WO2013159076A2 - Systèmes et procédés d'amélioration de la vue - Google Patents

Systèmes et procédés d'amélioration de la vue Download PDF

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WO2013159076A2
WO2013159076A2 PCT/US2013/037497 US2013037497W WO2013159076A2 WO 2013159076 A2 WO2013159076 A2 WO 2013159076A2 US 2013037497 W US2013037497 W US 2013037497W WO 2013159076 A2 WO2013159076 A2 WO 2013159076A2
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lens
vision enhancement
eye
visual axis
corneal
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PCT/US2013/037497
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WO2013159076A3 (fr
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Robert D. Anello
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Hoya Corporation
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/0016—Operational features thereof
    • A61B3/0025—Operational features thereof characterised by electronic signal processing, e.g. eye models

Definitions

  • the invention relates generally to vision enhancement and, in particular, to systems and methods for providing, facilitating, and/or presenting one or more ophthalmic assessments.
  • the ability to increase or decrease higher order aberrations with corneal incisions is important to predicting postoperative HO As with respect to multifocal IOL candidacy, and potentially in creating incisional strategies to reduce or eliminate HO As at the time of surgery. It would be useful to be able to provide a decision tool to assist surgeons with lens (e.g., IOL) selection and determining a treatment plan for each eye.
  • lens e.g., IOL
  • a method for enhancing vision includes: determining an estimated anatomical misalignment of a center of a lens following implantation of the lens in an eye, and applying the estimated anatomical misalignment to ocular information associated with the eye to control, generate, or provide a visual representation.
  • a method for enhancing vision includes: determining an estimated anatomical misalignment of a center of a lens following implantation of the lens in an eye, and applying the estimated anatomical misalignment to ocular information associated with the eye to facilitate, control, or initiate an action or process involving one or more of: controlling, generating, or providing a visual representation, comparing one or more vision enhancement procedures and/or products, selecting one or more vision enhancement procedures and/or products, identifying one or more candidate lens, selecting a lens and performing a surgical procedure involving the lens and the eye, selecting a surgical procedure and performing the surgical procedure on the eye, and inducing, simulating, estimating, or predicting a postoperative result in relation to one or more vision enhancement procedures and/or products.
  • a method for assessing potential candidates for lens implantation includes: using Angle Alpha and ocular anatomy information associated with one or more eyes to determine the location of the optical center for the one or more eyes; using the location of the corneal vertex and the location of the optical center to determine the visual axis for each of the one or more eyes; using a point along the visual axis and intersecting with a plane perpendicular to the lens axis to determine, for each of the one or more eyes, an optical alignment of the lens in relation to the visual axis; and applying the one or more optical alignments to ocular information associated with the one or more eyes to facilitate, control, or initiate an action or process of estimating outcomes for one or more lens implantation procedures.
  • a method for facilitating a vision enhancement procedure includes: accessing ophthalmic information for one or more eyes; and applying one or more criteria to the information to facilitate or initiate an action or process of controlling, generating, or providing a visual representation of one or more of a preoperative status associated with the one or more eyes, candidate vision enhancement procedures and/or products, estimated postoperative results for one or more vision enhancement procedures and/or products, a comparison of pre and postop corneal astigmatism, angle alpha associated with one or more of the eyes, an estimate of visual axis to lens deviation associated with one or more of the eyes, estimated image quality for one or more vision enhancement procedures and/or products, estimated surgeon specific surgically induced changes, an estimated postoperative assessment, a comparison of lenses that is one or more of surgeon-specific, lens style-specific, and surgical procedure-specific or approach-specific, one or more personalized parameters or determinations, and an indication of cases having desired outcomes.
  • a method for assessing surgically induced changes includes: measuring, determining, or estimating pre and postop corneal wavefront astigmatisms for an eye; and applying the pre and postop corneal wavefront astigmatisms in an action or process of controlling or utilizing one or more electronic devices and/or display devices to provide a visual representation of one or more surgically induced changes.
  • a method of selecting a vision enhancement procedure and/or product includes: for multiple subjects, utilizing pre and postoperative ophthalmic information including corneal topography and IOL centration relative to the corneal vertex to map surgeon-specific, IOL-specific surgically-related tendencies in relation to multiple different IOLs.
  • a method of selecting a vision enhancement procedure and/or product includes, for each of a series of subjects: obtaining corneal topography information for a preoperative eye, after implanting an IOL lens, determining IOL centration relative to the corneal vertex; after determining IOL centration, determining for all or a plurality of subjects of the series that have been postoperatively measured an aggregate or average estimated surgically induced change; and applying the aggregate or average estimated surgically induced change to control one or more electronic displays in relation to generating, updating, or providing a visual representation pertaining to one or more surgically induced changes.
  • a vision enhancement system includes: a computer- executable software application configured or programmed to receive or access ocular information associated with one or more eyes and to process the ocular information in relation to determining an optical center and a corneal vertex for an eye, using the optical center and corneal vertex to determine a visual axis for the eye, determining an intercept of the visual axis with a lens plane, and using the intercept to determine an optical alignment of the lens in relation to the visual axis.
