An enhancement to nGoggle: a VR Goggle for Structural and Functional assessment in Glaucoma

PROJECT SUMMARYAssessments of functional loss and of structural damage to the optic nerve are typical evaluations per- formed in the diagnosis and monitoring of glaucoma. This proposal aims at developing the hardware system that will allow acquisition of fundus photographs using the nGoggle, a portable Brain-Computer Interface (BCI) which integrates a wearable, wireless, electroencephalogram (EEG) system and a head-mounted display to monitor electrical brain activities associated with visual field stimulation. In a previous project, we developed the nGoggle portable system for the assessment of visual function deficits in order to address limitations of standard automated perimetry (SAP), a traditional but subjective visual field test. We compared the diagnostic accuracies of the nGoggle and SAP in discriminating patients with glaucoma from healthy subjects and found that the BCI performed at least as well, if not better than SAP, with the additional advantage of portability and objectivity.With rapid advancements in smartphone cameras, it is now possible to develop compact auto-focusing fundus cameras and integrate them into our neuro-monitoring nGoggle. Recently we developed an approach named Machine-to-Machine (M2M), a deep learning algorithm that was trained to analyze fundus photos and predict quantitative measurements of retinal nerve fiber layer thickness and neuroretinal rim provided by spectral domain-optical coherence tomography (SDOCT), with high correlation and agreement with the original SDOCT observations. This approach opens up the possibility of using simple fundus photographs to extract quantitative information about neural damage in glaucoma. By combining functional assessment currently provided by the nGoggle with structural assessment capability, this new system would result in a very unique device capable of portable structural and functional assessment of optic nerve damage for a multitude of eye conditions, not limited to glaucoma, such as age-related macular degeneration, retinal degenerations and non-glaucomatous optic neu- ropathies.The specific aims of this Phase I SBIR project are (1) to incorporate a high-resolution auto-focusing fundus camera to the nGoggle head-mounted display in full compliance with ophthalmic instrument safety stand- ards and fundus camera functional standards, and (2) to demonstrate the ability of the nGoggle fundus camera to capture high-quality optical nerve images from a model eye. Successful development of this system will enable both structural and functional assessments of retinal conditions to be performed easily and inexpensively using a portable device.PROJECT NARRATIVE NGoggle Inc. proposes to develop a new wearable ophthalmic diagnostic instrument capable of performing con- current structural and functional assessment to diagnose and monitor optic neuropathies and retinal diseases. This project aims at developing a pair of compact high-resolution fundus cameras in full compliance with oph- thalmic instrument safety standards and integrating them into our neuro-monitoring nGoggle, an instrument with the demonstrated capability of estimating functional vision loss in glaucoma patients based on their electroen- cephalogram (EEG) responses evoked by visual stimuli. We also intend to demonstrate that the optic nerve images of model eyes taken by the integrated fundus cameras can yield consistent and compatible cup-to-disc ratios when compared with the measurements obtained from the same model eyes using optical coherence tomography (OCT). After successful demonstration, we plan to conduct clinical tests in the subsequent phase of this project.