JP2018187037A - Visual function inspection device - Google Patents

Abstract

Provided is a visual function testing device that takes into account the effects of blood vessels. SOLUTION: Projection means for projecting stimulation light to the examination site of the fundus of the subject's eye, reaction acquisition means for acquiring the reaction of the subject by the stimulus light, and fundus image acquisition means for acquiring the fundus image of the fundus Blood vessel detection means for detecting blood vessels in the fundus, prediction means for predicting the influence of the blood vessel on the reaction based on the positional relationship between the examination site and the blood vessel, and notification means for notifying the examiner of the prediction result of the prediction means. Prepare. Therefore, the predicting means determines the degree of influence, and the notifying means notifies the degree. [Selection] Figure 5

Description

  The present disclosure relates to a visual function inspection device that inspects the visual function of an eye to be examined.

  Patent Document 1 discloses a fundus imaging apparatus that presents a test target in a state where the patient's eye fixes the fixation target, and performs a visual function test based on whether or not the patient has recognized the test target. Yes.

JP 2014-23768 A

  By the way, when an examination target is presented to the subject's eye (that is, a light stimulus is given to the examination part of the subject's fundus), and the visual function of the examination part is examined by the reaction of the subject, Even if the examiner is a healthy eye, an unintended test result may be obtained. For example, the subject's reaction (subjective or objective) may change greatly depending on whether or not a thick blood vessel is placed at the examination site to which light stimulation is applied. As a result, there is a risk that a healthy site may be mistaken for a disease site. For example, the effect of blood vessels tends to become more prominent as the visual function is examined with higher precision or higher accuracy. In addition, a thick blood vessel is likely to be disposed in the vicinity of the fundus, that is, the visual function test in the periphery of the fundus may be easily affected by the blood vessel.

  The present disclosure is for solving the above-described problems, and an object thereof is to provide a visual function inspection device in consideration of the influence of blood vessels.

In order to solve the above problems, the present invention is characterized by having the following configuration.
(1) Projection means for projecting stimulation light to the examination site of the fundus of the subject's eye, reaction acquisition means for acquiring the response of the subject by the stimulation light, and fundus image acquisition for acquiring the fundus image of the fundus Means, blood vessel detection means for detecting blood vessels in the fundus, prediction means for predicting the influence of the blood vessels on the reaction based on the positional relationship between the examination site and the blood vessels, and the prediction results of the prediction means are detected. A notification means for notifying a person.

  According to the visual function testing device of the present disclosure, it is possible to provide a visual function testing device that considers the influence of blood vessels.

It is an external appearance block diagram of the visual function inspection apparatus of this embodiment. It is explanatory drawing of the optical system and control system of the visual function inspection apparatus of FIG. It is a figure which shows a reference | standard image. It is a figure which shows a test | inspection pattern. It is a figure of a synthesized image (before inspection). It is a figure of a synthesized image (after inspection). It is a figure which shows the positional relationship of a test | inspection site | part and a blood vessel. It is a figure of the synthesized image (before a test | inspection) of a modification example. It is a flowchart regarding the flow of a visual function test | inspection. It is a flowchart regarding a synthetic | combination process.

<First Embodiment>
Hereinafter, embodiments of the present invention will be described with reference to the drawings. In this embodiment, as an example of an ophthalmologic apparatus, a visual function inspection apparatus 1 that can perform fundus observation, fundus imaging, and visual field inspection with a single unit will be described. FIG. 1 is an external configuration diagram of a visual function testing device 1 according to the present embodiment. FIG. 2 is an explanatory diagram of an optical system (observation / photographing optical system 30, inspection optical system 70, etc.) and a control system (control unit 80, etc.) of the visual function inspection apparatus 1.

  The visual function testing device 1 according to the present embodiment includes a base 1a, and a movable base 2 provided to be movable in the left-right direction (X direction) and the front-rear (working distance) direction (Z direction) with respect to the base 1a. The imaging unit 3 (optical) provided to be movable in the left-right direction (X direction), the up-down direction (Y direction), and the front-rear direction (Z direction) with respect to the eye E by the drive unit 6 provided on the moving table 2. And a face support unit 5 fixed to the base 1a in order to support the face of the subject. Note that an optical system and a control system, which will be described later, are housed in the housing of the photographing unit 3.

  In the present embodiment, a joystick 4, a control unit 7 a, and a monitor 8 are provided on the examiner side of the imaging unit 3. The joystick 4 is used to move the imaging unit 3 relative to the eye E. When the joystick 4 is tilted, the movable table 2 is slid in the XZ direction on the base 1a by the sliding mechanism. The joystick 4 has a rotary knob 4a on the side surface and a switch 4b on the top. When the rotary knob 4a is rotated, the drive unit 6 is driven and the photographing unit 3 is moved in the Y direction. When the switch 4b is operated, a fundus image photographing operation or the like is performed.