  • a vision enhancement method includes: measuring an image location at the retina and an axial length of the eye to approximate a visual axis of the eye; using an optic diameter to determine the distance between the cornea and the lens; determining an intercept of the visual axis with a lens plane; using the intercept to determine an optical alignment of the lens in relation to the visual axis; and applying the optical alignment to an action or process of providing, facilitating, and/or presenting one or more ophthalmic assessments.
  • a vision enhancement system includes: a computer- executable software application configured or programmed to receive or access ocular information associated with one or more eyes and to process the ocular information in relation to measuring an image location at the retina and an axial length of the eye to approximate a visual axis of the eye, using an optic diameter to determine the distance between the cornea and the lens, determining an intercept of the visual axis with a lens plane, and using the intercept to determine an optical alignment of the lens in relation to the visual axis.
  • a vision enhancement method includes: utilizing estimated or a priori determined coordinates of the visual axis at the cornea to locate arcuate corneal incisions during femtosecond laser surgery of the eye.
  • a vision enhancement method includes: selecting and/or optimizing one or more vision correction modalities in consideration of foveal curvature.
  • FIG. 1 shows an example embodiment of a vision enhancement system
  • FIG. 2 shows an example embodiment of a vision enhancement method
  • FIGs. 3-5 illustrate the relation between Angle Alpha, the Corneal Vertex and Lens Alignment with the Visual Axis
  • FIG. 6 is an example eye image showing the visual axis, pupil margin, pupil center, limbal center, and the 4 th Purkinje image of the 4-point illumination pattern
  • FIG. 7 shows an example visual representation of a "dashboard" for providing, facilitating, and/or presenting one or more ophthalmic assessments
  • FIG. 8 shows an example group of visual representations pertaining to estimated image quality performance of advanced aspheric IOLs
  • FIG. 9 shows an example "IOL Selection Overview” interface/visual representation
  • FIG. 10 shows an example "Preoperative Assessment” interface/visual representation
  • FIG. 11 shows an example "Multifocal IOL Summary” interface/visual representation
  • FIG. 12 shows an example “Toric IOL Summary” interface/visual representation
  • FIG. 13 shows an example “Monofocal IOL Summary” interface/visual representation
  • FIGs. 14 and 15 show example visual schemes utilized to present to a user factors or determinations relevant to selecting a vision enhancement procedure and/or product
  • FIG. 16 is a flow diagram representing alternative techniques for determining visual axis
  • FIG. 17 shows an IOL during dilation of the eye
  • FIG. 18 shows an example of a visual axis of the eye
  • FIG. 19 shows an example of an approximated visual axis
  • FIG. 20 shows an example of an anterior capsulotomy
  • FIG. 21 shows centering of arcuate corneal incisions for the treatment of astigmatism
  • FIGs. 22 and 23 show the impact of residual positive spherical aberration on retinal image curvature at the fovea
  • FIGs. 24 and 25 show the impact of residual negative spherical aberration on retinal image curvature at the fovea
  • FIG. 26 illustrates geometrically how the radius of curvature of image focus can be estimated by assuming that the image surface is part of a sphere; and FIG. 27 illustrates geometrically how the radius of curvature of image focus can be determined in consideration of a curved (non-spherical) imaging surface.
  • Example embodiments described herein generally involve systems and methods for providing, facilitating, and/or presenting one or more ophthalmic assessments.
  • An example methodology includes: determining or estimating an optical alignment of a lens in relation to the visual axis of an eye; and applying the optical alignment to an action or process of providing, facilitating, and/or presenting one or more ophthalmic assessments (e.g., in relation to one or more vision enhancement products and/or procedures).
  • a vision enhancement system 100 includes biometry device(s) 102, corneal topography/integrated topo/aberrometry device(s) 104, processing module(s) 106 (e.g., computers, system applications, add-ins), database(s) 108, display(s) 110 (e.g., electronic and/or computer-controlled display, user interface), and (additional) user input mechanism(s) 112 configured as shown.
  • the biometry device(s) 102 can include one or more systems, apparatuses, or devices such as the commercially-available products: IOLM aster 500 (Carl Zeiss International) and LENSTAR LS900® biometry product (Haag-Streit AG, Switzerland).
  • the corneal topography/integrated topo/aberrometry device(s) 104 can include one or more systems, apparatuses, or devices such as the commercially-available products: OPD-Scan III Wavefront Aberrometer (NIDEK Inc., Fremont, CA), iTrace Wavefront Aberrometer/Topographer (Tracey Technologies, Houston, Texas), and ATLASTM 9000 Corneal Topography System (Carl Zeiss International).
  • OPD-Scan III Wavefront Aberrometer NIDEK Inc., Fremont, CA
  • iTrace Wavefront Aberrometer/Topographer Tracey Technologies, Houston, Texas
  • ATLASTM 9000 Corneal Topography System Carl Zeiss International
  • the apex of the cornea, or corneal vertex is rarely perfectly aligned with the lens. Rather the corneal vertex is shifted in most eyes giving rise to the visual axis as shown by the arrow (denoted "VA") in FIG. 4.
