Oblique multi-periscopic prism for field expansion of homonymous hemianopia.

Oblique Fresnel peripheral prisms have been used for field expansion in homonymous hemianopia mobility such as walking and driving. However, limited field expansion, low image quality, and small eye scanning range limit their effectiveness. We developed a new oblique multi-periscopic prism using a cascade of rotated half-penta prisms, which provides 42° horizontal field expansion along with 18° vertical shift, high image quality, and wider eye scanning range. Feasibility and performance of a prototype using 3D-printed module are demonstrated by raytracing, photographic depiction, and Goldmann perimetry with patients with homonymous hemianopia.

Multi-periscopic prism device for field expansion.

Patients with visual field loss frequently collide with other pedestrians, with the highest risk being from pedestrians at a bearing angle of 45°. Current prismatic field expansion devices (≈30°) cannot cover pedestrians posing the highest risk and are limited by poor image quality and restricted eye scanning range (<5°). A new field expansion device: multi-periscopic prism (MPP); comprising a cascade of half-penta prisms provides wider shifting power (45°) with dramatically better image quality and wider eye scanning range (15°) is presented. Spectacles-mounted MPPs were implemented using 3D printing. The efficacy of the MPP is demonstrated using perimetry, photographic depiction, and analyses of the collision risk covered by the devices.

Validation of a spectral light scattering method to differentiate large from small particles in intraocular lenses.

A psychophysical approach has been designed to measure straylight from intraocular lenses (IOLs) in vitro. This approach uses a clinical straylight meter (C-Quant) and an observer's eye as optical detector. Based on this, we introduced a method for study of straylight-wavelength dependency for IOLs. This dependency can be used to distinguish between 2 types of scattering particles (small and large) as defined by Mie theory. Validation was performed using a turbidity standard and scattering filters. Several IOLs were analyzed to identify potential scattering sources. Large particles were found to predominate in scattering from the studied lenses. This was confirmed by straylight-angular dependency found in these IOLs.

Ocular Straylight with Different Multifocal Contact Lenses.

PURPOSE: Multifocal contact lenses have been growing in popularity as a modality to correct presbyopic eyes, although visual side effects such as disability glare have been reported. The objective of this study was to investigate the effect of multifocal contact lenses on disability glare by means of ocular straylight. METHODS: A prospective randomized, comparative study was performed that included 16 subjects free of ocular pathology. Straylight was measured using a commercial straylight meter with the natural and dilated pupil. Participants were fitted with Proclear Multifocal (Distance/Near), ACUVUE Oasys for Presbyopia, and Air Optix Aqua Multifocal randomized to the left or right eye. Straylight measurements were repeated with the contact lens in situ after the pupil dilation. Results obtained with the dilated pupil without contact lens acted as a control. RESULTS: Diameter of the natural and dilated pupil was 2.87 ± 0.40 mm and 7.45 ± 0.86 mm, respectively (P < .001). After pupil dilation, straylight increased from 0.92 ± 0.13 log(s) to 1.04 ± 0.11 log(s) (P < .001). Of the four studied lenses, a significant difference was only found between Air Optix and the control group (P = .006). The latter showed also slightly increased light scatter. CONCLUSIONS: A difference in measured straylight was found between the studied multifocal lenses. The observed variability and the straylight-pupil size dependency should be taken into account to avoid elevated straylight in multifocal contact lens wearers. The reason for the observed differences in straylight must be the subject of future studies.

Influence of Ametropia and Its Correction on Measurement of Accommodation.