  The control unit 7a is an input means for setting various imaging / inspection conditions. The control unit 7a of the present embodiment is a touch panel and is assembled to the monitor 8. The control unit 7a may be replaced with a mouse, a keyboard, or the like. On the monitor 8 (display means), an observation image, a captured image, various examination results, and the like of the eye E are displayed. The visual function testing device 1 of the present embodiment includes a response button 7b for a patient to input a response signal at the time of visual function test of the eye (retina). That is, it can be said that the response button 7b of the present embodiment is a reflection acquisition unit for acquiring the response of the subject who has received a light stimulus. On the subject side of the photographing unit 3, a photographing window 9 and a response button 7b are provided for the subject to look into the apparatus.

  The optical system of the visual function testing device 1 according to the present embodiment includes an illumination optical system 10 for illuminating the fundus Er of the eye E, an observation / imaging optical system 30 for imaging (observing or photographing) the fundus Er, and An inspection optical system 70 is provided for applying a light stimulus (hereinafter sometimes referred to as stimulus light or stimulus) to the retina of the eye E. Note that the inspection optical system 70 of the present embodiment can present a fixation target to the eye E.

<Illumination optics>
The illumination optical system 10 of the present embodiment includes a photographing illumination optical system and an observation illumination optical system. The imaging illumination optical system of the present embodiment includes an imaging light source 14 for illuminating the fundus Er with visible light (imaging illumination light), a ring slit 17 having a ring-shaped opening, a perforated mirror 22, an objective lens 25, and the like. . Further, the observation illumination optical system of the present embodiment shares the optical members from the ring slit 17 to the objective lens 25 with the photographing illumination optical system. The observation illumination optical system of this embodiment includes an illumination light source 11 for illuminating the fundus Er with infrared light (observation illumination light), a dichroic mirror 16, and the like.

<Observation / Shooting Optical System>
The observation / imaging optical system 30 (imaging optical system) of this embodiment includes a fundus observation optical system and a fundus imaging optical system. The observation / imaging optical system 30 of this embodiment is an imaging optical system that has a light receiving element and acquires a fundus image using the light receiving element, and can be said to be a fundus image acquisition unit for acquiring a fundus image of the fundus Er. . The fundus oculi observation optical system of this embodiment includes an objective lens 25, a photographing aperture 31, a focusing lens 32, an imaging lens 33, and a flip-up mirror 34. The imaging aperture 31 is disposed at a position conjugate with the pupil of the eye E. The moving mechanism 49 includes a motor. The focusing lens 32 can be moved along the optical axis L <b> 1 by the moving mechanism 49. The insertion / removal mechanism 39 is connected to the flip-up mirror 34. The flip-up mirror 34 is inserted into the optical path when observing the fundus oculi Er, and is retracted out of the optical path when photographing the fundus oculi Er. For example, instead of the combination of the flip-up mirror 34 and the insertion / removal mechanism 39, a dichroic mirror or the like may be fixed.

  A dichroic mirror 37, a relay lens 36, and an image sensor 38 (for observation) are arranged in this order on the optical path in the reflection direction of the flip-up mirror 34. The dichroic mirror 37 of the present embodiment has a characteristic of reflecting infrared light (observation light) and transmitting visible light (stimulation light). The fundus photographing optical system of the present embodiment shares the optical path from the objective lens 25 to the imaging lens 33 with the fundus observation optical system. The fundus photographing optical system includes an image sensor 35 (for photographing). The image sensor 38 has sensitivity in the infrared region, and the image sensor 35 has sensitivity in the visible region. The image sensor 38 and the image sensor 35 of the present embodiment are two-dimensional image sensors. The image sensor 38 and the image sensor 35 are arranged at a position conjugate with the fundus Er.

  The fundus observation optical system of the present embodiment can capture the fundus Er illuminated with infrared light as a moving image or a still image. When observing the fundus Er, the light emitted from the illumination light source 11 is once converged in the vicinity of the pupil of the eye E by the objective lens 25 and then illuminates the fundus Er while diffusing. Reflected light (infrared light) from the fundus oculi Er is the objective lens 25, the aperture of the perforated mirror 22, the imaging aperture 31, the focusing lens 32, the imaging lens 33, the flip-up mirror 34, the dichroic mirror 37, and the relay lens 36. And the light is condensed (imaged) on the image sensor 38. The fundus imaging optical system of the present embodiment can capture the fundus Er illuminated with visible light as a still image. At the time of photographing the fundus Er, the reflected light from the fundus Er illuminated by the light emitted from the photographing light source 14 is the objective lens 25, the opening of the perforated mirror 22, the photographing aperture 31, the focusing lens 32, and the imaging lens 33. And the light is condensed (imaged) on the image sensor 35.

  In the present embodiment, an observation image (still image or moving image) captured by the image sensor 38 and a captured image (still image) captured by the image sensor 35 are displayed on the monitor 8. In the present embodiment, the eye E is imaged with infrared light by a combination of the fundus observation optical system and the fundus observation optical system (first imaging means), and the combination of the fundus imaging optical system and the fundus imaging optical system (second). The eye E is imaged with visible light by the imaging means. However, the visual function testing device may include only one of the imaging means. Note that this embodiment is merely an example, and it is sufficient that the fundus Er can be imaged. For example, the fundus image of the eye E may be acquired by scanning the laser beam on the fundus Er.

