Patent Application
20070216865
The present invention relates to focused vision therapy and, in particular, to selectively apportioning light stimulation to different areas of a patient's visual field.
Stimulating the vision system of human subjects with vision impairment may improve their visual performance. For example, as documented in U.S. Pat. No. 6,464,356, and US Published Patent Application No. 2005/0213033, which are hereby incorporated by reference herein in their entirety, presenting visual stimuli to areas of a human's visual system may allow improvement in the user's vision. NovaVision, of Boca Raton, Fla., produces VRT™ (Visual Restoration Therapy) devices for effecting optical stimulation of defined locations of a patient's retina. During a course of VRT, a finite number of stimulation events are available. Therefore, these stimulation events should be judiciously directed to the particular visual field regions for which treatment is desired.
VRT may be used to treat neurological deficits of the visual system of a patient. Such deficits may result from retinal damage, damage to the optic nerve, damage to the visual cortex, such as may occur due to stroke or traumatic brain injury. For example, age related macular degeneration (AMD) may be treated with VRT.
In accordance with an illustrative embodiment of the invention, there is a method for treating the visual system of a human. The method comprises situating the human in proximity to a computer-actuated light emitting array that has a set of individually actuable elements. A campimetric representation of the visual field is used to select a stimulus distribution that is biased toward the central visual field. An actuable element subset is selected from the set of individually actuable elements based on the stimulus distribution. The subset of elements is actuated to emit a light stimulus that is directed to a specified region of the human's visual field.
Various related embodiments are provided including optional or additional features. For example, a fixation stimulus may be presented to the human. The steps of selecting and actuating the light stimulus may be repeated for a given number of cycles. A further step of recording the human's response to the stimuli may be included. The steps of selecting the stimulus, actuating the stimulus, and recording the human's response may be repeated for a given number of cycles. A record of the human's response to the stimuli may be used to update the distribution. For example, a change in the response with time for a given visual field location may be used to update the distribution. The distribution may be automatically updated. The subset of actuable elements may be a single actuable element. The actuable elements may be pixels of a computer display. The retinal area targeted by the subset of the elements may be in increasing relationship with corresponding distance from the center of the human's visual field. For example, larger subsets may be selected to target peripheral visual field regions and smaller subsets to target central visual field regions.
In another embodiment of the invention, there is a method for treating the visual system of the human comprising using a campimetric representation of the visual field to define at least a primary zone, a secondary zone, and a remainder zone. The remainder zone comprises that portion of the visual field that is outside of the other defined zones. A human is situated in proximity to a computer-actuated light emitting array that has a set of actuable elements. An actuable element subset is selected from the set of individually actuable elements and the subset is actuated to emit light stimulus directed to a specified region of the human's visual field. The selection of the actuable elements includes administering an apportioning bias in favor of the primary zone.
Various related embodiments are provided including optional or additional features. The steps of selecting an actuable element subset and actuating the elements to emit light stimulus may be repeated over a course of a therapeutic session so as to present a greater number of stimuli to the primary zone than to the secondary zone or to the remainder zone. The steps of selecting an actuable element subset and actuating the elements to emit light stimulus may be repeated over a course of a therapeutic session so as to present a greater number of stimuli to the primary zone than to the secondary zone or to the remainder zone, and a greater number of stimuli to the secondary zone than to the remainder zone. The number of stimuli presented to the remainder zone may be non-zero. A further step of recording the human's response to the stimuli may be included. A cycle of selecting a stimulus, actuating the stimulus and recording the human's response may be repeated for a given number of cycles. The record of the human's response to the stimuli may be used to redefined the primary zone or the secondary zone. A change in the response with time for a given visual field location may be used to redefine the zone. The redefinition may be done automatically. The subset of actuable elements may be a single actuable element. The retinal area targeted by the subset of elements may increase with corresponding distance from the center of the human's visual field. For example, larger subsets of elements may be selected to target peripheral visual field regions and smaller subsets selected to target central visual field regions.
In accordance with yet another embodiment of the invention, a method is provided for treating the visual system of a human. The method includes using a campimetric representation of the visual field to define a transition zone that is bordered by a blind zone and an intact zone. A human is situated in proximity to a computer-actuated light emitting array having a set of actuable elements. A subset of actuable elements is selected and actuated to a emit light stimulus directed to the transition zone of the human's visual field. The selecting and actuating steps are repeated to effectuate a course of therapy. The selection includes a bias for central visual field regions.
