WO2021048913A1 - Ophthalmic device - Google Patents

Abstract

Provided is an ophthalmic device capable of capturing a tomographic fundus image using OCT while performing visual field measurement.　This ophthalmic device is provided with: a visual field detection unit which is for performing visual field inspection on an eye to be inspected, and which includes an index display unit that has an outer surface and an inner surface and displays an index for visual field inspection by reflecting spot light projected onto the inner surface, and a visual index projection unit for projecting the spot light onto a desired position on the inner surface; an acquisition unit which is disposed on the outer surface side of the index display unit and acquires a tomographic fundus image of the eye to be inspected; and a movement unit for moving the acquisition unit so that the tomographic image is acquired.

Description

Ophthalmic equipment

The present invention relates to an ophthalmic apparatus.

Japanese Patent Application Laid-Open No. 2555882 discloses an ophthalmoscope that projects an index onto a dome to measure the visual field of the eye to be inspected, but an ophthalmic apparatus capable of performing tomography of the fundus by OCT while performing visual field measurement is desired. It is rare.

The ophthalmologic apparatus of the present disclosure technology has an outer surface and an inner surface, and has an index presenting unit that presents an index for visual field examination by reflecting the spot light projected on the inner surface, and the spot light on the inner surface. A visual field test unit for performing a visual field test of the eye to be inspected, including an optotype projection unit that projects at a desired position, and a tomographic image of the fundus of the eye to be inspected are obtained by being arranged on the outer surface side of the index presentation unit. An acquisition unit to be acquired, a moving unit that moves the acquisition unit so that the tomographic image is acquired, and a moving unit.
To be equipped.

It is a block diagram of the ophthalmology system 100 of the 1st Embodiment. It is a schematic block diagram which shows the whole structure of the ophthalmic apparatus 110 of 1st Embodiment. It is a schematic block diagram of the drive unit 60 of the ophthalmic apparatus 110 of 1st Embodiment. It is a schematic block diagram of the OCT unit 40 of the 1st Embodiment. The positions of the index presentation section 70, the dome 80, the eye 12 to be inspected, and the OCT unit 40, how the light of the index 74 reaches the eye 12 to be inspected, and the tomographic image of the fundus of the eye to be inspected 12 are acquired by the OCT unit 40. It is a figure which showed the state of being. It is a figure which showed the range 82R1 of the index projected on the inner surface 82 of the dome 80, and the range 82C0 of the inner surface 82 of the dome 80 corresponding to the range of the fundus of the eye to be inspected 12 which can acquire the tomographic image by the OCT unit 40. .. The range 82R2 of the fundus 12G of the eye to be inspected 12 corresponding to the range 82R1 of the index 74 projected on the inner surface 82 of the dome 80, and the range 82C1 of the fundus 12G of the eye to be inspected 12 to which the OCT unit 40 can acquire a tomographic image. It is a figure shown. It is a figure which shows that the range where the OCT unit 40 can acquire the tomographic image changes from the range 82C1 to the range 82C2 when the drive unit 60 rotates the OCT unit 40 clockwise with respect to a pupil. It is a block diagram of the function of the CPU 22 of the ophthalmic apparatus 110. It is a flowchart of the field of view measurement and OCT image acquisition processing program of 1st Embodiment. It is a figure which shows the visual field inspection map M. It is a figure which shows the state that the OCT unit 40 was rotated upward. It is a figure which showed the state which the OCT unit 40 was rotated downward. It is a figure which showed the appearance that the hole (84C, 84U-84R) was provided in the center of the inner surface 82 of the dome 80 and the top, bottom, left and right of the second embodiment. It is a figure which showed the position of the dome 80, the eye examinee 12, and the OCT unit 40X of the 2nd Embodiment. It is a figure which shows the range which can acquire the tomographic image by the OCT unit 40X in the 2nd Embodiment.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
[First Embodiment]
Hereinafter, the first embodiment will be described.

The configuration of the ophthalmic system 100 of the first embodiment will be described with reference to FIG. As shown in FIG. 1, the ophthalmology system 100 includes an ophthalmology device 110, a scanning laser optometry device (SLO (Scanning Laser Opphthalmoscope) device) 120, a management server device (hereinafter referred to as “server”) 140, and an image. It is equipped with a display device (hereinafter referred to as "viewer") 150. The ophthalmic apparatus 110 measures the presence or absence of a visual field defect in the fundus of the patient's eye to be inspected (so-called visual field test), and acquires a tomographic image of the retina (referred to as “OCT image”). The SLO device 120 acquires a frontal view image (referred to as an SLO image) of the fundus by scanning the fundus of the patient's eye with a laser. The server 140 stores the visual field measurement result and the OCT image obtained by the ophthalmic apparatus 110 and the SLO image obtained by the SLO apparatus 120 corresponding to the ID of the subject (also referred to as a patient). The viewer 150 displays various images and the like acquired from the server 140 and the visual field measurement results.