<Inspection optics>
The inspection optical system 70 of the present embodiment shares the optical path from the objective lens 25 to the dichroic mirror 37 with the observation / imaging optical system 30. The inspection optical system 70 of this embodiment includes a lens 73 and a display 72. The display device 72 is disposed at a position conjugate with the fundus oculi Er. The display device 72 of the present embodiment can display an inspection target. In the present embodiment, the examination target displayed on the display device 72 is used as a stimulus to the retina of the eye E to be examined. The inspection optical system 70 of the present embodiment is a stimulation optical system that projects stimulation light onto the fundus Er, and can be said to be a light projecting unit for projecting stimulation light onto the examination site of the fundus Er of the eye E. Note that the display device 72 of this embodiment can display a fixation target. Specifically, the display device 72 can simultaneously display the fixation target and the inspection target. The fixation target displayed on the display device 72 is used to guide the line of sight of the eye E to be examined.

  The control unit 80 according to the present embodiment controls the display device 72 to measure the size, shape, color tone (chromatic color / achromatic color), and gradation of the visual target (examination visual target or fixation target) projected onto the fundus Er. Can be changed arbitrarily. Further, the control unit 80 can change the projection position of the target on the fundus Er by changing the display position of the target displayed on the display device 72. The display device 72 of the present embodiment is a projector and includes a light source that emits white light, an LCD (liquid crystal display), and the like. Note that the method of presenting the visual target to the eye E (in other words, the method of stimulating the retina) is not limited to this. For example, various visual targets may be formed on the fundus Er (on the retina) by scanning the laser beam on the fundus Er.

  Although details will be described later, the visual function testing device 1 according to the present embodiment projects the test target on the examination site of the fundus Er in a state where the fixation target is stared at the eye E (in other words, gives a stimulus to the retina). The visual function of the examination site can be examined based on whether or not the subject can see the index. In the present embodiment, the boundary between the brightness at which the inspection target is visible and the brightness at which the inspection target is not visible is referred to as a threshold value. The visual function testing device 1 according to the present embodiment can test the threshold value of the test site by changing the brightness of the test target. Further, the visual function testing device 1 of the present embodiment can acquire the threshold distribution of the fundus Er of the eye E by changing the projection position of the test target (in other words, the test site).

  Note that the visual function testing device 1 of the present embodiment includes, for example, an Ishihara-type color vision abnormality test table and a test target using a specific wavelength color (for example, red, blue, green) (in other words, a visual function test target). Can be presented to the subject. Thereby, for example, the presence / absence of color vision abnormality of the eye E, an abnormal cone (color vision abnormality with respect to a specific color), and the like can be specified. The visual function inspection method is not limited to this. For example, the visual function inspection device 1 of the present embodiment can inspect the visual field of the eye E (refer to Japanese Patent Laid-Open No. 2014-23768 for the visual field inspection). .

<Control system>
The control unit 80 of this embodiment will be described. The control unit 80 includes a CPU and the like. A memory 83 is connected to the control unit 80. The CPU controls each part of the visual function testing device 1. The memory 83 of the present embodiment stores various programs, a plurality of different inspection patterns, initial values, and the like. The memory 83 can temporarily store various information. The control unit 80 according to the present embodiment reads out a program stored in the memory 83 and performs various controls of the visual function testing device 1. The control unit 80 of the present embodiment includes an image sensor 38, a display 72, an image sensor 35, a drive unit 6, a joystick 4, a moving mechanism 49, an illumination light source 11, an imaging light source 14, a memory 83, a monitor 8, and a control unit 7a. The response button 7b and the like are connected.

  The control unit 80 of this embodiment has a function as a display control unit, and can control the display of the monitor 8. The control unit 80 according to the present embodiment can display the fundus image acquired using the light receiving element (the image sensor 35 or the image sensor 38) on the monitor 8. In addition, the information processing terminal (for example, PC: personal computer) connected to the visual function test | inspection apparatus 1 may bear the part of the control part 80 and the monitor 8 of this embodiment. That is, an ophthalmic examination system that combines a visual function examination device and an information processing terminal may be used. In addition, you may perform the synthetic | combination process (refer FIG. 5, FIG. 6) mentioned later with an information processing terminal. For example, a composite image COMa may be created by the information processing terminal, data related to the composite image COMa may be transferred to the visual function inspection device 1, and the visual function inspection device 1 may perform a visual function inspection based on the received data.

<Visual function test>
Next, the flow of the visual function test using the visual function test apparatus 1 of the present embodiment will be described with reference to FIGS. FIG. 9 is a flowchart showing the flow of the visual function test executed by the control unit 80. The examiner first places the subject's face on the chin rest of the face support unit 5. Next, the examiner operates the joystick 4 while observing the observation image (moving image) displayed on the monitor 8 to bring the imaging unit 3 closer to the eye E to be examined. The display 72 displays a fixation target for guiding the line of sight of the eye E to be examined. The control unit 80 performs alignment of the imaging unit 3 with respect to the eye E and focusing of the imaging unit 3 with respect to the fundus Er (see step S101). The control unit 80 according to the present embodiment analyzes the observation image and drives the driving unit 6 or the focusing lens 32 based on the analysis result.