  • VA visual axis
  • the cornea is shifted nasally, which allows incoming paraxial light to be focused near the fovea.
  • This shifting of the corneal vertex also shifts the optical center of the eye, sometimes referred to as the "nodal point", shown as the black point (denoted "NP”) in FIGs. 3 and 4. In doing so, the lens is then effectively misaligned from the visual axis as shown in FIG. 5.
  • Angle Alpha is shown in FIG. 5 as the angular measure of alignment between the corneal vertex and the lens center.
  • the iTrace Wavefront Aberrometer/Topographer can be utilized to estimate the lens center using the limbal center.
  • Angle Alpha measurements can be obtained utilizing the LENSTAR LS900® biometry product.
  • Angle Alpha estimates the relation between the corneal vertex and the lens center, but does not directly determine lens alignment relative to the visual axis, which is shown in FIG. 5 (denoted as "Anatomical Misalignment").
  • Systems and methods described herein facilitate determining the actual anatomical misalignment shown in FIG. 5 for a given Angle Alpha and ocular anatomy. This approach is generalizable to the case of pseudophakic eyes and IOLs.
  • the lens center may also be identified as described herein utilizing the 4th Purkinje image reflection.
  • the example eye image shows the visual axis, pupil margin, pupil center, and limbal center.
  • the 4 th Purkinje image (denoted "4PI") of the 4-point illumination pattern gives a more direct measure of the lens center.
  • Purkinje image reflections can be utilized to determine the lens center.
  • the 4 th Purkinje image may be difficult to distinguish from the 1 st Purkinje image.
  • a light source or other device configured to generate or provide a Purkinje pattern is believed to be suitable in relation to reliably capturing images for the vast majority of eyes. See also, Dunne, M.C.M., et al., "Peripheral astigmatic asymmetry and angle alpha," Ophthal. Physiol. Opt., 1993, Vol. 13 (July 1993), pp. 303-305 (hereafter, "Dunne”), which is hereby incorporated by reference.
  • the light source includes one or more beams or rays.
  • infrared light rays directed (e.g., sequentially) along multiple different parallel paths can be utilized to assess lens alignment.
  • the iTrace Wavefront Aberrometer/Topographer (Tracey Technologies, Houston, Texas) can be utilized to provide such a light source.
  • multiple lens alignment determinations made at different known light source (e.g., laser beam) locations are utilized to provide a lens alignment assessment for an eye.
  • multiple lens alignment determinations e.g., associated with 256 paraxial laser beam locations, respectively
  • One or more (e.g., groups) of the lens alignment determinations can also be weighted or adjusted depending, for example, on a quality or other metric associated with determinations made in association with different groups of the known light source locations.
  • a vision enhancement method 200 includes, at 202, determining optical center and corneal vertex for an eye.
  • the optical center and corneal vertex are used to determine visual axis for the eye (e.g., calculate 3D linear equation of the visual axis as described below).
  • the intercept e.g., intercept point location: X I O L , Y I O L , Z I O L
  • the lens plane e.g., IOL plane
  • the optical alignment is applied to an action or process of providing, facilitating, and/or presenting one or more ophthalmic assessments (e.g., in relation to one or more vision enhancement products and/or procedures).
  • the location of the optical center of each eye is determined (e.g., calculated as described herein).
  • the approach has been generalized to any pseudophakic eye to estimate optical alignment that would result from IOL implantation, which involves using:
  • Approximate IOL parameters such as thickness, anterior/posterior power, postop location behind the cornea, and the index of refraction of the IOL material.
  • a three dimensional linear equation is used to find the intersection of the visual axis and the plane perpendicular to the lens axis at its center point (denoted "A") in FIG. 5.
  • the anatomical misalignment of the lens center from the visual axis can then be calculated (e.g., in mm) from the location of point A on the visual axis.
  • K s @ 9 S & K f @ 9 f that is, the steep principal meridian lies at 9 S (°) and the flat principal meridian lies at 9 f (°) and the corresponding principal powers along them are K s (D) and K f (D), respectively.
  • K s > K f and 9 S and 9 f are typically 90° apart.
  • the lens has front and back surface powers LA S (D) and LA f (D) at meridia a s (°) and ⁇ 3 ⁇ 4 (°) and LP S (D) and LP f (D) at meridia ⁇ 8 and
  • the reduced distance between the cornea and the lens is ACD (mm) and between the lens and the retina PCD (mm).
  • the lens has reduced thickness L (mm).
  • all the refracting surfaces are centered on longitudinal lens axis Z except that the cornea is decentered Alpha x (mm), Alpha y (mm) from the corneal vertex.
  • the index of the lens is n L and the index of the rest of the eye is n aq .
  • Decentration of Alpha x (mm), Alpha y (mm) is equivalent to displacing the longitudinal axis -Alpha x (mm), -Alpha y (mm). That is, from Equation 1 1 , of Harris, W.F., "Optical Axes of Eyes and Other Optical Systems,” Optometry and Vision Science, Vol. 86, No. 5 (May 2009), pp. 537-541 and Appendix, which are hereby incorporated by reference,
  • the anterior chamber has transference
  • the transference of the first surface of the lens is the transference of the first surface of the lens.
