JP2006061461A - Fundus examination device - Google Patents

Abstract

A two-dimensional visual field map, which is function information, is synthesized and displayed on a fundus image, which is morphological information, with high accuracy, and space saving and inspection time can be reduced.
In [Step 1], a predetermined index is presented to the eye to be examined, and an infrared fundus image Era is obtained and stored (S3). In [Step 2], it is confirmed whether or not the index is visually recognized (S4), and an infrared fundus image Erb is obtained and stored (S5). The infrared fundus images Era and Erb are compared to calculate a relative positional shift amount. If the amount is within a predetermined range (S6), the infrared fundus image Erb, the index presentation position, and the index information are recorded in association with each other. (S9). In [Step 3], when the scheduled examination is completed (S10), a visible fundus image Erc is obtained and recorded (S14). In [Step 4], the visible fundus image Erc is aligned for each of the plurality of infrared fundus images Erb to generate a two-dimensional visual field map (S16). In [Step 5], the visible fundus image Erc and the two-dimensional visual field image are generated. The map and the image are combined, displayed on the monitor, and recorded (S17).
[Selection] Figure 3

Description

  The present invention relates to a fundus inspection apparatus that is used in an ophthalmic clinic or the like and performs a visual function test.

  Conventionally, in order to evaluate and diagnose visual field injuries due to glaucoma, etc., photosensitivity is obtained from the results of perimetry by observing the state of the optic nerve head and optic nerve fiber bundle defects from the fundus image obtained by a fundus camera etc. By quantifying the visual function, the visual function is evaluated, each result is taken into account, and the state and progress of glaucoma and the like are diagnosed, which is useful for the subsequent treatment.

  However, optical systems such as a fundus camera have aberrations such as distortion, and the resulting fundus image may be distorted due to the influence of the aberration. When comparing the map and the fundus image, there is a problem in that an accurate position correspondence cannot be obtained due to the influence of the fundus image distortion.

  As one method for solving this problem, Patent Document 1 stores distortion characteristics unique to an image recording unit that captures a fundus image of the eye to be examined, and the fundus image is based on the distortion characteristics stored in the captured fundus image. An ophthalmologic image correction apparatus is disclosed in which distortion is corrected and image synthesis is performed with a two-dimensional visual field map obtained from a perimeter to enable comparison with a two-dimensional visual field map that is less affected by fundus image distortion. .

Patent Registration No. 2802758

  However, these conventional examples have the following problems. First of all, conventional perimeters are generally inspected on the assumption that the subject is fixing the fixation target, but the subject actually fixes the fixation target. I can't check if I'm watching.

  Second, since the fundus camera for obtaining the fundus image as the form information and the perimeter for obtaining the two-dimensional field map as the function information are separate devices, the fundus is determined depending on the diopter of the eye to be examined. There may be a difference in the accuracy of consistency between the position on the image and the position on the two-dimensional visual field map.

  Thirdly, since the fundus camera and the perimeter are separate devices, a large installation space is required, the subject must be guided to each device to perform alignment, and the examination time becomes longer.

  As one of the solutions for solving some of these problems, the present applicant, as shown in Patent Documents 2 and 3, projects the index light onto the fundus while observing the fundus of the eye to be examined, and the index light together with the fundus image. Has been filed for a fundus examination apparatus capable of recording the above image on a silver salt film.

JP 54-52894 A JP 54-54493 A

  However, Patent Documents 2 and 3 described above also have the following problems.

  (A) Since the means for recording the fundus image and the fundus examination result is a silver salt film, the reexamination is difficult, and in order to conduct the reexamination, the examination procedure must be repeated from the beginning.

  (B) Since the recording means is a silver salt film, information such as the brightness of the index projected on the fundus of the eye to be examined cannot be recorded.

  (C) The fixation state of the eye to be examined cannot be monitored quantitatively.

  (D) In order to make the balance between the projected index luminance and the background light variable, a light source is required for each, and since these are optically combined, the apparatus becomes complicated.