  When the alignment of the imaging unit 3 with respect to the eye E and the focusing of the imaging unit 3 with respect to the fundus Er are completed, the control unit 80 acquires the reference image STD (see step S102). The reference image STD of the present embodiment is a still image. The reference image STD of the present embodiment is a monochrome image (fundus image) obtained by imaging the eye E with infrared light. For example, a color image captured with visible light and a fluorescence reaction of the eye E are imaged. The fluorescence image (spontaneous fluorescence image, FAG fluorescence image, ICG fluorescence image) etc. may be sufficient. For example, the reference image STD may be acquired from an information processing terminal connected to the visual function testing device 1. In the present embodiment, the alignment of the imaging unit 3 with respect to the eye E and the focusing of the imaging unit 3 with respect to the fundus Er are continued until the visual function test result is displayed on the monitor 8.

  The control unit 80 displays the acquired reference image STD on the monitor 8. The examiner operates the control unit 7a to set the examination site (see step S103). The examination site in the present embodiment is a retinal site for examining a visual function by applying a light stimulus. In the present embodiment, the inspection pattern P (see FIG. 4) is used when setting the inspection site. The examiner selects the inspection pattern P and arranges the selected inspection pattern P in an arbitrary area on the reference image STD.

  FIG. 4 shows the inspection pattern P of this embodiment. The inspection pattern P is a pattern in which a plurality of inspection targets are arranged radially. The inspection pattern P of the present embodiment includes 25 inspection targets (inspection targets D1, D2, etc.). In the present embodiment, each inspection target of the inspection pattern P is selectively displayed on the display device 72. FIG. 5 shows an example in which the examiner arranges the inspection pattern P on the reference image STD. In addition, although mentioned later for details, the visual function test | inspection apparatus 1 of this embodiment alert | reports to the examiner the test | inspection site | part which may receive the influence of the blood vessel when test | inspecting a visual function. In FIG. 5, the position of the examination site F1 corresponding to the examination target D1 may be affected by blood vessels. Accordingly, the examination site F1 (without hatching) is presented (notified) to the examiner in a manner different from other examination sites (for example, the examination site F2 (with hatching)).

  Next, the examiner operates the control unit 7a to start a visual function test (see step S104). When the operation signal (inspection start signal) of the control unit 7a is input, the control unit 80 displays one of the 25 inspection targets included in the inspection pattern P on the display device 72 with a predetermined brightness. Note that the control unit 80 of the present embodiment repeatedly obtains the fundus image using the fundus observation optical system and analyzes the fundus image during the visual function test, and displays based on the analysis result using the reference image STD together. The position of the inspection target displayed on the instrument 72 is corrected. As described above, the control unit 80 according to the present embodiment corrects the display position of the inspection target so that the eye fundus site set in step S103 is stimulated even if the eye E moves. That is, the visual function testing device 1 according to the present embodiment includes a correcting unit that analyzes a fundus image and corrects the projection position of the stimulation light onto the fundus Er. Thereby, for example, the visual function inspection device 1 of the present embodiment can easily perform the visual function inspection with high precision.

  The subject stares at the fixation target presented at the center of the visual field, and presses the response button 7b when he feels the inspection target around the visual field. The control unit 80 detects that the response button 7b has been pressed, or shifts to display of the next inspection target when time-out occurs. In the present embodiment, the response button 7b is used to acquire the subject's response to the light stimulus. That is, the visual function test is performed subjectively. However, the visual function test may be performed objectively. For example, the visual function testing device 1 may acquire the fundus image before and after the presentation of the test target, and may acquire the reaction of the eye E from the change in the fundus image. The control unit 80 stores the examination part (display position of the examination index), the stimulus intensity (brightness of the examination index), and the presence / absence of the subject's response in association with the memory 83. The control unit 80 repeats the change of the display position of the inspection target and the change of the brightness of the inspection target. When the control unit 80 acquires the threshold value corresponding to each inspection target of the inspection pattern P, the control unit 80 ends the visual function inspection. The acquired threshold value is stored in the memory 83 in association with the display position of the examination target.

  Next, the control unit 80 acquires a color fundus image (see step S105). The control unit 80 turns on the photographing light source 14 and generates a photographed image PHO using the output signal of the image sensor 35. Next, the control unit 80 displays the visual function test result on the monitor 8 (see step S106). In the present embodiment, a composite image COMb obtained by combining the captured image PHO and the threshold map R is displayed on the monitor 8 as a visual function test result (see FIG. 6). Specifically, the control unit 80 of the present embodiment performs registration processing (enlargement / reduction, rotation, etc.) on the captured image PHO so that each part of the reference image STD substantially matches each part of the captured image PHO. Further, information on the threshold value is overlaid on the portion of the examination site on the fundus image corresponding to each examination target of the examination pattern P.