  • T T 6 T 5 T 4 T 3 T 2 T 1 , or
  • noisy 1 ⁇ 2 (n011 + n022).
  • the incident node is centered on the incident mid nodal longitudinal position. See, Harris, 2010.
  • N C "T x (nab- I - n vit x A T )
  • the emergent node is center on the emergent mid nodal longitudinal position.
  • the three dimensional equation for the visual axis can be determined by the location of the corneal vertex and the optical center:
  • the SRK II has been used to simply estimate the IOL power needed for each eye.
  • the SRK II formula is as follows:
  • P Al-2.5 X z-0.9 x K
  • P the IOL power for emmetropia
  • Al the modified lens constant
  • A the manufacturer recommended A constant for the specific IOL
  • K the average of K s and K f :
  • the "ACD" constant for the IOL may be used where:
  • A (ACD - Konst + 68.747) / 0.62467. See, HAIGIS, "IOL calculation according to HAIGIS," http://www.augenklinik.uni- wuerzburg.de/uslab/ioltxt/haie.htm, which is hereby incorporated by reference.
  • a method for enhancing vision includes: determining an estimated anatomical misalignment of a center of a lens following implantation of the lens in an eye, and applying the estimated anatomical misalignment to ocular information associated with the eye to control, generate, or provide a visual representation (e.g., via an interactive interface).
  • an example visual representation 700 (which can be referred to as a "dashboard”) includes an arrangement of windows, graphics, visual schema, and the like presented, for example, in light of each eye's custom lens alignment factor.
  • the visual representation 700 summarizes key data that may influence patient candidacy for various IOL choices.
  • a workstation (such as in FIG. 1) can be configured, for example, to provide an estimation of the image quality associated with aspheric IOLs applying each eye's custom lens alignment factor to other ocular information associated with each eye, respectively. More generally, a workstation can be configured for providing, facilitating, and/or presenting one or more ophthalmic assessments.
  • multifocal IOL candidacy are three-fold: Corneal astigmatism, corneal higher order aberrations, and lens alignment. These factors could contribute to increasing the overall higher order aberration burden on an eye implanted with a multifocal IOL.
  • FIG. 7 the color coding scheme presented for these parameters allows surgeons to tailor his or her patient selection process to their personal level of experience. For example, multifocal IOLs are not recommended in the presence of more than 0.75 D of corneal cylinder. Thus, if a surgeon has a plan to reduce corneal astigmatism below this level by using LRIs or LASIK then he or she may more aggressive approach baseline cylinder levels.
  • Lens misalignment can further increase the HOA burden of eye, especially one with the advanced aspheric multifocal IOLs available today.
  • consideration of the Custom Lens Alignment Factor, in conjunction with the corneal HOA and residual postop cylinder, can provide a more complete portrait of ideal candidates for multifocal implantation.
  • corneal cylinder may be suitable for Toric IOL correction.
  • Alcon the manufacturer of the only Toric IOL available in the US, recommends using manual keratometry to determine Toric IOL eligibility.
  • identifying the steep meridian and cylinder magnitude in eyes with asymmetrical astigmatism can be variable.
  • corneal topography approaches may be more robust in selecting Toric IOL candidates and planning their correction.
  • the Astigmatism Assessment area of the example Dashboard in FIG. 7 provides four separate measures of this patient's astigmatism.
  • the first is the Simulated Keratometry at 3 mm from the corneal topography measurement of the iTrace.
  • the next is the Refractive Corneal Power assessment within the 3 mm zone.
  • the next two measures represent the Regular portion of the corneal astigmatism from the wavefront assessment at the 3 mm zone and with consideration to the pupil size.
  • the color coded visual representation of the astigmatism assessment takes into account the patient's pupil size and compares the Regular Refractive Corneal Cylinder from wavefront at this larger zone to the Sim K Cyl at the 3 mm zone (FIG. 8). In this case there is very good agreement with identification of the steep merdian in all four measures, though the pupil based Regular Corneal Cylinder indicates that patients may have more astigmatism than the Sim K indicates. Deviations between the cylinder or meridian data across these measures could indicate asymmetrical astigmatism.
  • the surgeon next considers which monofocal IOL may be best in this particular eye.
  • the portion denoted "Advanced Aspheric Monofocal IOL Options" depicts the monofocal IOL selection capability of the Dashboard.
  • the dashboard confirms that a traditional Negative Aspheric may provide better image quality as compared with the Optimized aspheric IOL.
