Pilot study of a pedestrian collision detection test for a multisite trial of field expansion devices for hemianopia.

SIGNIFICANCE: Performance-based outcome measures are crucial for clinical trials of field expansion devices. We implemented a test simulating a real-world mobility situation, focusing on detection of a colliding pedestrian among multiple noncolliding pedestrians, suitable for measuring the effects of homonymous hemianopia and assistive devices in clinical trials. PURPOSE: In preparation for deploying the test in a multisite clinical trial, we conducted a pilot study to gather preliminary data on blind-side collision detection performance with multiperiscopic peripheral prisms compared with Fresnel peripheral prisms. We tested the hypothesis that detection rates for colliding pedestrians approaching on a 40° bearing angle (close to the highest collision risk when walking) would be higher with 100Δ oblique multiperiscopic (≈42° expansion) than 65Δ oblique Fresnel peripheral prisms (≈32° expansion). METHODS: Six participants with homonymous hemianopia completed the test with and without each type of prism glasses, after using them in daily mobility for a minimum of 4 weeks. The test, presented as a video on a large screen, simulated walking through a busy shopping mall. Colliding pedestrians approached from the left or the right on a bearing angle of 20 or 40°. RESULTS: Overall, blind-side detection was only 23% without prisms but improved to 73% with prisms. For multiperiscopic prisms, blind-side detection was significantly higher with than without prisms at 40° (88 vs. 0%) and 20° (75 vs. 0%). For Fresnel peripheral prisms, blind-side detection rates were not significantly higher with than without prisms at 40° (38 vs. 0%) but were significantly higher with prisms at 20° (94 vs. 56%). At 40°, detection rates were significantly higher with multiperiscopic than Fresnel prisms (88 vs. 38%). CONCLUSIONS: The collision detection test is suitable for evaluating the effects of hemianopia and prism glasses on collision detection, confirming its readiness to serve as the primary outcome measure in the upcoming clinical trial.

Understanding viewpoint changes in peripheral prisms for field expansion by virtual reality simulation.

Prism field expansion is a common treatment for patients with peripheral field loss, shifting images from the blind field into the seeing field. The shifted image originates from a new viewpoint translated and rotated from the original viewpoint by the prism. To understand such viewpoint changes, we simulated two field expansion methods in virtual reality: 1) angular (i.e., rotational) field expansion and 2) linear field expansion via image crop-and-shift. Changes to object locations, sizes, and optic flow patterns by those methods were demonstrated and analyzed in both static and dynamic conditions, which may affect navigation with such field expansion devices.

Egocentric Boundaries on Distinguishing Colliding and Non-Colliding Pedestrians while Walking in a Virtual Environment.

Avoiding person-to-person collisions is critical for visual field loss patients. Any intervention claiming to improve the safety of such patients should empirically demonstrate its efficacy. To design a VR mobility testing platform presenting multiple pedestrians, a distinction between colliding and non-colliding pedestrians must be clearly defined. We measured nine normally sighted subjects' collision envelopes (CE; an egocentric boundary distinguishing collision and non-collision) and found it changes based on the approaching pedestrian's bearing angle and speed. For person-to-person collision events for the VR mobility testing platform, non-colliding pedestrians should not evade the CE.

A rare case of ductal variant multilocular prostatic cystadenocarcinoma invading the rectum.

Prostate papillary and cribriform ductal prostatic adenocarcinoma is a rare malignancy infrequently reported in the literature. We describe a case of rectally invasive prostate cystic adenocarcinoma and surgical extirpative management not requiring fecal or urinary diversion.

Development of Virtual Reality Walking Collision Detection Test on Head-mounted display.

Detecting and avoiding collisions during walking is critical for safe mobility. To determine the effectiveness of clinical interventions, a realistic objective outcome measure is needed. A real-world obstacle course with moving hazards has numerous limitations (e.g., safety concerns of physical collision, inability to control events, maintaining event consistency, and event randomization). Virtual reality (VR) platforms may overcome such limitations. We developed a VR walking collision detection test using a standalone head-mounted display (HMD, Meta Quest 2) with the Unity 3D engine to enable subjects' physical walking within a VR environment (i.e., a busy shopping mall). The performance measures focus on the detection and avoidance of potential collisions, where a pedestrian may (or may not) walks toward a collision with the subject, while various non-colliding pedestrians are presented simultaneously. The physical space required for the system was minimized. During the development, we addressed expected and unexpected hurdles, such as mismatch of visual perception of VR space, limited field of view (FOV) afforded by the HMD, design of pedestrian paths, design of the subject task, handling of subject's response (detection or avoidance behavior), use of mixed reality (MR) for walking path calibration. We report the initial implementation of the HMD VR walking collision detection and avoidance scenarios that showed promising potential as clinical outcome measures.