The ophthalmic apparatus 110, the SLO apparatus 120, the server 140, and the viewer 150 are connected to each other via the network 130.

FIG. 2A shows a block diagram of the ophthalmic apparatus 110. As shown in FIG. 2A, the ophthalmic apparatus 110 includes a visual field test unit 10, an OCT unit 40, a drive unit 60, a display unit 34, and a control unit 20. As described above, the ophthalmic apparatus 110 is configured as one apparatus including the visual field test unit 10 and the OCT unit 40.
The OCT unit 40 is an example of the “acquisition unit” of the technique of the present disclosure. The drive unit 60 is an example of a "moving unit" of the technology of the present disclosure. The visual field inspection unit 10 is an example of the "visual field inspection unit" of the technique of the present disclosure.

The visual field test unit 10 includes an index presentation section 70, a hemispherical dome 80, and a reaction switch 36, and performs a visual field test of the eye to be inspected. The dome 80 is hemispherical, has an outer surface and an inner surface 82, and an index is presented on the inner surface 82. The index presentation section 70 projects the spot light onto the inner surface 82 as an index. The index is projected at a time staggered position within a predetermined range 82R1 (see also FIGS. 4 and 5A) of the inner surface 82 according to the visual field measurement program. As shown in FIG. 4, the index presentation section 70 includes an index presentation light source 70A that irradiates a spot light, a mirror 70B having a reflection surface facing a portion of the index presentation light source 70A that irradiates the spot light, and a reflection surface of the mirror 70B. It is provided with a moving unit 70C for moving the light source. The direction of the reflecting surface of the mirror 70B is changed by the moving portion 70C. The presentation position of the index is determined by the orientation of the mirror 70B. The reflective surface of the mirror 70B is moved so as to project the spot light emitted from the index presentation light source 70A to a desired position within the range 82R1 of the inner surface 82 under the control of the moving unit 70C controlled by the control unit 20. Be done. The reaction switch 36 is switched on by the subject when the subject recognizes the index presented on the inner surface 82 of the dome 80, and the switched-on reaction switch 36 outputs a perceptual signal to the control unit 20. To do.
The dome 80 is an example of the “index presentation unit” of the technology of the present disclosure, and the index presentation section 70 is an example of the “objective projection unit” of the technology of the present disclosure.
The technique of the present disclosure is not limited to the hemispherical dome 80, and may be a plane, a spherical surface, a curved surface, a polyhedral surface, a polyhedral surface, or the like in a closed space, and may be a surface capable of presenting a visual field inspection index. Just do it.

The OCT unit 40 is arranged in the space on the outer surface side of the dome 80.

The drive unit 60 pivots the OCT unit 40 arranged in the space on the outer surface side of the dome 80 with reference to the pupil of the eye to be inspected.
FIG. 2B shows a schematic configuration of the drive unit 60. As shown in FIG. 2B, both ends of the drive unit 60 are fixed to a frame (not shown) of the ophthalmic apparatus 110, and rails 60A are located in the YY plane and arranged along an arc with respect to the pupil. It has. The drive unit 60 includes rails 60B located in the ZX plane and arranged along an arc with respect to the pupil. In the drive unit 60, the rail 60B is fixed, the mover 60C that can move along the rail 60A with the rail 60B, and the rail 60B with the OCT unit 40 fixed so that the optical axis is located in the pupil. It is provided with a moving unit 60D that can move along the line.

The mover 60C is provided with a first motor (not shown) and a first pinion rotated by the first motor. The rail 60A is provided with a first rack that meshes with the first pinion. When the first pinion is rotated by the rotation control of the first motor by the control unit 20, the mover 60C is moved along the fixed rail 60A together with the rail 60B.

The rail 60B is movably supported in the Y direction by a support portion (not shown). The rail 60B is immovable in the X direction.
The operating unit 60D is provided with a second motor (not shown) and a second pinion rotated by the second motor. The rail 60B is provided with a second rack that meshes with the second pinion. When the second pinion is rotated by the rotation control of the second motor by the control unit 20, the operation unit 60D is moved along the rail 60B which is immovable in the X direction.

The control unit 20 controls the first motor and the second motor to move the mover 60C and the moving unit 60D, thereby causing the OCT unit 40 to pivot around the pupil of the eye to be inspected. be able to.