  As shown in FIG. 6, in this embodiment, a mark (square) indicating the examination site and a threshold value (number) of the site are presented to the examiner on each site (part M1, M2, etc.) of the threshold map R. ing. Similar to FIG. 5 described above, the location of the examination site that may be affected by the blood vessel is presented to the examiner in a manner different from other examination sites. Specifically, the part M1 is presented without hatching, and the part M2 is presented with hatching. As described above, in this embodiment, the visual function test using the visual function test apparatus 1 and the presentation of the visual function test result are performed. Note that the visual function test result of this embodiment is an example, and for example, a composite image obtained by combining the reference image STD and the threshold map R may be presented to the examiner as the visual function test result.

<Compositing process>
Next, with reference to FIG. 10, the details of the combining process for combining the reference image STD (fundus image) and the inspection pattern P (inspection information) will be described. Note that step S201 in FIG. 10 corresponds to step S102 (see FIG. 9) described above, and step S202 in FIG. 10 corresponds to step S103 (see FIG. 9) described above. The control unit 80 acquires the reference image STD in step S201, and acquires examination information (examination site, stimulation size, etc.) in step S202. Next, in step S203, the control unit 80 detects a blood vessel from the reference image STD. In the blood vessel detection of the present embodiment, the thickness (width) of the blood vessel is also detected. That is, it can be said that the control unit 80 of the present embodiment is a blood vessel detection unit for detecting a blood vessel of the fundus oculi Er.

  Next, in step S204, the control unit 80 determines the overlap between the examination site and the blood vessel. FIG. 7 is an enlarged view around the examination site F1 of FIG. 5, and is an example showing the overlap between the examination site and the blood vessel. The control unit 80 according to the present embodiment determines whether or not a blood vessel exists within a predetermined range C centered on the reference position U1 of the examination site as the first prediction. That is, it is determined whether or not a blood vessel exists in the vicinity of the reference position U1. Note that the reference position U1 of the present embodiment corresponds to the position of the center of gravity of the inspection target. Further, the predetermined range C of the present embodiment is based on the stimulus size. The stimulus size corresponds to the size of the inspection target. In the first prediction, the thickness (width) of the blood vessel involved in the prediction, or the relationship between the stimulation size and the thickness of the blood vessel may be considered. If it determines with the test | inspection site | part and the blood vessel overlapping, the control part 80 will progress to step S205, and if it determines with the test | inspection site | part and the blood vessel not overlapping, it will progress to step S206.

  In step S205, the control unit 80 determines whether or not the amount of overlap between the examination site and the blood vessel is equal to or greater than a predetermined amount. That is, the control unit 80 according to the present embodiment determines the degree of superimposition between the examination site and the blood vessel as the second determination. Specifically, the ratio between the blood vessel region and the region other than the blood vessel within the predetermined range C is detected. A reference ratio value is stored in the memory 83 in advance. The detected ratio is compared with the reference ratio value. In the second determination, the thickness (width) of the blood vessel related to the determination, or the relationship between the stimulation size and the thickness of the blood vessel may be considered. If the control unit 80 determines that the superposition amount is equal to or greater than the predetermined amount, the control unit 80 proceeds to step S208. If the control unit 80 determines that the superposition amount is less than the predetermined amount, the control unit 80 proceeds to step S207.

  The control unit 80 according to the present embodiment changes the mode of each examination site arranged on the reference image STD in consideration of the influence of blood vessels. Specifically, when examining the visual function of the eye E using light stimulation, if the light stimulation and a blood vessel overlap, the reaction of the eye E to the light stimulation may change. Therefore, the visual function testing device 1 according to the present embodiment notifies the operator of the test site where the influence of the subject reaction is predicted by the blood vessel.

  If the controller 80 determines that the examination site and the blood vessel are not superimposed (in other words, the influence of the blood vessel is negligible), the control unit 80 sets the corresponding examination site to the normal color (see step S206). If the control unit 80 determines that there is little overlap between the examination site and the blood vessel, the control unit 80 sets the corresponding examination site to the second notification color (see step S207). Further, when the control unit 80 determines that there are many overlaps between the examination site and the blood vessel, the control unit 80 sets the corresponding examination site to the first notification color (see step S208). In the present embodiment, the normal color is set to blue, the second notification color is set to orange, and the first notification color is set to red. That is, the visual function testing device 1 according to the present embodiment includes a predicting unit that predicts the influence of the blood vessel on the visual reaction based on the positional relationship between the examination site and the blood vessel. Note that the predicting means of the present embodiment predicts the influence of the blood vessel on the visual reaction step by step.