Metastatic papillary thyroid carcinoma presenting as an isolated renal mass: Case report and review of the literature.

Distant metastasis of Papillary Thyroid Cancer (PTC) to the kidney(s), while rare, has been observed, with approximately 30 cases described in the literature. We present the case of a 28-year-old male who was diagnosed with metastatic PTC following resection of a solitary renal mass. Pathological analysis of the thyroid gland following subsequent thyroidectomy revealed positive regional lymph nodes consistent with metastatic PTC, however, no evidence of malignancy was identified in the thyroid gland. To our knowledge, this is the only known case of metastatic PTC involving the kidney in which no primary lesion was found in the thyroid gland.

A Pilot Study on EEG-Based Evaluation of Visually Induced Motion Sickness.

The most prominent problem in virtual reality (VR) technology is that users may experience motion sickness-like symptoms when they immerse into a VR environment. These symptoms are recognized as visually induced motion sickness (VIMS) or virtual reality motion sickness (VRMS). The objectives of this study were to investigate the association between the electroencephalogram (EEG) and subjectively rated VIMS level (VIMSL) and find the EEG markers for VIMS evaluation. In this study, a VR-based vehicle-driving simulator (VDS) was used to induce VIMS symptoms, and a wearable EEG device with four electrodes, the Muse, was used to collect EEG data of subjects. Our results suggest that individual tolerance, susceptibility, and recoverability to VIMS varied largely among subjects; the following markers were shown to be significantly different from no-VIMS and VIMS states (P < 0.05): (1) Means of gravity frequency (GF) for theta@FP1, alpha@TP9, alpha@FP2, alpha@TP10, and beta@FP1; (2) Standard deviation of GF for alpha@TP9, alpha@FP1, alpha@FP2, alpha@TP10, and alpha@(FP2-FP1); (3) Standard deviation of power spectral entropy (PSE) for FP1; (4) Means of Kolmogorov complexity (KC) for TP9, FP1, and FP2. These results also demonstrate that it is feasible to perform VIMS evaluation using an EEG device with a small number of electrodes.

Self-position awareness based presence and interaction in virtual reality.

The awareness of self-position, which refers to the location of our cyclopean eye, is essential to the experience of being immersed and for interacting with a virtual environment. Currently, individual variability in the cyclopean eye location is not considered when presenting virtual reality (VR) content. The effect of the cyclopean eye shift was analyzed with theoretical and experimental methods, and it was found that human vision is sensitive to the visual direction offset caused by the cyclopean eye shift. To compensate for the cyclopean eye shift, an original model is proposed with shifting the 3D camera system accordingly. The proposed method is expected to make all individuals with different cyclopean eye shifts perceive the virtual environment from the same viewpoint as the designer desired and may achieve more accurate interaction.

Comparison of Pedestrian Detection With and Without Yellow-Lens Glasses During Simulated Night Driving With and Without Headlight Glare.

