JP5852187B2 - Perimeter - Google Patents

Description

    The present invention relates to a perimeter configured to measure a visual field in a state where a subject is fixed on a predetermined fixed viewpoint.

    It is known that when an eye disease such as glaucoma or diabetic retinopathy occurs, the field of view becomes narrower or missing. Therefore, perimeters having various structures have been proposed as devices for detecting such diseases (see, for example, Patent Document 1).

    FIG. 7 is a schematic diagram showing an example of the structure of a conventional perimeter. In FIG. 7, reference numeral 100 denotes a projection optical system for projecting the target A, and reference numeral 101 denotes a target. A hemispherical field dome is shown, and a reference numeral 103 denotes a response switch operated by the subject. Now, when the subject performs a visual field inspection while fixing the visual fixation on the inner surface of the visual field dome 101 (a visual target arranged at the center of the visual field), the projection optical system 100 is in various positions of the visual field dome 101. The target A is sequentially displayed on the screen. The subject operates the response switch 103 when the target A is recognized, and does not operate the response switch 103 when the target A cannot be recognized, but the subject's visual field is determined based on the results. Can be measured.

    By the way, in order to perform such visual field measurement accurately, it is important that the subject is fixing the fixation target correctly. In particular, elderly people and people with eye disease may have difficulty fixing the fixation target throughout the examination. It is necessary to determine whether or not the camera is correctly fixed.

    In view of this, devices having various structures have been proposed as devices for determining the fixation status of the subject (see, for example, Patent Documents 2 and 3).

    For example, an apparatus for projecting infrared light onto the fundus of the subject and determining whether the subject has moved his eyes by changing the amount of infrared light reflected from the fundus has been proposed (for example, Patent Document 2).

In addition, a target (blind spot position target) is presented at a predetermined timing at a position corresponding to the blind spot of the eye to be examined,
-If the subject cannot recognize the blind spot position target, it is determined that the subject is fixing the fixation target correctly,
A device has also been proposed in which when the subject recognizes the blind spot position target, the subject determines that the subject is not fixing the fixation target correctly (see, for example, Patent Document 3). .

JP 2002-272585 A Japanese Patent Publication No.62-9330 Japanese Patent Publication No. 4-3213

    However, in the case of the conventional device, if there is a certain probability that the subject does not fixate the fixation target, the reliability of all the inspection points in the visual field inspection result is low, and the visual field measurement is repeated from the beginning. There is a problem that a considerable burden is imposed on the subject and the inspector, and the inspection time becomes long.

    An object of the present invention is to provide a perimeter that can solve the above-mentioned problems.

The invention according to claim 1 is exemplified in FIG. 1 and FIG. 2, and is a perimeter (1) configured to measure a visual field in a state where a subject is fixed on a predetermined fixed viewpoint. In
A target display means (2) for sequentially displaying the target (A) at a predetermined brightness at various positions in the field of view of the subject;
An operation means (3) operated by a subject who visually recognizes the displayed target (A);
Visual field determination means (4) for determining the visual field of the subject based on signals from the visual target display means (2) and the operation means (3);
A fixation state determination means (5) for individually determining the fixation state of the subject in association with each displayed target (A) each time the target is displayed;
The fixation state determination means (5)
A fixation state detection unit (51) for detecting the fixation state of the subject;
A criterion output unit (52) for outputting a criterion for determining the fixation state;
A comparison determination unit (53) for determining a fixation state by comparing signals from the fixation state detection unit (51) and the determination reference output unit (52);
A determination result output unit (54) for outputting a fixation state determination result associated with each displayed target (A) based on signals from the target display means (2) and the comparison determination unit (53). and, have,
The fixation state detection unit (51) includes an imaging unit (not shown) that captures a continuous image by capturing an image of the anterior eye of the subject, and processes the image acquired by the imaging unit to detect the subject. An image processing unit (not shown) for extracting the pupil of the person and obtaining the center of the pupil,
The determination criterion output unit (52) includes a first determination criterion (see reference numeral RV1 in FIG. 3B) for determining a fixation state based on the obtained center position of the pupil, and the first determination. A second criterion (see reference RV2 in the figure) smaller than the criterion (RV1) is output,
The comparison / determination unit (53) determines that there is a fixation defect when the center position of the pupil obtained by the fixation state detection unit (51) is equal to or greater than the first determination criterion (RV1). If the center position of the pupil is between the first determination criterion (RV1) and the second determination criterion (RV2), it is determined that there is a suspicion of fixation failure, and the pupil If the center position is less than or equal to the second determination criterion (RV2), determine “no fixation failure”
In the threshold test in which the target display means (2) presents the target (A) a plurality of times while changing the luminance for each measurement point and obtains a threshold based on the presence or absence of a response from the subject, the determination result output unit The stimulus which is the target presentation for which the fixation state determination result is output in (52) is configured to be the final stimulus for which the threshold is determined and the immediately preceding stimulus.