The SLO device 120 includes a plurality of light sources (not shown), for example, a B light (blue light) light source, a G light (green light) light source, an R light (red light) light source, and an IR light (infrared ray (for example, near red). It is equipped with a light source (external light)). The light emitted from each light source is directed to the same optical path through a plurality of optical members (not shown), and is guided to the optical path of a photographing optical system (not shown). In the SLO device 120, the laser beam incident on the photographing optical system is scanned in the X direction and the Y direction by the scanning unit. The scanning light is applied to the posterior segment of the eye to be inspected (for example, the fundus) via the pupil. The reflected light reflected by the fundus is incident on the SLO device 120 via the photographing optical system. The reflected light reflected by the fundus is selectively detected by a plurality of photodetectors via a plurality of optical systems provided in the SLO device 120. The SLO device 120 has an image processing device that generates an SLO image corresponding to each color by using signals detected by each of a plurality of photodetectors.

FIG. 3 mainly shows a block diagram of the OCT unit 40. As shown in FIG. 3, the OCT unit 40 includes a lens 46, a half mirror 44, and a lens 52 in this order on the light irradiation side of the OCT image acquisition section 48, the fixation lamp 42, and the OCT image acquisition section 48. The half mirror 44 reflects the fixation light from the fixation lamp 42 and transmits the measurement light from the OCT image acquisition section 48 (IR light source 48A described later). The fixation lamp 42 irradiates one surface of the half mirror 44 with fixation light (visible light) that guides the patient's line of sight to the center (hole 84) of the inner surface 82 of the dome 80. The fixation light emitted by the fixation lamp 42 reflects on one surface of the half mirror 44 and is irradiated to the light irradiation side of the OCT unit 40 to reach the eye to be inspected 12. The fixation lamp 42 is used not only at the time of taking an OCT image but also at the time of a visual field test.

The OCT image acquisition section 48 includes a light source (IR light source) 48A, a sensor (detection element) 48B, a first optical coupler 48C, a reference optical system 48D, a collimating lens 48E, a second optical coupler 48F, a scanner 48G, and a scanner 48H. including.

The light emitted from the light source 48A (infrared rays (IR), for example, near infrared rays (Near-infrared, NIR)) is branched by the first optical coupler 48C. One of the branched lights is collimated with the collimated lens 48E and then scanned in the Y direction, the scanner 48G, the X direction is scanned in the scanner 48H, the lens 46, the half mirror 44, the lens 52, and the dome. The fundus of the eye 12 to be inspected is irradiated through the opening (hole 84) of 80. The measurement light reflected by the fundus returns to the OCT image acquisition section 48 through the opening (hole 84) of the dome 80, the lens 52, the half mirror 44, and the lens 46. Then, it enters the second optical coupler 48F via the scanner 48H, the scanner 48G, the collimating lens 48E, and the first optical coupler 48C.

The other light emitted from the light source 48A and branched by the first optical coupler 48C is incident on the reference optical system 48D as reference light, and is incident on the second optical coupler 48F via the reference optical system 48D. To do.

These lights incident on the second optical coupler 48F, that is, the measurement light reflected by the fundus and the reference light are interfered with by the second optical coupler 48F to generate interference light. The interference light is received by the sensor 48B. The image processing unit 206 (see FIG. 6) of the control unit 20 generates OCT data based on the detection signal detected by the sensor 48B. Then, by processing the OCT data, an OCT image such as a tomographic image or an en-face image is generated.

The control unit 20 is composed of a computer. The control unit 20 includes a CPU 22, a RAM 26, a ROM 24, an input / output port (I / O) 28, and a bus 30 for connecting these to each other. The input / output port (I / O) 28 includes an index presentation light source 70A, a moving unit 70C, a display unit 34, a reaction switch 36, a storage unit 32, and a communication unit 38.

The field of view measurement and OCT image acquisition processing programs described later are stored in the ROM 24 or the storage unit 32.

As shown in FIG. 4, an operator is provided with a support portion that supports the patient's jaw (not shown) so that the center of the pupil of the patient's eye 12 is located at the center of a spherical surface formed by the inner surface 82 of the dome 80. Adjusts.
The OCT unit 40 is arranged on a horizontal plane (ZX plane). In such an arrangement state of the OCT unit 40, the optical axis of the eye to be inspected 12 connecting the center C of the eyeball of the eye to be inspected 12 and the center of the pupil coincides with the optical axis of the OCT unit 40. A hole 84 is formed in the dome 80 so that light can pass between the eye to be inspected 12 and the OCT unit 40. Therefore, the OCT unit 40 can irradiate the measurement light toward the fundus through the hole 84 formed in the dome 80, and can acquire a tomographic image (OCT image) of the fundus of the eye 12 to be inspected.