  • a method for enhancing vision includes: determining an estimated anatomical misalignment of a center of a lens following implantation of the lens in an eye, and applying the estimated anatomical misalignment to ocular information associated with the eye to facilitate, control, or initiate an action or process involving one or more of: controlling, generating, or providing a visual representation (provided, for example, at an electronic and/or computer-controlled display), comparing one or more vision enhancement procedures and/or products, selecting one or more vision enhancement procedures and/or products, identifying (and testing) one or more candidate lens (or other vision enhancement products) (e.g., for a surgical procedure to be performed on the eye), selecting a lens (and/or one or more other vision enhancement products) and performing a surgical procedure involving the lens and the eye, selecting a surgical procedure (and/or a surgical procedure approach) and performing the surgical procedure on the eye, and inducing, simulating, estimating, or predicting a postoperative result in relation to one or more vision enhancement procedures and
  • determining an estimated anatomical misalignment include, for example: using an estimate of the relation between the corneal vertex and the lens center (e.g., a measured value of Angle Alpha to determine the location of the optical center (x, y, z) for the eye (e.g., in three dimensions, (Xo, Yo, Zo)); using the optical center and the location of the corneal vertex to determine the visual axis of the eye (e.g., solving 3D equation as described herein); and using the visual axis and a point along the visual axis that intersects a plane perpendicular to the lens axis to determine the distance of the lens center from the visual axis (which provides the estimated anatomical misalignment).
  • an estimate of the relation between the corneal vertex and the lens center e.g., a measured value of Angle Alpha to determine the location of the optical center (x, y, z) for the eye (e.g., in three dimensions, (Xo, Yo, Zo)
  • the step of using an estimate of the relation between the corneal vertex and the lens center includes, for example, using 4th Purkinje image reflections to identify or determine the lens center.
  • the step of using an estimate of the relation between the corneal vertex and the lens center includes, for example, determining the location of the optical center for the eye in three dimensions.
  • the step of using the optical center and the location of the corneal vertex to determine the visual axis of the eye includes, for example, using a three dimensional linear equation to determine the intersection of the visual axis and the plane perpendicular to the lens axis at the lens center.
  • a method for assessing potential candidates for lens implantation includes: using Angle Alpha and ocular anatomy information associated with one or more eyes (in the case of multiple eyes, information associated with each eye, individually) to determine the location of the optical center for the one or more eyes; using the location of the corneal vertex and the location of the optical center to determine the visual axis for each of the one or more eyes; using a point along the visual axis and intersecting with a plane perpendicular to the lens axis to determine, for each of the one or more eyes, an optical alignment (e.g., a custom lens alignment factor) of the lens (e.g., lens center) in relation to the visual axis; and applying the one or more optical alignments to ocular information associated with the one or more eyes to facilitate, control, or initiate an action or process of estimating outcomes for one or more lens implantation procedures (e.g., for multifocal IOL implantation).
  • Angle Alpha and ocular anatomy information associated with one or more eyes in the case of multiple eyes, information associated with
  • the one or more optical alignments can be applied to the ocular information in conjunction with corneal high order aberration (HOA) information associated with the one or more eyes.
  • the one or more optical alignments can be applied to the ocular information in conjunction with residual post operative cylinder information associated with the one or more eyes.
  • the action or process involves, for example, providing an assessment of image qualities associated with multiple different aspheric IOLs (or other lens, e.g., in consideration of each eye's custom lens alignment factor).
  • FIG. 9 shows an "IOL Selection Overview" interface/visual representation.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to a preoperative status associated with the one or more eyes (e.g., in relation to one or more of: Keratometric Astigmatism (Sim K Cyl), Total Corneal Higher Order Aberrations (Total Corneal HOAs), Corneal Spherical Aberration, and Visual Axis - Lens Deviation).
  • a preoperative status associated with the one or more eyes e.g., in relation to one or more of: Keratometric Astigmatism (Sim K Cyl), Total Corneal Higher Order Aberrations (Total Corneal HOAs), Corneal Spherical Aberration, and Visual Axis - Lens Deviation).
  • FIG. 10 shows a "Preoperative Assessment" interface/visual representation. In selecting the IOL best suited for each eye it is helpful to understand if and how each of these metrics changes due to surgery.
  • the surgically induced change in astigmatism following cataract surgery can be quantified using vector analysis of pre and postop keratometry measurements or pre and postop refractions. See, Thibos, L.N., et al, "Power vector analysis of the optical outcome of refractive surgery," J Cataract Refract Surg, Vol. 27 (January 2001), pp. 80-85, which is hereby incorporated by reference.
  • the mean magnitude of the vector change has decreased over time as incision size has been reduced from 6 mm 20 years ago to 2 mm today.
  • each surgeon's approach is still associated with a surgically induced change in cylinder magnitude and axis and it is important to know this in order to optimize toric IOL correction.
  • Use of the pre and postop corneal wavefront astigmatism to assess surgically induced changes may represent an improved approach over other methods.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to candidate vision enhancement procedures and/or products (e.g., arranged such that one or more vision enhancement procedures and/or products that satisfy the one or more criteria or a subset thereof is prominently presented at the interface)
  • a user interface pertaining to candidate vision enhancement procedures and/or products (e.g., arranged such that one or more vision enhancement procedures and/or products that satisfy the one or more criteria or a subset thereof is prominently presented at the interface)
  • the display areas labeled "Complete Astigmatism Assessment” and "Negative Aspheric Toric" are presented while other portions of the dashboard fade to the background or minimize (e.g., temporarily until the user provides an input, or responds to a prompt acknowledging that he or she has considered the presented factor).