    The invention according to claim 2 is the invention according to claim 1, further comprising monitor means (7) for displaying a visual field determination result of each measurement point and a fixation state determination result of each measurement point in the threshold test. It is characterized by that.

    The invention according to claim 3 is the invention according to claim 2, wherein the monitor means (7) displays the visual field determination result and the fixation state determination result simultaneously. The invention according to claim 4 is the invention according to claim 2 or 3, characterized in that there is one fixation state determination result of each measurement point displayed by the monitor means (7). . Further, the invention according to claim 5 is the invention according to claim 2 or 3, wherein the fixation state determination result output by the determination result output unit (52) is a fixed-state value for the final stimulus for which the threshold is determined. A fixation state determination result and a fixation state determination result for the immediately preceding stimulus, and the fixation state determination result displayed for each measurement point by the monitoring means (7) is a single fixation state determination result. It is characterized by being. According to a sixth aspect of the present invention, in the invention according to any one of the first to fifth aspects, the visual target display means (2) is controlled for a measurement point that is determined to have “fixation failure”. And a determination processing means (6) for presenting the target (A) again.

    Note that the numbers in parentheses are for the sake of convenience indicating the corresponding elements in the drawings, and therefore the present description is not limited to the descriptions on the drawings.

    According to the first to sixth aspects of the present invention, it is not determined whether the fixation state is good or bad for the entire visual field inspection, but is fixed individually for each target in association with each displayed target. The quality of the state is determined. That is, it is possible to distinguish between measurement points with high reliability and measurement points with low reliability. Therefore, even if it is determined that the fixation state is poor, it is only necessary to re-examine the point where the target is presented. The burden on the inspector is light, the inspection time is short, and the inspection efficiency is improved.

    The best mode for carrying out the present invention will be described below with reference to FIGS. 1 is a block diagram showing an example of the configuration of the perimeter according to the present invention, and FIG. 2 is a schematic diagram showing an example of the configuration of the target display means used in the perimeter according to the present invention. FIG. 3 (a) is a schematic diagram for explaining how to determine the presence / absence of fixation failure depending on the center position of the pupil. FIG. 3 (b) is a fixation failure depending on the center position of the pupil. It is a schematic diagram for demonstrating a state of performing presence / absence of fixation fixation suspected / not having fixation failure. FIG. 4 is a schematic diagram showing an example of display by the monitor means, FIG. 5 is a schematic diagram for explaining calibration of the eyeball rotation center position, and FIG. 6 is a fixation state in the threshold test. It is a schematic diagram for demonstrating the object of determination.

    The perimeter according to the present invention is exemplified by reference numeral 1 in FIG. 1, for example, and measures the visual field in a state where the subject is fixedly fixed to a predetermined fixed viewpoint (for example, the center point of the visual field dome). Is configured to do. This perimeter 1 is provided with a target display means 2 for sequentially displaying a target with a predetermined luminance at various positions in the field of view of the subject. The target display means 2 may be configured as illustrated in FIG. 2 (details will be described later).

    The perimeter 1 is provided with operation means 3 such as a push switch so that the subject can operate the operation means 3 when viewing the displayed target A.

    The perimeter 1 according to the present invention includes a visual field determination unit 4 that determines a visual field of the subject based on signals from the target display unit 2 and the operation unit 3. The visual field determination unit 4 is configured to perform determination according to the type of visual field inspection (screening inspection, threshold inspection, isopter inspection, etc.).

