Two Steps:

1. Download DiagnosticGame app to iPad or iPhone
    

2. Get a FREE (optional purchase) polarizing filter set from AMA Optics.com  Follow Instructions
    

• For Patients, Instruction. VIDEO     NEW

Test​ (see Video)

• Color Vision

• Visual Acuity

• Stereopsis

• Relative Brightness Sense

• Shows promise for Glaucoma Testing at Home

Eye Care professionals can now test Visual Acuity, Stereopsis, Brightness-Sense and Color Vision of your home bound patients using class I exempt devices with modifications for Telemedicine during the COVID-19 pandemic as per the guidance dated April 2020 issued by FDA. Peer-reviewed reports in 1990s validated the brightness-sense can accurately detect glaucoma. Using brightness-sense principles in programs presented on an iPad, Gise and Kane reported at ARVO in 2016 that normal subjects were able to accurately neutralize dimness imposed by monocular neutral density filters (r = 0.9817, p =0.0005). Every ophthalmologist knows that neutral density filter accurately quantifies relative afferent defects of optic nerve disease, therefore neutralizing imposed optic nerve defects is equivalent to neutralizing defects with neutral density filters. They also reported 100% detection of 16 amblyopes and found the depth of amblyopic defect was highly correlated to the lines of acuity disparity (r=0.85, p<0.0001).

In the absence of clinic studies of electronic bases brightness-sense testing in glaucoma , scientific evidence is compelling that this technology is safe and could be useful for monitoring optic nerve disease of patients’ home bound during this pandemic.  According to the FDA guidelines, modified devices should not be solely or primarily relied upon by the eye care provider or patient to prevent, diagnosis or treat ocular conditions.

MEASURE Visual Acuity

iPad self-testing of Visual Acglaucomauity, Color Vision, Stereopsis and Brightness-Sense (Glaucoma, other optic nerve diseases, and amblyopia).  DiagnosticGame app from Apple Store provides adult and child friendly testing of visual acuity that requires no language, the endpoint is simply: “Same E?”, Yes or No, a Binary Choice.

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Amblyometer

The chronology of brightness-sense testing:

1. 1985:  A A Sadun and S Lessell reported the value of the brightness-sense in optic nerve disease in Arch Ophthalmol.  They sequentially tested the brightness-sense in right and left eyes and concluded “Impairment of brightness-sense was a consistent finding among patients with optic neuropathies and, in some cases, brightness testing appeared to be more sensitive than other techniques in establishing the presence of disease.”  

2. 1990:  S L Tech, et al. reported in BJO that brightness disparity between the two eyes was significantly different in 86% of 28 glaucoma patients, “Moreover, there was a significant relationship between the interocular differences in brightness-sense and the difference in the degree of visual field loss between the two eyes”.

3. 1994:  E MacMillan, et al. reported in Arch Ophthalmol. a new simultaneous interocular brightness-sense test that was given to 91 normal observers and concluded, “ The test is quick and simple to complete and appears to offer considerable scope for the assessment of visual function when differences in the functional integrity of the optic nerves of the right and left eyes are suspected.”

4. 1994:  D Cummins, et al. reported in Arch Ophthalmol. that the test reported in #5 (E MacMillan, et al.) can also be used to test patients with ocular hypertension and glaucoma.  They found: (1) 36.8% of 19 patients with ocular hypertension exhibited brightness perception asymmetry outside the normal limits for age-matched controls and (2) all 20 patients with established POAG had results outside the normal limits for a test sensitivity of 100%.  Three control observers had abnormal results, giving a test specificity of 95%.  

5. 1999:  T S Hofeldt and A J Hofeldt reported in BJO that color rivalry suppression was positively correlated (p<0.0001) with the interocular difference in logMAR acuity and negatively correlated (p=0.019) with stereoacuity in 14 non-pediatric patients with amblyopia. 

6. 2016:  R Gise and S A Kane at ARVO reported using automated simultaneous comparison of rivalrous binocular stimuli for measuring the relative brightness-sense in 16 normal and 16 amblyopic children aged 3 to 7 years.  Tests were administered on an iPad utilizing the staircase algorithm program of the Amblyometer®, part of the DiagnosticGame app.  All 16 Amblyopes with greater than 1-line disparity on the Snellen Eye Chart were detected and there were no false positives for children without Amblyopia, sensitivity of 100%.  Comparison of test to retest scores, found testing was highly consistent (r=0.99, p <0.00001). The depth of amblyopic defect and lines of acuity disparity were also highly correlated. (r=0.85, p<0.0001).:

7. 2018: S A Kane reported at the American Academy of Pediatrics 2018 his results of testing 286 school children from 3 to 7 years of age using the Amblyometer® of the DiagnosticGame® app.  There were 284 true negatives and 2 true positives (100% sensitivity), 0 false negatives and 0 false positives.