor vision disorders, including glaucoma. [Background technology]

[0003] Many diseases of the visual system initially manifest as a selective geographic loss of vision in one or more locations. Screening for disease, monitoring progression during treatment, and developing new therapies rely on qualitative assessment of a patient's visual field defects. Visual field analysis, also known as "perimetry," measures how well a patient can see at various locations on the patient's retina.

[0004] Glaucoma is a progressive disease that results in the loss of peripheral vision due to damage to retinal ganglion cells, whose axons form the optic nerve. For example, primary open-angle glaucoma (POAG), which is estimated to affect millions of people in the United States, can lead to blindness if not detected early. Perimeter measurements are typically used to detect and monitor disease progression and evaluate new treatments for POAG and other visual disorders.

[0005] Current technologies for perimetry are expensive and often inconvenient for patients. Therefore, administering a cluster of perimetry tests to a patient over a short period of time is difficult, thereby limiting the ability to characterize the patient's vision at that time. Patients also typically must be instructed to keep their heads still, which can cause physical discomfort and reduce fixation accuracy. Furthermore, individual test results may be less reliable than desired, undermining the usefulness of administered tests.

[0006] Therefore, there is a need for improved techniques for analyzing a patient's visual field. Summary of the Invention

[0007] A method and system for assessing and monitoring a person's visual field is provided. Information can be presented to a person undergoing a visual field test in a way that captures their attention, taking advantage of a person's natural tendency to look at displayed objects. A fixation target can be displayed on a display at which the user is looking. Once it is determined that the user has looked at the fixation target and the position of the person's eyes is determined, the test target is displayed on the display at a location in the user's visual field, i.e., a location corresponding to a location on the user's retina. Thus, once the position of the user's eyes is known, the test target can be displayed on the display so that the test target is seen at a specific location on the patient's retina. The test target is determined to be detected or missed based on user input obtained while the user is looking at the display. For example, if a pointer displayed on the display (which the user can control in various ways) moves toward the location of the test target, the test target is determined to be detected. However, if the pointer moves in a direction different from the test target or if a certain period of time passes without the pointer moving, the test target can be determined to be missed. Multiple test targets can be displayed at different locations in this manner, allowing multiple locations on the user's retina to be tested. The evaluation can be used to test a patient's visual field, monitor disease progression, monitor treatment progress, and for other purposes.

[0008] In one aspect, a system for assessing a user's visual field is provided, the system including computing hardware configured to perform various operations, including displaying a fixation target in a virtual reality environment on a virtual reality display of a head-mountable virtual reality device, the virtual reality environment comprising a pointer controlled by a user wearing the head-mountable virtual reality device. For example, in various embodiments, the virtual reality environment can be any visual stimulus displayed to a user that is processed and simulated on a computer and displayed to the user based at least in part on the user's head position. This includes head-mounted or off-head displays, displays commonly referred to as augmented reality or mixed reality, and computer monitors configured to track head movement and update images to create a window-like effect. The operations further include, if the eye is determined to be fixated on the fixation target, determining whether at least one eye of the user is fixating on the fixation target, displaying a test target of the plurality of test targets at a first location in the virtual reality environment, the first location corresponding to a first location in the user's visual field, receiving user input comprising an indication of pointer movement in the virtual reality environment, determining whether the user input indicates that the pointer is moving toward the first location, obtaining an indication of whether the test target was detected by the user based on the received user input, and storing the indication. The operations further include repeatedly performing the displaying, determining, displaying, receiving, and acquiring steps until all test targets of the plurality of test targets are displayed, and providing an assessment of the state of the visual field based on a result of the determination of user detection of the test target during the repeated displaying, determining, displaying, receiving, and acquiring steps.

[0009] The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims.

[0010] The present disclosure will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings. [Brief explanation of the drawings]

[0011] [Figure 1A] 1 is a flowchart illustrating a process for administering a test to a patient to assess the patient's visual field, according to some embodiments. [Figure 1B] 1 is a spreadsheet for controlling a visual field test according to various embodiments of the disclosed technology. [Figure 2A] 1 is a block diagram illustrating a system in which some embodiments may be implemented. [Figure 2B] 1 is a block diagram illustrating a system in which some embodiments may be implemented. [Figure 3] 1 is an example of a rendered computing device user interface according to some embodiments. [Figure 4] 1 is an example of information that may be displayed on a rendered computing device user interface according to some embodiments. [Figure 5] 5 is another example of information shown on the user interface of FIG. 4. [Figure 6A] FIG. 10 is a schematic diagram of an example of a blind spot mapping layout of a template, according to some embodiments. [Figure 6B] 1 shows a sampling grid covering the expected locations of typical blind spots at a spatial resolution of 0.7 degrees target spacing. [Figure 6C] Two sets of data are shown, obtained by testing the left and right eyes. [Figure 6D] The data in Figure 6C are shown graphically overlaid on respective fundus images from the same individual. [Figure 6E] Another test pattern is shown with a spatial resolution of 0.3 degrees target interval, showing a vascular scotoma. [Figure 7A]FIG. 1 is a schematic diagram of an example of visual information that may be presented as part of a high acuity pattern determination task, according to some embodiments. [Figure 7B] 1 shows a simplified probe using a single figure rotational orientation that requires high visual acuity, such as the "Landolt C." [Figure 8] 1 is a schematic diagram of an example of a scene that can be displayed on a suitable display, according to some embodiments. [Figure 9] 1 is an example of a correlation map generated for a single point on the field of view, showing the correlation between that point and each of the other points, according to some embodiments. [Figure 10A] 1 is a schematic diagram of an embodiment of a method for testing a patient's visual field using a pointer displayed in a VR environment on a display of a head-mountable device, according to some embodiments. [Figure 10B] 1 is a schematic diagram of an embodiment of a method for testing a patient's visual field using a pointer displayed in a VR environment on a display of a head-mountable device, according to some embodiments. [Figure 10C] 1 is a schematic diagram of an embodiment of a method for testing a patient's visual field using a pointer displayed in a VR environment on a display of a head-mountable device, according to some embodiments. [Figure 10D] Indicate the test to which the patient is likely to respond by specifying one of four possible circular areas for the location of the test target. [Figure 10E] Indicate the test to which the patient is likely to respond by specifying one of six possible sectors for the location of the test target. [Figure 11A] FIG. 1 is a schematic diagram of an example test layout according to some embodiments. [Figure 11B] FIG. 1 is a schematic diagram of an example inspection layout in the shape of a ladybug, according to some embodiments. [Figure 11C] FIG. 1 is a schematic diagram of an example of a turtle-shaped inspection layout, according to some embodiments. [Figure 12]10 shows example results of an assessment of a patient's visual field using a head pointer approach, according to some embodiments. [Figure 13] 10 shows example results from two tests using a head pointer approach, according to some embodiments. [Figure 14] 1 is an example of the results of an assessment of the visual field of a patient with primary open-angle glaucoma using a head-pointer approach, according to some embodiments. [Figure 15] 10 is an example of the results of an assessment of the visual field of another patient with primary open-angle glaucoma using a head-pointer approach, according to some embodiments. [Figure 16] 1 shows a graph for representing the results of a visual field test, where the raw data is shown in a schematic layout corresponding to the spatial layout of the test targets. [Figure 17] 1 shows a graph for representing the results of a visual field test in which a color map is created by interpolation and extrapolation from sample points spaced proportionally to the test target interval in the test. [Figure 18A] 1 shows a model of the patient's cognitive process in relation to conventional perimetry. [Figure 18B] 1 illustrates a model of a patient's cognitive process for a method of perimetry according to various embodiments of the disclosed technology. [Figure 19] 1 is a flowchart of a process for assessing a user's field of view in accordance with various embodiments of the disclosed technology. DETAILED DESCRIPTION OF THE INVENTION

[0012] Certain exemplary embodiments are described herein to provide a general understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and shown in the accompanying drawings are non-limiting exemplary embodiments, and that the scope of the invention is defined only by the claims. Features illustrated or described in connection with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be within the scope of the present invention.

[0013] Furthermore, in this disclosure, like-named components of embodiments generally have similar characteristics, and therefore, within a particular embodiment, every feature of each like-named component is not necessarily described in full detail. Furthermore, to the extent that linear or circular dimensions are used in describing the disclosed systems, devices, and methods, such dimensions are not intended to limit the types of shapes that can be used in conjunction with such systems, devices, and methods. Those skilled in the art will recognize that the equivalents of such linear and circular dimensions can be readily determined for any geometric shape. The size and shape of the systems and devices and their components can depend, at least, on the anatomical structure of the subject with which the systems and devices are used, the size and shape of the components with which the systems and devices are used, and the method and procedure with which the systems and devices are used. Like reference symbols in the various drawings indicate like elements.

[0014] In certain embodiments, methods and devices are provided for diagnosing and monitoring a patient's visual impairment, including impairments affecting the patient's field of vision. In an exemplary embodiment, the methods and devices are used with head-mountable virtual reality devices that provide a visually realistic environment on their virtual reality display. However, the methods and devices can be utilized with any other device having a similar environment, such as an augmented reality or mixed reality environment on a mobile computing device or other computing device. Accordingly, it should be understood that the systems and methods described herein apply to virtual reality, augmented reality, mixed reality, or similar environments. A patient's visual field can be evaluated by displaying images to the patient at various locations within the patient's visual field and identifying locations of blind spots or reduced sensitivity. In this manner, it can be detected that the patient does not see images displayed on the display at locations corresponding to the impaired blind spots or retinal regions. Images are presented to the patient in a manner that takes advantage of people's natural tendency to view objects that attract their attention.

[0015] In one exemplary embodiment, a head-mountable virtual reality device has computing hardware configured to perform operations for analyzing a patient's visual field. The analysis (which may include either or both of diagnosis and treatment monitoring) can be performed in an automated manner and in a manner that is comfortable for the patient. Furthermore, the head-mountable virtual reality device can be used to perform the analysis in a cost-saving manner. For example, various diseases such as glaucoma, brain tumors, stroke, intraocular cancer, retinal detachment, and routine eye examinations can be addressed using high-quality visual field tests that can be performed in a relatively short time. For example, in some embodiments, the analysis can be performed in five minutes or less, although it should be understood that other durations may be required depending on various factors, including the desired statistical reliability, the time the patient needs to undergo the test, visual fatigue, and the purpose of the test (e.g., for screening versus monitoring).

[0016] Traditional perimetry setups are somewhat cumbersome. For example, patients must maintain visual fixation or gaze on a target that can be located in the center of the display. Patients must keep their eyes still throughout the entire test by staring at a central object (target) while the test target is presented. This is called static visual field. However, many patients, especially older patients and children, are unable to meet this requirement, even with normal vision. This is because they tend to look away from the central target and toward a new, salient or test target (the foveal reflex). Traditional methods do not take into account covert visual attention or specific eye movements. Covert attention, which is attention deployed to a location without eye movement, functions like a gain field, adjusting how well the brain can detect a target at a specific location, regardless of where the eyes are directed. A lack of covert attention to any part of the visual field reduces behaviorally measured visual sensitivity in that location. Efforts to maintain fixation on a single central target over time may require covert attention to the fixation target. Thus, a patient may fail to detect a visual target presented at another location on the display that they would otherwise have detected if their subconscious attention is allocated to the wrong location. Another complication is that patients with cataracts can see flashes from scattered light in their eyes even when they are not looking at the actual target location. However, the techniques disclosed herein allow patients to move their eyes away from a single fixation target.

[0017] Another drawback of traditional perimetry is that it is typically unnatural for patients to maintain eye contact without eye movement. Therefore, even if a patient initially fixates accurately on a target, fixation becomes more difficult as the test progresses, requiring the patient to continue gazing at the same target. If it is determined that the patient is not properly fixating the central target, the test can be restarted. In some cases, if a high rate of fixation errors is determined, the test results must be discarded. The techniques disclosed herein allow patients to change their fixation from one target to another, eliminating the need for patients to practice fixation or start over.

[0018] Furthermore, because existing systems accept "yes / no" or other types of binary user input during testing, it can be easy for patients to "cheat" by guessing whether a target has appeared. Patients often guess when a test target will appear, and while medical professionals overseeing the test may be able to take action to compensate for such guesses, such actions still lengthen the test and increase the cost of administering the test. Additionally, test accuracy may generally decrease if patients are able to guess inputs. An additional advantage of the described approach is that it leaves less room for patients to provide incorrect inputs, such as by guessing the correct answer. In particular, the described technique reduces the number of false positives because the likelihood of guessing the correct location may be an order of magnitude smaller than the likelihood of guessing that a target has been presented.

[0019] Furthermore, traditional perimetry techniques, such as standard automated perimetry (SAP), have certain limitations for testing and assessing a person's visual field, and some patients may not be able to position their head correctly. For example, patients who are bedridden or wheelchair-bound may not be able to maintain the correct head position for both traditional and standard automated perimetry.

[0020] In some embodiments, a pointer (e.g., an image of a relatively small object) can be displayed on a display of a device, such as a virtual reality (VR) display of a head-mountable virtual reality device or a display of a computing device. The pointer can be controllable based on user input. Thus, if the display is a display of a head-mountable virtual reality device, the pointer ("head pointer") moves as a patient wearing the head-mountable device moves their head. In this way, the patient's head movement serves as user input. The patient "points" at an object displayed on the display by moving their head toward the object, which can appear on the display at various positions within the patient's field of view. The position of the head pointer changes as the user's head moves, but the pointer itself can remain in the same position relative to the patient (e.g., the center of the user's field of view). In various embodiments, the patient holds a rotating and / or position-tracked hand controller that is used as a pointer to provide input to the test in much the same way as a head pointer does.

[0021] The patient's visual field can be divided into detection zones, each corresponding to a spot in the patient's visual field. When the head-mountable virtual reality device displays the VR environment on the device's VR display, test targets are displayed (e.g., in the patient's peripheral vision), and the patient can respond to each target by moving a pointer toward the target when the patient sees it. The targets, which can have various characteristics (described in more detail below), are intended to attract the patient's attention, thereby utilizing a person's natural tendency to view new images on a display. The test targets have associated detection zones within which the targets are displayed. When the pointer is moved in the correct direction toward the location of the test target (which may be out of sight because it was displayed for a short time (e.g., 0.3 seconds)) and the test target is determined to be detected, a subsequent fixation target is displayed on the display. The fixation target can be displayed near or, in some embodiments, within the detection zone associated with the test target. Furthermore, in some embodiments, the fixation target can be in the form of a movable object. The movement can be linear, a random walk, a quick jump, or any pattern, or a combination thereof. The fixation target can also be displayed in the form of a representation of a moving object or person as part of a 2D or 3D scene, such as a game-like or movie-like scene being displayed. Such a representation can be viewed by the patient as being "tracked" by a pointer, which can be in the form of a representation of any suitable object. In some implementations, the fixation target can be a (e.g., moving) part of a scene that resembles the real world. The fixation target can also be displayed as part of an actual movie or video clip.

[0022] Regardless of its particular form and whether and how it can be moved, the fixation target is intended for the patient to look at before moving their head (or other body part or input device held by the user) toward the location where the test target is displayed. The fixation target is determined to be visible to the user because the pointer at least partially overlaps (or "collides" with) the fixation target, and the user's eye position is therefore determined. Once the user's eye position is determined, a subsequent test target is displayed at a location corresponding to the location in the patient's visual field. In some embodiments, for a fixation target to be determined to be detected, the pointer must remain near the fixation target for a certain period of time. Once the pointer is positioned a predetermined distance within the fixation target (e.g., overlaps with the target), subsequent test targets are displayed at other locations on the display mapped to corresponding locations on the patient's retina (if there are more test targets to display in the current test or session), but the fixation target disappears. When the patient looks at the next test target, the patient moves the pointer toward the location of the next test target, based on the patient's natural tendency to orient their eyes toward objects that attract attention. In this way, multiple locations within the patient's visual field can be examined, ultimately providing an overall assessment of the patient's retinal condition.

[0023] The fixation target can be presented to one or both eyes simultaneously. If the fixation target is presented to only one eye, the test target is presented to the same eye. For individuals with normal binocular vision, a fixation target visible to both eyes increases fixation stability and is therefore preferred. However, some individuals do not accurately fixate binocular targets with both eyes simultaneously. For example, individuals with a history of amblyopia or strabismus should fixate using one eye and not simultaneously focus the other eye on the fixation target. In such cases, binocular fixation targets should not be used because the location of the test target relative to the visual axis of that eye cannot be accurately determined. Testing can include a decision at the beginning of the test regarding whether to use binocular fixation targets. For example, individuals with strabismus may view a target intended for a blind spot when it is displayed in the eye that does not control fixation. At that point, testing can use a monocular fixation target instead.