  The purpose of the present invention is to solve the above-mentioned problems, quantitatively grasp the fixation state of the subject, perform re-examination when the fixation state is poor, and inspection data with good fixation state Provides a fundus examination apparatus that saves space and shortens examination time by synthesizing and displaying a two-dimensional visual field map, which is functional information, on the fundus image, which is morphological information, with high accuracy. There is.

  In order to achieve the above object, the technical feature of the fundus examination apparatus according to the present invention includes a first imaging unit that captures an infrared fundus image illuminated with near-infrared light, and the red image captured by the first imaging unit. A first display means for displaying an external fundus image; a fixation target system for projecting a fixation target for guiding the eye to be examined; and a subject eye fundus for performing a subjective fundus examination of the subject. Index projection means for projecting an index of which at least one of brightness, size, and shape is variable at a predetermined position within the imaging range of the first imaging means; and reaction input means for inputting a subject's reaction A second imaging unit that captures a visible fundus image illuminated with visible light; a second display unit that displays the visible fundus image captured by the second imaging unit; and a start timing of the subjective fundus examination Managing the images picked up by the start input means and the first and second image pick-up means A fundus examination apparatus comprising: an image management unit configured to control an image processing unit configured to process the captured image; and a control unit configured to control an operation of each unit. The control unit is configured to perform fundus examination using the start input unit. A first step of projecting the index from the index projection means while displaying an infrared fundus image captured by the first imaging means after the start timing is input; and the reaction input At least one index of the infrared fundus image by the first imaging unit, the output result of the reaction input unit, the index presentation position by the index projection unit, and the brightness, size, and shape of the index according to the response of the unit A second step of associating information with the image management means and recording the image management means; and repeating the first step and the second step in response to an input from the reaction input means After that, a third step of recording the visible fundus image by the second imaging unit in the image management unit, and a recording in the second step for the visible fundus image recorded in the third step by the image processing unit. The fourth step of generating the index presentation position, the index information, and the output result of the reaction input means as a two-dimensional visual field map by aligning the infrared fundus image, and recording in the third step And a fifth step of synthesizing the visible fundus image and the two-dimensional visual field map generated in the fourth step by the image processing means and displaying them on the second display means.

  According to the fundus examination apparatus according to the present invention, the examination can be performed while always confirming the fixation, and when the fixation state is bad, the examined data is automatically excluded and further set at a predetermined position. Any inspection can be added manually after completion of the inspection.

  In addition, any inspection can be performed manually without performing the inspection at a predetermined position. Since the imaging element of the fundus imaging fundus and the fundus imaging means and the index of the subjective visual field inspection are optically conjugate, It is possible to detect whether the index is visually recognized at the site, and a highly accurate subjective visual field inspection is possible.

  Furthermore, the fundus image, which is the morphological information, and the two-dimensional visual field map, which is the functional information, can be obtained with one device, thereby saving space and guiding the subject's line of sight and aligning them. Since it is not necessary, the examination time can be shortened and the burden on the subject is reduced.

  The present invention will be described in detail based on the embodiments shown in the drawings.

  FIG. 1 is a configuration diagram of a fundus examination apparatus according to the first embodiment. In front of an eye E to be examined, an objective lens 1, a perforated mirror 2 having a photographing aperture 2a, and a focus lens 3 movable on the optical axis. The photographing lens 4, the optical path branching prism 5, the optical path branching prism 6, the liquid crystal display means 7 functioning as an index to be projected onto a predetermined position of the fundus Er of the eye E to be examined, and the backlight 8 are arranged to constitute an index projection means. Yes.

  In the reflection direction of the optical path branching prism 6, a fixation target plate 9 for fixing the eye E to be examined and an LED 10 for illuminating the fixation target plate 9 are arranged to constitute a fixation target projection means.