On the other hand, the perimeter 1 according to the present invention includes a fixation state determination unit 5 that individually determines a fixation state of a subject in association with each displayed target, and the fixation state determination unit 5 is configured to determine the fixation state individually each time the target is displayed. Specifically, the fixation state determination means 5
A fixation state detection unit 51 that detects the fixation state of the subject;
A determination criterion output unit 52 that outputs a determination criterion for determining the fixation state;
A comparison determination unit 53 that determines a fixation state by comparing signals from the fixation state detection unit 51 and the determination reference output unit 52;
A determination result output unit 54 that outputs a determination result associated with each displayed target based on signals from the target display unit 2 and the comparison determination unit 53;
It is good to comprise.

    Here, the fixation state detection unit 51 may be configured by an imaging unit (for example, an infrared CCD) that captures an anterior eye portion of a subject and acquires a continuous image. In addition to the imaging unit, the fixation state detection unit 51 includes an image processing unit that processes the image acquired by the imaging unit to extract the pupil of the subject and obtain the center of the pupil. Also good. The determination of the fixation state in that case will be described later with reference to FIG. Furthermore, in addition to the imaging unit and the image processing unit, the fixation state detection unit 51 includes a reference position (that is, a pupil center position when the subject is accurately fixing the fixation target). There may be provided a deviation amount calculation unit for calculating a deviation amount of the center of the pupil with respect to. In this case, the fixation state may be determined based on whether or not the calculated shift amount is within a determination criterion (reference shift amount). Note that such detection by the fixation state detection unit 51 is performed before displaying the target by the target display means 2 (individually before displaying each target). good. In addition, the calculation of the pupil center by the image processing unit may be performed a plurality of times instead of once for one target display, and an average value thereof may be calculated.

If the above-described determination criterion output unit 52 outputs one determination criterion, the above-described comparison determination unit 53
When the detection result of the fixation state detection unit 51 exceeds the determination criterion, it is determined that there is a fixation failure,
-If the detection result of the fixation state detection unit 51 does not exceed the determination criterion, it may be configured to determine "no fixation failure". FIG. 3 (a) is a schematic diagram for explaining how to determine the presence / absence of fixation failure based on the center position of the pupil (that is, the position of the pupil center calculated by the above-described image processing unit). RV0 indicates a determination reference output by the determination reference output unit 52, and symbol O indicates a reference position (that is, a pupil center position when the subject is fixing the fixation target accurately). If the calculated pupil center is inside the determination criterion RV0, it is determined that “no determination failure”, and if it is outside the determination criterion RV0, it is preferable to determine “determination failure”. However, when making such a determination,
(B) If it is determined that “with fixation failure” is “without fixation failure”, the failure data will be used as measurement data and the measurement accuracy will deteriorate.
(B) Conversely, if it is determined that “no fixation failure” is “with fixation failure”, there is a problem that valid measurement data is discarded without being used. In order to avoid such a problem, it is assumed that the detection by the fixation state detection unit 51 is accurately performed.

Therefore, in order to avoid the above problems (a) and (b), the determination criterion output unit 52 uses two determination criteria instead of one (hereinafter referred to as “first determination criterion, second determination criterion ( However, it is preferable that the first determination criterion> the second determination criterion) ”) be output. FIG. 3B illustrates how the determination of presence of poor fixation / suspect of fixation failure / non-fixation failure is performed based on the center position of the pupil (that is, the position of the pupil center calculated by the above-described image processing unit). The reference symbol RV1 indicates a first determination criterion, and the reference symbol RV2 indicates a second determination criterion. In this case, the comparison determination unit 53
-When the detection result by the fixation state detection unit 51 is equal to or higher than the first determination criterion (that is, when the calculated pupil center is outside the first determination criterion RV1), the determination of "fixation failure is present" And
When the detection result by the fixation state detection unit 51 is between the first determination criterion and the second determination criterion (that is, the calculated pupil centers are the first determination criterion RV1 and the second determination criterion RV2). In the case of (and between) and “judgment of poor fixation”
When the detection result by the fixation state detection unit 51 is equal to or less than the second determination criterion (that is, when the calculated pupil center is inside the second determination criterion RV2), the determination of “no fixation failure” It is better to do. If such a determination is made, even if the detection accuracy by the fixation state detection unit 51 is somewhat poor, what is supposed to be “with fixation failure” and “without fixation failure” is “suspected for fixation failure” It ’s just that
・ What is supposed to be “with poor fixation” is “no fixation failure”
-What is supposed to be "no fixation failure" is almost never "fixed fixation", and the above problems (a) and (b) can be avoided. In FIG. 3 (b), there are two criteria, but the case where there are three or more criteria is not excluded from the scope of the present invention.