IMPORTANCE: Some marketing materials for yellow-lens night-driving glasses claim that they increase nighttime road visibility and reduce oncoming headlight glare (HLG). However, there is no scientific evidence to support these claims. OBJECTIVE: To measure the association between yellow-lens glasses and the detection of pedestrians with and without an oncoming HLG, using a driving simulator equipped with a custom HLG simulator. DESIGN, SETTING, AND PARTICIPANTS: A single-center cohort study was conducted between September 8, 2016, and October 25, 2017, at the Schepens Eye Research Institute. A total of 22 individuals participated in the study, divided into groups to determine response to a pedestrian wearing a navy blue shirt by younger individuals and, to control for participant's age and the interaction of the shirt color with the filter, response to a pedestrian wearing an orange shirt by a group of younger and older participants. EXPOSURES: Participants drove scripted night-driving scenarios, 3 times with 3 commercially available yellow-lens glasses and once with clear-lens glasses, with the HLG simulator turned on and off. A total of 8 conditions were used for each participant. MAIN OUTCOMES AND MEASURES: Pedestrian detection response time. RESULTS: The 22 participants who completed the study included 12 younger (mean [SD] age, 28 [7] years; 6 men) individuals who responded to a pedestrian wearing a dark navy blue shirt, as well as 6 younger (mean [SD] age, 27 [4] years; 4 men) and 4 older (mean [SD], 70 [11] years; all men) participants who responded to a pedestrian in an orange shirt. All participants had normal visual acuity (mean [SD], -0.05 [0.06] logMAR). No significant difference in response time with yellow lens was found in all experiment conditions; younger participants for dark navy blue shirt pedestrians (F1,33 = 0.59; P = .45), orange shirt pedestrians (F1,15 = 0.13; P = .72), and older participants for orange shirt pedestrians (F1,9 = 0.84; P = .38). Among all participants (n = 22), no significant main effect of yellow lenses was found (F1,63 = 0.64; P = .42). In all measuring conditions, the response times with the yellow lenses were not better than with the clear lenses. Significant main effects of HLG were found with dark navy blue shirt pedestrian condition for young participants (F1,33 = 7.34; P < .001) and with orange shirt pedestrian condition for older individuals (F1,9 = 75.32; P < .001), where the difference in response time between with and without HLG was larger for older (1.5 seconds) than younger (0.3 seconds) participants. CONCLUSIONS AND RELEVANCE: Using a driver simulator equipped with an HLG simulator, yellow-lens night-driving glasses did not appear to improve pedestrian detection at night or reduce the negative effects of HLG on pedestrian detection performance. These findings do not appear to support having eye care professionals advise patients to use yellow-lens night-driving glasses.

IMPACT OF HEADLIGHT GLARE ON PEDESTRIAN DETECTION WITH UNILATERAL CATARACT.

Detecting pedestrians while driving at night is difficult, and is further impeded by oncoming headlight glare (HLG). Cataracts increase intraocular light scattering, making the task even more challenging. We used a within-subjects repeated measures design to determine the impact of HLG on driving with unilateral cataract. Pedestrian detection performance of six young normal vision (NV) subjects was measured with clear lens glasses and with simulated unilateral cataract (0.8 Bangerter foil) glasses. The subjects drove night-time scenarios in a driving simulator with and without custom simulated headlight glare. With simulated unilateral cataracts, pedestrian detection rates decreased and response times increased with oncoming HLG. We verified these effects with six patients who already underwent cataract surgery for one eye and were scheduled to get cataract surgery in the other eye. We measured their performance before and after the second cataract surgery. The results were similar to those obtained with the simulated unilateral cataract, confirming that a negative impact of HLG persists with untreated cataract in one eye.

Stereoscopic 3D Optic Flow Distortions Caused by Mismatches between Image Acquisition and Display Parameters.

We analyze the impact of common stereoscopic 3D (S3D) depth distortion on S3D optic flow in virtual reality (VR) environments. The depth distortion is introduced by mismatches between the image acquisition and display parameter. The results show that such S3D distortions induce large S3D optic flow distortions and may even induce partial/full optic flow reversal within a certain depth range, depending on the viewer's moving speed and the magnitude of S3D distortion introduced. We hypothesize that the S3D optic flow distortion may be a source of intra-sensory conflict that may be a source of visually induced motion sickness (VIMS) in S3D.

Correcting geometric distortions in stereoscopic 3D imaging.

Motion in a distorted virtual 3D space may cause visually induced motion sickness. Geometric distortions in stereoscopic 3D can result from mismatches among image capture, display, and viewing parameters. Three pairs of potential mismatches are considered, including 1) camera separation vs. eye separation, 2) camera field of view (FOV) vs. screen FOV, and 3) camera convergence distance (i.e., distance from the cameras to the point where the convergence axes intersect) vs. screen distance from the observer. The effect of the viewer's head positions (i.e., head lateral offset from the screen center) is also considered. The geometric model is expressed as a function of camera convergence distance, the ratios of the three parameter-pairs, and the offset of the head position. We analyze the impacts of these five variables separately and their interactions on geometric distortions. This model facilitates insights into the various distortions and leads to methods whereby the user can minimize geometric distortions caused by some parameter-pair mismatches through adjusting of other parameter pairs. For example, in postproduction, viewers can correct for a mismatch between camera separation and eye separation by adjusting their distance from the real screen and changing the effective camera convergence distance.

Impact of Oncoming Headlight Glare With Cataracts: A Pilot Study.