The hole 84 is formed within the range 82R1 (see also FIG. 5A) on which the spot light is projected and the index is presented. Further, a visual field measurement program is set so that the index is not projected at the position of the hole 84 (in other words, the hole 84 is formed at a position where the index is not presented). Specifically, the hole 84 coincides with the center of the hole 84 at the intersection of the vertical (Y-axis) line L1 and the horizontal (XX plane) line L2 passing through the center of the inner surface 82 of the dome 80. Is formed in.

The moving unit 70C controlled by the field of view measurement program moves the mirror 70B (changes the inclination of the mirror 70B) to irradiate spot light from the index presentation light source 70A with the brightness specified by the field of view measurement program. Spot light is projected onto any position within the range 82R1 on the inner surface 82 of the dome 80. The position where the spot light is projected on the inner surface 82 is an index. The visual field measurement program has a function of designating the projection position of the index, the brightness to be projected, and the time to continue the projection for each index. FIG. 4 shows how the spot light emitted from the index presentation light source 70A is reflected by the mirror 70B and the index 74 is presented at a position within the range 82R1.

As shown in FIG. 5A, the index 74 is presented within the range 82R1 of the inner surface 82 of the dome 80 (the range set by the visual field test program). The light from the index 74 reaches the position 74P of the fundus of the eye to be inspected 12 (see also FIG. 4) through the pupil of the eye to be inspected 12. The range of the fundus of the eye 12 to be inspected corresponding to the range 82R1 of the inner surface 82 of the dome 80 is the range 82R2 (see also FIG. 5B). As shown in FIG. 4, this range 82R2 is a range of the internal irradiation angle θc centered on the eyeball center C. The range 82R2 is the range from the upper position U1 to the lower position D2 on the YY plane.

On the other hand, as shown in FIG. 4, the range of the fundus 12G of the eye 12 to be inspected from which the OCT unit 40 arranged on the horizontal (ZX) plane can acquire a tomographic image is internal irradiation centered on the eyeball center C. It is the range of the angle θv, and as shown in FIG. 5B, it is the range 82C1. The range 82C1 is the range from the upper position U0 to the lower position D0 on the YY plane. The range 82C1 on the fundus corresponds to the range 82C0 (see FIG. 5A) on the inner surface 82 of the dome 80.

As described above, the range of the fundus of the eye 12 to be inspected corresponding to the range 82R1 (FIG. 5A) whose index is presented on the inner surface 82 of the dome 80 is the range 82R2 (see FIG. 5B). On the other hand, the range of the fundus 12G of the eye 12 to be inspected by which the OCT unit 40 arranged on the horizontal (ZX) plane can acquire a tomographic image is the range 82C1 (see FIG. 5B). In the present embodiment, a tomographic image of a range including the position of the fundus (for example, position 77P) corresponding to the position where the index in the range 82R2 is presented outside the range 82C1 on the fundus can be acquired. In addition, as shown in FIGS. 9 and 10, the drive unit 60 rotates the OCT unit 40 with reference to the pupil of the eye 12 to be inspected.

For example, when the drive unit 60 rotates the OCT unit 40 clockwise with respect to the pupil in the YY plane as shown in FIG. 10, the end portion of the OCT unit 40 on the emission side of the light (scanning light). (Left end of FIGS. 4 and 10) is above the end opposite to the injection side (right end of FIGS. 4 and 10). As a result, the range from which the tomographic image can be obtained is from the range 82C1 when the OCT unit 40 is arranged on the horizontal (ZX) plane as shown in FIG. 5B to the range 82C2 as shown in FIG. 5C. Change. When the OCT unit 40 rotates, the area of the area where the tomographic image can be acquired does not expand, but the position of the area where the tomographic image can be acquired changes.

Next, the functional part of the CPU 22 of the ophthalmic apparatus 110 will be described with reference to FIG.
The CPU 22 has a field of view measurement function, an image processing function, and other processing functions, and functions as a field of view measurement unit 204, an image processing unit 206, and a processing unit 208 when a field of view measurement program is executed.

Next, the visual field measurement process by the CPU 22 of the ophthalmic apparatus 110 will be described in detail with reference to FIG. 7. FIG. 7 shows a flowchart of the visual field measurement program. When the CPU 22 of the ophthalmic apparatus 110 executes the visual field measurement program, the visual field measurement method shown in the flowchart of FIG. 7 is realized.

In step 111, the visual field measurement unit 204 initializes the variable n to 0. The variable n is the index data of the index presented on the dome 80 (projection coordinates, data such as the angle and position of the scanner 70B corresponding to the projection coordinates, the brightness of the index and the projection time of the index, and scanning by the OCT unit corresponding to the projection coordinates. It is a variable indicating the number of (data such as position). In the visual field measurement program, a plurality of (1 to N) indexes are presented on the dome 80, and the visual field measurement is performed based on the patient's reaction (reaction information obtained by the perception switch) to those indexes. The index is presented by the index data specified by the variable n.
In step 113, the visual field measurement unit 204 increments the variable n by one.