[0024] The system may use the model to estimate the viewer's true fixation. The model can receive inputs including, but not limited to, head position, head velocity, eye position, eye velocity, and information about the test target (e.g., the pixel on the screen that changed before the estimated fixation). This allows the system to more accurately estimate the patient's fixation while the test target is displayed, allowing it to be more accurately placed on a specific part of the retina.

[0025] FIG. 1A illustrates one embodiment of a method 100 for testing or assessing a patient's visual field according to the described techniques. The process illustrated in FIG. 1A can be initiated by any suitable trigger and at any suitable time. For example, if a patient / user is conducting an assessment in a home environment (or outside of a clinical setting), the process can begin when the user initiates a system configured to perform the described techniques. The system can be, for example, a computing device (e.g., a smartphone or personal computer) and a head-mountable VR device. A particular test can be selected by the user, or the test can be selected and automatically presented to the user. For example, a particular test can be pre-selected by a clinician. In some cases, the clinician can remotely monitor the user's performance of the test in real time, or the clinician can evaluate the test results after the test is completed. In some embodiments, selecting a test includes selecting a template and template layout, which are discussed in more detail below. Templates can be selected to assess the range of the visual field and the sensitivity of the patient's vision in various portions of the visual field. As discussed in more detail below, various parameters of the test can be pre-set and / or adjusted in real time. In some embodiments, at least some parameters can be adjusted in real time as the test is being administered. Additionally, in some embodiments, the locations of the test and fixation targets can be dynamically selected, for example, using a probabilistic approach (e.g., a Bayesian approach).

[0026] As shown in FIG. 1A, in block 102, a pointer (e.g., a head pointer or other type of pointer, such as a pointer controlled by a hand controller) can be displayed in the patient's field of view. Next, in block 104, a next fixation target can be displayed on a specific background. This is the first fixation when the assessment begins. The next fixation target can have any suitable characteristics and can be displayed in the patient's field of view at a randomly selected location or a predetermined location. The position of the head or handheld pointer can be updated to match changes in the position of the head or hand controlling the pointer. Alternatively, the pointer position can be updated with a gain greater than 1.0 to encourage the patient to move the pointer quickly. Alternatively, the pointer position can be updated with a gain less than 1.0 to encourage the patient to succeed at the task during fixation. To smooth pointer movement in the event of a patient tremor or lack of fine motor control, the pointer position can be updated with a delay to allow integration of head or hand position over time, or various other algorithms can be used to control the pointer position relative to the fixation target.

[0027] The fixation target is presented for the purpose of obtaining input indicating completion of a fixation task associated with the fixation target. A fixation task can be defined as a task the patient must complete to properly fixate on the fixation target. For example, the fixation task can be a task of moving a pointer toward the fixation target so that (in some cases) the pointer at least partially overlaps the fixation target. The fixation target, which can have any of a variety of properties (e.g., it can move in various ways, such as jumping on the display, or it can have various features that can be displayed to prompt the patient to view the fixation target), is displayed until the patient completes the required fixation task, and the fixation target (and its characteristics) are viewed by the patient. In some embodiments, the fixation task performed by the patient includes moving a pointer so that it at least partially overlaps the fixation target. Thus, as shown in FIG. 1A, at decision block 106, it is determined whether the fixation target is detected / viewed by the patient. The described technique requires confirming that the patient's fovea is fixated on the fixation target. If it is determined in block 106 that the fixation target was not seen by the patient (e.g., the patient does not receive an indication that they saw the fixation target (e.g., based on tracking the patient's head and / or the patient's eyes)), process 100 may continue to block 108, where it is determined that the fixation target was not detected. Process 100 then returns to block 104, where the fixation target not detected by the patient continues to be displayed. One or more properties of the fixation target may be modified to display the fixation target in a manner that is more easily seen by the patient. However, in some implementations, if it is determined that the patient did not see the displayed fixation target, an additional one or more fixation targets may be displayed (block 104) until an indication is received that the patient saw the fixation target (e.g., based on tracking the patient's head and / or the patient's eyes).

[0028] Once it is determined at decision block 106 that the patient has looked at the fixation target (or one of one or more such fixation targets) so that the fixation task is considered complete, the patient's eye position is determined, and at block 110, the next test target (also referred to as a "stimulus" or "test target") is displayed. Test targets can be displayed to one or both of the user's eyes. At the beginning of the test, the next test target is the first test target. As described in more detail below, test targets can have various properties. In some cases, the location within the patient's visual field for displaying the test target can be random and / or selected from several predetermined locations (corresponding to locations on the retina) intended for testing. The test target can be displayed for a specific period of time, for example, a period ranging from about 100 milliseconds (ms) to about 300 ms, or any other suitable period of time.

[0029] The pointer can also have a variety of properties: In at least one embodiment, the pointer is in the form of a spot (e.g., in one example, approximately 0.8 degrees in diameter, but can have any suitable size and shape) that moves with the patient's head and is controlled by a handheld controller or other user input device.

[0030] In some embodiments, once the fixation task is determined to be complete, the test target is briefly displayed (at block 110) and perceived as "flashed" by the patient. As noted above, the described technique requires confirmation that the patient's fovea is fixating on the fixation target. During this fixation period, the test target is briefly displayed or flashed. Because the fovea is small and has much better visual acuity than peripheral vision, the fixation target must perform a high-detail or high-attention task to accurately determine where the patient's eyes are directed. If the eye's direction is known, the test target can be displayed at a location in the patient's visual field that corresponds to a specific location on the patient's retina. In this way, regardless of its properties, the fixation target is displayed in a way that identifies where the patient's eye (or eyes) are directed.

[0031] Thus, the fixation target can be displayed at least partially simultaneously with the time the test target is flashed. In some embodiments, once the test target is displayed, the fixation target may disappear from the patient's field of view. In some embodiments, as the pointer is moved toward the test target's location, both the fixation target and the test target may disappear from the patient's field of view. However, in some embodiments, the fixation target (or a portion thereof) can remain on the display, or one or more of its characteristics can change, while the next test target is displayed. At decision block 112, the user indicates whether they have seen the test target. This can be by the user moving the pointer toward the test target, the user moving their head toward the test target, a pupillary response, a button press, or some combination of these indications. If the user indicates that they have seen the target, then at block 114, it is determined that the test target has been detected, because the patient was able to perceive the test target (e.g., in the form of a flash) at a specific location on the patient's retina. This result is stored in an appropriate format and in appropriate memory hardware. It should be understood that the processing in block 112 may additionally or alternatively include determining whether the pointer is not moving toward the location of the test target and a predetermined time has elapsed (which may be an adjustable parameter). If it is determined that the pointer is not moving toward the location of the test target (e.g., the pointer is not moving or is not moving in the wrong direction) and the predetermined time has elapsed, the test target has not been detected, i.e., it has been missed due to a defect in the corresponding position of the retina.

[0032] It is natural for humans to move their heads in the direction of a target that has attracted their attention, and the human orienting response begins with an eye movement followed by a catch-up head movement, during which the eyes rotate back and forth to maintain fixation. In one embodiment, if it is detected that the pointer (e.g., as a result of the patient's head movement) has moved in the correct direction (e.g., within the correct 30-degree sector when the range of motion reaches 5 degrees) toward the location of the test target, it can be determined that the target has been detected by the patient.

[0033] Referring to FIG. 1A , if it is determined at decision block 112 that the pointer is not moving toward the location of the test target, then at block 116 it is determined that the test target has not been detected. This may include determining that a predetermined period of time has passed without the pointer being brought toward the test target. Alternatively, a model may be used to determine whether the test target has been detected. The model receives inputs including, but not limited to, head position, head velocity, eye position, eye velocity, and information about the visual test target being displayed in the viewer (e.g., how the pixels on the screen changed leading up to the display / display of the test target). Next, process 100 may proceed to decision block 118 to determine whether there are other test targets to display. If so, process 100 may proceed to block 104 to display the fixation target, followed by the test target (at block 110) as described above.

[0034] If it is determined at block 114 that the test target has been detected, process 110 may proceed to decision block 118 to determine whether there are other test targets to display. If there are more test targets to display, process 100 may return to block 104 to display the next fixation target. If the fixation target is detected (determined at block 106), the next test target may be displayed at block 110. The fixation target may disappear from the patient's field of view or remain displayed. It should be understood that the processing at block 118 is provided by way of example only, as certain conditions may be determined to be met to determine whether to proceed with displaying subsequent test targets. For example, in some embodiments, process 100 may run for a predetermined period of time, such that process 100 terminates when that period has elapsed. Process 100 may also terminate based on other factors, such as when a certain number of test targets are missed by the patient, or via more complex models.

[0035] 1A , if it is determined at block 118 that there are no other test objectives (depending on the test parameters) to display, the process ends and the results of the test can be provided in an appropriate format at block 120. For example, the results can be provided to the patient's computing device and / or the clinician's computing device (which may be a remote device), where the results can be displayed, stored, and manipulated in text, graphics, or any other format. A diagnosis can be generated based on the results, including the likelihood that the patient has multiple diseases, the patient's current progress, or more complex models.

[0036] It should be appreciated that in some embodiments, block 118 may determine whether there are any more test targets to display in the current layout of the current template. The layout may determine one or more of the position, number, order, and other features related to the display of the test targets. A template may include multiple layouts, and the layouts of a template may have common characteristics. The template may be generated from a spreadsheet or other data file, such as spreadsheet 150 of FIG. 1B for layout 175. In one embodiment, the spreadsheet includes a row for each possible stimulus or test target, with a column for each characteristic. Test target properties controlled by the columns may include position, brightness, duration, size, background brightness, motion, and shape. One or more columns may contain text written in a simple programming language that is interpreted and used to determine the conditions under which a particular test target or group of test targets is displayed. The simple programming language allows the loaded layout to use information such as the status of individual or group stimuli seen, missed, presented, or remaining presented to determine whether to enable new stimuli during the test. For example, if half of a different group of stimuli is missing, a group of test targets may be enabled. The test administrator may be able to edit the spreadsheet or data file using a text editor, or it may be generated by a computer program. One purpose of controlling the test in this manner using a spreadsheet or data file is to allow the test to be changed without rewriting or recompiling the computer code that controls the test. This allows users other than programmers to create layouts that use information gathered during the test in the test strategy.

[0037] Once it is determined in block 118 that all test targets in the current layout have been displayed, or the algorithm has reached a certain level of statistical confidence, or the disease classification has reached a certain confidence, or time has run out, process 100 may proceed to select the next layout in the template, or, if there are no more layouts in the currently selected template, select another template. However, it should be understood that in some embodiments, templates are not used and the information displayed on the display may be determined randomly. The information (e.g., properties, number, and locations of test targets, properties and locations of fixation targets, etc.) may be dynamically adjusted based, for example, on the user's current performance on the test and / or other factors.

[0038] The described techniques allow for the detection and monitoring of various patient conditions (e.g., glaucoma). A patient's visual field is assessed by examining various locations within the visual field to determine blind spots or areas of reduced function. The results of the assessment can be analyzed in various ways, as described in more detail below.

[0039] The described techniques can be implemented in any suitable system that may include a device having a display on which images are presented to a patient, a device controlling the presentation of images on the display, and an input device configured to be controlled by the patient performing a visual activity (e.g., a test, a task, etc.) and to obtain user input from the patient. The same device can include both a display and an input device. For example, a head-mountable virtual reality device can have a virtual reality (VR) display, and user input is obtained in the form of head and / or eye movements of a user wearing the head-mountable virtual reality device and viewing the VR display. The head-mountable virtual reality device can be in the form of VR glasses incorporating a VR display, VR goggles, and other headset VR devices. Regardless of the implementation of the head-mountable virtual reality device, the described embodiments include tracking head movements of a patient wearing the head-mountable device. In various embodiments, for example, an external camera tracks the patient's head movements when the patient uses a monitor or phone instead of the head-mountable device. Additionally, eye tracking can be used. Electroencephalography (EEG) signals and other types of signals can also be acquired. Thus, various sensors can be used to obtain information as a user / patient performs a test according to the described techniques.

[0040] In some implementations, a user (e.g., a patient) can view a display of the device (e.g., the display of a smartphone, personal computer, tablet, smartwatch, etc.), and user input can be obtained through an input mechanism that is part of the device (e.g., touch buttons, touchscreen display) and / or through other input devices such as a computer mouse, joystick, keyboard, or other handheld controller. User input can be received through one or more of a gesture and motion tracking device (capable of recognizing movements and gestures of a user's hands, arms, other body parts, entire body, etc.), a microphone, at least one camera, an omnidirectional treadmill, and a gamepad. In various embodiments, user input can be received using at least one sensor selected from the group consisting of a head tracking sensor, a face tracking sensor, a hand tracking sensor, a body tracking sensor, a voice recognition sensor, a heart rate sensor, a skin capacitance sensor, an electrocardiogram sensor, a brain activity sensor, a geolocation sensor, at least one retinal camera, a balance tracking sensor, a body temperature sensor, a blood pressure monitor, and a respiration rate monitor.

[0041] Additionally, computing devices used by patients to perform activities (e.g., tests) in accordance with the described techniques can be associated with eye tracking or other sensors that monitor the patient's eyes (or entire face) as they perform the activities. For example, smart TVs or other devices can have real-time eye tracking sensors that monitor the observer's eyes, which can be utilized in conjunction with the techniques described herein. Smartphones or personal computers can similarly incorporate eye tracking technology that can be utilized in addition to (or depending on the embodiment) user input acquired using various user-controlled devices. Furthermore, in some embodiments, the values ​​of various parameters of a head tracker or other device used by the patient are monitored. For example, images can be acquired to determine whether a camera lens is in proper condition, etc. Wearing glasses within a VR HMD may prevent the eye tracking device in the headset from functioning properly. To address this issue, lens inserts can be manufactured within the headset to hold one or more trial lenses, eliminating the need for the observer's glasses during testing. These inserts are typically sized to fit commonly available trial lens sets. Alternatively, custom inserts can be created to order and transmit a specific user's prescription. Alternatively, the patient can wear contact lenses.

[0042] FIG. 2A illustrates one embodiment of a system 200 that may be configured to perform a process for assessing the visual field of a user 212, such as, for example, process 100 shown in FIG. 1A or other processes according to the described techniques. The user 212 may be any patient of any suitable age and may have any demographic characteristics, such as a child or an adult. The system 200 includes a computing device 202 that includes computing hardware 204 and memory hardware 206 coupled to the computing hardware 204. In this example, the system 200 also includes a head-mountable virtual reality (VR) device 208 configured to communicate with the computing device 202 and having a display 210 configured to display a virtual reality (VR) environment to the user 212 wearing the VR device 208 so that the VR environment is viewed by the user. As shown in FIG. 2A, the system 200 may also include one or more input devices 214 configured to acquire user input based on active input received from the user 212 and / or based on passively acquired sensor image data (e.g., head and eye tracking sensors). As shown in FIG. 2A, information obtained by one or more input devices 214 is transmitted to computing device 202 .

[0043] 2A , the computer system 200 can include or communicate via a remote connection with a server 216, which can be stored in one or more memory hardware and can include one or more databases 217 configured to store information obtained by the computing device 202 and other computing devices. The information can also be stored, at least in part, in the memory hardware 206 of the computing device. The server can automatically process data accessible from devices in communication with the server. The server can coordinate communications between clinicians and users.

[0044] 2A , computer system 200 may also include a controller 218, such as, for example, a touch display coupled to computing device 202 and configured to receive user input from a clinician 220 or other type of input for controlling the operation of computing device 202 and VR device 208 in connection with diagnosing, evaluating, or treating a visual impairment afflicting user 212. In some embodiments, controller 218 may be part of computing device 202. However, in other embodiments, controller 218 may be or be included in a remote computing device (e.g., a clinician's computing device).

[0045] Computing device 202 may be any suitable computing device, such as a desktop or laptop personal computer, a personal digital assistant (PDA), a smart mobile phone, a server, or any other suitable computing device that can be operated by a user and provide services to the user. As described above, computing device 202 includes computing hardware 204 and memory hardware 206. Computer-executable instructions implementing the techniques described herein may be encoded on memory hardware 206, which may include a hard disk drive, a compact disc (CD), a digital versatile disc (DVD), persistent or non-persistent solid-state memory hardware (e.g., flash memory, magnetic RAM, etc.), or other suitable memory hardware. The memory hardware has at least one physical characteristic that is altered in some way during the process of recording data. For example, the magnetization state of a portion of the physical structure of the computer-readable medium may be altered during the recording process.