Purpose: Oncoming headlight glare (HLG) reduces the visibility of objects on the road and may affect the safety of nighttime driving. With cataracts, the impact of oncoming HLG is expected to be more severe. We used our custom HLG simulator in a driving simulator to measure the impact of HLG on pedestrian detection by normal vision subjects with simulated mild cataracts and by patients with real cataracts. Methods: Five normal vision subjects drove nighttime scenarios under two HLG conditions (with and without HLG: HLGY and HLGN, respectively), and three vision conditions (with plano lens, simulated mild cataract, and optically blurred clip-on). Mild cataract was simulated by applying a 0.8 Bangerter diffusion foil to clip-on plano lenses. The visual acuity with the optically blurred lenses was individually chosen to match the visual acuity with the simulated cataract clip-ons under HLGN. Each nighttime driving scenario contains 24 pedestrian encounters, encompassing four pedestrian types; walking along the left side of the road, walking along the right side of the road, crossing the road from left to right, and crossing the road from right to left. Pedestrian detection performances of five patients with mild real cataracts were measured using the same setup. The cataract patients were tested only in HLGY and HLGN conditions. Participants' visual acuity and contrast sensitivity were also measured in the simulator with and without stationary HLG. Results: For normal vision subjects, both the presence of oncoming HLG and wearing the simulated cataract clip-on reduced pedestrian detection performance. The subjects performed worst in events where the pedestrian crossed from the left, followed by events where the pedestrian crossed from the right. Significant interactions between HLG condition and other factors were also found: (1) the impact of oncoming HLG with the simulated cataract clip-on was larger than with the plano lens clip-on, (2) the impact of oncoming HLG was larger with the optically blurred clip-on than with the plano lens clip-on, but smaller than with the simulated cataract clip-on, and (3) the impact was larger for the pedestrians that crossed from the left than those that crossed from the right, and for the pedestrians walking along the left side of the road than walking along the right side of the road, suggesting that the pedestrian proximity to the glare source contributed to the performance reduction. Under HLGN, almost no pedestrians were missed with the plano lens or the simulated cataract clip-on (0 and 0.5%, respectively), but under HLGY, the rate of pedestrian misses increased to 0.5 and 6%, respectively. With the optically blurred clip-on, the percent of missed pedestrians under HLGN and HLGY did not change much (5% and 6%, respectively). Untimely response rate increased under HLGY with the plano lens and simulated cataract clip-ons, but the increase with the simulated cataract clip-on was significantly larger than with the plano lens clip-on. The contrast sensitivity with the simulated cataract clip-on was significantly degraded under HLGY. The visual acuity with the plano lens clip-on was significantly improved under HLGY, possibly due to pupil myosis. The impact of HLG measured for real cataract patients was similar to the impact on performance of normal vision subjects with simulated cataract clip-ons. Conclusion: Even with mild (simulated or real) cataracts, a substantial negative effect of oncoming HLG was measurable in the detection of crossing and walking-along pedestrians. The lowered pedestrian detection rates and longer response times with HLGY demonstrate a possible risk that oncoming HLG poses to patients driving with cataracts.

Rapid Adaptation of Night Vision.

Apart from the well-known loss of color vision and of foveal acuity that characterizes human rod-mediated vision, it has also been thought that night vision is very slow (taking up to 40 min) to adapt to changes in light levels. Even cone-mediated, daylight, vision has been thought to take 2 min to recover from light adaptation. Here, we show that most, though not all adaptation is rapid, taking less than 0.6 s. Thus, monochrome (black-white-gray) images can be presented at mesopic light levels and be visible within a few 10th of a second, even if the overall light level, or level of glare (as with passing headlamps while driving), changes abruptly.

Positive and negative polarity contrast sensitivity measuring app.

Contrast sensitivity (CS) quantifies an observer's ability to detect the smallest (threshold) luminance difference between a target and its surrounding. In clinical settings, printed letter contrast charts are commonly used, and the contrast of the letter stimuli is specified by the Weber contrast definition. Those paper-printed charts use negative polarity contrast (NP, dark letters on bright background) and are not available with positive polarity contrast (PP, bright letters on dark background), as needed in a number of applications. We implemented a mobile CS measuring app supporting both NP and PP contrast stimuli that mimic the paper charts for NP. A novel modified Weber definition was developed to specify the contrast of PP letters. The validity of the app is established in comparison with the paper chart. We found that our app generates more accurate and a wider range of contrast stimuli than the paper chart (especially at the critical high CS, low contrast range), and found a clear difference between NP and PP CS measures (CSNP>CSPP) despite the symmetry afforded by the modified Weber contrast definition. Our app provides a convenient way to measure CS in both lighted and dark environments.