  In the reflection direction of the optical path branching prism 5, a field lens 11, a cold mirror 12 that transmits near-infrared light and reflects visible light, a lens 13, and an imaging device 14 that has sensitivity in the near-infrared region are sequentially arranged. . The output of the imaging device 14 is connected to a signal amplification circuit 15 that amplifies an electric signal, and a first fundus imaging means for obtaining an infrared fundus image from the objective lens 1 by the signal amplification circuit 15 is configured.

  On the other hand, in the reflection direction of the cold mirror 12, a lens 16, a color separation prism 17, and image sensors 18b, 18r, and 18g are provided. The color separation prism 17 guides red light to the image sensor 18r, blue light to the image sensor 18b, and green light to the image sensor 18g. Outputs of these imaging elements 18b, 18r, and 18g are connected to a signal amplification circuit 19 that amplifies an electric signal, and a second fundus imaging for obtaining a visible fundus image is obtained by the configuration from the objective lens 1 to the signal amplification circuit 19. Means are configured.

  In the incident direction of the perforated mirror 2, only a relay lens 20, a diaphragm 21 having a ring-shaped opening, a red free filter that does not transmit red light to improve the contrast of reflected light from the retinal nerve fiber layer, and only blue light. A wavelength selection filter 22 disposed in an optical path such as a blue filter that transmits light, a strobe light source 23 that emits flash light, a visible cut filter 24 that blocks visible light and transmits infrared light, a condenser lens 25, and visible light In addition, an observation light source 26 such as a halogen lamp that emits infrared steady-state light is sequentially arranged, and a fundus illumination unit is configured together with the perforated mirror 2 and the objective lens 1.

  The outputs of the signal amplification circuit 15 and the signal amplification circuit 19 are connected to an image processing means 27 having a memory 27a, and a monitor 28, an image management means 29, and a control means 30 are connected to the image processing means 27. The image management means 29 is an index such as the near-infrared fundus image and the visible fundus image captured by the first and second fundus imaging means, the index presentation position projected by the index projection means, and the index brightness and size. Information and reaction output results to be described later can be managed and stored.

  Further, the control means 30 includes the LED 10, the liquid crystal display means 7, the backlight 8, the observation light source 26, the input means 31 for inputting the start / end timing of the subjective visual field examination, and the eye fundus to be examined for the subjective visual examination. An operating means 32 capable of selecting a method of presenting an index projected on the screen, selecting brightness, size, and shape of the index, changing a presentation position, and dimming the amount of light from the observation light source 26; A reaction input means 33 for inputting whether or not the projected index has been visually recognized by the subject at the time of the visual field inspection, and a strobe light emission control means 34 for controlling the strobe light source 23 are connected.

  The input means 31 is attached to the upper part of the operation rod (not shown). When the first switch is pressed, a subjective visual field test described later is started, and a predetermined projection is applied to the fundus Er of the eye E by the index projection means. When the indicator is projected and the predetermined visual field examination performed in response to the input of the reaction input means 33 is completed, when the switch of the input means 31 is pressed again, a visible fundus image is captured by the second fundus imaging means. And is recorded in the image management means 29.

  Such first and second fundus imaging means, fixation target projecting means, index projecting means, and fundus illumination means are configured as an inspection optical unit held in one housing, and the inspection optical unit is illustrated. It is installed on a pedestal that can be moved up and down, left and right, and back and forth, and can be aligned with the eye E using an operating rod (not shown).

  FIG. 2 is a front view of the liquid crystal display means 7, in which cells capable of controlling the light transmittance are arranged in a matrix, and the transmission index 7a is a backlight 8 composed of a plurality of LEDs (light emitting diodes). By illuminating, an index for subjective visual field inspection is projected onto the fundus Er. The transmission index 7a of the liquid crystal display means 7 is controlled to a predetermined size and shape at a preset position by the control means 30, and the light flux that has passed through the transmission index 7a is presented to the fundus Er.

  The liquid crystal display means 7 is preferably a VGA computer LCD (liquid crystal display). As a means for controlling the LCD, a personal computer having an operation system can be used. In such a configuration, general-purpose operation means such as a keyboard and a mouse can be used for the operation means 32, and the operability is further improved.