In step 115, the visual field measurement unit 204 determines whether or not it is necessary to move the OCT unit 40. Specifically, in the visual field measurement unit 204, the light of the index presented at the position n identified by the variable n can be acquired by the OCT unit 40 arranged on the horizontal (ZX) plane. It is determined whether or not it is within the possible range 82C1.

If it is determined that it is not necessary to move the OCT unit 40, the visual field measurement process skips step 117 and proceeds to step 119.

If it is determined that the OCT unit 40 needs to be moved, the visual field measurement unit 204 moves the OCT unit 40 in step 117. That is, the visual field measurement unit 204 moves the OCT unit 40 so as to acquire a tomographic image of the position of the fundus 12G corresponding to the position n of the inner surface 82 of the dome 80 defined by the index data n. Therefore, the drive unit 60 is controlled so that the OCT unit 40 rotates with respect to the pupil based on the scanning position data defined by the index data n.
Further, in step 117, the visual field measurement unit 204 rotates the half mirror 44 so that the inspected eye 12 is always irradiated with the fixation light in a constant direction even if the direction of the OCT unit 40 is changed. It should be noted that only the fixation lamp 42 may be rotated, or both the half mirror 44 and the fixation lamp 42 may be rotated so that the fixation light is always emitted in the same direction.

As shown in FIG. 9, when the projected index 75 is located above the dome 80, the light from the index 75 causes the OCT unit 40 to be arranged in a horizontal (ZX) plane to acquire a tomographic image. It is located at a position 75P below the position D0 below the range 82C1 of the fundus 12G where the fundus can be formed. Therefore, the OCT unit 40 is rotated upward, that is, rotated counterclockwise with respect to the pupil so that the tomographic image at the position 75P can be acquired by the drive unit 60. Specifically, the end portion (left end in FIG. 9) of the light (scanning light) of the OCT unit 40 on the injection side is lower than the end portion (right end in FIG. 9) on the opposite side to the injection side. As a result, the lower end of the range in which the tomographic image can be obtained changes to the position D2 below the position D0, and the tomographic gift at the position 75P of the fundus can be obtained.

As shown in FIG. 10, when the projected index 77 is located below the dome 80, the light from the index 77 causes the OCT unit 40 to be arranged in a horizontal (ZX) plane to acquire a tomographic image. It is located at a position 77P above the upper position U0 of the range 82C1 of the fundus 12G that can be formed. Therefore, the OCT unit 40 is rotated downward, that is, rotated clockwise with respect to the pupil so that the tomographic image at position 77P can be acquired by the drive unit 60. Specifically, the end portion (left end in FIG. 9) of the light (scanning light) of the OCT unit 40 on the injection side is higher than the end portion (right end in FIG. 9) on the opposite side to the injection side. As a result, the lower end of the range in which the tomographic image can be obtained changes to the position U1 above the position U0, and the tomographic gift at the position 77P of the fundus can be obtained.

In step 119, the visual field measurement unit 204 controls the index presentation light source 70A and the moving unit 70C, and presents the index at the position n. For example, as shown in FIG. 4, the index 74 is presented at position n.

In step 121, the visual field measurement unit 204 confirms the presence or absence of the switch of the reaction switch 36. Specifically, as shown in FIG. 4, when the index 74 is presented at the position n and the perception switch 36 is turned on, the perception signal is input from the perception switch 36 to the control unit 20. When the perceptual signal is input, the visual field measurement unit 204 determines in the index data n the data indicating that the perceptual switch is ON and the time taken from presenting the index until the perceptual switch is pressed. , Inspection data n is generated by adding to the index data n. When the sensory switch is ON, it means that the patient is perceiving the light of the index 74 at the position 74P of the retina corresponding to the position n where the index 74 is presented.
On the contrary, when the index 74 is presented at the position n but the perception switch 36 is not turned on, the perception signal is not input from the perception switch 36 to the control unit 20. Therefore, when the perceptual signal is not input, the visual field measurement unit 204 generates the inspection data n by adding only the data indicating that the perceptual switch is not turned on in the index data n to the index data n. .. When the sensory switch is not turned on, it means that the patient is not perceiving the light of the index 74 at the position 74P of the retina corresponding to the position n where the index 74 is presented.

The position 74P of the retina corresponding to the position n where the index 74 is presented is the positional relationship between the center of the inner surface 82 (center of the inner surface) and the position n where the index 74 is displayed, and the position n of the retina of the eye 12 to be inspected. The positional relationship between the position of the optical axis and the position 74P is the corresponding position.