[0046] In some embodiments, the computing device 202 can be coupled to the head-mountable VR device 208 via a wired or wireless connection. Similarly, the computing device 202 can be coupled to the controller 218 via a wired or wireless connection.

[0047] The head-mountable VR device 208 may be any suitable wearable device configured to provide a virtual reality, augmented reality, mixed reality, holographic reality, or similar environment to a user 212 of the device 208. For clarity of presentation, examples herein may refer to VR or virtual reality. However, augmented reality, mixed reality, holographic reality, or similar environment may be used for the disclosed examples and embodiments and when applying the disclosed technology. The VR device 208 includes computing hardware, a visual interface such as a display 210, and memory hardware for storing computer-executable instructions for execution by the computing hardware. In some aspects, a portion of the display of the VR device 208 may be transparent, translucent, or opaque. The VR device 208 may be a holographic computing device with a see-through holographic display. For example, the VR device may be a HoloLens device developed by Microsoft Corporation. The VR device may be in the form of smart glasses or other configurations.

[0048] The display 210 of the VR device 208 can display a different image to each eye of the user, thus providing the user with a sense of depth and 3D vision. The VR device 208 is configured to use head tracking technology such that the device 208 acquires and transmits information regarding the position and / or rotation of the head of the user 212 to the computing device 202 and / or other computing devices. The display 210 can also be configured to implement eye tracking technology, which allows the VR device 208 to acquire information regarding the position, x-y position, rotation, pupil size indicating pupil dilation of the user's eyes, and other information that can be acquired by tracking the user's eyes.

[0049] The VR device 208 provides a VR visual environment that gives the user a more realistic sense of being part of such an environment and a larger field of view where precise control of the image shown to each eye can be achieved. Furthermore, when the user is wearing the head-mountable VR device 208, brightness can be a more controllable parameter because the VR device 208 itself provides the light source for the displayed image. Other parameters of the displayed image are also more controllable, producing more consistent results. This is particularly advantageous for the reproducibility of activities performed by the user and for comparing performance results across the same user or multiple tests.

[0050] However, it should be understood that system 200 is shown with VR device 208 by way of example only. Figure 2B illustrates a system 250 in which the head-mountable VR device 208 may not be present. In such an embodiment, visual information (e.g., fixation and test targets and any other visual information) may be displayed on a user computing device 230 (e.g., a smartphone, personal computer, etc.) for viewing by the patient, and user input 236 may be obtained in a variety of ways that may differ from obtaining user input via a VR device.

[0051] As described above, the VR device 208 can obtain and transmit input in the form of information regarding the user's eye movements and / or information regarding the user's head movements to the computing device 202. User input can also be obtained based on the user using one or more input devices 214 communicatively coupled to the computing device 202. Non-limiting examples of the input devices 214 include a mouse, keyboard, gesture / motion tracking device, microphone, camera, omnidirectional treadmill, gamepad, temperature monitor, pulse rate monitor, blood pressure monitor, respiratory rate monitor, electroencephalography device, or other device.

[0052] The computing device 202 and the VR device 208 may be used in a home environment or other environment outside of a medical facility. Thus, the computing device 202 coupled to the VR device 208 may be controlled by a user 212 operating the device. It should be understood that if the user 212 is a young child who needs assistance operating the device, a parent or other person may assist such a user.

[0053] In some aspects, the computing device 202 and the VR device 208 may be used in a clinical setting, such as a suitable medical facility. In such a scenario, the operation of the computing device 202 may be controlled via a controller 218, which may be, for example, a touchscreen device coupled to the computing device 202 and operated by a clinician 220. The touchscreen device may mirror the images seen by the user 212 through the VR display 210 (e.g., images for the left and right eyes of the user 212) and may be configured to receive inputs for controlling the virtual environment image displayed on the VR display 210. The controller 218 may be a monitor or computing device similar to the computing device 202, or any other device. Regardless of the particular type of controller 218, when the user 212 is wearing the VR device 208, the virtual environment provided to the user 212 may be controlled in real time using a display associated with the controller 218.

[0054] In some embodiments, the controller 218 can wirelessly communicate with the computing device 202 via a computing network, including a wireless communication medium for exchanging data between two or more computers, such as the Internet. Thus, the controller 218 can be located in any location accessible via the computing network, including locations geographically remote from the location of the computing device 202. Thus, a user equipped with a computing device 202, such as a mobile phone (e.g., a smartphone, or any handheld computing device that may be a converged device encompassing the functionality of multiple devices) and a suitable VR device 208 (which may be a low-cost headset known in the art or developed in the future), can be remotely located from a clinician operating the controller 218 and control the user's virtual environment via the computing device 202. This telemedicine technology enables simplified, cost-reduced, and more accessible early diagnosis and timely treatment of many vision disorders. Because communication between trained medical professionals and patients is simplified, requiring fewer or even complete hospital visits, more patients can receive appropriate treatment for their vision problems. A telemedicine approach may be particularly advantageous for people living in rural and remote areas where access to appropriate vision care is otherwise limited.

[0055] As shown in FIG. 2A, computing device 202 can communicate with server 216 via a communications network, such as the Internet. Server 216 serves as a central repository of data related to a vision therapy platform (e.g., a platform executing the process of FIG. 1A or other processes according to the described techniques) running on multiple computing devices, including computing device 202. Data related to all measurements and treatments performed using the described techniques, including timing data, can be recorded and stored in database 217 of server 216, which can be one or more databases. A user can then view a complete history of their visual performance. The data stored on server 216 can be accessible to a user via a computing device, such as computing device 202 or any other device, in a manner that allows the user to sort and analyze the historical data in various ways, display various statistics derived from the data, and compare that user's performance with that of other users (e.g., based on an average or other parameter generated from all users). The results of the analysis and comparison can be presented to the user or others (e.g., a clinician) in a visual format that facilitates understanding of the results. The user can customize how the results are presented.

[0056] As shown in FIG. 2B, user computing device 230 can communicate with server 216 via a communications network, such as the Internet. Server 216 serves as a central repository of data related to a vision therapy platform (e.g., a platform executing the process of FIG. 1A or other processes according to the described techniques) running on multiple computing devices, including user computing device 230. Data related to all measurements and treatments performed using the described techniques, including timing data, can be recorded and stored in database 217 of server 216, which can be one or more databases. The user can then view a complete history of their visual performance. The data stored on server 216 can be accessible to a clinician via a computing device, such as computing device 202, and to a user via a computing device, such as user computing device 230 or any other device, in a manner that allows each clinician and user to sort and analyze the historical data in various ways, display various statistics derived from the data, and compare that user's performance with that of other users (e.g., based on an average or other parameter generated from all users). The results of the analysis and comparison can be presented to the user or others (e.g., a clinician) in a visual format that facilitates understanding of the results. Users can be given the ability to customize how the results are presented.

[0057] As mentioned above, it should be understood that the VR device 208 is shown in FIG. 2A by way of example only. As shown in FIG. 2B , the described techniques can be implemented using a user computing device 230 including computing hardware 232 and memory hardware 234 coupled to the computing hardware 232 having or associated with a display 238. For example, test stimuli or targets can be rendered on a user interface of a display 238 of a smartphone, personal computer, tablet, TV, smartwatch, or the like. Thus, in some embodiments, a display of a computing device other than the head-mountable device 208 is configured to be viewed by the user 212. Furthermore, in some embodiments, multiple user input devices can be used, e.g., a head-mountable VR device 208 and a handheld user computing device 230. In some cases, visual information can be displayed or user input obtained for testing, and the user's overall body position and movement can be monitored. This may or may not be done in combination with one or more input devices.

[0058] In some embodiments, the system is configured to accept user input indicating the location of the detected target, and the user input is deemed appropriate if it includes an indication of the location of the target and an indication of detection of the target, thereby reducing or eliminating the need for long-term training to maintain patient gaze fixation on the target.

[0059] As described above, because head-mountable devices are used to display targets in a virtual reality environment rendered by a display, the test (or other activity) does not require sacrificing patient comfort. For example, the test does not require the patient to remain motionless and sit upright for a period of time, keeping their head still (with or without specific head fixation support, such as a chin rest). Young, weak, and elderly patients may have difficulty maintaining the required physical position with existing systems and therefore often are unable to complete the test. The use of head-mountable devices in some embodiments described herein eliminates the need for immobile, bulky, and expensive equipment while reducing the discomfort experienced by some patients. Head-mountable devices are typically smaller in size, more portable, and less costly than existing devices and systems for perimeters. Head-mountable devices can be used in combination with a variety of input devices. For example, monitored user input may include the head, hands, other body parts or central body, eye tracking, etc. In some cases, sensors can be attached to the user's body (e.g., head or other parts) to receive user input in an objective format.

[0060] Additionally, the described techniques may include displaying information on other types of displays, such as, for example, computer monitors, smartphones, and TV monitors. Various types of user input devices may be utilized. Also, as previously mentioned, sensors may be attached to the user's body (e.g., on the head or other parts) to receive user input in an objective form.

[0061] In some embodiments, a continuous focus of vision (SFP) technique is used, which overcomes the potential drawbacks of fixation loss by taking advantage of a person's tendency to look at a new visual target without inhibition. This is achieved by presenting visual information to the patient. In this way, the patient is encouraged to look at the test target as it is presented. The visual information is also presented in a way that allows for input from the user indicating the location of the presented test target. In this way, the information is presented in a way that prevents the patient from responding to test targets that the patient did not see, thereby reducing the number of false positives.

[0062] The described system utilizes statistical methods to determine and test locations within the visual field, estimate the likelihood that the results indicate disease, and monitor disease progression over any period of time (e.g., days, weeks, months, or years). Testing and other activities can be performed with or without eye tracking or other response methods. Activities can be performed to screen for diseases affecting the visual field and to map various thresholds across the retina. Activities such as testing can also be used to map binocular (cortical) scotoma in patients with strabismus and / or amblyopia. Information obtained during testing for each patient can be stored in an appropriate location. Bayesian or other approaches can be used to analyze the collected data.

[0063] When the test is used for screening, a pattern of visual field loss in which both eyes show similar defects can be used to diagnose cortical damage.

[0064] In some embodiments, at least one target is displayed on the display of the head-mountable device, such that the target appears as a "white-on-white" spot of light (e.g., flashes briefly). For example, the target can be displayed on a white (or other light-colored) background, with the targets taking the form of various light-colored objects. In other embodiments, using a "dark-on-white" test, the target is displayed on a white (or other light-colored) background, with the targets taking the form of various dark-colored objects (e.g., dark spots). A "dark-on-white" test may better utilize the OFF subsystem of the human visual system, which may be more sensitive than the ON subsystem. In other embodiments, additionally or alternatively, the target may include a moving Gabor target. Furthermore, in some embodiments, various parameters of the displayed test target may be varied. Non-limiting examples of such parameters include target position, contrast, brightness, target size, color, movement, duration, etc. Colored and / or flickering test targets, as well as other types of targets, may be presented.

[0065] In some embodiments, the head-mountable device may be an Oculus Rift, Samsung Gear, and HTC Vive, or any other head-mountable device. The head-mountable device may be configured to be worn by a patient for a relatively long period of time without causing discomfort to the patient. The head-mountable device may be configured to be used by a patient at home, for example, with no or minimal supervision by a medical professional (e.g., via a telemedicine platform or any other communication method). Also, because the headset is configured to be attached to the patient, the patient does not need to keep their head still (e.g., without an uncomfortable chin / forehead rest, as in some conventional setups for perimetry). Furthermore, the headset may be worn by a patient while sitting, standing, or lying down without compromising the performance of the test using the headset.

[0066] The headset may incorporate an eye-tracking sensor. Additionally, in some embodiments, various other techniques may be used to determine whether the target is seen by the patient. Non-limiting examples of such techniques include electroencephalography (EEG) and pupil size / response measurements. In some embodiments, electroretinography (ERG) may be used to determine whether the patient's photoreceptor and ganglion cells are responding to light striking the retina.

[0067] Targets can be presented in a way that encourages the patient to naturally look at the target as it appears. As mentioned above, user input indicating the target's location is captured, reducing the occurrence of false positives. Furthermore, patient instruction and performance monitoring can be automated, allowing clinicians to remotely monitor patients' visual field tests, evaluate new tests, and present targets to one (or both) eyes for a given test. Additionally, data captured during each test can be stored for subsequent analysis.

[0068] In some embodiments, the test target can be displayed in conjunction with a "head-pointing" technique, as described above, which involves displaying the target in a way that requires the patient to orient their head toward it. The test is conducted so that the patient intends to fixate their gaze on the fixation target presented on the display (i.e., view the fixation target with their / her fovea). Additionally, the test stimulus (or test target) is displayed on the display at a specific location in the patient's visual field. The test can be conducted by instructing the patient to perform a task that requires them to fixate on the fixation target. In some embodiments, the test can be conducted using a template containing one or more layouts with logic that controls how the test is administered. The layouts can be configured to test various regions of the patient's visual field. The layout administered to the patient can be selected based on the patient's characteristics, previous results of the patient's visual field assessment, and / or other factors. During the test, the display of a head-mountable device worn by the patient, or another display, displays a head pointer, such as a small object (e.g., a reticle, virtual dot, etc.) visible to the patient, rendered to have fixed coordinates relative to the patient's head. In this way, the head pointer appears "directly in front" of the user, regardless of the patient's head position or movement. Therefore, even if the patient's head rotates, the position of the head pointer as seen by the patient remains the same as it was before the head rotation. When the test target appears (e.g., "flashes" - displayed for a relatively short period of time), the patient moves their head toward the detection zone, which is the area where the patient moves the head pointer to indicate that they have detected the detection target. The detection zone is a predetermined area within the patient's visual field, and the size (e.g., area) of the test target can be selected so that the test target is smaller than the detection zone.

[0069] For each patient, the type of test to be presented to that patient can be selected. This can include selecting various test parameters, such as the points to be tested (e.g., the format of the detection zone), the type of test target or stimulus (including various properties of the stimulus, such as size, color, shape, duration of rendering, frequency of rendering, etc.), and the order in which the test targets are presented on the display. The test parameters can be selected manually, e.g., via a suitable user interface configured to receive input from a user, e.g., a medical professional, or the test parameters can be selected, at least in part, automatically. For example, the test parameters can be automatically selected before or during the test. This can be performed based on various factors, such as patient-specific characteristics (e.g., age, sex, anatomical characteristics, medical conditions, etc.) and historical information regarding the patient's previous test performance.

[0070] Furthermore, it should be appreciated that in some embodiments, other types of user input can be detected to determine whether the patient was able to see the test target instead of, or in addition to, tracking the patient's head movements. For example, user input can include input received from an eye tracking sensor, an eye pointer, or other device.

[0071] In some embodiments, the test targets can be displayed in the form of a series of fixations on the target in a VR environment presented, for example, on the VR display of a head-mountable VR device. A head pointer object is also displayed and can be moved by moving the user's head. After at least one target is displayed on the display of the head-mountable device worn by the patient, it is detected whether user input is received indicating that the patient has "placed" their head point at least partially on (or above) the fixation target (e.g., by moving their head or otherwise). If user input is detected and the received user input indicates that the head pointer is correctly positioned at least partially on the fixation target in the virtual environment, the next target can be displayed. In this way, the patient may not be specifically instructed to fixate their gaze on the target. Rather, fixating on the displayed target is necessary to quickly perform the task. This is because the head pointer object needs to be created to "collide" (partially overlap) with the fixation target, and both the head pointer object and the fixation target can be relatively small in size. Eye fixation is required for sufficient vision to perform this task.

[0072] Upon receiving user input indicating that the head pointer object is within a certain distance of or at least partially overlaps the fixation target, other visual test targets can be displayed. It should be understood that the head pointer object can be at least partially “placed” on the fixation target in various ways. For example, the head pointer object can be displayed at least partially on top of the target, or the target can be displayed at least partially on top of the head pointer object. In some scenarios, the head pointer object may need to be “placed” entirely on or within the head pointer object. Any visual representation within the virtual environment can be used to enable the user (one or both eyes) to perceive the head pointer object as moving toward the target. Each test target can be displayed for a certain amount of time (e.g., approximately 300 ms in one example), and the patient can move the head pointer object visible to the patient toward the test target (if the target is visible to the patient).

[0073] In at least one embodiment, the test method may include displaying a blind spot target to each eye and instructing the patient to adjust the headset position until the blind spot target disappears from the headset display (the blind spot target is positioned in the correct location on the retina of each eye so that it lands in the retinal blind spot). Additionally, a tutorial mode may display false (training) targets to help the patient learn to perform the test (the tutorial mode may be optional). Also, prior to performing the test (e.g., during the tutorial mode), calibrations of response time, motor control, and pointer accuracy may be performed to change various parameters of the test, such as the elapsed time between the display of the test target and determining that the test target has been missed (if appropriate user input-based instructions are not received). After the training / configuration mode is complete, a template (e.g., a test algorithm) and an initial / current layout of the template may be selected. The test method may then be performed, for example, similar to process 100 (FIG. 1A) or in other ways.