  Next, the subject inputs the reaction input means 33 according to the visual recognition status, and sequentially changes the presentation position or brightness of the transmission index 7a by the liquid crystal display means 7 according to the output result of the reaction input means 33. Perform subjective visual field tests. In addition, when manual subjective visual field inspection is selected by the operation unit 32, the operation unit 32 is operated so that an index can be presented to the eye E at an arbitrary position with arbitrary brightness and size. It is possible to carry out manual visual field inspection.

  FIG. 3 is a flowchart of the fundus examination, and an example of a visual field examination for determining the presence / absence of visual recognition at a predetermined site by the limit method using the brightness of the index as a parameter will be described.

  At the time of fundus examination, the control means 30 turns on the observation light source 26. The light emitted from the observation light source 26 is collected by the condenser lens 25, and only near-infrared light is transmitted by the visible cut filter 24, passes through the strobe light source 23 and the aperture 21 having a ring-shaped aperture, and passes through the lens 20. As a result, it is reflected to the left by the mirror part around the perforated mirror 2 and illuminates the fundus Er through the objective lens 1 and the pupil Ep of the eye E to be examined.

  The reflected light from the fundus Er illuminated with near-infrared light passes through the objective lens 1 and the photographing aperture 2a, the focus lens 3 and the photographing lens 4 disposed in the hole of the perforated mirror 2 and is disposed in the optical path. The light is reflected upward by the optical path branching prism 5, passes through the lens 16, passes through the cold mirror 12, forms an image on the image sensor 14 having sensitivity in the near infrared region via the lens 13, and is converted into an electric signal. This signal is amplified to a predetermined amplification rate through the signal amplification circuit 15, input to the image processing means 27, and sequentially displayed on the monitor 28.

  The operator observes the fundus oculi image 28a displayed on the monitor 28, operates the operating rod to align the inspection optical unit with the eye E, operates the focus knob, moves the focus lens 3, and focuses. Align. Here, the operator prompts the subject to fixate the index from the fixation target plate 9 illuminated by the LED 10.

  At this time, the image pickup device 14, the image pickup devices 18b, 18r, and 18g, the fixation target plate 9, and the liquid crystal display means 7 are all arranged at optically conjugate positions, so that these are the same as the fundus oculi Er of the eye E to be examined. It becomes a conjugate relationship. Further, in order to correct the diopter of the eye E, when the focus lens 3 is moved in the optical axis direction to focus the fundus image 28a, the magnification of the obtained fundus image 28a changes. Since the conjugate relationship among the image sensors 18b, 18r, 18g, the fixation target plate 9, and the liquid crystal display means 7 does not change, the correlation between the cells of the liquid crystal display means 7 and the pixels such as the image sensors 14 does not change. Therefore, it is possible to accurately grasp on which part of the fundus Er the transmission index 7a for the subjective visual field inspection is projected.

  The light beam from the transmission index 7a of the liquid crystal display means 7 illuminated by the backlight 8 passes through the optical path branching prism 6 and the optical path branching prism 5, and passes through the photographing lens 4, the focus lens 3, the photographing aperture 2a, and the objective lens 1. And reaches the eye E to be presented on the fundus Er. Since the backlight 8 can emit light having a wavelength in the visible light region and a wavelength in the near-infrared region, the subject can visually recognize the transmission index 7a, and the imaging element 14 is infrared using the fundus Er as a screen. It can be taken together with the fundus image. As a result, the operator can perform the examination while always confirming on the monitor 28 which part of the fundus Er the projection index 7a for the subjective visual field examination is projected.

  In the flowchart of FIG. 3, when START is performed, the operator observes the infrared fundus image 28 a sequentially displayed on the monitor 28, aligns the inspection optical unit with the eye E and adjusts the focus on the fundus Er. Then, the subject is prompted to fixate the fixation target plate 9, and the switch of the input means 31 is input.

