A Novel Approach to AMD Detection: Using an Augmented Reality Headset for Dark Adaptometry

Abstract

Purpose : To evaluate the use of a rapid dark adaptation (DA) test on an augmented reality head-mounted display to differentiate among healthy and those with mild, moderate, and severe dry and wet age-related macular degeneration (AMD).

Methods : A DA test was administered to 110 subjects (69 females and 41 males) aged 50 to 88. The normal cohort consisted of 62 subjects without any pathology that may impact DA while the disease cohorts consisted of 48 subjects with varying severities of AMD (23 mild, 18 moderate, and 7 severe). The test was administered using Heru (Heru, Inc., Miami, FL) software on a Magic Leap 1 (Magic Leap, Plantation, FL) device with a light shield and a neutral density filter to establish a dark testing environment. A spherical equivalent distance correction was used as needed. A two-step calibration was used to ensure proper eye tracking and bleach location. Consistent photoreceptor bleaching was achieved with Heru’s Dark Adaptation Accessory System by using a set number of flashes inversely proportional to the pupil size. During the test, stimuli were presented to the bleached photoreceptors. Thresholds were recorded as the subject responded to stimuli of varying luminance. These thresholds were plotted over time and used to determine the DA Index (DAI). A higher DAI indicates a better dark adaptation recovery rate. Due to differences in sample size, bootstrap resampling was used within each cohort to estimate mean DAIs.

Results : Data analysis showed a statistically significant difference (p<0.0001, Kruskal-Wallis test) between normal and each of the diseased cohorts. The normal cohort had a sample mean DAI of 0.688 (±0.022). The AMD cohorts consisted of mild with a sample mean DAI of 0.556 (±0.038), moderate with a sample mean DAI of 0.393 (±0.037), and severe with a sample mean DAI of 0.263 (±0.04). These metrics are shown in Figure 1.

Conclusions : Heru’s DA rapid test is a 4.5-minute dark adaptometer that allows clinicians to screen and monitor for AMD progression. The statistically significant difference in the mean cohort DAIs shows that this test is capable of differentiating disease severity. Further studies could aid in the use of DAI for the screening of glaucoma, retinal toxicity, and ischemic vasculopathies.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1: Bootstrap resampling analysis. The whiskers and boxes represent the 90% and 50% confidence intervals for the cohort mean DAI, respectively.