PURPOSE: Amplitude of accommodation (AA) is reportedly greater for myopic eyes than for hyperopic eyes. We investigated potential explanations for this difference. METHODS: Analytical analysis and computer ray tracing were performed on two schematic eye models of axial ametropia. Using paraxial and nonparaxial approaches, AA was specified for the naked and the corrected eye using the anterior corneal surface as the reference plane. RESULTS: Assuming that axial myopia is due entirely to an increase in vitreous chamber depth, AA increases with the amount of myopia for two reasons that have not always been taken into account. First is the choice of reference location for specifying refractive error and AA in diopters. When specified relative to the cornea, AA increases with the degree of myopia more than when specified relative to the eye's first Gaussian principal plane. The second factor is movement of the eye's second Gaussian principal plane toward the retina during accommodation, which has a larger dioptric effect in shorter eyes. CONCLUSIONS: Using the corneal plane (placed at the corneal vertex) as the reference plane for specifying accommodation, AA depends slightly on the axial length of the eye's vitreous chamber. This dependency can be reduced significantly by using a reference plane located 4 mm posterior to the corneal plane. A simple formula is provided to help clinicians and researchers obtain a value of AA that closely reflects power changes of the crystalline lens, independent of axial ametropia and its correction with lenses.

Method for in vitro assessment of straylight from intraocular lenses.

Ocular straylight has been measured by means of psychophysical methods over the years. This approach gives a functional parameter yielding a straight comparison with optically defined light scattering, and the point-spread-function. This is of particular importance when the effect of intraocular lenses (IOLs) on postoperative straylight is sought. An optical system for straylight measurements of IOLs was adapted to a commercial device (C-Quant, Oculus), which employs such psychophysical method. The proposed modifications were validated using light-scattering filters and some sample IOLs. The measurements were performed by 3 observers to prove that results are independent from straylight of the eye. Other applications will be discussed.

Quantitative phase microscopy of transparent samples using a liquid crystal display.

We propose a new quantitative phase microscope based on spatial filtering of the beam carrying the sample-induced wavefront. A prototype built using a transmissive liquid crystal display for the experimental demonstration of the principle and preliminary results obtained with artificial and biological samples are presented.

Optical functional properties of the Boston Keratoprosthesis.

PURPOSE: To evaluate the optical characteristics of the Boston Keratoprosthesis (KPro), identify glare sources, evaluate possible glare control, and examine the benefit of implantation when the fellow eye has normal vision. METHODS: Computed and optical-bench-measured point spread function (PSF) and glare sources were compared. A translucent plastic cornea was used to determine the impact of glare caused by scatter in the cornea and its control with a dark-iris tinted contact lens. The effect of glare in implanted eyes was measured with a brightness acuity test (BAT), with and without the dark-iris contact lens. Computed and measured visual fields were compared. Stereopsis was measured in patients with an intact fellow eye. RESULTS: Computed and measured modulation transfer functions for the KPro were found to be very close to the diffraction limit. Both the model-eye measurements and patients' BAT glare responses identified that the hazy corneal graft surrounding the KPro is the main source of glare and can be controlled with a dark-iris contact lens. The lid effectively blocks the light that would be scattered in the hazy cornea of patients in whom the type II KPro was implanted. An intact fellow eye remains the dominant eye, with better acuity, and the KPro eye supports only minimal stereo ability and does not expand the binocular visual field. CONCLUSIONS: Glare can be reduced significantly with the use of a contact lens with a dark iris. Implanting the KPro in a patient whose fellow eye has normal or near normal vision does not seem to improve visual function.

A versatile optoelectronic aid for low vision patients.

The purpose of this work is to describe a versatile optoelectronic aid for low vision rehabilitation based on reconfigurable hardware. This aid is easily adaptable to diverse pathologies (with different associated processing tasks) and to the progression of the visual impairment. This platform has a mobile configuration that uses a see-through head-mounted display (Nomad). We have implemented different types of vision enhancement on this versatile platform, and briefly summarize here their computational costs (in terms of hardware resource requirements). We have evaluated two representative capabilities of this aid (Augmented View and digital zoom) with measurements of visual acuity, contrast sensitivity and visual field. We have tested the Nomad head-mounted display and the Augmented View modality, in eight subjects with retinitis pigmentosa: the digital zoom was tested in six low vision subjects and nine normally-sighted subjects. We show that the Nomad display with Augmented View configuration does not impair the residual vision; and that there is an increase in visual acuity (VA) with the digital zoom configuration. The major advantage of this platform is that it can easily embed different image processing tasks and since it is based on a FPGA device, it can be specifically configured to tasks requiring real-time processing.