  In [Step 1], the control means 30 continuously displays the infrared fundus image 28a on the monitor 28 (S1), and determines whether or not the first switch of the input means 31 has been input (S2). When it is determined that there has been an input from the input unit 31, an infrared fundus image captured by the image sensor 14 is recorded in the image management unit 29, and a buzzer or the like that informs the subject that an index has been presented Along with the signal sound, the liquid crystal display means 7 is controlled to present a transmission index 7a having a predetermined brightness, size and shape to the eye E at a predetermined position. After the presentation, the infrared fundus image Era imaged by the image sensor 14 is stored in the memory 27a inside the image processing means 27 (S3). The brightness of the transmission index 7a at this time is set to about 1/10 times the brightness that a normal person can visually recognize, and is set as the initial value of the brightness of the transmission index 7a.

  In [Step 2], the subject operates the reaction input means 33 to input whether or not the transmission index 7a projected on the fundus Er can be visually recognized while fixing the index on the fixation target plate 9. The reaction input means 33 is provided with two switches. When the subject can visually recognize, the left switch is pressed, and when the subject cannot be visually recognized, the right switch is pressed (S4). Here, it is possible to determine that the reaction time is not visually recognized when a limit is set for the reaction time without providing the right switch and this time limit is exceeded.

  When the input to the reaction input means 33 of the subject is performed, the control means 30 immediately stores the infrared fundus image Erb imaged by the imaging device 14 in the memory 27a of the image processing means 27 (S5). Then, the image processing means 27 compares the infrared fundus image Era and the infrared fundus image Erb stored in the memory 27a, calculates the relative positional shift amount of each fundus image on the image sensor 14, and performs the positional shift. It is determined whether the amount is within a predetermined range (S6). In the present embodiment, the predetermined range of the positional deviation amount is within 300 μm on the fundus Er of 0 diopter, but the predetermined range can be changed by setting means (not shown).

  When it is determined in S6 that the amount of positional deviation is within the predetermined range, the control unit 30 determines whether the input result of the reaction input unit 33 is view authorization or not visible (S7).

  If it is determined in S6 that the amount of positional deviation is outside the predetermined range, the process returns to S3, and the transmission index 7a is presented to the eye E at the same position as the previous time with the same brightness and size. By this control, when fixation of the eye E to be examined is unstable, the data can be excluded from the visual field inspection data, so that the visual field inspection with high accuracy can be performed.

  When it is determined that the input result of the reaction input means 33 is not visible in S7, the control means 30 controls the liquid crystal display means 7 so that the one-step index is brighter than the previous time (S8), and returns to S3.

  When it is determined in S7 that the input result of the reaction input means 33 is visual approval, the input result of the reaction input means 33, the infrared fundus image Erb, the presentation position of the transmission index 7a, and the brightness / size of the transmission index 7a Are recorded in the image management means 29 in association with each other (S9). After returning to S3, the inspection is performed according to the flow of S4 to S8 and S9.

  In [Step 3], the control means 30 determines whether or not the inspection at a predetermined position set in advance has been completed (S10). When it is determined that the examination at the predetermined position is not completed, the reaction input means 33 controls the liquid crystal display means 7 to change the presentation position of the transmission index 7a to the next predetermined position (S11), S3 to S10, and S11 is repeated, and according to a preset program, the position and brightness of the transmission index 7a on the liquid crystal display means 7 are changed, and visual field inspections of different parts on the fundus Er are sequentially performed for each index presentation position. The infrared fundus image Erb is recorded in the image management means 29.

  When it is determined in S10 that the inspection at the predetermined position is completed, the control means 30 displays on the monitor 28 together with the buzzer sound that the predetermined visual field inspection data acquisition is completed (S12), and responds. The input unit 33 determines whether or not the second switch of the input unit 31 is pressed (S13).

  By performing the above control, a single infrared fundus image associated with the brightness that can be visually recognized for each index of a predetermined position, a predetermined size, and a shape is recorded in the image management unit 29. become.