[0074] FIG. 3 illustrates an example of a user interface 300 that can be rendered on the display of a computing device used by a person (e.g., a medical professional) supervising a patient performing a vision test or activity. A user interface can additionally or alternatively be provided to the patient, as shown in FIG. 3. The user interface includes a panel (on the left) that presents patient information and includes features (in this example, buttons and slide bars) that allow adjustment of various parameters (e.g., dominant eye, horizontal deviation, vertical deviation, contrast ratio, occlusion, and blur). The user interface also includes a right panel that contains several tabs, such as "Games," "Activities," "Tests," "Settings," "Data," and "Log." In this example, the game Ring Runner, designed to aid in suppression, stereo acuity, and acuity, has been selected. The information presented in connection with the selected Ring Runner relates to the game description: "In Ring Runner, you pilot a spaceship through a planet's ring system, collecting boost rings to increase speed and attempt to go as far as possible in each session."

[0075] FIG. 4 schematically illustrates an example user interface 400 including various selectable tabs. In this example, the tabs in the left panel include "Patients," "Archived," and "Add Patient." The tabs in the right panel include "Templates," "Layout," and "Results." In FIG. 4, the "Patient" tab, which contains various information about the patient, is selected. Also shown is the "Templates" tab, which contains various types of screening tests and control buttons associated with each test. Thus, a template can be selected to start (i.e., use for a test) or edit. Each template allows a user (e.g., a healthcare professional) to define an algorithm for the test. Each template can use multiple layouts. For example, a screening layout can be created that can proceed with a layout designed for a specific disorder. Once a test is selected (e.g., when the "Start Test" virtual button is selected), the user interface renders information related to the test. FIG. 5 schematically illustrates another example user interface 500 of FIG. 4 with the "Layout" tab selected.

[0076] During the test, the user interface of the computing device may display information about the test and the patient's performance of the test. The information may include, for example, information about the current status of the test and options to pause, start, or change one or more parameters associated with the test. Once the test is complete, the results of the test may be displayed on the user interface.

[0077] For each layout, you can change the default settings associated with that layout. For example, you can select and edit an inspection target to override the default settings for that inspection target. Some inspection algorithms can use the layout (e.g., basic grid search). However, other inspection algorithms are layout-independent and use probabilistic (e.g., Bayesian) methods to determine where and how to inspect parts of the field of view.

[0078] In some embodiments, the layout may specify test target size, test target duration (the amount of time the test target is displayed), test target luminance, test target detection radius, fixation target size, fixation task, modifiers and / or quantifiers for confirming fixation, number of test targets, and properties (e.g., color, brightness, etc.) of the background on which the test and fixation targets are displayed.

[0079] An example of the layout settings is as follows:

[0080] Inspection target size: 0.1-2 degrees, default 0.43 degrees

[0081] Inspection period: 0.1-1 seconds, default 0.2 seconds

[0082] Inspection target brightness: 0-1, default 0 (black)

[0083] Inspection target detection radius: 0.1 to 10 degrees, default 4 degrees

[0084] Fixation target size: 0.1-2 degrees, default 0.5 degrees

[0085] Fixation task: abxy buttons, trace, no default

[0086] Fixation Check: True, False, Default True

[0087] Layout: 42 points, concentric circles

[0088] Background brightness: 0-1, default 1 (white)

[0089] It should be understood that various other layouts can be used with the described techniques. Figure 6A shows an example 600 of a template blind spot mapping layout. As shown, the blind spot mapping layout includes a high-density grid located in the center of the layout and a low-density grid surrounding the high-density grid. The dashed ellipse represents the average location of the blind spot, which is typically 5 degrees wide and 7 degrees high. In individuals with very stable fixation, the blind spot map can be used to register visual field test data to a photograph of the retina or other anatomical image.

[0090] Figure 6B shows a sampling grid 610 covering the expected locations of typical blind spots at high spatial resolution (0.7 degree target spacing) along with a close-up 620. The vertical line pattern circles 630 correspond to standard blind spot inspection locations. The inspection parameters for the example of Figure 6B include:

[0091] Background brightness: White (up to 80 cd / m 2 )

[0092] Target brightness: 0.5x white (~40cd / m 2 )

[0093] Target period: 300ms

[0094] Grid spacing: 0.7 degrees

[0095] Target spot size: 0.3 degree diameter

[0096] Total inspection time: 15 minutes 45 seconds

[0097] Array center: (15.0, -2.0) degrees

[0098] Array radius: 5 degrees

[0099] Figure 6C shows two sets of data 640 and 650 obtained by testing with the left and right eyes, respectively. In these images, small dots represent locations where the target was seen and not tested again. Medium-sized spots represent locations where the target was missed, reappeared, and seen. Large spots represent locations where the target was missed twice. The circles with vertical line patterns 645 and 655 correspond to standard blind spot testing locations for each eye. These targets were also missed twice.

[0100] Figure 6D shows the data 640 and 650 from Figure 6C graphically overlaid on respective fundus images 660 and 670 from the same individual. The data has been rotated, scaled, and translated to match the vascular pattern of each eye. By overlaying the data from 6C on the vascular pattern of each eye, vascular scotoma patterns can be identified, where the pattern of blind spots corresponds to blood vessels. The vascular scotoma patterns form streaks or linear segments, as opposed to the blind spots formed by the position of the optic nerve.

[0101] Figure 6E shows another test pattern 685 at higher spatial resolution (0.3 degree target spacing). The same fitting parameters (rotation, scaling, and translation) used to overlay the data from test patterns 640 and 650 onto retinal images 660 and 670 in Figure 6D were used to transform the data 685 in Figure 6E and overlay the data 685 onto retinal image 690. As a result, it can be seen that the location of blood vessels within the eye can be measured with high accuracy using the fixation and testing strategy of the described device, and subsequent visual field data can be spatially co-registered with high accuracy.

[0102] This method of mapping normal blind spots and mapping the location of blood vessels in blind spots or elsewhere on the retina can be used to register visual field test data distorted by the magnification or reduction of the image caused by wearing ophthalmic corrections. Currently, visual field testers do not take into account the magnification caused by wearing plus lenses or the reduction caused by minus lenses.

[0103] In the illustrated embodiments, the results of the test can be analyzed and interpreted automatically. For example, in some embodiments, visual fields are interpreted intraocularly and binocularly by comparing corresponding points in different quadrants of the same eye and the other eye. If a particular test target or cluster of test targets is missed, the likelihood of an abnormality is estimated by reporting the likelihood that the test target or cluster would be missed in an age-matched, gender-matched normal population. This process classifies the result of each test target as normal (1), borderline (0), or abnormal (-1).

[0104] In some embodiments, a point-by-point comparison with a panel of reference fields (e.g., homonymous hemianopsia, unilateral hemianopsia, arcuate defect, nasal step, etc.) (or test data bank) provides a differential diagnosis, with associated conditions listed in order of likelihood. In some cases, a relatively short screening test may provide a result in the form of "normal" or "abnormal." In some embodiments, if the test is performed as part of monitoring a patient's condition, each test position can be scored as "improved," "worsened," or "unchanged." It should be understood that any number of suitable qualification and quantification parameters can be used. A suitable visual representation of the results can be displayed in any format, such as, for example, a plot showing the patient's condition over time. In some embodiments, a confidence score is provided for the test results, and recommendations for further testing can be included along with the expected change in confidence.

[0105] Test results

[0106] The test results can be presented to a user (e.g., a medical professional) in any suitable format, such as electronically, i.e., on a computing device display, in video, audio, or a combination thereof. In some embodiments, the test results include patient information, medical history information, and test session information. Patient information can include, for example, the patient's name, date of birth, medical record number, gender, and / or any other suitable information. Medical history information can include, for example, a clinical diagnosis (e.g., a previous diagnosis by a medical professional), a diagnostic code number, and / or any other suitable information. Test session information can include, for example, the date and time of the test, the test strategy, the test diagnosis if available, a results grid for each eye, the test duration, the success of fixation target interaction (if applicable), the name and address of the test supervisor, the department logo, a reference to the test website, and / or other suitable information. The results grid can display information about the test targets seen by the patient in the form of empty spots or circles. Missed test targets can be displayed in the form of filled circles. The color and intensity of the fill represent the color and intensity of the missed test targets. The margin, color, and intensity of the background zone can be displayed (e.g., averages on a paper printout and results over time displayed in video format). The results also include fixation errors in an appropriate format.

[0107] Regardless of the particular format in which test results are provided, the results and other related information (e.g., patient-specific information) can be processed and stored in accordance with the requirements of electronic protected health information. Therefore, the information is processed and stored in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

[0108] Inspection parameters

[0109] In the described embodiments, any property that varies across the visual field can be controlled, adjusted, and measured. Non-limiting examples of properties include contrast / brightness, binocular disparity, interocular suppression, motion, and color. The described techniques can also detect when an object becomes salient in the visual field. Salient objects attract attention and become oriented toward them. Orientation can be defined as a rotation of the eyes and / or head toward the object that elicits it. Other detectable responses that coincide with or follow orienting include pupillary responses, EEGs, ERGs, and galvanic skin responses, among others. Object properties that become salient in a bottom-up manner (without patient prompts) include changes in local luminance (e.g., bright or dark spots) and motion. Instructive properties that patients orient toward and that cause them to become salient include color (e.g., "look for red spots") and depth (e.g., "look for targets that are closer than others"). In general, a "saliency map" constructed within the human visual system directs visual resources toward objects of interest. These resources include both overt allocations of attention (head rotations and eye movements) and covert allocations of attention, such as switching the central nervous system to increase visual processing of specific parts of the visual field or to detect desired test target properties based on a patient-instructed task, such as responding to colored objects.

[0110] Fixation target and task

[0111] In the described embodiment, the interactive fixation target has properties such that when it is displayed, the patient's attention is drawn to a specific point on the test area, allowing the patient to successfully perform the sequential task.

[0112] To enhance patient cooperation, the fixation target can be modified in various ways. In some embodiments, the fixation target can be in the form of a movable object, such as a car driving along a winding road, a fighter jet flying away (as viewed from the patient), or any other object that can be displayed in combination with a specific background. In some embodiments, a test target or stimulus is presented on the display when the head pointer at least partially overlaps the fixation target (e.g., in the form of a circle) and follows the fixation target through a specific number of consecutive movements of the fixation target. The size, color, and contrast of the fixation target can be adjusted, and this visual tracking is possible only when the patient is looking directly at the target. For example, the Gabor stimulus principle can be followed. In some embodiments, a pixelated grid allows for the generation of fixation targets with various (e.g., complex) shapes, colors, color patterns, etc. In one embodiment, the default diameters of the head pointer, test target, and fixation target are 0.5 degrees, 0.43 degrees, and 0.8 degrees, respectively. In at least one embodiment, the test target can be in the form of a dark gray object (e.g., a spot) on a light gray fixation target, so that the average light intensity across the target is equal to that of the background.

[0113] Non-limiting examples of various tasks that a system according to the described techniques may be configured to manage are described below.

[0114] High Acute Pattern (HAP) discrimination task

[0115] Figure 7A shows an example of visual information that may be presented as part of a high-acuity pattern decision task. In this example, when the head pointer enters the fixation target, four probe locations within the fixation target are temporarily filled with objects, such as one "correct" object or probe and three "incorrect" objects or probes. The patient attempts to move the head pointer to the correct probe. If any of the incorrect probes "hit" the head pointer (i.e., the patient moves their head so that the head pointer visible to the patient overlaps with an incorrect probe), the task is repeated to ensure that fixation remains near the task. Due to the small size and close proximity of the probes, the task cannot be performed without properly fixating on the probes.

[0116] FIG. 7A schematically illustrates a series of visual features that may be presented to a patient on a display device (e.g., the display of a head-mountable device, smartphone, smartwatch, computer, TV, etc.) in accordance with the described technique. Section A of FIG. 7A illustrates a pointer (which may be shown in red or other colors) and a fixation target in the form of a circle, with the pointer and fixation target located in the detection zone. The pointer may be a head pointer, or another type of pointer, such as a joystick pointer or button pad pointer, if this information is presented to the wearer of the head-mountable device. In section A of FIG. 7A, the fixation target has just become visible (because the patient has appropriately moved the head pointer into the detection zone), but the pointer is still outside the fixation circle. In section B of FIG. 7A, the patient is moving the pointer to the fixation target so that it is positioned within the circle representing the fixation target. Once the pointer is moved within the fixation target, four probes—correct probes (“x”) and three “incorrect” probes (“+”)—appear within the fixation target, as shown in section C of FIG. 7A. The correct probe is the one the patient needs to move the pointer over. The four probes are displayed for a predetermined period of time, such as 50 milliseconds, in at least one embodiment. However, the probes can be displayed for other periods of time.

[0117] Section D of Figure 7A shows a schematic representation of four response zones that are invisible to the patient. One of the four response zones contains the correct probe. In section E of Figure 7A, the pointer is shown after being moved toward the correct probe, thereby confirming correct fixation on the test target.

[0118] Figure 7B shows a simplified probe using the rotational orientation of a single figure requiring high acuity, such as the "Landolt C" as shown in section A of Figure 7B. Section A corresponds to the view displayed to the user during the test. Section B of Figure 7B shows four response zones from which the patient can choose. In this example, fixation is verified when the patient identifies the gap in the "Landolt C" at the top of the figure and, for example, moves the pointer to the top response zone. The zone can be on one side of the square containing the "Landolt C." This satisfies the fixation requirement when the pointer passes through the top of the square.

[0119] Circle-in-Circle Task

[0120] The task is administered so that the patient must maintain a pointer (e.g., a head pointer in the form of a spot) within a fixation target (e.g., a circle). The fixation target can be a circle that is displayed to move randomly horizontally and vertically. The spot is controlled by the patient moving their head, the patient moving a handheld device, or the patient moving their eyes in the required direction. The level of the task (e.g., its difficulty) can be automatically adjusted (e.g., within a predetermined range) according to the patient's success in maintaining the pointer within the circle. For example, the level of the task can be adjusted based on the ratio of the period during which the pointer is within the boundary of the circle to the period during which the pointer is outside the boundary of the circle.

[0121] Trace Task

[0122] Fixation tasks are administered by having the patient trace small objects of specific shapes (e.g., letters, numbers, squares, triangles, circles) using an input device such as a suitable controller (e.g., joystick, button, pointer, head pointer, etc.). The objects are small enough that the task can only be performed accurately if peripheral vision is utilized.

[0123] Small Spinner Task

[0124] For example, an object such as a small plus sign of the appropriate correct size can be displayed as spinning on the display. The patient can determine the direction of the spin only with their foveal field of vision. User input is obtained from the patient for the purpose of determining whether the patient can identify the way the object is spinning so that the system can determine whether the patient is using the fovea. If it is determined that the patient is using the fovea, a test target (test target) can be displayed (flashed) at a desired location on the display corresponding to the location of the retina being tested.

[0125] Grouping by common-fate tasks

[0126] The flashing target can be flashed (e.g., displayed for a relatively short duration so that the patient perceives it as "flashing") in the center of the display (i.e., in the patient's central visual field), while other targets can be flashed in the patient's peripheral visual field (i.e., in areas of the display surrounding the focal center). The task can be administered so that the patient must determine whether the central target is flashing in sync with the peripheral visual target. The central visual target can remain in the same position throughout the test or session (part of the test), while the peripheral visual target can be flashed in various positions. The central visual target can be, for example, a small object with balanced luminance contrast. In some implementations, multiple types of targets can be flashed in the peripheral visual field, e.g., at different speeds or other phases. For example, one type of target can flash at one speed, while other types of targets can flash at a different speed in the peripheral visual field. One type of target can differ from other types of targets by size, color, shape, brightness, or one or more other properties.

[0127] Luminance-balanced fixation target task

[0128] Tests can be conducted so that a fixation target is displayed on a display that the patient is expected to view using foveal vision. Such targets can be luminance balanced and displayed so that their color changes from frame to frame. In this case, the target is visible in the foveal field of vision but not in the peripheral field of vision. The target can be seen in the foveal field of vision without moving the pointer or without moving the pointer only partially toward the fixation target. The target can be in the form of a small fixation spot, for example, centered or not centered within a larger circle, with the larger circle readily visible so that the patient can find the fixation spot within their field of vision.