  • Such a display i.e., showing a subset of a complete dashboard, can be automatically generated or provided in response to a user input such as, for example, a voice command to present key decisional factors in order of importance or relevance in deciding whether to further consider (or eliminate from further consideration as candidates) particular vision enhancement products and/or procedures.
  • a user input such as, for example, a voice command to present key decisional factors in order of importance or relevance in deciding whether to further consider (or eliminate from further consideration as candidates) particular vision enhancement products and/or procedures.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to estimated postoperative results for one or more vision enhancement procedures and/or products (e.g., estimated postoperative results for multiple different IOLs) (e.g., for monofocal and/or multifocal candidates) (e.g., for negative aspheric candidates) (e.g., for negative aspheric multifocal candidates) (e.g., for negative aspheric toric candidates). See e.g., FIGs. 9-13.
  • FIG. 11 shows an example "Multifocal IOL Summary" interface/visual representation.
  • FIG. 12 shows an example "Toric IOL Summary” interface/visual representation.
  • FIG. 13 shows an example "Monofocal IOL Summary” interface/visual representation.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to a comparison of pre and postop corneal (wavefront) astigmatism (e.g., a measured preoperative corneal wavefront astigmatism and an estimated postoperative corneal wavefront astigmatism) (e.g., vector analysis of individual pre and postop HO As, such as coma or trefoil, when combined with induced astigmatism results, or induced corneal astigmatism results).
  • Vector analysis of individual pre and postop HO As, such as coma or trefoil when combined with induced astigmatism results, provides a complete picture of the impact of cataract surgery on corneal optical quality.
  • Spherical aberrations being radially symmetric, are generally not altered by traditional cataract surgery.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to angle alpha associated with one or more of the eyes (e.g., determined from a corneal topography measurement/determination that provides Zernike lower- and higher-order aberrations (HO As)).
  • a user interface pertaining to angle alpha associated with one or more of the eyes e.g., determined from a corneal topography measurement/determination that provides Zernike lower- and higher-order aberrations (HO As)).
  • the action or process can involve controlling, generating, or providing a user interface pertaining to an estimate of visual axis to lens deviation associated with one or more of the eyes.
  • the visual axis to lens deviation can be estimated as described herein.
  • the limbal center for example, is used as a marker for the crystalline lens center. While this is a reasonable approximation of where the center of an implanted IOL may lie, IOLs have been reported to center differentially in a particular direction with respect to the limbal center. For example, the HOYA VA-60BB IOL has been reported to center at 0.3 mm from the limbal center at approximately 45 degrees supero-nasally from the horizontal. See, Kim, K.H., et al.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to estimated image quality (e.g., in relation to percent aligned) for one or more vision enhancement procedures and/or products.
  • the visual representation can include a display area (or key) such as displays 1400 and 1500 (shown in FIGs. 14 and 15, respectively) in which different sections or portions of the display areas represent different percentage ranges.
  • each of the different sections or portions is generated or provided as a visually distinguishable area (e.g., each area having a different fill color).
  • a visual (e.g., color) scheme (e.g., presented via an Image Quality display area or key) is utilized (e.g., to identify factors or determinations relevant to different estimated image qualities) in multiple different visual representation areas.
  • a visual representation can include a color coded column such as in display 1400 (FIG. 14) and/or a color coded gauge (or dial) such as in display 1500 (FIG. 15) as in a vehicle dashboard or cockpit.
  • the vision enhancement technologies described herein can help a user to more easily visualize and consider factors or determinations relevant (or important, critical, or dispositive) to identifying or selecting a vision enhancement procedure and/or product.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to estimated surgeon-specific surgically induced changes such as, for example, surgeon-specific surgically induced astigmatism or induced corneal astigmatism.
  • a visual representation can include visible indicia (e.g., positioned on a plot in relation to Nasal-Temporal and Inferior-Superior axes) representing one or more of a pupil center, a limbal center, and a visual axis center.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to an estimated postoperative assessment.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to a comparison of lenses (e.g., candidate IOLs) that is one or more of surgeon-specific, lens style-specific (or lens model-specific, lens design specific, lens size- specific, or lens batch-specific), and surgical procedure-specific or approach-specific (e.g., as to different surgical approaches, for example, approaching superiorly)
  • a visual representation can include one or more visual representation areas such as an IOL- specific comparison in relation to different Angle Alpha selections (e.g., a visual representation including an arrangement of multiple different areas or windows in which plots of image quality vs. Angle Alpha are shown for different Angle Alpha values).
  • a visual representation can include a personalized lens parameter such as a lens power constant (A constant).
  • a constant e.g., a lens power constant
  • a provisional A constant e.g., specified by a lens manufacturer
  • a personalized A constant e.g., IOL-specific
  • a dashboard represents a starting point for a surgeon utilizing a given workstation to gain greater insight into matching the best IOL option to each patient. Ideally, this approach will be "personalized" to each surgeon and can include an assessment of the each patient's postoperative results.
  • the action or process can involve controlling, generating, or providing a user interface pertaining to an indication (e.g., a percentage, or other characterization or identification or description) of cases (e.g., IOL-specific) having a (range of) desired (or acceptable or superior) outcomes (e.g., % cases within 0.5 D of target).
