Compared Near-Vision Testing With the Nintendo 3DS PDI Check Game on the Thai–Burma Border

Abstract

Background: A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non–English-speaking patients was not known. Methods: Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. Results: Seventeen Burma adults (aged 19–58), 20 Burma children (aged 7–15), and 14 US military staff (aged 21–36) completed the testing. Conventional testing correlated with PDI Check for stereo ( P < 0.001), acuity oculo dexter ( P < 0.01), acuity oculo sinister ( P < 0.01). For visual acuity and stereopsis, the intraclass coefficient was 0.55 [95% confidence interval (CI) 0.28–0.72] and 0.62 (95% CI 0.41–0.77) respectively, but with few color deficient cases color was 0.30 (95% CI –0.05 to 0.60). The time in seconds to complete near vision testing with PDI Check (172 ± 27, overall; 198 ± 34, Burma; 99 ± 20, military) was significantly (25% ± 18%) briefer than conventional testing (226 ± 31, overall; 270 ± 34, Burma; 126 ± 20, military). The Burma patients took significantly longer than the military staff (234 ± 25 vs 112 ± 14, P < 0.01). Time for Burma children did not differ from Burma adults for PDI (109 ± 47 vs 217 ± 54, P = 0.42) and for conventional testing (266 ± 51 vs 275 ± 52, P = 0.80). Conclusions: Non–English-speaking Burma children and adults were able to reliably perform 3 types of near vision testing with a Nintendo 3DS game 25% quicker than the 2 to 3 minutes for conventional methods. They were slower than experienced US military staff adults.

Trichromatic Enhanced Dynamic Color Screening on the PDI Check Nintendo 3DS Game

“… 4 Near monocular visual acuity, stereopsis and color vision can be screened in normal military staff and also in remote, non-English speaking villagers. 5 PDI Check correlates well with conventional near vision tests and helps identify ocular suppression both through stereo deficiency, but also with autostereoscopically presented, rivalry near optotypes. 6 Champion shotgun shooters demonstrated extraordinary red-cone and blue cone detection with PDI Check compared to age-matched normal subjects.…”

“…It is not simple to collect large numbers of color deficient individuals due to the relative rarity of the condition. 5 We did not yet include patients with acquired color defects. We defined color cone deficiency by Innova Rabin method that may not exactly represent FM 100 or anomaloscope.…”

Extraordinary Dynamic Near Vision in Champion Shotgun Shooters: PDI Check Evaluation of Stereo and Color without Floor Effect

“…The Army volunteers previously had faster and better performance than villagers from a remote region in Burma. 7 In another recent validation study, normal color-vision civilian volunteers demonstrated the rapid capacity for PDI Check to identify inherited protanomaly and deuteranomaly compared to Innova Rabin industry-standard computerized testing. 9 The PDI Check scores did not definitively predict eye dominance with stereo or monocular performance in shotgun shooters with a sample size of 29.…”

“…9 Former PDI Check color validation studies utilized Ishihara color plates as controls with few color deficient subjects and are much less rigorous since Ishihara is more of a screening test, and not a quantitative test of color. 7 …”

“…The control groups were taken from previous PDI Check validation using identical component versions of the app. One group of controls came from healthy Army volunteers with no prior history of eye disease 7 and the other group was asymptomatic control subjects when PDI Check color test was applied to other patients identified as inherited color deficient. 7 …”