[0129] Furthermore, characteristics of the fixation target (e.g., the rate at which the fixation target blinks, the phase of the blink, color, direction of movement, etc.) can be paired with characteristics of the peripheral targets. In this way, the task can be administered by ensuring that the patient is fixating on the fixation target and using one or more properties of the fixation target to select one of one or more peripheral targets for orientation. Detecting commonalities (e.g., one or more identical or similar characteristics) between the fixation target and the peripheral targets can be based, for example, on instructions provided to the patient in an appropriate format. Additionally or alternatively, identifying common characteristics between the fixation target and the peripheral targets can occur as an automatic response to the way the targets and other information are presented to the patient. In this way, this task resembles the common fate grouping task described above.

[0130] 8 shows an example of a scene 800 that can be displayed on a suitable display, the scene including a background (in this example, "half gray") and a fixation target. As shown, the color (and in this case, the method of coloring) of the fixation target is changed from frame 1 to frame 2. The total luminance of the scene remains constant as the test target flashes.

[0131] Inspection Goals

[0132] According to the described embodiments, various types of test stimuli or test targets can be rendered on the display of a head-mountable VR device or other device. Different types of test targets can be used to examine different attributes of visual processing. In some embodiments, test targets can vary by size, texture, luminance polarity (e.g., dark on a light background or vice versa), spatial distribution, color, duration, temporal characteristics, shape, pattern, position on the display, and other parameters.

[0133] Tests come in a variety of sizes. In some embodiments, the size of the test target can be adjusted to use larger dots in the peripheral field, where resolution is not as good as in the central field. Larger targets can be used in tests intended for administration to patients with advanced retinal disease, who may not be able to see smaller targets. Larger targets can be displayed as part of an adaptive test procedure, which involves increasing the size of the target during the test until the patient can see it.

[0134] The test targets can have various textures. In some embodiments, the test targets are in the form of scattered dots or textures. People with low vision typically do not integrate visual stimuli across space. Such people have been observed to exhibit deficits in "global motion perception" and "global form perception" even when viewing the test targets with unblinded vision. Because these deficits may not be uniform across the entire visual field, they can be tested region by region.

[0135] The test targets can be spatially distributed on the display in a variety of ways. In some embodiments, the spatial distribution of the test targets can be in the form of a grid of targets, such as a square grid, a hexagonal grid, or other type of grid. The size of the grid can be uniform or anisotropic. For example, in one embodiment, it can be denser in the central vision, which can be presented with targets that are designed to disappear or change their appearance. The patient is asked to detect the targets.

[0136] Test targets can have any suitable color or color combination. Some people with abnormal color vision exhibit differences in the mix of cone photoreceptor types between eyes or between regions of the eye. People with normal vision express different proportions of the three cone classes of color vision, which may vary geographically across the retina or between eyes. This can be measured with visual field testing using color test targets. For example, distinguishing between red and green test targets requires the presence of L or M cones in the test region of the visual field. Test stimuli may also differ from the background color along the blue-yellow axis. Blue-yellow perimetry is more sensitive than white-on-white perimetry for early detection of glaucoma.

[0137] The test target can be displayed for any suitable period of time and can have various temporal characteristics. In some embodiments, the test target can be displayed very briefly or "flashed" so that the test target appears at a location on the display corresponding to a particular retinal location, since eye movement does not have enough time to displace the image on the retina. Test targets that last longer or flash are easier for the patient to detect. However, there may be uncertainty in maintaining the retinal location of the image. In some embodiments, eye position is monitored so that multiple retinal locations of at least one test target can be estimated.

[0138] The ability to distinguish flicker from non-flicker depends on the "flicker fusion frequency" or "flicker fusion rate," and the temporal frequency of flicker that can be distinguished from a steady-state test target (of the same mean luminance) depends on retinal location, the state of adaptation to the overall light level, and factors that vary between individuals and possibly between individual eyes, especially those with disease. A biocular asymmetry in flicker fusion rate at a particular location in the visual field is diagnostic of a disease that causes one eye to respond less than the other, resulting in a lower (worsened) flicker fusion temporal frequency threshold.

[0139] Test targets can have a variety of shapes and patterns. Non-limiting examples of shapes include geometric shapes such as spots, circles, squares, and triangles. Test targets can also be in the form of human or animal faces, photographs, cartoons, or animated objects including animal or animated faces. Furthermore, patients may be better able to complete the test if the targets presented to them have shapes that interest them. This approach may be particularly suitable for administering tests to children. Thus, test targets presented to children can include cartoon characters, animal images, toys, or human faces familiar to the child. In this way, the test can be presented to children in the form of a game. The visual characteristics of the test targets presented to patients can be selected and adjusted as needed based on the patient's age, gender, preferences, and other factors. In addition to generating greater interest, shapes can be used to test cortical processing. For example, individuals with prosopagnosia may have difficulty identifying faces, and individuals with autism spectrum disorder may be unable to identify some of the emotions expressed in the facial images of the targets.

[0140] In some embodiments, any test target parameters can be automatically changed, for example, via control by a staircase or any other adaptive procedure. One or more parameters of the test target can be set before the start of the test procedure. For example, a suitable user interface of the computing device can receive user input (e.g., from a clinician) via one or more slide bars or any other input function rendered on the user interface. Additionally or alternatively, parameters of the test target can be adjusted in real time as the test (task) is being performed by the patient, in some embodiments, by the clinician prior to the test. In some embodiments, the results of the test can be made visible to the patient, possibly including in real time.

[0141] Test targets are displayed at various locations on a display visible to the patient. The locations can be determined using a test algorithm. The locations can be predetermined. Additionally or alternatively, in some embodiments, the locations can be adjusted in real time, for example, based on the patient's performance on the current test. Test targets can be displayed to only one eye or binocularly to both eyes simultaneously, so that a single binocular map can be generated.

[0142] In some embodiments, the test target can be created to have a constant overall brightness against the background, for example, on a gray background, the target can be black and white so that someone with low spatial resolution cannot see the modulation in brightness of the target.

[0143] Inspection Background

[0144] In some embodiments, the test background has a single color. In other embodiments, the test background has multiple colors, which can have various patterns. In some embodiments, the test background can include concentric regions, and the width of each region can be adjusted at all meridians by dragging its edges. The background color and brightness of each region can be adjusted (e.g., by sliding a pointer on a slider bar or using other input functions). Various visual properties of the test background can be set before the test. Alternatively, at least some properties can be adjusted in real time during the test (manually or automatically). In some implementations, the test background can differ in at least one aspect for each test target presentation.

[0145] Additionally, in some embodiments, the test background has visual characteristics, such as a still image, a movie, or an entire three-dimensional scene. The test background can be in the form of a computer game. One or more features included in the test background can vary in brightness and hue over time, or in part, of the feature, and can be automatically controlled.

[0146] Inspection period

[0147] Tests using the described techniques can be controlled to start and end in any suitable manner. Tests can be initiated by a suitable trigger, such as a user input instructing the testing system to begin displaying images (e.g., test targets, fixation targets, a pointer over a background, etc.) on a display visible to the patient. In some embodiments, a decision on whether to end a test can be based on one or more of the following: (a) when all test targets have been presented; (b) when a particular test target is missed; or (c) after a specified test period. Other factors can additionally or alternatively be used to determine when to end a test. Tests can be run in an automatic mode. In some embodiments, tests can be performed to determine the probability that a patient has one or more diseases, and the test can be run until a predetermined certainty or probability of a disease affecting the patient's vision is reached.

[0148] Lateral examination

[0149] In some embodiments, the test can be conducted so that both of the patient's eyes are tested simultaneously, with a test target presented to each eye. This can be done in a semi-random manner (e.g., randomization of each left-right pair). However, in some embodiments, the test can be conducted so that one of the patient's eyes is tested. The laterality, color, and brightness of the visual field presented to the other (untested) eye can be selected appropriately depending on the particular test. Furthermore, in some embodiments, the test can include presenting test targets to one or both of the patient's eyes, for example, alternately or in other ways.

[0150] Response Mode

[0151] The described techniques can determine whether the patient viewed the test target in a variety of ways, for example, this can be done using a discrete trial subjective mode, a discrete trial objective mode, a continuous tracking mode, or in other ways.

[0152] Discrete Trial Subjective Mode

[0153] In subjective tasks, patients are instructed to report what they see during the test. This requires the patient to recognize the test target. The patient indicates recognition of the test target by moving their head, a handheld pointer (e.g., a "pistol"), or their eyes toward the target's location (the target disappears by the time the patient responds). This movement is indicated by the patient's head, eyes, handheld device, or other moving gaze pointer. Detection of the test target is indicated by the gaze pointer entering an invisible detection zone (or "hit zone") surrounding the target. The size and shape of this detection zone are adjusted for each test target presentation, either automatically or manually (e.g., via a user interface presented to the clinician supervising the patient as the test is administered). In some cases, the detection zone can be triangular in shape, with its apex pointing toward the fixation target, but it should be understood that the detection zone can have a variety of other shapes and sizes.

[0154] In some embodiments, once it is determined that the test target has been detected by the patient, a fixation target is displayed on a display viewed by the patient and the process is repeated, or in some embodiments, a new fixation target appears near the edge of the "hit zone" and the patient's gaze is directed thereto.

[0155] If it is determined that the test target is not detected by the patient within the specified time, the previous fixation target remains displayed, and the next test target is displayed in the same location (e.g., a "stronger" test target, with one or more properties adjusted to make the target easier for the patient to see) or in another part of the patient's visual field. It is also possible to move the fixation target after it is determined that the stimulus is not detected.

[0156] Non-limiting examples of subjective input include input received via the patient's head, eye, or other movements, one or more controller devices, a position-tracked controller, the patient's voice, a mouse and / or keyboard, a touch interface, etc.

[0157] Discrete Trial Objective Mode

[0158] In objectively measured tasks, the patient responds automatically to the test target. This may be a "natural" response, such as a movement toward the new test target or some other reaction to the appearance of the new test target. This may not require prior patient training. Also, the patient may or may not be aware of the test target. In objective mode, eye tracking (or other sensors) can be used to automatically detect whether the patient is looking at the test target and where the patient's gaze is fixating. Therefore, the patient may not need to provide explicit indication that she / he looked at the test target.

[0159] In some embodiments, individualized adaptive Bayesian response measures can be obtained. A patient's response profile in the objective mode can be generated by measuring one or more response metrics. This can be done, for example, during a training mode administered to the patient before the test begins. The training mode involves administering activities similar to the actual test or other types of activities to the patient aimed at obtaining user input to collect appropriate response metrics. Measurements obtained during the training mode can be used to generate prior values ​​used in the test mode to determine whether a response metric obtained during the test mode should indicate a "seen" or "missed" test target. This improves the accuracy of the test results. For example, some people turn their eyes toward the target when looking, while others turn their head and eyes. The described techniques can determine for each individual when the target is seen based on a combination of these response measurements (and possibly based on a combination with other responses, such as pupil dilation). The response metrics can be adjusted based on the results obtained during the test mode. In this way, as the patient is administered the test, the accuracy of result interpretation improves from test to test. Response metrics can be adjusted on a patient-by-patient, test-by-test, and / or other basis.

[0160] Continuous Tracking Mode

[0161] In some embodiments, visual field testing can involve presenting a peripheral test target on a display that the patient briefly views to ensure the test target is not discovered by the patient through a visual search process. In some cases, the test target can be displayed on the display for approximately 0.5 seconds, allowing the patient to typically "find" the target on the display. Alternatively, a new target can be displayed at a desired retinal location, and the patient can remain on the screen long enough to locate it using a search strategy. The patient's task is to identify the target. In this case, the dependent response measure is eye position. Alternatively, the task can be to point to the target with a hand or head pointer. In this case, the dependent response measure is hand or head position. Whether (or how quickly) the target is detected at the onset can be determined based on measurements taken during tracking. For example, a patient can initiate head pointer movement toward a target with a very short response latency for a seen target, but a target that is not visible until the patient searches for it using eye movements requires a much longer response latency.

[0162] In some embodiments, a tracking mode task may require performing time-dependent tracking of a moving target that "jumps" to new positions. For example, a task could involve maintaining a head pointer within a target circle that moves across the screen on a motion path with a random component. This task requires visual fixation. To test a new location, the target circle jumps to that position in the visual field, and the patient resumes tracking as soon as they see the target. For example, in at least one embodiment, the delay in responding to the onset of a new target can be measured as the time offset of the peak probability in the cross-correlation diagram between the dependent measurement signal and the test target. This can be done, for example, as described by Bonnen, K., Burge, J., Yates, J., Pillow, J., and Cormack, L.K. (2015) Continuous Psychophysics: Target Tracking for Measuring Visual Sensitivity, Journal of Vision, 15(3):14, 1-16.

[0163] Inspection Approach

[0164] In some embodiments, a Bayesian approach is used for visual field testing, using available information to determine the location to test within the visual field. In some embodiments, patient data can be updated before the test is performed, and the location to test is determined based on the updates. A Bayesian classifier can be used to determine the current probability of each disease. The test can be configured to end manually, on a timer, or when a certain confidence level is reached.

[0165] The information used to generate the prior probability distribution is stored in an appropriate memory location on the computing device. In some embodiments, a database of inspection data (e.g., a database of Humphrey Field of View (HVF) results) is generated and can be used to generate the prior probability distribution. In some embodiments, a Monte Carlo Markov Chain (MCMC) Bayesian approach is used to construct the probability distribution and measure new points in the field.

[0166] In some embodiments, a prediction and classification module can be used and can be implemented in suitable computing software. In some embodiments, the prediction module receives patient data as input and generates a two-dimensional probability map across the entire visual field. In some cases, a miss (i.e., a test target not visible to the patient) or a hit (i.e., a test target visible to the patient) at each location is predicted. In some embodiments, a fixed luminance at each location is used as a cutoff normalized across the entire visual field to account for normal sensitivity differences between central and peripheral vision based on a visual field test database.

[0167] The prediction module can also use correlation maps. Once a single point in the field of view is measured, a correlation map can be generated that matches the demographic data. The correlation map can show how each point in the field of view correlates with other points, given the patient's current probability provided by the classifier. This information can indicate the point that is most likely to learn new information for this patient. Figure 9 shows a correlation map 900 of a single point (a "point of interest") on the field of view, showing how each other point correlates to that point.

[0168] Once a map of the probability that the patient will miss / see the test target at each location in the field of view is generated, this map can be used as measurements are taken. The measurements taken can be added to the prior knowledge collected about the patient, and a classification module can be run. The classification module uses the information acquired about the patient to generate a set of probabilities of potential diagnoses. The classification module can be a neural net, a boosted decision tree, or any other classifier. Multiple classifiers can be used. A confidence score is generated associated with each result. The probabilities generated by the classification module are also used to update the prior probabilities used in the prediction module.

[0169] Furthermore, a Bayesian classifier configured to detect a specific disease may differ from a Bayesian classifier configured to estimate a target threshold at all tested locations in the visual field. In the latter case, the goal is to construct a visual field map that characterizes the ability to see multiple locations in the visual field under some constraints, such as a certain number of target presentations or a time limit for testing. The goal of a Bayesian classifier configured to detect a specific disease is to estimate the probability that a patient has a specific condition, which may not require estimating a threshold or may not require estimating a threshold at all locations in the visual field.

[0170] In some embodiments, a continuous approach to visual field testing is utilized. For example, some embodiments include modeling attention to spatial location, boredom, fixation ability, and response time as specific sources of variability that affect an individual's performance on the test. These factors can be taken into account when performing probabilistic testing for glaucoma screening or for creating field maps (or tracking progression over time). Relatively simple target detection (e.g., near the fovea or in a location known to lack a scotoma) can be used to characterize these aspects of the observer-responder.

[0171] In some embodiments, tasks can be performed that allow multiple locations in the patient's visual field to be tested at once. For example, the indications obtained from the patient as a result of presenting test information to the patient depend on several (or all) of the locations being tested. In some embodiments, people's ability to fixate images of some objects more easily than others can be exploited. For example, an empty box can provide more stable fixation than a solid dot. Also, people tend to fixate human faces in the most informative location between the nose and the eyes. Therefore, in some embodiments, human faces (e.g., real people's faces, fictional or computer-generated faces, etc.) and / or specific regions of faces can be used to perform accurate fixations. In some embodiments, faces familiar to the patient can be obtained from the patient or from social media sites.