The effect of biomicroscope illumination system on grading anterior chamber inflammation.

PURPOSE: To determine how a biomicroscope illumination system affects the grading of anterior chamber (AC) inflammation. DESIGN: Laboratory investigation. METHODS: An artificial AC was designed to replicate optically a human AC and was filled with 5-mum polystyrene beads suspended in ethanol. A high-definition video eyepiece camera recorded the moving beads. Using image processing software, the main outcomes measures determined were the average number of beads in a 1 x 1-mm field at varying widths of the slit-beam. RESULTS: The volume of light and number of beads observed increased significantly as the slit-beam widened. Additionally, 3 separate biomicroscopes of identical make and model were found to produce different levels of luminance at the same aperture dial settings, influencing the number of beads observed, with the brighter biomicroscope yielding higher bead counts. CONCLUSIONS: Ability to count beads and perhaps the ability to count inflammatory cells in an inflamed eye depend on a number of factors, including the level of illumination and width of the slit-beam. This study demonstrated that the brighter the illumination and the wider the beam, the more beads were observed. This illustrates the importance of standardizing biomicroscopy, particularly where consecutive observations are used to make clinical decisions and in cases of multicenter clinical trials where clinical data are evaluated across different facilities.

In-the-spectacle-lens telescopic device.

Spectacle-mounted telescopic systems are prescribed for individuals with visual impairments. Bioptic telescopes are typically mounted toward the top of the spectacle lens (or above the frame) with the telescope eyepiece positioned above the wearer's pupil. This allows the wearer to use up and down head tilt movements to quickly alternate between the unmagnified wide view (through the carrier lens) and the magnified narrow field of view (available through the eyepiece). Rejection of this visual aid has been attributed mainly to its appearance and to the limited field of view through the smaller Galilean designs. We designed a wide-field Keplerian telescope that is built completely within the spectacle lens. The design uses embedded mirrors inside the carrier lens for optical pathway folding, and conventional lenses or curved mirrors for magnification power. The short height of the ocular, its position, and a small tilt of the ocular mirror enable the wearer to simultaneously view the magnified field above the unmagnified view of the uninterrupted horizontal field. These features improve the cosmetics and utility of the device. The in-the-lens design allows the telescope to be mass produced as a commodity ophthalmic lens blank that can be surfaced to include the wearer's spectacle prescription.

The role of peripheral vision in saccade planning: learning from people with tunnel vision.

Both visually salient and top-down information are important in eye movement control, but their relative roles in the planning of daily saccades are unclear. We investigated the effect of peripheral vision loss on saccadic behaviors in patients with tunnel vision (visual field diameters 7 degrees-16 degrees) in visual search and real-world walking experiments. The patients made up to two saccades per second to their pre-saccadic blind areas, about half of which had no overlap between the post- and pre-saccadic views. In the visual search experiment, visual field size and the background (blank or picture) did not affect the saccade sizes and direction of patients (n = 9). In the walking experiment, the patients (n = 5) and normal controls (n = 3) had similar distributions of saccade sizes and directions. These findings might provide a clue about the large extent of the top-down mechanism influence on eye movement control.

Eye movements of patients with tunnel vision while walking.

PURPOSE: To determine how severe peripheral field loss (PFL) affects the dispersion of eye movements relative to the head in patients walking in real environments. This information should help to define the visual field and clearance requirements for head-mounted mobility visual aids. METHODS: Eye positions relative to the head were recorded in five patients with retinitis pigmentosa who had less than 15 degrees of visual field and in three normally sighted people, each walking in varied environments for more than 30 minutes. The eye-position recorder was made portable by modifying a head-mounted system (ISCAN, Burlington, MA). Custom data processing was implemented, to reject unreliable data. Sample standard deviations of eye position (dispersion) were compared across subject groups and environments. RESULTS: The patients with PFL exhibited narrower horizontal eye-position dispersions than did the normally sighted subjects (9.4 degrees vs. 14.2 degrees , P < 0.0001), and the vertical dispersions of patients with PFL were smaller when they were walking indoors than when walking outdoors (8.2 degrees vs. 10.3 degrees ; P = 0.048). CONCLUSIONS: When walking, the patients with PFL did not increase their scanning eye movements to compensate for missing peripheral vision information. Their horizontal scanning was actually reduced, possibly because of lack of peripheral stimulation. The results suggest that a field of view as wide as 40 degrees may be needed for closed (immersive) head-mounted mobility aids, whereas a much narrower display, perhaps as narrow as 20 degrees , may be sufficient with an open design.