Various related embodiments are provided including optional or additional features. The method may include recording the human's response to the stimuli. The record of the human's response to the stimuli may be used to update the definition of the transition zone. Updating the transition zone may include using a change in the response with time for a given visual field location. The zone may be redefined automatically.
In a further embodiment of the invention, there is a system for treating the visual system of a patient. The system includes a display that has an array of individually actuable light emitting elements adapted to present stimuli to a human during a course of therapy. The system also includes an apportioner that is adapted to accept a campimetric representation of the visual field and apportion a sequence of stimuli to specified regions of the visual field. The system further includes an actuator for actuating display elements according to the apportionment of the apportioner. The apportioner apportions a greater share of stimuli to those the visual field regions nearer the center of the visual field.
Various related embodiments are provided including optional or additional features. The actuator may present a fixation stimulus to the human. The system may include software and/or hardware for recording the human's response to the stimuli, for using the record of the human's response to the stimuli to allocate future stimuli and/or for using a change in the response with time for a given visual field location to allocate future stimuli. The system may include software and/or hardware for varying the targeted retinal area of the presented stimulus so as to increase with corresponding distance from the center of the human's visual field. The retinal area may be targeted by the subset of elements sized in increasing relationship with corresponding distance from the center of the human's visual field by selecting larger stimuli to target peripheral visual field regions and smaller subsets to target central visual field regions.
In a further embodiment of the invention, there is a system for treating the visual system of a patient. The system includes a display having an array of individually actuable light emitting elements adapted to present stimuli to a human during a course of therapy and an apportioner that is adapted to accept a campimetric representation of the visual field and apportion a sequence of stimuli to specified regions with the visual field. The system also includes an actuator for actuating display elements according to the apportionment of the apportioner. The apportioner apportions by using a campimetric representation of the visual field to define at least a primary zone, a secondary zone, and a remainder zone, the remainder zone comprising that portion of the visual field that is outside of the other defined zones.
Various related embodiments are provided including optional or additional features. The system may include software and/or hardware for presenting a greater number of stimuli to the primary zone than to the secondary zone or to the remainder zone. The system may include software and/or hardware for presenting, over the course of therapy, a greater number of stimuli to the primary zone than to the secondary zone or to the remainder zone, and a greater number of stimuli to the secondary zone than to the remainder zone. The number of stimuli presented to the remainder zone may be non-zero. The system may include software and/or hardware for recording the human's response to the stimuli, for using the record of the human's response to the stimuli to allocate future stimuli and/or for using a change in the response with time for a given visual field location to allocate future stimuli. The system may include software and/or hardware for increasing the targeted retinal area of the presented stimulus increases with corresponding distance from the center of the human's visual field. The retinal area may be targeted by the subset of elements in increasing relationship with corresponding distance. The system may include software and/or hardware for using the record of the human's response to the stimuli to redefine one of the primary zone and the secondary zone. The system may use a change in the response with time for a given visual field location to redefine one of the primary zone and the secondary zone. The zone may be automatically redefined.
In a further embodiment of the invention, there is a system for treating the visual system of a patient. The system includes a display having an array of individually actuable light emitting elements adapted to present stimuli to a human during a course of therapy and an apportioner that is adapted to accept a campimetric representation of the visual field and apportion a sequence of stimuli to specified regions with the visual field. The system also includes an actuator for actuating display elements according to the apportionment of the apportioner. The apportioner apportions by using a campimetric representation of the visual field to define at a transition zone bordered by a blind zone and an intact zone and apportion stimuli to the transition zone with a bias toward the central visual field.
Various related embodiments are provided including optional or additional features. The system may include software and/or hardware for recording the human's response to the stimuli, for using the record of the human's response to the stimuli to update the transition zone, for updating the transition zone using a change in the response with time for a given visual field location, and for automatically redefining the transition zone.