The perimeter 1 according to the present invention is preferably provided with determination processing means 6 for performing a predetermined process based on the determination result of the fixation state determination means 5. As processing by the determination processing means 6,
(1) Detection of poor fixation due to blind spot stimulation performed when it is determined that “fixation failure exists”,
(2) A process of displaying the fixation state determination result associated with the visual target together with the visual field determination result associated with the visual target,
(3) Processing for correcting fixation failure and presenting an inspection index (4) For a measurement point determined as fixation failure, processing for re-inspecting by presenting a target again .

In addition, when two determination criteria are provided as described above (that is, using these two determination criteria, “fixation failure”, “fixation failure” and “fixation failure” are not detected for each measurement point. In the case where the fixation state determination unit 5 performs any one of the three determinations) and the blind spot stimulation of (1) is performed, the determination processing unit 6 controls the target display unit 2. Then, the following fixation failure detection by blind spot stimulation may be performed. That is,
・ Be sure to perform blind spot stimulation for the measurement points that are judged to have “fixation failure”.
• For the measurement point determined as “suspected of fixation failure”, blind spot stimulation is performed with a first probability (for example, a probability of 1/10).
For a measurement point determined as “no fixation failure”, a second probability that is considerably lower than the first probability (where 0 ≦ second probability <first probability, eg 1/30 Of the blind spot). In addition, when it is determined as “no fixation failure” as described above, blind spot stimulation may not be performed.

On the other hand, when performing the process (2) described above, the perimeter 1 according to the present invention is provided with the monitor means 7 controlled by the determination processing means 6, and the monitor means 7 includes:
A visual field determination result associated with the target A (individual target A displayed by the target display means 2);
It is preferable to display a fixation state determination result associated with the target A (individual target A displayed by the target display unit 2). FIG. 4 is a diagram showing an example of the display, and the two-digit number in the figure indicates the measurement result of each measurement point in the threshold test (that is, the visual field determination result associated with each target A), A square symbol surrounding “27” is an index indicating “fixed defect”, and a double underline drawn by “32” is an index indicating “suspected fixation failure”. In addition, when two determination criteria are provided in this way (that is, using these two determination criteria, three-stage determination is performed: “with fixation failure”, “suspected fixation failure”, and “without fixation failure”. In the case), by displaying on the monitor means 7 an index in the case of “with fixation failure” and an index in the case of “suspected fixation failure”, the amount of information can be further increased.

    Further, when performing the above-described processing (3), if the fixation state determination means 5 determines that “fixation failure is present”, the determination processing means 6 controls the target display means 2. , The coordinates of the eye being viewed at that time are regarded as the coordinates of the fixation target (deemed fixation coordinates), and the target is moved from the deemed fixation coordinates to a coordinate that causes relatively no fixation failure. Present and automatically correct poor fixation.

    Further, when performing the above-described processing (4), if the fixation state determination means 5 determines that “fixation failure is present”, the determination processing means 6 controls the target display means 2. It is advisable to present the visual target again at the measurement point determined to have “fixation failure”, and to inspect the point again. The timing for re-presenting the target may be after the inspection for all the measurement points is completed, or at an appropriate timing during the inspection (that is, before the inspection for all the measurement points is completed). It may also be a point in time when there are still measurement points to be inspected. Note that when the number of determination criteria is three or more as described above, the processes (1) to (4) may be appropriately changed according to the number of the determination criteria.