  • an indication e.g., a percentage, or other characterization or identification or description
  • cases e.g., IOL-specific
  • a (range of) desired (or acceptable or superior) outcomes e.g., % cases within 0.5 D of target.
  • a method for facilitating a vision enhancement procedure includes: accessing ophthalmic information (e.g., including measurements and calculations and/or determinations made utilizing the information) for one or more eyes; and applying one or more criteria (e.g., one or more vision enhancement and/or information presentation criteria) to the information to facilitate or initiate an action or process of controlling, generating, or providing a visual representation (e.g., via an interactive interface) of one or more of (as previously discussed) a preoperative status associated with the one or more eyes, candidate vision enhancement procedures and/or products, estimated postoperative results for one or more vision enhancement procedures and/or products, a comparison of pre and postop corneal astigmatism, angle alpha associated with one or more of the eyes, an estimate of visual axis to lens deviation associated with one or more of the eyes, estimated image quality for one or more vision enhancement procedures and/or products, estimated surgeon specific surgically induced changes, an estimated postoperative assessment, a comparison of lenses that is one or more of surgeon-specific, lens style-specific,
  • the visual representation is controlled, generated, or provided via an interface that is generated utilizing a custom add-in or plug-in system application which functions as an extension and overlay to an existing third party system application or other platform that facilitates ophthalmic assessments.
  • the preoperative status is associated with the one or more eyes in relation to one or more of, for example: Keratometric Astigmatism (Sim K Cyl), Total Corneal Higher Order Aberrations (Total Corneal HOAs), Corneal Spherical Aberration, and Visual Axis and Lens Deviation.
  • Keratometric Astigmatism Sim K Cyl
  • Total Corneal Higher Order Aberrations Total Corneal HOAs
  • Corneal Spherical Aberration and Visual Axis and Lens Deviation.
  • the candidate vision enhancement procedures and/or products can be arranged such that one or more vision enhancement procedures and/or products that satisfy the one or more criteria or a subset thereof are prominently presented (e.g., in the visual representation and/or at another user interface).
  • the estimated postoperative results for one or more vision enhancement procedures and/or products involve one or more of, for example: estimated postoperative results for multiple different IOLs, monofocal and/or multifocal candidates, negative aspheric candidates, negative aspheric multifocal candidates, and negative aspheric toric candidates.
  • the comparison of pre and postop corneal astigmatism pertains, for example, to a measured preoperative corneal wavefront astigmatism and an estimated postoperative corneal wavefront astigmatism.
  • pre and postop corneal astigmatism pertains, for example, to individual pre and postop HOAs (such as coma or trefoil) and induced astigmatism results.
  • the estimated image quality for one or more vision enhancement procedures and/or products can be presented in relation to a visual scheme correlating multiple different ranges of estimated image quality with different visually distinct representations, respectively (e.g., as previously discussed).
  • the estimated surgeon-specific surgically induced changes include visible indicia (e.g., positioned on a plot in relation to Nasal-Temporal and Inferior- Superior axes) representing one or more of a pupil center, a limbal center, and a visual axis center.
  • the comparison of lenses includes, for example, an IOL-specific comparison in relation to different Angle Alpha selections.
  • the one or more personalized parameters or determinations include, for example, one or more of a personalized A constant and an IOL-specific parameter or determination.
  • a method for assessing surgically induced changes includes: measuring, determining, or estimating pre and postop corneal wavefront astigmatisms for an eye; and applying the pre and postop corneal wavefront astigmatisms in an action or process of controlling or utilizing one or more electronic devices and/or display devices to provide a visual representation of one or more surgically induced changes.
  • the method further includes: measuring, determining, or estimating a postoperative centration of IOLs relative to the limbal center and/or the corneal vertex; and using the location of the lens center to update or modify (e.g., personalize) a determination and/or a visual representation involving visual axis to lens center deviation.
  • the predictive utility of the dashboard can be significantly augmented by aggregating pre and postop data following IOL implantation in a series of subjects.
  • corneal topography converted to Zernike coefficients and IOL centration as measured by, for example, Purkinje images relative to the corneal vertex could be used to map the surgeon-specific, IOL-specific surgically-related tendencies.
  • a quantification of these trends can then be incorporated into the estimated postoperative assessment provided by the dashboard to greatly improve its utility in selecting which IOL may be best suited for each eye.
  • a method of selecting a vision enhancement procedure and/or product includes: for multiple (e.g., a series of) subjects, utilizing pre and postoperative ophthalmic information including corneal topography (e.g., converted to Zernike coefficients) and IOL centration (e.g., determined utilizing Purkinje images relative to the corneal vertex) to map surgeon-specific, IOL-specific (or len style/type- specific) surgically-related tendencies in relation to multiple different IOLs (e.g., of different lens style or type).
  • corneal topography includes, for example, corneal topography information and, in example embodiments, can include ocular wavefront information created or influenced by the cornea.