The foregoing features of the invention will be more readily understood by reference to the following detailed description, taken with reference to the accompanying drawings, in which:
Definitions. As used in this description and the accompanying claims, the following terms shall have the meanings indicated, unless the context otherwise requires:
Aspects of the present invention may solve the problems outlined above by apportioning or rationing stimuli over a course of VRT so as to optimize stimulation to obtain more significant clinical outcomes when using limited amounts of light stimuli. For a given length of therapy (e.g., a single session, or a course of therapy over weeks or months), a patient will receive a finite number of stimuli. For example, a patient may receive 500-600 stimuli in a 20 to 30 minute VRT session. A therapist may desire to stimulate multiple visual field zones (e.g., both functionally important central areas and ARVs). However, a tradeoff must be made between the number of stimuli directed at a given zone and areal coverage. Illustrative embodiments of the present invention may solve some of these or other problems by dividing a therapy area into regions and applying different stimuli densities to each region. Unless otherwise indicated, the operations of the VRT systems described below may be fully automatic in the sense that the therapist need not intervene during a therapy session or even a multi-session course of therapy.
A campimetric representation of the patient's visual field (a “visual field map”) is obtained (step 110). The representation may be manifested as a multi-dimensional data set or visual field map, either as an array in computer memory, or expressed graphically. The campimetric representation may be the result of a previous VRT session or other campimetric activity. For example, the campimetric representation may contain, as a function of position relative to the a fixation point, or in an array corresponding to pixels on a VRT display, response times, fraction of correct responses, or other data related to the sensitivity of the patient's visual field neurons to light stimuli. Alternately, rather than starting with the map, the map can be generated through subsequent steps in the process, such a those listed below.
The campimetric representation is then used to assign the potential for a given neuron or visual field area to respond to VRT (step 120). For example, depending on the type of therapy chosen by the therapist, regions of the visual field that are partially responding, or are in a transition zone between a blind zone and an intact (i.e., seeing) zone may be indicative of a high recovery potential. Scores may be assigned based on potential. In an another example, a visual field location corresponding to a pixel element of a VRT may be assigned a low score if bounded on all sides by nonresponsive locations (i.e., blind regions), or bounded on all sides by intact regions, whereas locations bounded by both blind and intact locations, or one or more partially responding locations, may be awarded a higher scores. Trending data, i.e. improvements or decreases in patient responses in a given visual field areas may also be used to assign priorities; e.g., stimuli may be better invested in those areas showing an improvement with time. The result of step 120 may be used as a priority map, which may be used to distribute (i.e., apportion) stimuli among multiple locations.
In a specific example of a scoring system, points are awarded to each element in a two dimensional array of VRT pixel locations as follows:
i) locations adjacent to 8 blind locations (locations include diagonal locations)-0 points;
ii) locations adjacent to 8 intact locations—0 points;
iii) locations adjacent to one or more partially responding locations—1 point for each partially responding location;
iv) locations adjacent to both blind and intact locations—5 points
Optionally, additional factors may be used to assign priorities (step 130). Examples of additional factors include therapist intervention, or application of additional biases, which may be arrived at by using physiological or statistical factors. In one embodiment, a physiological bias is included that favors more central visual field regions over more peripheral regions so as to create a stimulus distribution that effects presentation of a larger fraction of the administered stimuli to more central regions. Thus, result may be desirable because more central regions of the visual field (e.g., the center 3-5°) have more neuronal synapses and are thus critical in certain key activities such as reading. The stimuli distribution can be tuned to match approximately the number of neuronal synapses at a given location (i.e. the cortical magnification factor) by using population-derived visual field structures, or maps of the individual patient's visual field.
Stimuli are apportioned to the patient based on the assigned priorities by actuating the individual actuable light-emitting elements of a display device to target a specified region of the patient's visual field. Various techniques are available to apportion the stimuli, including:
i) randomly assigning locations, and multiplying by a weighting factors based on a corresponding scores from those location obtained from the priority map; and
ii) populating a location table with a list of locations, the locations having a frequency that is proportional to priority scores. The sequence of location presentations may then be randomized. Additionally, the list may be further sorted to temporal clustering of stimuli presentations in a given area or zone.
After presenting a given stimuli, a patient response may be recorded; e.g., the by detection of a button actuation by the patient. Response times may also be recorded. Patient responses may be used to update the visual field map “in real time,” i.e., prior to completion of a therapy session or course of therapy. In other words, the loop is closed by returning to step 110 and repeating the loop for the duration of therapy (step 160). As discussed above, derivative aspects of the patient response, including temporal improvements of the patient response accuracy, response time, or threshold intensity required for a patient to see a stimulus may be utilized in setting priorities and assigning the apportioning distribution. Alternately, the loop may be closed by returning to step 140.