    In addition, when performing a threshold test using the perimeter 1 according to the present invention, it is necessary to present the target multiple times for each measurement point while changing the luminance, and to determine the threshold based on the presence or absence of a response from the subject. However, in this case, it is necessary to consider which stimulus (target presentation) is to be displayed as “with fixation failure” or “suspected fixation failure”. If “Fixed fixation, good response” → “Fixed fixation, good response” → “Fixed fixation, good response”, the second poor fixation is due to the last “Good fixation, good response”. It can be ignored (even if all responses are no response in the above example). That is, when “response is received (or no response)” continues, the last fixation state of the response state (response is received or no response) is targeted. Further, in a general threshold value determination algorithm in visual field inspection, as shown in FIG. 6, the threshold value is determined in the order of “with response” → “no response” → “with response” (“○” in the figure indicates response) Yes, “×” means no response.) Since the final stimulus and the previous stimulus always have two states, no response and response, the final stimulus for which the threshold is determined and one It is sufficient to target the previous stimulus.

    Before performing the visual field inspection described above, the position of the blind spot may be determined by the method disclosed in Japanese Patent Application Laid-Open No. 2008-36297. In addition, the reference position indicated by the symbol O in FIGS. 3 (a) and 3 (b) (that is, the pupil center position when the subject is fixing the fixation target accurately) is the position of the blind spot. It should be calculated after the decision. Specifically, an average value may be calculated by sampling the pupil center position, and the average value may be used as the reference position.

By the way, since there is a variation in the individual eyeball rotation center position, it is preferable to calibrate the angle by the following procedure in order to eliminate measurement errors caused by the variation in the eyeball rotation center position. That is,
• Present a visual target at the specified position of the visual field dome (it is better to match the angle to be detected) and prompt the subject to see the visual target (see Fig. 5 (a)).
・ Present the target several times at different positions, such as up, down, left and right.
• Sampling the pupil center position coordinates while presenting the optotype.
-The angle coefficient with respect to the coordinates of the CCD is calculated from the angle at which the target is actually presented and the calculated coordinates (see FIG. 5B).

Note that the following may be considered as criteria for determining poor fixation.
(A) Since the average size of the blind spot is about 5 °, when the standard is ± 2 ° (b) Before the visual field test, measure the size A (°) of the subject's own blind spot. , When ± A / 2 (°) is used as a reference (c) When the reference value is based on the standard deviation of the position sampled at the time of determining the blind spot before visual field inspection (for example, the reference is ± 2α, etc.)

    According to the present invention, the quality of the fixation state is not determined for the entire visual field inspection, but the quality of the fixation state is individually determined for each target in association with each displayed target. The That is, it is possible to distinguish between measurement points with high reliability and measurement points with low reliability. Therefore, even if it is determined that the fixation state is poor, it is only necessary to re-examine the point where the target is presented. The burden on the inspector is light, the inspection time is short, and the inspection efficiency is improved.

    Hereinafter, the configuration of the visual target display means 2 shown in FIG. 2 will be briefly described.

    Reference numeral 20 in the figure denotes a target presentation unit that presents the target A in the visual field of the subject, reference numeral 21 denotes a display position changing unit that changes the display position of the target A, and reference numeral 22. Indicates a luminance setting unit for setting the luminance of the target A.

    The illustrated target presentation unit 20 includes a projection optical system 20A for projecting a target and a projection member 20B on which the target is projected by the projection optical system 20A. Any structure may be used as long as the target is presented therein. For example, a plurality of LEDs may be arranged and selectively lit. The projection member 20B shown in FIG. 2 has a hemispherical dome shape (field dome), but is not limited to this, and may have a curved surface other than a hemispherical surface or a flat surface. It is good also as a shape.

In addition, as shown in FIG. 2, when the optotype presenting unit 20 is configured by the projection optical system 20A and the projection member 20B, the display position changing unit 21 includes components (for example, reference numerals) of the projection optical system 20A. It may be configured by driving means (not shown) for changing the position of the projector / mirror shown in 211,212. On the other hand, as described above, when the optotype presenting unit is configured by a plurality of LEDs, it is preferable to control which LED is turned on by the display position changing unit. In addition, in the case of using either the projection optical system or the LED, an instruction for changing the display position is
-Even if the person who is inspecting is to do it manually using a touch pen, mouse, keyboard, etc. while looking at the display during the inspection,
・ Even if it is automatically performed by a program created in advance,
both are fine.