[0172] Continuous tracking can be combined with step changes in position. One task can be performed when a patient needs to track a target that jumps to a new position. Tracking accuracy can be used to determine eye fixation, and patient tracking can be detected via head tracking, a suitable controller, or a pointing device. In some embodiments, tracking can be performed on the patient's fingers using a tracker, such as a Magic Leap or optical tracking sensor (e.g., the sensor built into a Microsoft VR headset), eliminating the need for a trackable badge on the finger. In some embodiments, the tracking device can be worn by the patient. The headset can have an augmented reality (AR) display, allowing the person wearing the headset to see their actual fingers.

[0173] In some embodiments, the task may be to maintain a pointing device (e.g., a tracking spot) within a target (e.g., a circular shape) that moves in a random manner. At specific time intervals (e.g., approximately 1 second), the target "jumps" to a new location (during testing). When the patient looks at the target, the pointing device moves toward the target. If the patient does not look at the target, the patient begins searching for the target in their visual field. This can be detected as one or more of the response time of the pointer movement, the direction in which the pointing device is moved by the patient, and the detection of eye movement (response time, and optionally, the direction of movement). In one embodiment, if the target moves along a linear trajectory, the moment it is seen can be used. That is, if the response occurs within approximately 200 milliseconds, and saccadic movement can be initiated in approximately 100 milliseconds in addition to the perceptual processing time of approximately 80 milliseconds, it means that it has emerged from the dark as a method of performing kinetic perimetry. Fixation can be determined during the tracking task, followed by a period of minimal eye movement for approximately 150 ms after target offset (and its simultaneous or asynchronous reappearance elsewhere), so that moving the eye or pointer to a new target within 200 ms is a reliable indicator that the new target has been seen at the retinal location being tested (based on the vector from the previous target at the fovea to the new peripheral target). This procedure can be repeated until the visual field is mapped.

[0174] In some embodiments, as described above, the target may be a face. Accurate face tracking may be automatic and reliable, allowing for simple tasks in central vision, allowing more visual attention to be allocated to peripheral vision, improving sensitivity measures.

[0175] In some embodiments, a "standard" suprathreshold test can be performed. In such embodiments, N suprathreshold, black-on-white test targets can be presented in the central 24-degree field in order of priority until all are tested or until a specified time (e.g., approximately 180 seconds per eye) is reached, whichever occurs first. Once all points have been tested, missed points are retested, excluding clusters of missed points (e.g., greater than a certain number of adjacent points). Blind spot test targets that have been seen can be retested. In some embodiments, for standard suprathreshold testing, the prioritization can be as follows: Category 1—four quadrants (i.e., the 45-degree meridian) at 24 degrees eccentricity; Category 2—the lower hemisphere at 16 degrees eccentricity; Category 3—the upper hemisphere at 12 degrees eccentricity; Category 4—the blind spot at 15.5 degrees eccentricity and 3 degrees above and below the horizon; Category 5—the nasal region, 15 degrees above and below the horizon at 16, 20, and 24 degrees eccentricity; and Category 6—the paracentral zone at 4 degrees eccentricity and the 45-degree meridian. Testing targets within each category can be randomized.

[0176] In some embodiments, detailed suprathreshold testing can be performed. If the specified test duration is not reached (e.g., 5 minutes per eye), standard suprathreshold testing continues with the intervening test points between the seen and missed test targets. Once the specified test duration is reached, testing stops.

[0177] In some embodiments, a simple suprathreshold screening test can be performed. Standard suprathreshold testing stops after a specified period of time has elapsed or if any test target is missed twice. Missed test targets are retested immediately after one test target in the next position has been tested. Normal blind spots are tested.

[0178] In some embodiments, threshold testing can be performed. A standard threshold test is performed using a weak stimulus test target (e.g., light gray). Missed points are retested with a medium stimulus test target (e.g., dark gray). Points missed the second time are retested with a strong stimulus test target (e.g., black). The intensity of the weak stimulus is based on normal values ​​(i.e., age- and sex-matched healthy individuals).

[0179] In some embodiments, chloroquine retinopathy screening can be performed, for example, by presenting yellow and blue stimuli at 4 degrees eccentricity in all meridians, with missed points being retested unless two or more adjacent points are missed.

[0180] In some embodiments, points between the previously missed inspection target and the previously seen inspection target are inspected first, and then inspection proceeds according to the previously used strategy.

[0181] In some embodiments, pairs of test targets from each category are presented simultaneously, with one test target from each vertical hemisphere (i.e., medial and lateral). The pairs are randomized (e.g., superior temporal and superior nasal, superior nasal and inferior temporal). The patient must view both test target locations and freely choose which location to view first.

[0182] In some embodiments, a stenosis test can be performed, for example, the test target is displayed at 4 degrees eccentricity in the nasal region at the 45 degree meridian and 15 degrees above and below the horizontal, then at 12 degrees, then at 20 degrees, then at 8 degrees between the seen and missed points, then at 16 degrees.

[0183] In some embodiments, blind spot testing can be performed. Using small white-on-black test targets, the center of the blind spot is tested at vertical, horizontal, and diagonal meridians relative to the center of the blind spot. Each test target is spaced two degrees radially, and radial points between the seen and missed points are tested.

[0184] The described techniques include presented information intended to train patients to perform various tests. As such, information in text, still images, animated graphics, audio, and other formats (or combinations of formats) can be used to educate patients on how to perform the tests, what visual fields are, causes of visual field loss, etc. Training can also include administering training "tests" to patients before the actual tests are performed. Information can be displayed on a personal computer, smartphone, tablet, smartwatch, or virtual reality device worn by the patient during the test. The described techniques also include training and educational information presented to clinicians.

[0185] 10A-10C illustrate one embodiment of a method for testing a patient's visual field using a pointer (e.g., a head pointer or head cursor) that may be displayed in a VR environment on a head-mountable device's display. Views 1010, 1020, and 1030 shown in FIGS. 10A-10C are what the patient sees during the test. The patient moves the head pointer (in this example, a dot) toward a fixation target (e.g., a circle with a diameter larger than that of the head pointer) rendered on the display, as shown in FIG. 10A. This may occur, for example, when a previous test target is displayed and the head pointer is moving toward the location where the previous test target was displayed. Alternatively, the fixation target may be the first fixation target displayed on the VR display in this example. When the head pointer at least partially overlaps the fixation target, the next test target or targets are displayed. Thus, in this example, as shown in FIG. 10B, the next test target is rendered when the head pointer enters the fixation target. If the head pointer begins to move toward the location where the next test target is displayed, the patient is determined to have seen the next test target. The next fixation target then appears near the location where the next test target appeared. Figure 10C shows the patient's field of view after the next fixation target has been detected (i.e., in this example, the pointer has been moved to appear within the fixation target), and the subsequent test target is displayed. Thus, the process can continue until all test targets intended to be displayed according to this test have been presented. Each displayed test target can be classified as a detection or a miss based on whether the head pointer was moving toward the test target when it was displayed.

[0186] Alternatively, the patient can respond by specifying the target's location in one of two or more locations. Figure 10D shows an example in which four responses 1042, 1044, 1046, and 1048 are possible for each trial. The target flashes at location 1050, indicated by a dark gray dot. Four response zones 1042, 1044, 1046, and 1048 are displayed simultaneously with the target, before the target, after the target, or any combination thereof. While fixating on the fixation target 1041, the patient can see these response zones, here represented by four gray circles 1042, 1044, 1046, and 1048. The patient can respond by moving the cursor to one of these response zones or by failing to move the cursor to one of the response zones within a specified time, such as two seconds. The response zones may be a number other than four, and they may be regularly spaced, as in Figure 10D, or irregularly spaced. In this example, the head cursor 1052 has been moved to the correct zone that previously contained the target. Using an odd number of equally spaced response zones is not recommended because patients can sometimes guess the correct zone as being the zone to the right or left of fixation when presented with a target in their normal physiological blind spot.

[0187] Figure 10E shows an example in which there are seven possible responses. In this example, there are six sectors defined by delimiting lines 1074 within which a cursor 1078 can be moved to select the location of the target 1076. Alternatively, the patient can wait until the end of the test without selecting a displayed sector corresponding to regions 1062, 1064, 1066, 1068, 1070, or 1072. Lines 1074 separating the sectors are displayed to the patient. Additionally, as indicated by the colored regions with dashed borders, the sector boundaries can be extended toward the fixation mark 1061 to facilitate a response when the target 1076 appears closer to the fixation mark 1061 than the end of the line separating the sectors. Avoiding placing visible features of the response zone, such as the circles and lines in Figures 10D and 10E, too close to the target location can reduce the visibility of the target through forward masking (when the feature is presented before the target) or simultaneous or backward masking (when the feature is presented immediately after the target).

[0188] FIG. 11A shows an example test layout 1100 that includes 69 locations for each eye (left eye (“OS”) and right eye (“OD”)) that can be tested in one embodiment. In this example, each test target is in the form of a dark (e.g., black) dot displayed on a white background. Each test target is a 1-degree object, displayed for 300 milliseconds, and displayed a specific number of times per location. Test targets can be presented randomly so that all 69 locations in the patient's visual field are ultimately tested.

[0189] FIG. 11B shows an example test layout 1120 that includes 54 locations for each eye (left eye (“OS”) and right eye (“OD”)) that can be tested in one embodiment. This example is a “ladybug” design, so named because it resembles a ladybug. In this example, each stimulus (represented by a blue disk) is in the form of a gray dot displayed on a light gray background. In this embodiment of the test, sampling is denser in central vision than in peripheral vision, which is appropriate because ganglion cells are denser in central vision than in peripheral vision. In one embodiment not shown, the spatial layout of the targets accurately reflects ganglion cell density, so that each target location has approximately the same number of ganglion cells nearby. In one embodiment not shown, the size and shape of the targets are designed to tile the visual field so that the receptive field of every ganglion cell contributes to the visual system's response to at least one target.

[0190] The stimulus layout shown in Figure 11B is intended for use in glaucoma screening tests and therefore includes denser sampling at locations within the nasal field that may be necessary to detect the "nasal step" pattern of reduced sensitivity commonly seen in glaucoma.

[0191] FIG. 11C shows an example test layout 1140 that includes 62 positions for each eye (left eye (“OS”) and right eye (“OD”)) that can be tested in one embodiment. This example is a “turtle” design, so named because it looks like a turtle. The stimulus layout shown in FIG. 11B is intended for use in glaucoma monitoring tests. It is similar to the screening test layout of FIG. 11A. However, due to the large number of stimulus positions, the test takes longer. The advantage for glaucoma patients is that a large portion of the patient's visual field is tested, which is useful for monitoring the progression of vision loss over time.

[0192] An additional advantage of testing more densely in the central visual field is that, once the cortical magnification of the type of target used is taken into account, the target locations reflect equal spacing, so that the stimuli sample the functionally relevant map of the visual field more uniformly than would be the case with uniformly spaced samples on the retina.

[0193] Cortical expansion rates are greater for pattern discrimination and pattern discrimination tasks than for detection tasks. That is, the ability to distinguish or discriminate letters and other objects from one another declines more rapidly with eccentricity than the ability to detect transient changes in luminance. Thus, stimuli requiring discrimination or discrimination are more densely spaced in the central visual field and more sparsely spaced in the peripheral visual field than stimuli requiring the detection of luminance changes, and they increase in size more rapidly with increasing eccentricity.

[0194] In Figures 11A, 11B, and 11C, each stimulus can be an object whose size increases with the eccentricity of the stimulus, so that the threshold luminance for detecting the stimulus is approximately constant for all stimuli in the display for observers with normal vision. For example, the size of the stimuli can be selected so that, on average, a person of the same age as the patient will correctly report the location of the target 95% of the time. For example, all stimuli in the display could be presented at a luminance equal to 90% of the background luminance, and missed stimuli would be presented again at 0% of the background luminance, creating a "three-zone" test in which the stimulus was seen, missed and then seen, or missed and then missed again.

[0195] Stimuli in layouts like those in Figures 11A, 11B, or 11C can be presented at one eccentricity at a time, allowing patients to anticipate targets occurring within this limited region of the display. For example, the first target tested might be the most central target, followed by the central ring of targets. Thus, patients can allocate their visual attention to a specific ring of the display, improving detection thresholds compared to when visual attention must be scattered across the entire display. Furthermore, patients can more easily complete the test by attending to one annular region of the display at a time, compared to attending to the entire display for the entire duration of the test.

[0196] FIG. 12 shows example results 1200 using the described system using a head pointer approach, demonstrating the effectiveness of this method. An example test involves identifying blind spots in a patient with normal vision. The results are shown in FIG. 4, where section A ("OS" displayed on the left) shows the location and size of the blind spot in the patient's left eye, and section B ("OD" displayed on the right) shows the location and size of the blind spot in the patient's right eye. As shown, the system correctly determines the location and size of the blind spots.

[0197] Figure 13 shows another example of results 1300 from two tests using the head-pointer approach. "OS" sections A and B and "OD" sections C and D show the results of testing a user's left and right eyes, respectively. In this case, sampling was performed densely in the blind spot, with an 8x9 grid of targets centered on the expected location of the blind spot and extending beyond. Each location was sampled five times. The map interpolates the percentage of targets detected in the test from 0 / 5 (black) to 5 / 5 (white). The top (A and C) and bottom (B and D) sections show the first and second replicates of the test, respectively. Figure 13 demonstrates that the test can provide reliable (test-retest) results in patients with normal vision.

[0198] Figures 14 and 15 show example results from using the described system for head pointer testing in two patients with primary open-angle glaucoma. Figure 14 shows results plotted at 1400 based on data acquired for the right eye of a 50-year-old man with severe primary open-angle glaucoma (POAG). The results demonstrate deviations from age-matched normal results. Figure 15 shows results plotted at 1500 based on data acquired for the right eye of an 80-year-old man with mild POAG, whose OCT (neuro) showed thinning of the inferior temporal border and developed a cataract. The results demonstrate estimated sensitivity across the entire visual field. The normal blind spots for both patients are shown in Figures 14 and 15. Figure 15 demonstrates a slight narrowing of the nasal passages and a loss of sensitivity beyond the normal blind spot, along with a defect in the superior blind spot.

[0199] Figure 16 shows a graph 1600 for representing the results of a visual field test. In this format, the raw data is displayed in a schematic layout 1600 that corresponds to the spatial layout of the stimuli. In this case, the spacing of the test targets is not proportional to the spacing of the test targets in the test. Instead, the eccentricity and target size are transformed to be regular, facilitating comparison of results between test locations. In this example, the data show central targets that were sometimes missed (light or dark gray) or always (black), while peripheral targets were always seen (white with a gray circle) except near the normal blind spot. The normal blind spot was never seen (black).

[0200] FIG. 17 shows a graph 1700 for representing the results of a visual field test. The loss of sensitivity progresses from white (normal) to gray (some loss) to black (severe loss) compared to normal. Unlike the schematic layout of FIG. 16, in FIG. 17 the color map is not systematically distorted. The color map was created by interpolation and extrapolation from sample points spaced proportionally to the spacing of the test targets.

[0201] Figure 18A shows a model 1800 of a patient's cognitive process for traditional perimetry. At 1805, a test target appears at one of many (e.g., 54) locations. At 1810, the patient estimates the signal strength of the test target at the many locations. At 1815, the patient determines the probability that there was a signal at each location. At 1820, the patient considers whether the stimulus (test target) was likely to have flashed. If not, at 1825, the patient does not respond. If so, at 1830, the patient clicks a response button.

[0202] 18B shows a model 1850 of a patient's cognitive process for a method of perimetry according to various embodiments of the disclosed technology. At 1855, a test target appears at one of several locations (e.g., six). At 1860, the patient estimates the signal strength at several locations. At 1865, the patient considers whether the signal strength of the test target exceeds a standard at any location. If not, at 1870, the patient does not respond. If so, at 1875, the patient indicates the location of the signal.

[0203] Thus, in traditional perimetry (Figure 18A), the patient makes a single "continue / no-continue" decision, resulting in a non-response at the final stage of cognitive processing for the test. In the method according to the disclosed technology (Figure 18B), the patient reports the location of the target with a "continue" response. For example, the patient may select one of six possible locations where the stimulus could have occurred in that trial. This change in task requirements, while subtle, can have a significant impact on patient comfort for two reasons: (1) the patient can be instructed, "If you see a stimulus, please report where it was." Indeed, people with intact neurology do not detect objects without also being aware of their location. Because the location of the stimulus is always encoded, reporting the stimulus's location incurs no additional cost to the patient. In particular, consider a situation in which the patient is 75% certain that the target appeared at location A and 75% certain that the target appeared at location B. This situation can arise if the patient's sensitivity to locations A and B is low or if the stimulus contrast is low. In traditional testing, the stimulus may have occurred even if the patient does not know where it occurred. The optimal choice is to click the response button. In the new test, the optimal choice is not to respond. This is because the stimulus does not exceed the criterion at either location individually, meaning there is a 50% chance of being incorrect at either location. Combining probabilities across locations in the manner required to achieve optimal threshold-level performance in traditional no / no-go task designs can be difficult and unnatural. (2) Patients can use a higher criterion for responding. This allows for the use of stronger (e.g., higher contrast) stimuli during testing. As a result, patients are more likely to feel comfortable deciding whether to respond. If the optimal decision rule were simply that no location exceeded the criterion, choosing "not seen" would be less stressful. Another way of saying this is that in the new method, patients feel comfortable not responding when there is high uncertainty about where the target will appear.