In accordance with another embodiment, the effectiveness of stimulus allocation is improved by varying the size of a stimulus according to the selected visual field location targeted by the stimulus. Because visual field resolution decreases with distance from the center of the visual field in a known way, stimulation of various neurons can be accomplished with different stimulus sizes (e.g., by altering the number of adjacent elements actuated). This approach may result in improved economies of stimulation allocation. For example, a computerized VRT apparatus may use an algorithm that randomly distributes stimuli, but avoids repetitive stimulation in the same location; using larger stimuli in peripheral regions of the visual field will result in a bias in favor of the central visual field. The larger stimuli are sized so as to illuminate a larger area of the patient's retina.
In a specific embodiment, the transition zone is defined as the primary zone and receives the majority of the stimuli, e.g., 70%. The remaining stimuli are presented to a border region secondary zone. The transition zone may be either continuous or discontinuous. The border region may be sized to extend beyond the transition zone into both blind and intact zones by a certain amount. For example, approximately two visual field cells on either side of the transition zone may be targeted. The patient response record may be used, periodically or continuously, to update the transition zone definition. A central visual field bias may also be applied to the transition zone.
In a related embodiment, vision is more intensely stimulated in a given zone, yet patient response is tracked by stimulating outside the given zone with fewer stimuli, and optionally, at a lower frequency (i.e., stimuli per unit time) in order to track patient response across a larger visual field region or the entire visual field. In this way, the various cells in the visual field are reconnoitered for potential recruitment into the set of locations receiving the more intense or frequent therapy. For example, in this way, a cell may be discovered to be exhibiting a recovery trend and the therapy regimen is adjusted accordingly (either automatically, or manually)
In various embodiments, zones may be defined and redefined automatically. However, tools may be provided to a therapist to define zones manually. For example, zones may be drawn on a computer screen so as to overlay a visual representation of the visual field (e.g., a campimetric map). For example, circles or ovals may be drawn to demark a zone for preferential stimulus apportionment.
In alternative embodiments, the disclosed methods for stimulative therapy may be implemented as a computer program product for use with a computer system. Such implementations may include a series of computer instructions fixed either on a tangible medium, such as a computer readable medium (e.g., a diskette, CD-ROM, ROM, or fixed disk) or transmittable to a computer system, via a modem or other interface device, such as a communications adapter connected to a network over a medium. The medium may be either a tangible medium (e.g., optical or analog communications lines) or a medium implemented with wireless techniques (e.g., microwave, infrared or other transmission techniques). The series of computer instructions embodies all or part of the functionality previously described herein with respect to the system. Those skilled in the art should appreciate that such computer instructions can be written in a number of programming languages for use with many computer architectures or operating systems.
Furthermore, such instructions may be stored in any memory device, such as semiconductor, magnetic, optical or other memory devices, and may be transmitted using any communications technology, such as optical, infrared, microwave, or other transmission technologies. It is expected that such a computer program product may be distributed as a removable medium with accompanying printed or electronic documentation (e.g., shrink wrapped software), preloaded with a computer system (e.g., on system ROM or fixed disk), or distributed from a server or electronic bulletin board over the network (e.g., the Internet or World Wide Web). Of course, some embodiments of the invention may be implemented as a combination of both software (e.g., a computer program product) and hardware. Still other embodiments of the invention are implemented as entirely hardware, or entirely software (e.g., a computer program product).
The described embodiments of the invention are intended to be merely exemplary and numerous variations and modifications will be apparent to those skilled in the art. All such variations and modifications are intended to be within the scope of the present invention as defined in the appended claims.
This application claims priority from U.S. Provisional Patent Application Ser. No. 60/784,235, filed Mar. 21, 2006, and is a continuation-in-part of U.S. patent application Ser. No. 10/503,869, filed May 18, 2005 in the United States, which claims priority from PCT Patent Application No. PCT/EP02/01339, which was filed in English on Feb. 8, 2002; all of these applications are hereby incorporated by reference in their entirety.
| Number | Date | Country | |
|---|---|---|---|
| 60784235 | Mar 2006 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10503869 | May 2005 | US |
| Child | 11689230 | Mar 2007 | US |