  When the switch of the input unit 31 is pressed again in S13, the control unit 30 emits the strobe light source 23 to illuminate the fundus Er with visible light, and the visible fundus image Erc is image processing unit 27 by the imaging elements 18b, 18r, and 18g. Is recorded in the image management means 29 (S14).

  Here, when a wavelength selection filter 22 such as a red free filter that does not transmit red light or a blue filter that transmits only blue light in FIG. 1 is inserted in the optical path, the reflected light from the retinal nerve fiber layer is contrasted. It can be well imaged, can clearly record the state of the retinal nerve fiber layer, and is suitable for visual field inspection.

  Next, in [Step 4], the control means 30 uses the image processing means 27 to align the fundus image for each of the plurality of infrared fundus images Erb with respect to the visible fundus image Erc recorded in the image management means 29, and each red A position correction amount of the external fundus image Erb is obtained (S15). Based on the obtained position correction amounts, the two-dimensional visual field maps Ma and Mb as shown in FIGS. 4 and 5 are obtained from the index presentation position and index information by the image processing unit 27 and the visual recognition result by the reaction input unit 33. Is generated (S16).

  Here, FIG. 4 is a two-dimensional visual field map Ma in which the threshold value of the luminance of the transmission index 7a that can be visually recognized at each position where the transmission index 7a is projected is displayed in five levels, and FIG. 5 is represented by an isosensitivity curve. This is the two-dimensional visual field map Mb. Since these two-dimensional visual field maps Ma and Mb are optically conjugate of the fundus oculi Er and the image sensor 14, the image sensors 18b, 18r, and 18g, the fixation target plate 9, and the liquid crystal display means 7, the visible fundus image Erc and It corresponds with high accuracy.

  Further, in [Step 5], the control means 30 combines the visible fundus image Erc and the two-dimensional visual field map Ma as shown in FIG. 6 by the image processing means 27 and displays them on the monitor 28 as shown in FIG. It records in the image management means 29 (S17). Further, the two-dimensional visual field maps Ma and Mb and the visible fundus image Erc as shown in FIGS. 4 and 5 can be displayed on the monitor 28 independently.

  In addition, in the previous [Step 3], after the pre-programmed predetermined examination is completed, the operator operates the operating means 32 as necessary to perform a subjective visual field examination at a site other than the predetermined position of the fundus Er. It is possible to project a transmission index 7a for and to make additional measurements. When no additional measurement is required, the operator presses the second switch of the input unit 31 to capture the visible fundus image Erc.

  In the first embodiment, the switch is used as the reaction input means 33 for inputting whether or not the subject can visually recognize the transmission index 7a projected on the fundus Er. However, the present invention is not limited to this, and various reaction input means can be considered. It is done. For example, by detecting objectively whether or not the subject has recognized the index by ERG, VEP, electroencephalogram detection, etc., a more precise fundus examination can be performed and the measurement time can be shortened.

  FIG. 8 is a configuration diagram of a fundus inspection apparatus according to the second embodiment. The second embodiment is an example of a fundus visual acuity test in which a predetermined visual acuity of the subject's fundus Er is determined by a limit method using the size of the index as a parameter. It is. In addition, in this Example 2, the same code | symbol as Example 1 has shown the equivalent component.

  In front of the eye E, an objective lens 1, a perforated mirror 2, a photographing aperture 2a disposed in the hole, a focus lens 3 movable on the optical axis, a photographing lens 4, an optical path branching prism 5, and liquid crystal display means 41, the backlight 8 is arranged. An index and a fixation target that function as an index projected to a predetermined position of the fundus Er for performing a subjective visual field inspection of the subject and also function as a fixation target projection means for fixing the eye to the subject. Projection means is configured.

  In the reflection direction of the optical path branching prism 5, a field lens 11, a mirror 42 that reflects near-infrared light and visible light, a lens 16, a color separation prism 17, and image sensors 18b, 18r, and 18g are provided. The outputs of these imaging elements 18b, 18r, and 18g are connected to a signal amplification circuit 19 that amplifies an electrical signal, and a fundus imaging means is configured. Further, in the incident direction of the perforated mirror 2, fundus illumination means similar to that in the first embodiment is provided.

