FINDEX Inc.

Key Factors for Product Introduction

At our clinic, we introduced visual field testing using the FDT in 2014. The FDT test required patients to press a button, which led to issues of false positives when the test procedure was not adequately explained to them, resulting in incorrect results.

In 2022, Toyota Tsusho Corp. introduced us to the GAP-screener. This product uses a new testing method (eye-tracking), which is revolutionary, highly accurate, and has a strong correlation with the Humphrey Field Analyzer. The most noteworthy feature is that it places minimal burden on the patient. The in-house test operation began two years ago, with tests conducted by our staff, including ophthalmologists. The results were favorable, detecting even minor visual field abnormalities, which reconfirmed the accuracy of the test.

At that time, the awareness of the GAP-screener was still low, but ophthalmologists evaluated it, saying, "This is impressive. It can be used for health screenings." Furthermore, with the growing importance of visual field testing in the ophthalmology community and the promising future of the GAP-screener, we decided to enhance our visual field testing capabilities and adopted the the GAP-screener.

Benefits and Improvements After GAP-screener Introduction

The introduction of the GAP-screener has significantly improved the accuracy of the tests. When we were using the FDT, we were unable to monitor the patient’s eye condition during the test, so there were times when we didn’t understand why they couldn’t press the button. This sometimes resulted in false positives, and staff members would express concerns, asking, “Is this really reliable?” However, with the GAP-screener, such concerns have greatly diminished. During the test, the stuff can monitor the patient’s condition in real-time on the PC screen, for instance, noticing if a patient wearing contact lenses is blinking frequently due to dryness, which may be affecting the test. Additionally, using eye-tracking, when a patient is unable to follow the target or is having trouble, the stuff can decide to switch to a fixation button, thereby reducing the burden on the patient.

Being able to respond promptly to the individual needs of each patient has significantly enhanced the accuracy of the tests. I believe the greatest advantage is being able to monitor the patient’s eye condition during the test.

Patient Reactions to GAP-screener Introduction

When patients see the head-mounted device, many get excited because it gives off a game-like impression. The fact that the latest technology is used for the test sparks interest in what can be discovered and draws attention to the novelty of the equipment. With the previous FDT test, some patients were uncertain about whether they had seen the stimulus or not when pressing the button, which caused some to question the reliability of the test.
However, with the GAP-screener, when we explain that the machine analyzes eye movements and uses AI, many patients feel reassured.

On the other hand, some patients have mentioned that wearing the head-mounted device can cause neck fatigue. Additionally, many believe they shouldn’t blink during the test, leading to eye dryness and fatigue.

Operational Innovations Following GAP-screener Introduction

At our clinic, we take the following steps when conducting visual field tests:

1. To encourage patients to undergo the new test with the GAP-screener, we include an information leaflet with their appointment slip.
2. When patients mention during other ophthalmological exams (such as fundus or intraocular pressure tests) that they have a family member with glaucoma or that their vision has recently worsened, we recommend a visual field test.
3. If a patient who does not plan to undergo a fundus exam expresses interest in a visual field test, we recommend taking both tests together as a set.
4. We have created an operational manual to improve the skills of the staff. Additionally, since this is a new type of test, we ensure that knowledge gained from daily operations is shared quickly among the staff.
5. We developed an easy-to-understand test result sheet for patients (in collaboration with FINDEX).
6. Starting from fiscal year 2023, we added this test as a follow-up (tracking) item at our clinic. This allows us to recommend further detailed testing to target patients and share information for their next examination.

*Items 4, 5, and 6 were newly implemented after introducing the GAP-screener.

Impact on Overall Evaluation After GAP-screener Introduction and Recommendation to Other Facilities

When we first began conducting visual field tests, they were primarily for new patients.
However, recently we have been recommending additional visual field tests for those who show signs of optic disc cupping or glaucoma during fundus exams.

Among the patients who require further ophthalmological exams, many are identified through fundus exams with findings like “optic disc cupping.” These patients need secondary tests, such as visual field tests, at ophthalmology clinics. Since the same guidance is given year after year, many patients haven't taken the necessary tests. In response, our clinic now provides comprehensive evaluation reports, including visual field test results, to ensure accurate assessments. Currently, this test is an optional add-on, but we recommend it as it provides reliable results. I’ve heard that there are still very few health check facilities offering visual field tests, and some facilities with the equipment report that the number of tests conducted has not increased. At our clinic, we’ve been conducting visual field tests for nine years, and many patients choose to undergo them. We place great importance on communication with our patients, and we believe that the results of this test depend on the patients’ understanding. Raising awareness at health check facilities is essential.

Before introducing the GAP-screener last year, we put up an age-related macular degeneration (AMD) checklist near the entrance to the fundus exam room, and more than half of the patients reviewed it while waiting. Many people are concerned about their eye health, but at the same time, many tend to ignore potential issues. When health-conscious people undergo medical checkups, I believe that offering additional tests like visual field testing at health check facilities would be beneficial to the patients. I also think that visual field testing will become even more important in the future.
The GAP-screener does not require a dark room and uses eye-tracking technology, making it a minimally invasive test with high accuracy. We have also implemented this at other branches within our group, and I hope that visual field testing becomes a standard option at more health check facilities.

Expectations for Future Developments of the GAP-screener

1. I think it would be convenient to have a dedicated face cover for the GAP-screener. Currently, we use commercially available covers, but they don’t fit everyone, so having a custom-made one would be helpful.
2. When a visual field defect is suspected, the FDT results are displayed in shades ranging from light gray to dark black, making it easy to intuitively understand the defect. However, with the GAP-screener, the suspected scotoma areas are only represented by dots. It would be better if the severity could be displayed in a graded manner, from mild to severe.
3. We also have requests to make it easier to compare the results with the previous test.
4. We hope for improvements in the functionality to easily input and apply corrective lenses.

In the future, I believe that the device will allow patients to perform the tests somewhat independently. However, it is still essential that the staff understand the tests and the results so they can explain them effectively.