Development of VIPER: a simulator for assessing vision performance of warfighters

Abstract

Background: When evaluating vision, it is important to assess not just the ability to read letters on a vision chart, but also how well one sees in real life scenarios. As part of the Warfighter Refractive Eye Surgery Program (WRESP), visual outcomes are assessed before and after refractive surgery. A Warfighter’s ability to read signs and detect and identify objects is crucial, not only when deployed in a military setting, but also in their civilian lives. Objective: VIPER, a VIsion PERformance simulator was envisioned as actual video-based simulated driving to test warfighters’ functional vision under realistic conditions. Designed to use interactive video image controlled environments at daytime, dusk, night, and with thermal imaging vision, it simulates the experience of viewing and identifying road signs and other objects while driving. We hypothesize that VIPER will facilitate efficient and quantifiable assessment of changes in vision and measurement of functional military performance. Study Design: Video images were recorded on an isolated 1.1 mile stretch of road with separate target sets of six simulated road signs and six objects of military interest, separately. The video footage were integrated with customdesigned C++ based software that presented the simulated drive to an observer on a computer monitor at 10, 20 or 30 miles/hour. VIPER permits the observer to indicate when a target is seen and when it is identified. Distances at which the observer recognizes and identifies targets are automatically logged. Errors in recognition and identification are also recorded. This first report describes VIPER's development and a preliminary study to establish a baseline for its performance. In the study, nine soldiers viewed simulations at 10 miles/hour and 30 miles/hour, run in randomized order for each participant seated at 36 inches from the monitor. Relevance: Ultimately, patients are interested in how their vision will affect their ability to perform daily activities. In the military context, in addition to reading road signs, this includes vision with night sensors and identification of objects of military interest. Once completed and validated, VIPER will be used to evaluate functional performance before and after refractive surgery. Results: This initial study was to prove the principle, and its results at the time of this publication were very preliminary. Nine Soldiers viewed visible-day and IR-day VIPER simulations with civilian and military targets, separately, at 10 and 30 miles/hour. Analyses were performed separately for visible and IR, and also aggregated. Only the civilian targets are discussed in this report. At 10 miles/hour, the population detected civilian road signs at an aggregated average of 90.11 ± 64.20 m, and identified them at 26.93 ± 22.27m. At 30 miles/hour, the corresponding distances were 103.03 ± 58.81 and 26.26 ± 8.55, respectively. Conclusion: This preliminary report proves the principle and suggests that VIPER could be a useful clinical tool in longitudinal assessment of functional vision in warfighters.