In step 123, the visual field measurement unit 204 acquires an OCT image of the fundus position corresponding to the index n. Specifically, the visual field measurement unit 204 drives the scanners 48G and 48H based on the scanning position data included in the index data n, and creates a tomographic image in a predetermined range centered on the fundus position corresponding to the index n. get. The visual field measurement unit 204 sends the tomographic image data of the fundus position corresponding to the index n to the image processing unit 206. The image processing unit 206 executes segmentation processing of tomographic image data to generate a thickness map of the optic nerve fiber layer. This thickness map of the optic nerve fiber layer is a map in which the thickness of the optic nerve layer at the fundus position corresponding to the position of the index n is quantified or visualized by a heat map, contour lines, or the like.
In the technique of the present disclosure, the tomographic image acquisition process in step 123 is not limited to being uniformly performed after the process in step 121.
First, for example, the threshold value of the patient may be detected in advance in the stage before step 111, and when the threshold value is detected and the threshold value is abnormal, the tomographic image acquisition process of step 123 may be performed. .. If there is no abnormality in the threshold value, step 123 is omitted.
Here, the threshold value is the sensitivity of the retina, that is, the brightness of the index that the subject can press the reaction switch 36 and can determine that he / she is visible.
In addition, when there is an abnormality in the threshold value, for example, when it is lower than the threshold value of the standard data by normal eyes, or when the threshold value is lower than the previous test result (note that the amount of decrease is arbitrarily set) can be seen. There are cases.
As a method of detecting the threshold value, for example, the brightness of the index is gradually brightened, and the index is detected by the patient recognizing the index and detecting the brightness of the index when the reaction switch 36 is pressed.
Secondly, the tomographic image acquisition process in step 123 may be performed when it is confirmed in step 121 that the perception switch 36 has not been turned on.

In step 125, the visual field measurement unit 204 determines whether the variable n is equal to the total number N of the positions where the index is to be presented. When the variable n is not the total number N, the index is presented at all the planned positions and the tomographic image is not acquired, so that the visual field measurement and the OCT image acquisition process return to step 113 (step 125: N).
When the variable n is equal to the total number N, N indexes defined by the visual field measurement program are presented, and the OCT data of the fundus position corresponding to the information and the indexes is acquired from the perception switch for each index. (Step 125: Y). Then, the process proceeds to step 127, and the image processing unit 206 generates the visual field inspection map M.
In step 127, the image processing unit 206 uses the inspection data (1 to N) obtained in step 121 and the tomographic image (1 to N) obtained in step 125 to perform a visual field inspection as shown in FIG. Generate map M.

The visual field inspection map M has a plurality of grids g. The center point of the grid g corresponds to the position of the fundus corresponding to the position of the inner surface 82 of the dome 80 on which the index n is presented. When the index n is presented but the perception switch is not turned on, the image processing unit 206 generates the visual field test map M so that "*" is displayed on the grid ng. When the index n is presented and the perception switch is turned on, the image processing unit 206 generates the visual field test map M so that "*" is not displayed on the grid gd. Based on the thickness of the optic nerve fiber at the position of the fundus corresponding to the index n calculated as described above, the image processing unit 206 sets the visual field inspection map so that the thinner the calculated thickness, the darker the color of the grid. Generate M.

In step 127, the visual field test map M generated by the image processing unit 206 is primarily stored in the RAM 26 by the processing unit 206, and is transmitted to the server 140 through the communication unit 38 and stored in association with the patient ID. To. Not only the visual field inspection map M but also the inspection data (1 to N) and the tomographic image data (1 to N) may be transmitted to the server 140.

In step 127, the image processing unit 206 generates a visual field test screen (not shown) together with the patient information such as the patient ID and the eye test information such as the left eye and the right eye as a result of the visual field measurement of the visual field test map M. The generated visual field test screen is displayed on the display unit 34 of the ophthalmic apparatus 110 by the processing unit 208. The visual field test screen may be generated on the server and displayed on the viewer 150.
Then, the visual field measurement unit 204 ends the visual field measurement process.

As described above, in the first embodiment, the visual field test unit 10 and the OCT unit 40 are integrally configured in the ophthalmic apparatus 110. Therefore, it is possible to measure the presence or absence of visual field defects in a plurality of retinas of the patient's eye to be inspected and to obtain a tomographic image of the optic nerve fiber layer. Therefore, visual field measurement and OCT measurement are performed at the same time, and information on the function and structure of the retina can be obtained in a single examination.