  As described above, the second embodiment shares the first fundus imaging unit for obtaining the infrared fundus image provided in the first embodiment and the second fundus imaging unit for obtaining the visible fundus image. . Further, as shown in FIG. 9, an index 41 b projected onto the fundus Er is displayed together on the liquid crystal display means 41 in order to perform a subjective visual field inspection using a fixation target 41 a for fixing the subject to fixation. . As a result, the inspection optical unit can be simplified, and the entire apparatus can be miniaturized.

  Since the flow of the fundus examination according to the second embodiment is the same as the flow of the fundus examination according to the first embodiment described above, the description thereof will be omitted, but the initial value of the size of the index to be presented is set to, for example, visual acuity 2.0. This is expanded sequentially according to the reaction of the subject.

  Further, in the second embodiment, by operating the mode switch of the operation means 32, the size of the cut in any one of the four directions for performing the visual acuity test on the liquid crystal display means 41 as shown in FIG. The Landolt ring 41c as a parameter is displayed and can be presented on the fundus Er, and the subject responds to the cut direction in which the Landolt ring 41c that is sequentially displayed can be visually recognized. The subjective visual acuity test can be performed by depressing the provided switch-like switch.

  In the second embodiment, the operator can always observe the infrared fundus image 28a on the monitor 28 while performing the fundus examination, and simultaneously observe the image of the Landolt ring 41c projected on the fundus Er. Can do. Thereby, it is possible to observe which part of the fundus Er the eye E examines to visually recognize the Landolt ring 41c, which is important information for determining a subsequent treatment policy.

  In addition, when the second stage switch of the input unit 31 is pressed, a visible fundus image can be recorded in the image management unit 29 via the image processing unit 27. At this time, since the image of the Landolt ring 41c is not clear, the image processing means 27 can create a character corresponding to the Landolt ring 41c, synthesize it on the visible fundus image, and display it on the monitor 28.

  In the above two examples, as a program for determining the visibility / invisibility threshold of the subject, a unique determination method based on the limit method in which an inspection is performed by presenting an index from the invisibility direction, Not only this method but various methods can be considered. For example, an index is presented from the viewer side, or a method of repeatedly inspecting by changing parameters such as brightness and size from the threshold to obtain an accurate threshold, or an index to be presented at each inspection position A constant method in which parameters such as brightness and size are randomly changed may be employed.

1 is a configuration diagram of a fundus inspection apparatus of Example 1. FIG. It is a front view of a liquid crystal display means. It is a flowchart figure of a fundus examination. It is explanatory drawing of a two-dimensional visual field map. It is explanatory drawing of a two-dimensional visual field map. It is an image composition figure of a visible fundus image and a two-dimensional visual field map. It is an image composition figure of a visible fundus image and a two-dimensional visual field map. FIG. 6 is a configuration diagram of a fundus examination apparatus according to a second embodiment. It is a one part enlarged view of the liquid crystal display means at the time of a subjective visual field test | inspection. It is a one part enlarged view of the liquid crystal display means at the time of a subjective visual acuity test.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Objective lens 2 Perforated mirror 3 Focus lens 4 Shooting lens 5, 6 Optical path branching prism 7, 41 Liquid crystal display means 8 Backlight 9 Fixation target plate 14 Imaging element 17 Color separation prism 18r Red light imaging element 18g For green light Image sensor 18b Image sensor for blue light 23 Strobe light source 26 Observation light source 27 Image processing means 28 Monitor 29 Image management means 30 Control means 31 Input means 33 Reaction input means 34 Strobe light emission control means

Claims (12)