  Next, in step S209, the control unit 80 combines the reference image STD and the inspection pattern P based on the colors set in steps S206 to S208 (see FIG. 5). That is, the visual function inspection device 1 of the present embodiment includes a combining unit that generates a combined image in which inspection information related to light stimulation is superimposed on a fundus image. The control unit 80 according to the present embodiment arranges the examination information at the position of the examination site on the fundus image, and determines the color tone of the examination information based on the prediction result. In addition, the visual function testing device 1 according to the present embodiment includes notification means for notifying the examiner of the prediction result (the influence on the visual reaction by the blood vessel). In FIG. 5, the examination site F1 that is predicted to have a large blood vessel effect is not hatched, and the test site that is predicted to have a small blood vessel effect (for example, the test site F2) is hatched.

  As described above, the visual function testing device 1 according to the present embodiment notifies the operator of the test site where the test site and the blood vessel overlap and the effect on the visual function test result is predicted, with different display colors. Further, the display color is changed according to the degree of influence, and the examiner is notified. Note that the method of notifying the examiner is not limited to the color tone of the display color, but may be notified by the gradation of the display color. Further, for example, the examination site mark may blink to notify the examiner. Further, the examiner may be notified of the shape of the examination site mark different from the others. Note that the method of notifying the blood vessel effect to the examiner is not limited to the visual function test. As described above with reference to FIG. 6, when the visual function test result is displayed (output), the effect of the blood vessel may be notified to the examiner. In FIG. 6, a threshold is included as examination information to be superimposed on the fundus image. In the present embodiment, the composite image COMb is displayed (output) on the monitor 8, but the output method of the composite image COMb is not limited to this. For example, the composite image COMb may be transferred to the information processing terminal connected to the visual function inspection device 1. In the present embodiment, an inspection pattern including a plurality of inspection parts is used, but an inspection pattern having only one inspection part may be used. What is necessary is just to alert | report the test | inspection site | part by which the influence by the blood vessel is estimated.

  In a perimeter without fundus tracking, the stimulus position on the retina may be shifted depending on the fixation disparity of the eye E to be examined. On the other hand, in the microperimetry (fundus perimetry that measures the retina local sensitivity under direct vision) that performs tracking while acquiring the fundus image as in the visual function testing device 1 of the present embodiment, an arbitrary eye E can be detected. It is possible to accurately stimulate the position. However, since the stimulation can be performed accurately, the perimeter pattern in which the stimulation is arranged on the blood vessel sometimes displays a poor threshold sensitivity result even if the retinal sensitivity is normal. On the other hand, the visual function testing device 1 of the present embodiment displays the stimulus points on the blood vessels so as to be clearly understood by the user when changing the result (changing the color, changing the shape, etc.). . In addition, when the pattern is placed on the fundus before the examination is started, an alert is issued when the stimulation light overlaps the blood vessel. In the present embodiment, the color is changed as an alert (notification) to the examiner, but a message may be displayed on the monitor 8 or a notification sound may be generated. In addition, you may change the reference | standard made explicit by the relationship between a blood vessel and a stimulus size. Conventionally, the threshold result may be locally deteriorated when stimulating on a thick blood vessel, which may lead to an unintended diagnosis. However, the visual function testing device 1 of the present embodiment can easily obtain or determine the threshold value of the eye E to be examined. Moreover, it becomes easy to understand the local sensitivity difference due to the arrangement on the blood vessel.

<Summary>
As described above, the visual function testing device 1 according to the first embodiment acquires the light projecting unit that projects the stimulation light onto the examination site of the fundus Er of the eye E and the reaction of the subject by the stimulation light. The reaction acquisition means, the fundus image acquisition means for acquiring the fundus image of the fundus Er, the blood vessel detection means for detecting the blood vessel of the fundus Er, and the influence of the blood vessel on the subject reaction based on the positional relationship between the examination site and the blood vessel Predicting means for predicting the prediction, and notifying means for notifying the examiner of the prediction result of the predicting means. Thereby, it is easy to perform a visual function test considering the influence of blood vessels. For example, it is difficult for a normal part to be mistaken for an abnormal part.

  In addition, the determination unit of the first embodiment determines the degree of blood vessel influence, and the notification unit notifies the degree of blood vessel influence. Thereby, it is easy to perform a visual function test in consideration of not only the presence / absence of blood vessel influence but also the degree of blood vessel influence. Further, the determination unit of the first embodiment considers the size of the light stimulus or the thickness of the blood vessel. Thereby, it becomes easy to consider the blood vessel effect more accurately. In addition, the visual function inspection device 1 according to the first embodiment includes a combining unit that generates a combined image in which inspection information related to light stimulation is superimposed on a fundus image. The examination information is arranged at the position of the examination site on the fundus image, and the notification means determines the color tone, gradation, or shape of the examination information based on the prediction result of the prediction means. Thereby, for example, the examiner can determine the blood vessel effect only by looking at the color of the examination region displayed on the monitor 8. It is easy to quickly determine the visual function test or the visual function test result.

  Further, the inspection information of the first embodiment includes a threshold value. As a result, the visual function test result can be quickly determined. The visual function testing device 1 of the present embodiment includes a light receiving element, an imaging optical system that acquires a fundus image using the light receiving element, a stimulation optical system that projects stimulation light on the fundus Er, and a fundus image. A correcting means for analyzing and correcting the light projection position of the stimulus light on the fundus is provided. Thereby, for example, it is easy to perform a precise visual function test in consideration of blood vessel effects.