Conventionally, the visual field measurement and the acquisition of the OCT image are performed by separate devices. The patient has to move from the place where the visual field measuring device is arranged to the place where the OCT image acquisition section is arranged, which is relatively burdensome. In addition, since the measurement of the presence or absence of visual field defects in the retina and the acquisition of tomographic images are performed by separate devices, it takes a relatively long time and the burden on the patient is relatively large. Furthermore, it takes a lot of time and effort to accurately align the threshold (sensitivity) map of the visual field test with the position of the OCT test result. In addition, a place for arranging each of the visual field measuring device and the OCT image acquisition section is required.

However, in the first embodiment, the visual field test unit 10 and the OCT unit 40 are integrally configured in the ophthalmic apparatus 110. Therefore, in the first embodiment, the burden on the patient is relatively small, the presence or absence of visual field defects in the optic nerve cells can be measured and the tomographic image can be acquired in a relatively short time, and the ophthalmic apparatus 110 is arranged. The space required for this can be relatively reduced.

Also, the back of the dome, which displays the index for visual field measurement, is usually not placed and used. Therefore, in the first embodiment, the OCT unit 40 is arranged on the outer surface 83 of the dome at a place where the OCT unit 40 can be easily arranged. Therefore, the work of arranging the OCT unit 40 is easy, and an unused space can be used.

Further, in the first embodiment, the presence or absence of visual field defects in the retina and the acquisition of tomographic images are continuously performed for each of a plurality of locations on the fundus of the patient's eye to be inspected. Therefore, it is possible to measure the presence or absence of visual field defects in the retina and acquire a tomographic image in a relatively short time.

Further, in the first embodiment, since the optical axis of the OCT unit 40 is moved within the range of the hole 84 of the dome 84, the presence or absence of visual field defect in a larger area of the retina of the fundus of the eye to be examined is present. Measurement and acquisition of OCT images can be performed.

[Second Embodiment]
Next, a second embodiment will be described. Since the configuration and operation of the second embodiment are substantially the same as the configuration and operation of the first embodiment, different parts will be mainly described.

As shown in FIG. 11, a plurality of holes 84C, 84R, 84U, 84L, 84D are formed in the dome 80. The holes 84C, 84R, 84U, 84L, and 84D are formed at positions other than the position where the index is presented within the range 82R1 where the spot light is projected and the index is presented. The holes 84C, 84R, 84U, 84L, 84D pass through the center of the inner surface 82 of the dome 80 and are formed on the vertical (Y-axis) line L1 and the horizontal (XX plane) line L2. Specifically, the holes 84C are located on the vertical line L1 at the center of the inner surface 82 of the dome 80, and the holes 84U and 84D are located on the horizontal line L2 at positions sandwiching the center of the inner surface 82 of the dome 80. Holes 84R and 84L are formed at positions sandwiching the center of 82.

The configuration of the OCT unit 40X shown in FIG. 12 is substantially the same as that of the OCT unit 40. In the OCT unit 40X, the fixation lamp 42 is omitted. In the second embodiment, a sticker 85 having a color different from that of the inner surface 82 is attached around the hole 84C to guide the patient's finger line instead of the fixation lamp.

In the second embodiment, the range of the fundus 12G corresponding to the range in which the spot light of the inner surface 82 of the dome 80 is irradiated and the index is presented is the range 82RR as shown in FIG.

The range in which the OCT unit 40X in the fundus 12G is located on the horizontal (ZX) plane and a tomographic image can be obtained is the range 82C1. The range in which the tomographic image can be obtained by rotating the OCT unit 40X with respect to the pupil while the optical axis of the OCT unit 40X is located within the range of the hole 84C is the range 82C2.

In the second embodiment, the range 82RR is wider than the range 82C2. Therefore, outside the range 82C2, the position of the fundus 12G where the index light reaches even if the OCT unit 40X is rotated with respect to the pupil while the optical axis of the OCT unit 40X is located within the range of the hole 84C. The tomographic image of the OCT unit 40X cannot be acquired.

Therefore, the drive unit 60 moves the OCT unit 40X from the hole 84C to the position corresponding to the hole in the holes 84R, 84U, 84L, 84D.

When the OCT unit 40X moves to the position corresponding to the hole 84R, the range in which the tomographic image can be acquired by the OCT unit 40X is the range 82CR. When the OCT unit 40X moves to the position corresponding to the hole 84U, the range in which the tomographic image can be acquired by the OCT unit 40X is the range 82CU. When the OCT unit 40X moves to the position corresponding to the hole 84L, the range in which the tomographic image can be acquired by the OCT unit 40X is the range 82CL. When the OCT unit 40X moves to the position corresponding to the hole 84D, the range in which the tomographic image can be acquired by the OCT unit 40X is the range 82CD.

The range 82CR, the range 82CU, the range 82CL, and the range 82CD can cover the range 82RR.