[0204] In some embodiments, in addition to head tracking, eye tracking of the patient is also performed, which can improve the performance of tests using the described system. Head and eye tracking are thus combined to improve the user experience. The system is comfortable for the patient while also being accurate in mapping the visual field.

[0205] In some embodiments, the test performed by the patient may be in the form of a game. The in-game VR-based diagnostic visual test can be performed at home or other environment outside of a medical facility. A user interface presented to the patient (on the user's home computing device or a computing device in the clinic) can be configured to receive the user's login information and details related to the user's performance of the in-game VR test in the clinic or at home. In some cases, real-time monitoring of test results and patient compliance by medical personnel can occur simultaneously with the test. Thus, patient compliance can be monitored remotely, and real-time home diagnostic testing can be performed in the patient's home (or other location outside of a medical facility). Data acquired by the system (e.g., via a computing device) as the patient performs the test in a home environment can be supplemented with data acquired at the medical facility under the supervision of a trained medical professional.

[0206] Additionally, as noted above, in some embodiments, the fovea (the tilt of the eyes to focus on an object) can be used, and the patient is prompted to make eye movements toward peripheral targets as they appear. Additionally, as noted above, the patient can be instructed to choose from several alternative eye movement options. Thus, the patient can specify a direction toward a target using natural eye movements. For example, the patient's eyes can be tracked while the patient performs the test and / or activity.

[0207] In some embodiments, during perimetry, multiple targets can be displayed on the head-mountable device's display at 2-second intervals. This interval allows the patient to re-fixate on a central target (which may be unchanging), broadly reposition their attention, and confirm that their fixation is accurate. Humans, on the other hand, can sequentially fixate at 2 Hz or faster, reducing test time by more than fourfold. Therefore, the described technique utilizes tracking of eye movements to visual targets for perimetry, which then become the fixation target for the next trial. Allowing the patient to move around the targets improves the speed of the test and the overall patient experience.

[0208] In some embodiments, both head pointing and eye tracking are used to create a sensitivity map. Eye tracking can be used to determine the patient's response (whether the patient looked at the target) and to determine the patient's eye position at the moment of the next target presentation. The eye position and head pointer information can be combined to create a metric for the direction of the patient's orienting response.

[0209] The described systems and techniques use a variety of computational algorithms. For example, in some embodiments, a "flood-fill" mesh algorithm can be used to dynamically increase sampling density in areas of detected scotoma. Common forms of blindness do not affect all parts of the retina equally but have stereotypical geographies. Therefore, efficient screening requires deviation from isotropic sampling to take advantage of prior probabilities. Similarly, to monitor glaucoma progression, a characteristic arcuate geography is used to efficiently position each test target at a specific location to maximize information about the dB sensitivity map as a whole. In some embodiments, to monitor glaucoma progression, a Bayesian optimal algorithm adapted from a model of human fixation behavior when the goal is to locate a hidden visual target is used. Test locations can be reassigned according to the history of earlier sessions and / or previous sessions. The slope of the psychometric function for sudden changes in sensitivity across space (whether it is sufficiently shallow) can be determined. Furthermore, the goal of each test is to improve the overall map of sensitivity.

[0210] Furthermore, in some embodiments, patient instructions can be provided in the form of a game, in conjunction with auditory feedback during training and testing. For example, the auditory feedback can be intended to motivate the patient to perform the required procedures in an appropriate manner and to "reward" the patient for proper performance. Furthermore, the system can be configured to process images acquired from a camera (which can be incorporated into a head-mountable device) to detect fogging, proper centering, and other features that may affect the patient's performance. Furthermore, in some embodiments, no audio instructions are provided to the patient; any instructions and / or prompts are visual. For example, in at least some embodiments, patient instructions can be provided in the form of a video demonstrating examples of proper performance of the test. In some embodiments, training can include providing "rewards" to the patient in the form of pleasant auditory signals (or visual signals for the hearing impaired).

[0211] As described above, various information related to the visual examination (e.g., instructions, patient information, results in graphical or other formats, etc.) can be displayed on the display of one or more computing devices, which may be mobile devices. For example, a user interface that can be presented to a clinician can display a login page for a patient portal used at the initial clinic visit to create a secure patient account. As another example, the user interface can be rendered on an online platform with clinical research functionality such as masking, remote randomization, enrollment, privacy, auditing, remote monitoring of results and compliance, and other features used to remotely monitor patient status. Data can be displayed based on permissions. For example, different permissions can be set (in a configurable manner) for different individuals. The user interface can visually display diagnostic results and test compliance data for a specific patient and update the data in real time.

[0212] 19 is a flowchart of a process 1900 for assessing a user's field of view, according to various embodiments of the disclosed technology. Referring to FIGS. 2A, 2B, and 19, the process 1900 may be performed by the computing device 202 or the user computing device 230.

[0213] At 1910, the computing device 202 displays a fixation target in a virtual reality environment on the virtual reality display 210 of the head-mountable virtual reality device 208, the virtual reality environment comprising a pointer controlled by a user wearing the head-mountable virtual reality device 208.

[0214] At 1920, the computing device 202 determines whether at least one eye of the user is fixating on a fixation target.

[0215] At 1930, if the computing device 202 determines that the eye is fixating on the fixation target, the computing device 202 displays the test target at a first location in the virtual reality environment, the first location corresponding to a first location in the user's field of view.

[0216] At 1940, the computing device 202 receives the user input and determines whether the user input indicates that the user has detected the inspection target location.

[0217] At 1950, the computing device 202 obtains an indication of whether the inspection target was detected by the user based on the received user input and stores the indication.

[0218] At 1960, the computing device 202 repeatedly performs the steps of displaying, determining, displaying, receiving, and obtaining until a particular condition is met.

[0219] At 1970, the computing device 202 provides an assessment of the status of the visual field based on the results of the determination of the user's detection of the inspection target during the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps.

[0220] In various embodiments, the user input indicating that the user has detected the test target at the first location includes determining whether the user input indicates a pointer moving toward the first location. In various embodiments, the user input indicating that the user has detected the test target at the first location includes determining whether the user input indicates that the user's head is moving toward the first location. In various embodiments, the user input indicating that the user has detected the test target at the first location includes determining whether the user input includes a pupillary response. In various embodiments, the user input indicating that the user has detected the test target at the first location includes determining whether the user input includes a button press.

[0221] In various embodiments, the process 1900 includes determining the position of the eye and / or pupil when the eye is determined to be fixating on the fixation target.

[0222] In various embodiments, the repetitive execution of the displaying, determining, displaying, receiving, and acquiring steps continues until all test targets of the plurality of test targets are displayed. In various embodiments, the repetitive execution of the displaying, determining, displaying, receiving, and acquiring steps continues until a predetermined period of time has elapsed. In various embodiments, the repetitive execution of the displaying, determining, displaying, receiving, and acquiring steps continues until a predetermined level of statistical confidence in the evaluation is reached.

[0223] In various embodiments, when it is determined that the eye is fixating on the fixation target, the test target is at least partially displayed simultaneously with displaying the fixation target, hi various embodiments, determining whether the eye is fixating on the fixation target includes determining whether the patient's fovea is fixating on the fixation target.

[0224] In various embodiments, process 1900 includes comparing the patient's binocular fixation stability with the patient's monocular fixation stability for each eye to determine whether to display the fixation target one eye at a time or to both eyes simultaneously.

[0225] In various embodiments, the user input includes an indication of a pointer movement in the virtual reality environment.

[0226] In various embodiments, obtaining an indication that the test target has been detected by the user includes determining that the pointer is positioned within a predetermined distance from the first location. In various embodiments, obtaining an indication that the test target has been detected by the user includes obtaining an indication that the location of the test stimulus has been detected by the user. In various embodiments, obtaining an indication that the test target has been detected by the user includes determining movement of one or both eyes, head, facial muscles, one or both pupils, and / or the user's body.

[0227] In various embodiments, the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps includes displaying a subsequent inspection target of the plurality of inspection targets at a second position on the virtual reality environment corresponding to a second position of the user's field of view that is different from the first position of the user's field of view.

[0228] In various embodiments, the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps includes displaying a subsequent fixation target in the virtual reality environment, determining whether the eye is fixating on the subsequent fixation target, displaying a subsequent test target of the plurality of test targets at a second location in the virtual reality environment corresponding to a second location of the user that is different from the first location of the user's field of view if the eye is determined to be fixating on the subsequent fixation target, receiving user input including an indication that the user has detected the subsequent test target at the second location, obtaining a second indication of whether the subsequent test target was detected by the user based on the received user input, and storing the second indication. In various embodiments, the subsequent test target has at least one characteristic that is different from the at least one characteristic of the test target displayed at the first location.

[0229] In various embodiments, determining whether the eye is fixating on a fixation target includes determining whether a pointer has moved such that the pointer at least partially overlaps the fixation target. In various embodiments, the fixation target includes a representation of at least one movable object. In various embodiments, the fixation target is displayed near the first location.

[0230] In various embodiments, receiving user input further includes obtaining eye tracking information using a sensor monitoring at least one eye of a user wearing the head-mountable virtual reality device.

[0231] In various embodiments, the head-mountable virtual reality device includes glasses.

[0232] In various embodiments, user input is further received from at least one input device selected from the group consisting of a mouse, a joystick, a keyboard, a handheld gesture and motion tracking device, a non-handheld gesture and motion device, a microphone, at least one camera, an omnidirectional treadmill, a head tracker, a body tracker, a facial muscle sensor, and a gamepad.

[0233] In various embodiments, the system 250 includes a mobile computing device that includes computing hardware. In various embodiments, the pointer includes a head pointer and / or a hand pointer.

[0234] In various embodiments, the physical and other characteristics of the fixation or test targets and the rules for whether and how they are displayed are described in a spreadsheet or data file that can be modified by the person administering the test. In various embodiments, the physical and other characteristics of the fixation or test targets and the rules for whether and how they are displayed are configured on a separate computing device and received by the device administering the test via a network connection.

[0235] In various embodiments, the results and data collected during the test are transmitted to a separate computing device. In various embodiments, one or more characteristics of the test stimulus are determined at least in part by previous test results from the current patient and / or other patients.

[0236] In various embodiments, obtaining an indication that the test stimulus has been detected by the user includes determining that the pointer is positioned within one of at least two sectors surrounding the location of the fixation target.

[0237] In various embodiments, the assessment of visual field status includes information regarding the identification, status, and / or progression of glaucoma, multiple sclerosis, macular degeneration, diabetic retinopathy, neurological function, retinitis pigmentosa, color vision, binocular vision including suppressive scotoma, and / or vascular disease.

[0238] In various embodiments, a method for assessing a user's visual field includes displaying a fixation target on a user interface rendered on a display associated with a computing device. The user interface includes a pointer controlled by a user displaying the user interface. The method further includes determining whether at least one eye of the user is fixating on the fixation target. If it is determined that the eye is fixating on the fixation target, the method further includes displaying a test target of the plurality of test targets at a first location on the user interface, the first location corresponding to a first location in the user's visual field. The method further includes receiving user input including an indication that the user detected the test target at the first location. The method further includes obtaining an indication of whether the test target was detected by the user based on the received user input and storing the indication. The method further includes repeatedly performing the displaying, determining, displaying, receiving, and acquiring steps until a specific condition is met. The method further includes providing an assessment of the state of the visual field based on a result of the determination of the user's detection of the test target during the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps. In various embodiments, the computing device includes a smartphone. In various embodiments, the computing hardware is included in a computing device. In various embodiments, the display is part of the computing device. In various embodiments, the computing device includes a smart television. In various embodiments, the computing device includes a personal computer. In various embodiments, the user interface includes a virtual reality environment on a virtual reality display of a head-mountable virtual reality device. In various embodiments, user input is further received from at least one input device selected from the group consisting of a mouse, a joystick, a keyboard, a gesture and motion tracking device, a microphone, at least one camera, an omnidirectional treadmill, and a gamepad.

[0239] It should be understood that the various embodiments described herein can have various modifications. For example, the image displayed on the display viewed by the patient using the vision test assessment can be displayed to either or both of the patient's left and right eyes. In some embodiments, one eye can be tested without the patient being aware that this particular eye is being tested.

[0240] One or more aspects or features of the subject matter described herein may be implemented in digital electronic circuitry, integrated circuits, specially designed application-specific integrated circuits (ASICs), field-programmable gate array (FPGA) computer hardware, firmware, software, and / or combinations thereof. These various aspects or features include implementation in one or more computer programs executed and / or interpreted by a programmable system including at least one programmable computer hardware, which may be a specialized or general-purpose processor, coupled to receive data and instructions from, and transmit data and instructions to, a storage system, at least one input device, and at least one output device. The programmable system or computing system may include clients and servers. Clients and servers are typically remote from each other and typically interact through a communications network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other.

[0241] These computer programs, also referred to as programs, software, software applications, applications, components, or code, contain machine language instructions for a programmable processor and may be implemented in high-level procedural languages, object-oriented programming languages, functional programming languages, logic programming languages, and / or assembly / machine languages. As used herein, the term "machine-readable medium" refers to any computer program product, apparatus, and / or device used to provide machine instructions and / or data to a programmable processor, including a machine-readable medium that receives machine instructions as a machine-readable signal, such as, for example, a magnetic disk, optical disk, memory, and programmable logic device (PLD). The term "machine-readable signal" refers to any signal used to provide machine instructions and / or data to a programmable processor. A machine-readable medium may store such machine instructions non-transitoryly, such as, for example, a non-transitory solid-state memory or a magnetic hard drive or any equivalent storage medium. Alternatively or additionally, a machine-readable medium may store such machine instructions in a transitory manner, such as, for example, a processor cache or other random access memory associated with one or more physical processor cores.

[0242] To provide for user interaction, one or more aspects or features of the subject matter described herein can be implemented on a computer having a display device, such as a cathode ray tube (CRT) or liquid crystal display (LCD) or light-emitting diode (LED) monitor for displaying information to a user, and a keyboard and pointing device, such as a mouse or trackball, through which a user can provide input to the computer. Other types of devices can also be used to provide user interaction. For example, feedback provided to the user can be any form of sensory feedback, such as visual feedback, auditory feedback, or tactile feedback. And input from the user can be received in any form, including, but not limited to, acoustic input, speech input, or tactile input. Other possible input devices include, but are not limited to, touchscreens or other touch-sensitive devices, such as single- or multi-point resistive or capacitive trackpads, voice recognition hardware and software, optical scanners, optical pointers, digital image capture devices, and associated interpretation software.

[0243] In the above description and in the claims, phrases such as "at least one" or "one or more" may be followed by a connective list of elements or features. The term "and / or" may also appear in a list of two or more elements or features. Unless otherwise implicitly or explicitly contradicted by the context of use, such phrases are intended to refer to the listed element or feature individually, or the listed element or feature in combination with other listed elements or features. For example, the phrases "at least one of A and B," "one or more of A and B," and "A and / or B" are intended to mean "A only, B only, or A and B together," respectively. A similar interpretation applies to lists containing more than two items. For example, the phrases "at least one of A, B, and C," "one or more of A, B, and C," and "A, B, and / or C" are intended to mean "A only, B only, C only, A and B together, A and C together, B and C together, or A, B, and C together," respectively. Additionally, use of the term "based on" above and in the claims is intended to mean "based at least in part on," allowing for unrecited features or elements.

[0244] The subject matter described herein may be embodied in systems, devices, methods, and / or articles, depending on the desired configuration. The implementations set forth in the foregoing description do not represent all implementations consistent with the subject matter described herein. Instead, these are merely some examples consistent with aspects related to the described subject matter. While several variations have been described in detail above, other modifications or additions are possible. In particular, additional features and / or variations may be provided in addition to those described herein. For example, the implementations described above may be directed to various combinations and subcombinations of the disclosed features and / or combinations and subcombinations of several additional features disclosed above. Furthermore, the logic flow illustrated in the accompanying figures and / or described herein does not necessarily require the particular order shown, or sequential order, to achieve desirable results. Other implementations may be within the scope of the following claims.