Second Embodiment
Next, a second embodiment will be described. The visual function inspection device of the second embodiment includes, for example, a connection unit (communication unit) and a registration unit with other inspection devices in addition to the configuration of the first embodiment. The visual function testing device 1 according to the first embodiment described above sets the examination site using the fundus image captured by the observation / imaging optical system 30. On the other hand, in the visual function testing device according to the second embodiment, a normal site and an abnormal site on the retina are specified based on fundus information acquired by another testing device (ophthalmologic device). For example, the visual function inspection apparatus according to the second embodiment includes a fluorescence construction device (SLO capable of fluorescence construction photography such as FA and ICG), a spontaneous fluorescence device (SLO having a FAF function, a fundus camera, etc.), a fundus photography device (fundus) Fundus information acquired by at least one of an inspection apparatus such as a camera or PS-OCT) or a fundus blood flow measurement device (laser speckle flowography, Doppler OCT, or OCT-angiography) is acquired. Here, the visual function testing device of the second embodiment identifies a normal site and an abnormal site on the retina based on the fundus information acquired via the above-described testing device. In addition, the aspect of the combo type | mold inspection apparatus with which the structure of the other test | inspection apparatus mentioned above and the structure of the visual function test | inspection apparatus 1 of this embodiment were united may be sufficient.

  Note that registration between the eye information output by another inspection apparatus and the visual function inspection site may be performed on the DB. The normal part / abnormal part on the fundus information (images) obtained by other inspection apparatuses may be manually specified by a user such as an examiner, or image diagnosis or normal eye DB (database) May be automatically detected from the difference. The identified part may be not only normal / abnormal binarization but also step-by-step information according to the degree of abnormality and the degree of concern. The visual function testing device according to the second embodiment arranges a test pattern (visual field stimulation pattern) as shown in FIG. 8 based on the identified part.

  FIG. 8A is an example in which the control unit 80 automatically arranges the inspection pattern P in consideration of the region Q1 manually set by the examiner. In other words, the visual function testing device of the second embodiment includes area designating means for designating a predetermined area on the fundus image and arrangement means for arranging the examination site on the fundus image. Note that a plurality of inspection patterns of different types are stored in advance in the memory 83 (storage means) of the present embodiment. In addition, the control unit 80 of the present embodiment has a function as a selection unit for selecting any one of a plurality of inspection patterns stored in the storage unit, and an automatic arrangement unit that automatically arranges the selected inspection pattern. As a function. The description of the same reference numerals as those in FIG. 5 described in the first embodiment is omitted. In FIG. 8 (a), an examination part (for example, examination part F3) having a high possibility of an abnormal part is represented by vertical and horizontal stripes, and a normal part and an examination part (for example, examination part F2) that does not overlap with a blood vessel (thick blood vessel). It is represented by oblique hatching, and a normal site and a test site (for example, test site F1) that overlaps with a blood vessel is represented without hatching. In FIG. 8, the examiner is informed of the shape of the examination site F1 that overlaps the blood vessel with a square mark.

  In the present embodiment, the visual function test is performed only on the test site (vertical and horizontal stripe hatching) that is highly likely to be an abnormal site. More specifically, only the area where the inspection pattern P and the specified area (within the area Q1) overlap is inspected. That is, the visual function inspection device of the second embodiment includes a prohibiting unit that prohibits the stimulation light from being projected onto the inspection site arranged outside the predetermined region. FIG. 8B is also an example in which the control unit 80 automatically arranges the inspection pattern P in consideration of the region Q2 set manually by the examiner. The description of the same reference numerals as in FIG. In FIG. 8B as well, the visual function test is performed only on the test site having a high possibility of an abnormal site (vertical and horizontal stripe hatching site: test site F4 and the like). As described above, in the second embodiment, the inspection pattern in which unnecessary patterns are deleted from the inspection pattern P that is the default pattern in consideration of the regions (Q1, Q2) manually set (specified) by the examiner is considered. A functional test is performed. In the present embodiment, an inspection pattern including a plurality of inspection parts is used, but an inspection pattern having only one inspection part may be used. It is only necessary to suppress the projection of the stimulation light to the examination site arranged outside the predetermined area.

<Summary>
The visual function testing device according to the second embodiment includes a light projecting unit that projects stimulation light onto an examination site of the fundus Er of the eye E, a reaction acquisition unit that acquires a reaction of the subject by the stimulation light, and a fundus Er. Fundus image acquisition means for acquiring a fundus image, area designating means for designating a predetermined area on the fundus image, arrangement means for arranging an examination part on the fundus image, and examination part arranged outside the predetermined area There is a prohibition means for prohibiting the projection of stimulation light to the head. Therefore, for example, the inspection time is shortened, and it is easy to follow up only the point to be observed. Still further, the visual function testing device of the second embodiment selects a test pattern that defines the arrangement of a plurality of test sites, a memory that stores a plurality of test patterns having different arrangements, and a test pattern from the memory. The selecting means arranges the inspection pattern selected by the selecting means on the fundus image, and the prohibiting means corrects the inspection pattern to stimulate the light to be inspected outside the predetermined area. Is prohibited. Therefore, for example, even if there are many inspection parts, it is easy to inspect in a short time.