In step 117 (see FIG. 7) in the second embodiment, the control unit 20 controls the drive unit 60 so that the OCT unit 40X can acquire a tomographic image at a position where the index light reaches. Is moved not only to the range of the hole 84C but also to the position corresponding to the holes 84R, 84U, 84L and 84D.

In the second embodiment, since the optical axis of the OCT unit 40 is moved not only within the range of the hole 84C of the dome 84 but also within the range of the holes 84R, 84U, 84L, 84D, the fundus of the eye to be examined , It is possible to measure the presence or absence of visual field defects in more regions and acquire tomographic images than in the first embodiment. Specifically, in the YY plane, it is possible to inspect the visual field defects up to the positions U11 and D22 on the pupil side of the positions U1 and D2 and acquire the tomographic image.

[Modification example]
Next, various modifications of the technique of the present disclosure will be described.
<First modification>
In the first embodiment, the range 82R1 for presenting the index is wider than the range 82C0 of the inner surface 82 of the dome 80 corresponding to the range 82C1 of the fundus 12G where the OCT unit 40 arranged in the horizontal plane can acquire the tomographic image. There is. The techniques of the present disclosure are not limited to this. In the first modification, the range 82R1 is set to the range 82C0 or less. In this case, it is not necessary to rotate the OCT unit 40. Therefore, in the first modification, the drive unit 60 is omitted.

<Second modification>
In the first embodiment and the first embodiment, a hole is formed in the dome 80, but the technique of the present disclosure is not limited to this, and the dome transmits the measurement light and the reflected light reflected by the fundus of the eye. It may be configured depending on the material to be used. Examples of the resin material that transmits both fixed-view light (visible light) and measurement light include an infrared transmissive transparent resin sheet (GAT).
Further, for example, a short wavelength cut filter that cuts light of 800 nm or less may be provided in the hole. It is possible to prevent visible light for visual field measurement from being detected by the OCT unit.

<Third modification example>
An external camera that photographs the anterior segment of the eye to be inspected is photographed at predetermined time intervals, and the center position of the pupil of the eye to be inspected is detected from the obtained image, and the optical axis of the OCT unit 40 is located at the detected position. The drive unit 60 may be controlled at predetermined time intervals so that

<Fourth modification>
In the above embodiment, the ophthalmic system 100 including the ophthalmic apparatus 110, the server 140, and the viewer 150 has been described as an example, but the technique of the present disclosure is not limited thereto. For example, the ophthalmic apparatus 110 may further have the function of at least one of the server 140 and the viewer 150. For example, when the ophthalmic apparatus 110 has the function of the server 140, the server 140 can be omitted. Further, when the ophthalmic apparatus 110 has the function of the viewer 150, the viewer 150 can be omitted. Further, the server 140 may be omitted so that the viewer 150 executes the function of the server 140.

<Other variants>

The processing described in the above-described embodiment to the fourth modification is only an example. Therefore, it goes without saying that unnecessary steps may be deleted, new steps may be added, or the processing order may be changed within a range that does not deviate from the purpose.

Further, in the above-described embodiment to the fourth modification, a case where data processing is realized by a software configuration using a computer is illustrated, but the technique of the present disclosure is not limited to this. For example, instead of the software configuration using a computer, the data processing may be executed only by a hardware configuration such as FPGA (Field-Programmable Gate Array) or ASIC (Application Specific Integrated Circuit). Some of the data processing may be performed by the software configuration and the rest may be performed by the hardware configuration.

Claims (6)

An index presentation unit that has an outer surface and an inner surface and presents an index for visual field inspection by reflecting the spot light projected on the inner surface, and an optotype projection that projects the spot light at a desired position on the inner surface. A visual field test section for performing a visual field test of the eye to be inspected, including a section,
An acquisition unit that is arranged on the outer surface side of the index presentation unit and acquires a tomographic image of the fundus of the eye to be inspected.
A moving part that moves the acquisition part so that the tomographic image is acquired,
An ophthalmic device equipped with. A hole is provided in the index presentation portion.
The acquisition unit acquires the tomographic image through the hole.
The ophthalmic apparatus according to claim 1. A plurality of holes are provided in the index presentation portion.
The acquisition unit acquires a tomographic image of the eye to be inspected through a hole corresponding to a position moved by the moving unit among the plurality of holes.
The ophthalmic apparatus according to claim 1 or 2. The hole is provided in a region other than the desired position in the index presenting portion.
The ophthalmic apparatus according to claim 2 or 3. The acquisition unit acquires the tomographic image by irradiating the fundus with irradiation light and acquiring the reflected light from the fundus.
The index presenting portion is composed of a material that transmits the irradiation light and the reflected light.
The ophthalmic apparatus according to any one of claims 1 to 4. The ophthalmic apparatus according to any one of claims 1 to 5, wherein the index presenting portion has a dome shape.

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