Claims

1. 1. A system for assessing a user's visual field, the system comprising computing hardware configured to perform operations, the system comprising: displaying a fixation target in a virtual reality environment on a virtual reality display of a head-mountable virtual reality device, the virtual reality environment including a pointer controlled by a user wearing the head-mountable virtual reality device; determining whether at least one eye of the user is fixating on a fixation target; If the eye is determined to be fixating on the fixation target, displaying a test target of the plurality of test targets at a first location in the virtual reality environment, the first location corresponding to a first location in the user's field of view; receiving a user input and determining whether the user input indicates that a user has detected the inspection target at the first location; obtaining an indication of whether the inspection target was detected by a user based on the received user input, and storing the indication; Repeating the steps of displaying, determining, displaying, receiving, and acquiring until a specific condition is met; The system provides an assessment of the state of the visual field based on the results of the determination of the user's detection of the inspection target during the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps.

2. 2. The system of claim 1, wherein the user input indicating that the user has detected the inspection target at the first location comprises determining whether the user input indicates that the pointer is moving toward the first location.

3. The system of claim 1 or 2, wherein the user input indicating that the user has detected the inspection target at the first position includes determining whether the user input indicates that the user's head is moving toward the first position.

4. 4. The system of claim 1, further comprising: determining whether the user input indicating that the user has detected the test target at the first position includes determining whether the user input includes a pupillary response.

5. 5. The system of claim 1, further comprising determining whether the user input indicating that the user has detected the inspection target at the first location includes a button press.

6. 6. The system of claim 1, wherein the operations the computing hardware is configured to perform further include determining eye and / or pupil position when an eye is determined to be fixating on the fixation target.

7. The system of claim 1 , wherein the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps continues until all test targets of the plurality of test targets are displayed.

8. 8. The system of claim 1, wherein the repeated execution of the displaying, determining, displaying, receiving, and obtaining steps continues until a predetermined period of time has elapsed.

9. 9. The system of claim 1, wherein the repeated execution of the displaying, determining, displaying, receiving, and obtaining steps continues until a predetermined level of statistical reliability of the assessment is reached.

10. 10. The system of claim 1, wherein if it is determined that the eye is fixating on the fixation target, the system displays the test target at least partially at the same time as displaying the fixation target.

11. 11. The system of claim 1, wherein determining whether the eye is fixating on a fixation target comprises determining whether the patient's fovea is fixating on the fixation target.

12. 12. The system of claim 1, wherein the system compares the patient's binocular fixation stability with the patient's monocular fixation stability for each eye to determine whether to display fixation targets to one eye at a time or to both eyes simultaneously.

13. The system of claim 1 , wherein the user input comprises a direction for movement of the pointer in a virtual reality environment.

14. 14. The system of claim 1, wherein obtaining an indication that the inspection target has been detected by the user comprises determining that the pointer is positioned within a predetermined distance from the first position.

15. 15. The system of claim 1, wherein obtaining an indication that the test target has been detected by the user comprises obtaining an indication that the location of the test stimulus has been detected by the user.

16. 16. The system of claim 1, wherein obtaining an indication that the test target has been detected by the user comprises determining movement of one or both eyes, head, facial muscles, one or both pupils, and / or body of the user.

17. The repetitive execution of the displaying, determining, displaying, receiving, and obtaining steps includes:

17. The system of claim 1, further comprising displaying a subsequent inspection target of the plurality of inspection targets at a second location in the virtual reality environment corresponding to a second location in the user's field of view that is different from the first location in the user's field of view.

18. The repetitive execution of the displaying, determining, displaying, receiving, and obtaining steps includes: Displaying a subsequent fixation target in a virtual reality environment; determining whether the eye is fixating on the subsequent fixation target; If it is determined that the eye is fixating on the subsequent fixation target, displaying a subsequent test target of the plurality of test targets at a second location in the virtual reality environment corresponding to a second location in the user's field of view that is different from the first location in the user's field of view; receiving user input including an indication that a user has detected the subsequent inspection target at the second location; 18. The system of claim 1, further comprising: based on received user input, obtaining a second indication of whether the subsequent inspection target has been detected by the user; and storing the second indication.

19. 20. The system of claim 18, wherein the subsequent test target has at least one property that is different from at least one property of the test target displayed in the first location.

20. 20. The system of claim 1, wherein determining whether the eye is fixating on a fixation target comprises determining whether the pointer has moved such that the pointer at least partially overlaps the fixation target.

21. 21. The system of claim 1, wherein the fixation target comprises a representation of at least one movable object.

22. 22. The system of claim 1, wherein the fixation target is displayed near a first location.

23. 23. The system of claim 1, wherein receiving user input further comprises obtaining eye tracking information using a sensor monitoring at least one eye of a user wearing a head-mountable virtual reality device.

24. 24. The system of claim 1, wherein the head-mountable virtual reality device comprises glasses.

25. 25. The system of claim 1, wherein the user input is further received from at least one input device selected from the group consisting of a mouse, a joystick, a keyboard, a handheld gesture and motion tracking device, a non-handheld gesture and motion device, a microphone, at least one camera, an omnidirectional treadmill, a head tracker, a body tracker, a facial muscle sensor, and a gamepad.

26. 26. The system of any one of claims 1 to 25, wherein the system comprises a mobile computing device including computing hardware.

27. 27. The system of claim 1, wherein the pointer comprises a head pointer.

28. 28. The system of claim 1, wherein the pointer comprises a hand pointer.

29. 29. The system of any one of claims 1 to 28, wherein the physical characteristics of the one or more fixation targets and the rules for whether and how they are displayed are described in a spreadsheet or data file that can be modified by the person administering the test.

30. 30. The system of any one of claims 1 to 29, wherein the physical characteristics of the one or more fixation targets and rules for whether and how they are displayed are configured on a separate computing device and received by the device administering the test via a network connection.

31. 31. The system of any one of claims 1 to 30, wherein results and data collected during the test are transmitted to a separate computing device.

32. 32. The system of any one of claims 1 to 31, wherein one or more properties of the test stimulus are determined at least in part by previous test results from the current patient and / or other patients.

33. 33. The system of claim 1, wherein obtaining an indication that a test stimulus has been detected by a user comprises determining that the pointer is positioned within one of at least two sectors surrounding the location of the fixation target.

34. 34. The system of any one of claims 1 to 33, wherein the assessment of visual field status includes information regarding glaucoma identification, status, and / or progression.

35. 35. The system of any one of claims 1 to 34, wherein the assessment of visual field status includes information regarding multiple sclerosis identification, status, and / or progression.

36. 36. The system of claim 1, wherein the assessment of visual field status includes information regarding macular degeneration identification, status, and / or progression.

37. 37. The system of claim 1, wherein the assessment of visual field status includes information regarding diabetic retinopathy identification, status, and / or progression.

38. 38. The system of claim 1, wherein the assessment of visual field status includes information regarding the identification, status, and / or progression of neurological function.

39. 39. The system of any one of claims 1 to 38, wherein the assessment of visual field status includes information regarding retinitis pigmentosa identification, status, and / or progression.

40. 40. The system of claim 1, wherein the assessment of the visual field status includes information regarding color vision identification, status, and / or progression.

41. 41. The system of claim 1, wherein the assessment of visual field status includes information regarding binocular vision identification, status, and / or progression, including inhibitory scotoma.

42. 42. The system of claim 1, wherein the assessment of visual field status includes information regarding vascular disease identification, status, and / or progression.

43. 1. A system for assessing a user's visual field, the system comprising computing hardware configured to perform operations, the system comprising: displaying a fixation target on a user interface rendered on a display associated with a computing device, the user interface including a pointer controlled by a user viewing the user interface; determining whether at least one eye of the user is fixating on a fixation target; If it is determined that the eye is fixating on the fixation target, displaying a test target of the plurality of test targets at a first location on the user interface, the first location corresponding to a first location in the user's visual field; receiving user input including an indication that a user has detected an inspection target at the first location; obtaining an indication of whether the inspection target was detected by a user based on the received user input, and storing the indication; Repeating the steps of displaying, determining, displaying, receiving, and acquiring until a specific condition is met; The system provides an assessment of the state of the visual field based on the results of the determination of the user's detection of the inspection target during the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps.

44. 44. The system of claim 43, wherein the computing device comprises a smartphone.

45. 45. The system of claim 43 or 44, wherein the computing hardware is included in the computing device.

46. 46. ​​The system of any one of claims 43 to 45, wherein the display is part of the computing device.

47. 47. The system of any one of claims 43 to 46, wherein the computing device comprises a smart television.

48. 48. The system of any one of claims 43 to 47, wherein the computing device comprises a personal computer.

49. 49. A system according to any one of claims 43 to 48, wherein the user interface comprises a virtual reality environment on a virtual reality display of a head-mountable virtual reality device.

50. 50. The system of any one of claims 43 to 49, wherein the user input is further received from at least one input device selected from the group consisting of a mouse, a joystick, a keyboard, a gesture and motion tracking device, a microphone, at least one camera, an omnidirectional treadmill, and a gamepad.

51. 1. A method for assessing a user's visual field, the method comprising: displaying a fixation target in a virtual reality environment on a virtual reality display of a head-mountable virtual reality device, the virtual reality environment including a pointer controlled by a user wearing the head-mountable virtual reality device; determining whether at least one eye of the user is fixating on the fixation target; if it is determined that the eye is fixating on the fixation target, displaying a test target of the plurality of test targets at a first location in a virtual reality environment, the first location corresponding to a first location in the user's field of view; receiving a user input and determining whether the user input indicates that a user has detected the inspection target at the first location; obtaining an indication of whether the inspection target was detected by a user based on received user input, and storing the indication; repeatedly performing the displaying, determining, displaying, receiving, and acquiring steps until a specific condition is met; and providing an assessment of the state of the visual field based on the results of the determination of the user's detection of the test target during the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps.

52. 52. The method of claim 51, wherein the method further comprises determining whether the user input indicates that the pointer is moving toward the first location.

53. 53. The method of claim 51 or 52, wherein the method further comprises determining whether the user input indicates that the user's head is moving towards the first position.

54. 54. The method of any one of claims 51 to 53, wherein the method further comprises determining whether the user input comprises a pupillary response.

55. 55. The method of any one of claims 51 to 54, wherein the method further comprises determining whether the user input comprises a button press.

56. 56. The method of any one of claims 51 to 55, wherein the method further comprises determining the position of the eye and / or pupil if the eye is determined to be fixating on a fixation target.

57. 57. The method of any one of claims 51 to 56, wherein the repeated execution of the displaying, determining, displaying, receiving, and obtaining steps continues until all test targets of a plurality of test targets have been displayed.

58. 58. The method of any one of claims 51 to 57, wherein the repeated execution of the displaying, determining, displaying, receiving, and obtaining steps continues until a predetermined period of time has elapsed.

59. 59. A method according to any one of claims 51 to 58, wherein the repeated execution of the displaying, determining, displaying, receiving and obtaining steps continues until a predetermined level of statistical confidence in the assessment is reached.

60. 60. The method of any one of claims 51 to 59, wherein the test target is at least partially displayed simultaneously with displaying the fixation target if the eye is determined to be fixating on the fixation target.

61. 61. The method of any one of claims 51 to 60, wherein determining whether the eye is fixating on a fixation target comprises determining whether the patient's fovea is fixating on the fixation target.

62. 62. The method of any one of claims 51 to 61, further comprising comparing the patient's binocular fixation stability with the patient's monocular fixation stability for each eye to determine whether to display fixation targets to one eye at a time or to both eyes simultaneously.

63. 63. A method according to any one of claims 51 to 62, wherein the user input comprises directing movement of the pointer in a virtual reality environment.

64. 64. The method of any one of claims 51 to 63, wherein the method further comprises determining that the pointer is located within a predetermined distance from the first position.

65. 65. The method of any one of claims 51 to 64, wherein the method further comprises obtaining an indication that the location of the test stimulus has been detected by the user.

66. 66. The method of any one of claims 51 to 65, further comprising determining movement of one or both eyes, head, facial muscles, one or both pupils, and / or body of the user.

67. The repetitive execution of the displaying, determining, displaying, receiving, and obtaining steps includes:

67. The method of any one of claims 51 to 66, comprising displaying a subsequent inspection target of the plurality of inspection targets at a second location in the virtual reality environment corresponding to a second location in the user's field of view that is different from the first location in the user's field of view.

68. The repetitive execution of the displaying, determining, displaying, receiving, and obtaining steps includes: displaying a subsequent fixation target in a virtual reality environment; determining whether the eye is fixating on the subsequent fixation target; if it is determined that the eye is fixating on the subsequent fixation target, displaying a subsequent test target of the plurality of test targets at a second location in the virtual reality environment corresponding to a second location in the user's field of view that is different from the first location in the user's field of view; receiving user input including an indication that a user has detected the subsequent inspection target at the second location; and obtaining a second indication of whether the subsequent inspection target has been detected by the user based on received user input, and storing the second indication.

69. 69. The method of any one of claims 51 to 68, wherein the subsequent test target has at least one property that is different from at least one property of the test target displayed in the first location.

70. 70. The method of any one of claims 51 to 69, wherein the method further comprises determining whether the pointer has moved such that it at least partially overlaps the fixation target.

71. 71. A method according to any one of claims 51 to 70, wherein the fixation target comprises a representation of at least one movable object.

72. 72. The method of any one of claims 51 to 71, wherein the fixation target is displayed near the first location.

73. 73. The method of any one of claims 51 to 72, further comprising obtaining eye tracking information using a sensor monitoring at least one eye of a user wearing the head-mountable virtual reality device.

74. 74. The method of any one of claims 51 to 73, wherein the physical characteristics of the one or more fixation targets and the rules for whether and how they are displayed are described in a spreadsheet or data file that can be modified by the person administering the test.

75. 75. The method of any one of claims 51 to 74, wherein the physical characteristics of the one or more fixation targets and rules for whether and how they are displayed are configured on a separate computing device and received by the device administering the test via a network connection.

76. 76. The method of any one of claims 51 to 75, wherein results and data collected during the test are transmitted to a separate computing device.

77. 77. The method of any one of claims 51 to 76, wherein one or more properties of the test stimulus are determined at least in part by previous test results from the current patient and / or other patients.

78. 78. The method of any one of claims 51 to 77, wherein obtaining an indication that a test stimulus has been detected by a user comprises determining that the pointer is positioned within one of at least two sectors surrounding the location of the fixation target.

79. 79. The method of any one of claims 51 to 78, wherein the assessment of visual field status includes information regarding glaucoma identification, status, and / or progression.

80. 80. The method of any one of claims 51 to 79, wherein the assessment of visual field status includes information regarding multiple sclerosis identification, status, and / or progression.

81. 81. The method of any one of claims 51 to 80, wherein the assessment of visual field status includes information regarding macular degeneration identification, status, and / or progression.

82. 82. The method of any one of claims 51 to 81, wherein the assessment of visual field status includes information regarding diabetic retinopathy identification, status, and / or progression.

83. 83. The method of any one of claims 51 to 82, wherein the assessment of visual field status includes information regarding the identity, status, and / or progression of neurological function.

84. 84. The method of any one of claims 51 to 83, wherein the assessment of visual field status includes information regarding retinitis pigmentosa identification, status, and / or progression.

85. 85. The method of any one of claims 51 to 84, wherein the assessment of the visual field status includes information regarding color vision identification, status, and / or progression.

86. 86. The method of any one of claims 51 to 85, wherein the assessment of visual field status includes information regarding binocular vision discrimination, status, and / or progression, including inhibitory scotoma.

87. 87. The method of any one of claims 51 to 86, wherein the assessment of visual field status includes information regarding vascular disease identification, status, and / or progression.

88. 1. A non-transitory computer-readable medium storing instructions that, when executed by at least one data processor, perform the following operations: displaying a fixation target in a virtual reality environment on a virtual reality display of a head-mountable virtual reality device, the virtual reality environment including a pointer controlled by a user wearing the head-mountable virtual reality device; determining whether at least one eye of the user is fixating on a fixation target; if it is determined that the eye is fixating on the fixation target, displaying a test target of the plurality of test targets at a first location in the virtual reality environment, the first location corresponding to a first location in the user's field of view; receiving a user input and determining whether the user input indicates that a user has detected the inspection target at the first location; obtaining an indication of whether the inspection target was detected by a user based on received user input, and storing the indication; repeatedly performing the displaying, determining, displaying, receiving, and acquiring steps until a specific condition is met; and providing an assessment of the state of the visual field based on the results of the determination of the user's detection of the test target during the repeated execution of the displaying, determining, displaying, receiving, and acquiring steps.

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