  Note that it may be possible to switch between a stimulus for only a normal part and a stimulus for only an abnormal part. For stepped information, the presence or absence of stimulation may be switched according to the hierarchy. Also, the inspection pattern may be changed without changing the inspection pattern (not deleting some inspection sites), and only the start luminance and the stimulus size may be changed. Furthermore, a false positive or false negative stimulus may be set for a normal site / abnormal site. These operations may be performed manually by a user such as an examiner or may be performed automatically. Further, these operations may be performed on the visual function inspection device (or the visual field measurement device), other inspection equipment, or a database. Furthermore, the application of the present disclosure is preferably a microperimetry type visual function inspection device (field-of-view measuring device) that facilitates accurate registry, but a classical perimeter (for example, a dome-shaped inner surface) that projects a target on a screen. It may be applied to a perimeter that projects a visual target.

  As one of the conventional problems, measurement limited to only a lesioned part or a region where a lesion is suspected cannot be performed, and there is a problem that inspection time can be increased in an unnecessary region. Here, a method of limiting the region only from the layer thickness information of the OCT is conceivable. However, when the abnormality is detected by the OCT, the visual field is not necessarily abnormal. In the technology of the present disclosure, for example, it is easy to omit an unnecessary examination region specialized for a lesion that cannot be determined only by OCT information. In addition, it is easy to shorten the examination time by predicting the threshold result (visual field threshold result) and setting the initial stimulus luminance near the threshold. Further, for example, the visual function of the eye E can be easily and precisely inspected. Needless to say, the technique of the second embodiment may be applied to the first embodiment.

  It should be thought that embodiment disclosed this time is an illustration and restrictive at no points. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

7b: Response button 70: Inspection optical system 80: Control unit E: Eye to be examined Er: Fundus STD: Reference image

Claims (9)

A light projecting means for projecting stimulation light to the examination site of the fundus of the subject eye;
A reaction acquisition means for acquiring a response of the subject by the stimulation light;
Fundus image acquisition means for acquiring a fundus image of the fundus;
Blood vessel detection means for detecting blood vessels of the fundus;
Prediction means for predicting the influence of the blood vessel on the reaction based on the positional relationship between the examination site and the blood vessel;
Informing means for informing the examiner of the prediction result of the predicting means;
A visual function testing device comprising: The visual function testing device according to claim 1 comprises:
The predicting means determines the degree of the influence;
The notification means notifies the degree;
A visual function testing device characterized by the above. The visual function testing device according to claim 2 comprises:
The predicting means considers the size of the stimulation light or the thickness of the blood vessel;
A visual function testing device characterized by the above. The visual function inspection device according to any one of claims 1 to 3,
Comprising synthesis means for generating a synthesized image in which examination information relating to the stimulus light is superimposed on the fundus image,
The examination information is arranged at the position of the examination site on the fundus image,
The notification means determines a color tone, a gradation, or a shape of the inspection information based on a prediction result of the prediction means;
A visual function testing device characterized by the above. The visual function testing device according to claim 4 comprises:
A visual function inspection device, wherein the inspection information includes a threshold value. The visual function testing device according to any one of claims 1 to 5,
An imaging optical system having a light receiving element and acquiring the fundus image using the light receiving element;
A stimulation optical system that projects the stimulation light on the fundus;
Correcting means for analyzing the fundus image and correcting the projection position of the stimulus light on the fundus;
A visual function testing device comprising: The visual function testing device according to any one of claims 1 to 6,
Area designating means for designating a predetermined area on the fundus image;
Disposition means for disposing the examination site on the fundus image;
Prohibiting means for prohibiting the emission of stimulation light to the examination site arranged outside the predetermined area;
A visual function testing device comprising: A light projecting means for projecting stimulation light to the examination site of the fundus of the subject eye;
A reaction acquisition means for acquiring a response of the subject by the stimulation light;
Fundus image acquisition means for acquiring a fundus image of the fundus;
Area designating means for designating a predetermined area on the fundus image;
Disposition means for disposing the examination site on the fundus image;
Prohibiting means for prohibiting the emission of stimulation light to the examination site arranged outside the predetermined area;
A visual function testing device comprising: The visual function testing device according to claim 8 comprises:
A test pattern that defines the placement of multiple test sites;
Storage means for storing a plurality of inspection patterns having different arrangements;
Selecting means for selecting the inspection pattern from the storage means,
The arrangement means arranges the inspection pattern selected by the selection means on the fundus image,
The prohibition unit corrects the inspection pattern and prohibits the projection of the stimulation light to the inspection site arranged outside the predetermined area.
A visual function testing device characterized by the above.

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