  First imaging means for capturing an infrared fundus image illuminated with near-infrared light, first display means for displaying the infrared fundus image captured by the first imaging means, and a fixed eye for guiding the eye to be examined A fixation target system for projecting the visual target onto the eye to be examined, and brightness / size at a predetermined position within the imaging range of the first imaging means of the fundus of the eye to be examined in order to perform subjective fundus examination of the subject. Index projection means for projecting an index of which at least one of the shapes is variable, reaction input means for inputting the response of the subject, second imaging means for imaging a visible fundus image illuminated with visible light, and The second display means for displaying the visible fundus image captured by the two imaging means, the start input means for inputting the start timing of the subjective fundus examination, and the images captured by the first and second imaging means are managed. Image management means for processing, image processing means for processing the captured image, In the fundus examination apparatus including a control unit that controls the operation of each unit, the control unit receives the infrared imaged by the first imaging unit after the start timing of the fundus examination is input by the start input unit. A first step of projecting the index from the index projection means while displaying a fundus image on the first display means; and the infrared fundus image by the first imaging means according to a reaction of the reaction input means; A second step of associating and recording the output result of the reaction input means, the index presentation position by the index projection means, and at least one index information of the brightness, size, and shape of the index in the image management means; After the first step and the second step are repeated according to the input from the reaction input means, the visible fundus image is recorded by the second imaging means on the image management means The index presenting position by aligning the infrared fundus image recorded in the second step with the visible fundus image recorded in the third step by the image processing means. A fourth step of generating the index information and the output result of the reaction input means as a two-dimensional visual field map; the visible fundus image recorded in the third step; and the two-dimensional visual field generated in the fourth step. A fundus examination apparatus comprising: a fifth step of combining a map by the image processing means and displaying the map on the second display means.   The fundus examination apparatus according to claim 1, wherein the first imaging unit is shared with the second imaging unit.   The fundus examination apparatus according to claim 1, wherein the first display unit is shared with the second display unit.   In the first step, after inputting the timing of the start of subjective fundus examination by the input unit, the first infrared fundus image captured by the first imaging unit is recorded, and the second In the step, the second infrared fundus image is recorded corresponding to the input of the reaction input means, and the positional shift amount between the first infrared fundus image and the second infrared fundus image is processed in the image processing. The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus performs a determination process for determining whether the positional deviation amount is within a predetermined amount by a means.   When the determination unit determines that the shift amount is within the predetermined amount by the determination process, either the first infrared fundus image or the second infrared fundus image and the reaction input unit 5. The fundus examination according to claim 4, wherein an output result, an index presentation position by the index projection unit, and index information of brightness, size, and shape of the index are associated and recorded in the image management unit. apparatus.   When the control unit determines that the amount of displacement exceeds the predetermined amount by the determination process, the control unit performs re-examination of the same part, interrupts the inspection, or uses the fixation target or voice The fundus examination apparatus according to claim 4, wherein the fundus examination apparatus is informed.   The fundus examination apparatus according to claim 1, wherein the input unit is arranged on an upper part of an operation rod for aligning an eye to be examined.   The index projection unit includes an index illumination light source that illuminates the index with visible light and infrared light, and captures an index image projected onto the fundus of the eye to be examined by the first imaging unit together with the infrared fundus image. The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus displays on one display means.   The fixation target of the fixation system and the index of the index projection unit are the same two-dimensional display, and the two-dimensional display is a position optically conjugate with the first imaging element provided in the first imaging unit. The fundus examination apparatus according to claim 1, wherein the fundus examination apparatus is disposed on the fundus.   The image processing unit synthesizes the fundus image captured by the first image capturing unit or the second image capturing unit and the fixation target or the index displayed on the two-dimensional display, and outputs the image to the second display unit. The fundus examination apparatus according to claim 9, wherein the fundus examination apparatus displays.   2. The visible fundus image recorded in the image management unit in the third step and the two-dimensional visual field map generated in the fourth step are associated with each other and recorded in the image management unit. The fundus examination apparatus according to 1.   The visible fundus image recorded in the image management means in the third step and the two-dimensional visual field map generated in the fourth step are independently displayed on the second display means. The fundus examination apparatus according to claim 1.