Calibrated measurement of acuity, color and stereopsis on a Nintendo® 3DS™ game console

Abstract

Significance: A Nintendo® 3DS™ game can reliably test monocular near acuity, stereopsis and color without the need for occlusion patches or goggles. Purpose: We developed dynamic, forced-multiple choice games to measure monocular near acuity, color vision and stereopsis on the autostereoscopic barrier screen of the Nintendo 3DS gaming system. Methods: In an institutional review board-approved study, pediatric and adult patients and normal subjects performed routine patched near visual acuity, Ishahara's color test and Stereo Fly tests. Then each subject performed a two-phase orientation and testing game, "PDI Check", on a Nintendo 3DS. Results: Forty-five patients aged 5-60 years completed the routine and Nintendo near tests, resulting in positive, consistent, discriminatory correlation functions. From ROC curves, referral criteria were determined to separate poor from fair-to-normal monocular acuity with 98% sensitivity and 100% specificity, stereoacuity with 80% sensitivity and 97% specificity, and color with 83% sensitivity and 100% specificity. Conclusion: The Nintendo 3DS game PDI Check can provide consistent near vision testing via a dynamic, randomized method that does not require goggles for stereo, and does not require patching to assure monocular testing.

Keywords: autostereoscopic barrier screen; dynamic color test; monocular visual acuity; near sensory testing; stereopsis; video game.

Conflict of interest statement

The authors are board members of PDI Check, LLC, which markets the patent-pending game “PDI Check” for the Nintendo 3DS. Kyle A Smith reports no other conflicts outside PDI Check, LLC, outside the submitted work. Alex G Damarjian has nothing to disclose. Aaron Molina has nothing to disclose. Robert W Arnold reports that, in addition to PDI Check, being a board member of Glacier Medical Software, coordinating the Alaska Blind Child Discovery and being a protocol developer and investigator for the Pediatric Eye Disease Investigator Group (PEDIG). In addition, There is a PDI Check patent pending for Robert W Arnold and Alex G Damarjian. The authors report no other conflicts of interest in this work.

Figures

Figure 1

Relationship between near monocular acuity measured with barrier screen–monocular acuity on the Nintendo® 3DS™ game PDI Check (abscissa) and the patched Rosenbaum near card (ordinate). Note: The arrow indicates chosen referral criteria from the receiver operating characteristics curve in Figure 4.

Figure 2

Relationship between autostereoscopic screen, dynamic stereo game on the Nintendo® 3DS™ (abscissa) and Stereo Fly circles stereopsis in arc seconds (ordinate). Note: The arrow indicates chosen referral criteria from the receiver operating characteristics curve in Figure 5.

Figure 3

Relationship between dynamic deutanopic confusion axis color game on the Nintendo® 3DS™ (abscissa) and Ishihara’s concise color test missed plates (ordinate). Note: The arrow indicates chosen referral criteria from the receiver operating characteristics curve in Figure 6.

Figure 4

Receiver operating characteristics curve for near monocular visual acuity with the PDI Check game compared to Rosenbaum pocket visual acuity with non-tested eye patched. Note: Arrow indicates the selected referral criteria.

Figure 5

Receiver operating characteristics curve for stereopsis with the PDI Check game compared to Titmus Stereo Fly circle with polarized goggles. Note: Arrow indicates the selected referral criteria.

Figure 6

Receiver operating characteristics curve for typical color vision deficiency with PDI Check dynamic game compared to missed color plates on the Ishihara concise test. Note: Arrow indicates the selected referral criteria.

Figure 7

Test–retest for stereo testing on the Nintendo® 3DS™ game PDI Check for three uncorrected presbyopic patients and six normal subjects, over 18 repeated presentations.