New Contrast Metric for Realistic Display Performance Measure.

The contrast ratio (CR) has been used to describe display's performance. However, CR is unbound, ignores the impact of ambient illumination, or viewer's contrast perception. We propose new metric for display's contrast performance based on a modified Weber contrast definition that considers human contrast adaptation and applies for both opaque and see-through displays.

An augmented-reality edge enhancement application for Google Glass.

PURPOSE: Google Glass provides a platform that can be easily extended to include a vision enhancement tool. We have implemented an augmented vision system on Glass, which overlays enhanced edge information over the wearer's real-world view, to provide contrast-improved central vision to the Glass wearers. The enhanced central vision can be naturally integrated with scanning. METHODS: Google Glass' camera lens distortions were corrected by using an image warping. Because the camera and virtual display are horizontally separated by 16 mm, and the camera aiming and virtual display projection angle are off by 10°, the warped camera image had to go through a series of three-dimensional transformations to minimize parallax errors before the final projection to the Glass' see-through virtual display. All image processes were implemented to achieve near real-time performance. The impacts of the contrast enhancements were measured for three normal-vision subjects, with and without a diffuser film to simulate vision loss. RESULTS: For all three subjects, significantly improved contrast sensitivity was achieved when the subjects used the edge enhancements with a diffuser film. The performance boost is limited by the Glass camera's performance. The authors assume that this accounts for why performance improvements were observed only with the diffuser filter condition (simulating low vision). CONCLUSIONS: Improvements were measured with simulated visual impairments. With the benefit of see-through augmented reality edge enhancement, natural visual scanning process is possible and suggests that the device may provide better visual function in a cosmetically and ergonomically attractive format for patients with macular degeneration.

Instability of the perceived world while watching 3D stereoscopic imagery: A likely source of motion sickness symptoms.

Watching 3D content using a stereoscopic display may cause various discomforting symptoms, including eye strain, blurred vision, double vision, and motion sickness. Numerous studies have reported motion-sickness-like symptoms during stereoscopic viewing, but no causal linkage between specific aspects of the presentation and the induced discomfort has been explicitly proposed. Here, we describe several causes, in which stereoscopic capture, display, and viewing differ from natural viewing resulting in static and, importantly, dynamic distortions that conflict with the expected stability and rigidity of the real world. This analysis provides a basis for suggested changes to display systems that may alleviate the symptoms, and suggestions for future studies to determine the relative contribution of the various effects to the unpleasant symptoms.

Development of a Headlight Glare Simulator for a Driving Simulator.

We describe the design and construction of a headlight glare simulator to be used with a driving simulator. The system combines a modified programmable off-the-shelf LED display board and a beamsplitter so that the LED lights, representing the headlights of oncoming cars, are superimposed over the driving simulator headlights image. Ideal spatial arrangement of optical components to avoid misalignments of the superimposed images is hard to achieve in practice and variations inevitably introduce some parallax. Furthermore, the driver's viewing position varies with driver's height and seating position preferences exacerbate such misalignment. We reduce the parallax errors using an intuitive calibration procedure (simple drag-and-drop alignment of nine LED positions with calibration dots on the screen). To simulate the dynamics of headlight brightness changes when two vehicles are approaching, LED intensity control algorithms based on both headlight and LED beam shapes were developed. The simulation errors were estimated and compared to real-world headlight brightness variability.

Semantic guidance of eye movements in real-world scenes.

The perception of objects in our visual world is influenced by not only their low-level visual features such as shape and color, but also their high-level features such as meaning and semantic relations among them. While it has been shown that low-level features in real-world scenes guide eye movements during scene inspection and search, the influence of semantic similarity among scene objects on eye movements in such situations has not been investigated. Here we study guidance of eye movements by semantic similarity among objects during real-world scene inspection and search. By selecting scenes from the LabelMe object-annotated image database and applying latent semantic analysis (LSA) to the object labels, we generated semantic saliency maps of real-world scenes based on the semantic similarity of scene objects to the currently fixated object or the search target. An ROC analysis of these maps as predictors of subjects' gaze transitions between objects during scene inspection revealed a preference for transitions to objects that were semantically similar to the currently inspected one. Furthermore, during the course of a scene search, subjects' eye movements were progressively guided toward objects that were semantically similar to the search target. These findings demonstrate substantial semantic guidance of eye movements in real-world scenes and show its importance for understanding real-world attentional control.