Visual fields at the wheel.

PURPOSE: "Looked-but-failed-to-see" errors are a common cause of accidents, but it has never been determined whether obstructive elements within an automobile (e.g., window posts or the interior rearview mirror) have actually been an obstacle to vision. This work describes a technique that can easily be used to determine the available visual field of drivers at the wheel and illustrates its potential in a number of applications. METHOD: The technique involves calibrating a minicamera for use as a device for perimetry and then mounting it on spectacles so that it lies between the eyes of the subject who wears them. With the spectacle-mounted camera worn by a driver, snapshots were taken when the automobile was parked and the driver looked in different directions, and video sequences were recorded during natural driving in an urban area and on a winding mountain road. RESULTS: All of the automobiles studied place obstacles to vision for any given direction of gaze, although the resultant scotomata have different sizes and are placed in different regions of the visual field for each combination of car and driver. These regions encroach into central vision as drivers turn their head and eyes as required by the characteristics of the road or the urban area during natural driving, in some cases resulting in very poor visibility regardless of the good vision of the driver and the certification of the automobile. CONCLUSION: Our technique is useful for determining what parts of a given scene are visible to a given driver on a given automobile and, hence, it is useful not only as a tool for accident investigation and in visual ergonomics, but also as an aid for the design of automobiles and road environments.

Augmented-view for restricted visual field: multiple device implementations.

PURPOSE: An augmented-view device for patients with severely restricted peripheral visual fields (tunnel vision) was proposed, combining a see-through head-mounted display and a simultaneous minified view of a wide field presented as contour information. Here we create and evaluate multiple implementations of the augmented-view concept and report responses from potential users. METHODS: Several prototypes using commercial off-the-shelf devices were implemented. Then they were evaluated in real environments in daylight and at night by two retinitis pigmentosa patients. RESULTS: Effective expansion of the visual field of patients was achieved. Patients indicated their preferences for different properties, devices, and combinations. CONCLUSIONS: Patients found the augmented-view concept of help for their impairment, but wanted much more ergonomic design than the prototypes provided. Benefits, limitations, and possible improvements for the evaluated devices are discussed.

Effect of the polarization on ocular wave aberration measurements.

Measurement of the eye's wave aberrations has become fairly standard in recent years. However, most studies have not taken into account the possible influence of the polarization state of light on the wave aberration measurements. The birefringence properties of the eye's optical components, in particular corneal birefringence, can be expected to have an effect on the wave aberration estimates obtained under different states of polarization for the measurement light. In the work described, we used a psychophysical aberrometer (the spatially resolved refractometer) to measure the effect of changes in the polarization state of the illumination light on the eye's wave aberration estimates obtained in a single pass. We find, contrary to our initial expectation, that the polarization state of the measurement light has little influence on the measured wave aberration. For each subject, the differences in wave aberrations across polarization states were of the same order as the variability in aberrations across consecutive estimates of the wave front for the same polarization conditions.

Measurements of the corneal birefringence with a liquid-crystal imaging polariscope.

An imaging polariscope has been used to analyze the spatially resolved polarization properties of living human corneas. The apparatus is a modified double-pass setup, incorporating a liquid-crystal modulator in the analyzer pathway. Keeping the incident polarization state fixed (first passage), we recorded a series of three images of the pupil's plane corresponding to independent polarization states of the analyzer unit. Azimuth and retardation at each point of the cornea were calculated from those images. Results show that the magnitude of retardation increases along the radius toward the periphery of the cornea. Left-right eye symmetry in retardation was also found. Maps of azimuth indicate that the direction of the corneal slow axis is nasally downward.