Furthermore, although the thing of various structures can be considered as the brightness | luminance setting part 22, in FIG.
Turrets 221 and 222 having a plurality of filters that are rotatably supported and have different attenuation levels;
A drive mechanism 223 for changing the positions of the turrets 221 and 222
Thus, the luminance setting unit 22 is configured.

FIG. 1 is a block diagram showing an example of the configuration of a perimeter according to the present invention. FIG. 2 is a schematic diagram showing an example of the configuration of the target display means used in the perimeter according to the present invention. FIG. 3 (a) is a schematic diagram for explaining how to determine the presence / absence of fixation failure according to the center position of the pupil, and FIG. It is a schematic diagram for demonstrating a mode of performing the determination of a fixation failure suspected / non-fixation failure. FIG. 4 is a schematic diagram showing an example of display by the monitor means. FIG. 5 is a schematic diagram for explaining calibration of the eyeball rotation center position. FIG. 6 is a schematic diagram for explaining an object of fixation state determination in the threshold test. FIG. 7 is a schematic diagram showing an example of the structure of a conventional perimeter.

DESCRIPTION OF SYMBOLS 1 Perimeter 2 Visual target display means 3 Operation means 4 Visual field determination means 5 Fixation state determination means 6 Judgment processing means 7 Monitor means 51 Fixation state detection part 52 Judgment reference output part 53 Comparison determination part 54 Determination result output part A View Mark

Claims (6)

In the perimeter configured to measure the visual field in a state where the subject is fixed on a predetermined fixation point,
A target display means for sequentially displaying a target with predetermined brightness at various positions in the field of view of the subject;
An operation means operated by a subject who visually recognizes the displayed target;
Visual field determination means for determining the visual field of the subject based on signals from the target display means and the operation means;
A fixation state determination means for individually determining the fixation state of the subject in association with each displayed target each time the target is displayed;
The fixation state determination means includes
A fixation state detection unit for detecting the fixation state of the subject;
A criterion output unit that outputs a criterion for determining the fixation state;
A comparison determination unit that determines a fixation state by comparing signals from the fixation state detection unit and the determination reference output unit;
The visual based on the target display device and the signal from the comparison determination unit includes a determination result output unit that outputs the fixation state judgment results associated with individual optotypes to be displayed, and
The fixation state detection unit extracts a pupil of the subject by processing the image acquired by the imaging unit, and an imaging unit that captures a continuous image by imaging the anterior eye part of the subject. An image processing unit for determining the pupil center,
The determination criterion output unit outputs a first determination criterion for determining a fixation state based on the obtained center position of the pupil, and a second determination criterion smaller than the first determination criterion,
The comparison determination unit determines that there is a fixation defect when the center position of the pupil obtained by the fixation state detection unit is equal to or greater than the first determination criterion, and the center position of the pupil is If it is between the first determination criterion and the second determination criterion, it is determined that there is a suspicion of fixation failure, and if the center position of the pupil is equal to or less than the second determination criterion Judge “No fixation failure”
In the threshold test in which the target display means presents the target multiple times for each measurement point while changing the brightness and obtains a threshold based on the presence or absence of a response from the subject, the determination result output unit determines the fixation state determination result The stimulus that is the target presentation to output is the final stimulus for which the threshold is determined, and the stimulus immediately before the stimulus.
This is a perimeter. A monitor means for displaying a visual field determination result of each measurement point in the threshold test, and a fixation state determination result of each measurement point;
The perimeter according to claim 1, further comprising: The monitor means simultaneously displays the visual field determination result and the fixation state determination result;
The perimeter according to claim 2. The fixation state determination result of each measurement point displayed by the monitor means is one.
The perimeter according to claim 2 or 3, wherein The fixation state determination result output by the determination result output unit is a fixation state determination result for the final stimulus for which the threshold is determined, and a fixation state determination result for the immediately preceding stimulus,
The fixation state determination result displayed for each measurement point by the monitor means is one fixation state determination result.
The perimeter according to claim 2 or 3, wherein Determination processing means for controlling the visual target display means and presenting the visual target again for the measurement point determined to have “fixation failure”;
The perimeter according to any one of claims 1 to 5, further comprising:

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