  • the method further includes: identifying (e.g., quantifying) one or more trends associated with the pre and postoperative ophthalmic information; and utilizing the one or more trends to provide or modify an estimated postoperative assessment (for example, quantifications of one or more of the trends can be incorporated into an estimated postoperative assessment).
  • a method of selecting a vision enhancement procedure and/or product includes, for each of a series of subjects: obtaining corneal topography information for a preoperative eye (e.g., by measuring, or data from a previous preoperative measurement), after (selecting and) implanting an IOL lens, determining IOL centration (e.g., identifying the lens center using the 4th Purkinje image reflection) relative to the corneal vertex; after determining IOL centration, determining for all or a plurality of subjects of the series that have been postoperatively measured an aggregate or average estimated (surgeon-specific) surgically induced change (e.g., Expected Surgical Change in Cyl (D)); and applying the aggregate or average estimated (surgeon-specific) surgically induced change to control one or more electronic displays in relation to generating, updating, or providing a visual representation pertaining to one or more surgically induced changes.
  • IOL centration e.g., identifying the lens center using the 4th Purkinje image reflection
  • the visual representation pertains, for example, to one or more estimated or predicted tendencies in relation to surgically induced changes (e.g., surgeon-specific surgically induced changes).
  • the visual representation pertains, for example, to surgeon- specific, IOL-specific surgically-related tendencies.
  • the visual representation pertains, for example, to surgeon-specific, lens style-specific surgically-related tendencies.
  • the surgically-related tendencies can also be lens type- specific, lens model-specific, lens design specific, lens size-specific, or lens batch-specific.
  • the surgically-related tendencies can also be surgical procedure-specific or approach-specific (e.g., as to different surgical approaches, for example, approaching superiorly).
  • a lens e.g., IOL
  • the computer-executable software application is, for example, configured or programmed to apply the optical alignment to an action or process of providing or facilitating an ophthalmic assessment in relation to one or more vision enhancement products and/or procedures.
  • the computer-executable software application is configured or programmed, for example, to apply the optical alignment to an action or process of controlling, generating, or providing a display and/or a user interface.
  • the computer-executable software application can be a custom add-in or plug-in system application which functions as an extension and overlay to an existing third party system application or other platform that facilitates ophthalmic assessments.
  • the computer-executable software application is at least partially cloud- based and/or accessible via a website or other electronic or communications platform (e.g., provided in the form of an application for a personal computing and/or communications device, such as a smartphone or tablet computer).
  • the previously described method 1600 including a technique for calculation of the nodal point of the eye so that, when combined with the measured visual axis point at the cornea, we could describe a three dimensional equation for the visual axis (path A). Then knowing the equation of the visual axis in space, and measuring the position along the longitudinal axis of the IOL using methods such as ultrasound or a Scheimpflug techique, one could calculate the deviation of the IOL center from the visual axis in the plane of the IOL.
  • an alternative technique (path B) for determining visual axis involves calculating the equation for the visual axis of the eye without assuming knowledge of the nodal point.
  • the cornea (1) by measuring the coordinates of the visual axis point at the cornea (1) and the corresponding coordinates of a paraxial ray traveling through point (1) at the retina (4) one can calculate the three dimensional equation of the visual axis as before.
  • the position of the IOL along the longitudinal axis of the eye known as the "pseudophakic ACD"
  • the deviation of the IOL center from the visual axis can be determined as in path A.
  • the three dimensional equation of the visual axis can be used to optimize the location of the anterior capsulorhexis using a femtosecond laser so as to shift the IOL center towards the visual axis upon capsular bag contraction.
  • the coordinates of the visual axis point at the cornea may prove to be the optimal point of centration for arcuate incisional procedures to treat astigmatism on the cornea using a femto second laser.
  • the methods disclosed herein can facilitate various approaches to guiding selection of IOL features so as to optimize image quality for each eye.
  • example embodiments involve a method to estimate the distance along the longitudinal axis to the plane of the IOL from a dilated photograph.
  • a portion of the IOL optic edge is made visible with dilation of the eye. This section of the optic edge can be used to guide the extrapolation of the complete circumference, which then gives an estimate of the diameter of the optic and its center.
  • the diameter of a 6.0 mm optic actually measures 7.2 mm due to corneal magnification of the image. Knowing the estimated optic diameter and the measured corneal power the "IOL ACD" can be calculated as above.
  • a 7.2 mm magnified optic corresponds to location of the IOL plane at 5.0 mm behind the anterior cornea.
  • Corneal magnification of the optic image and the corneal power can be used to determine the distance of the IOL behind the anterior cornea
  • the visual axis (1-3-4) of the eye is not coincident with the longitudinal axis of the eye (2-5).
  • Points 1, 2 and 3 may or may not be collinear.
  • the focal image must be positioned on the fovea (4) for optimal vision.
  • the eye rotates so as to accomplish this and thus establishes a point of intersection between the visual axis and the cornea (1).
  • the coordinates of the visual axis point at the cornea can be assessed by any vision testing device with adequate fixation. (See mathematics above as to points 1 and 3, which can be utilized in relation to points 1 and 4.)
  • the visual axis can be approximately by the line defined by points 1 and 4 instead of the set of rays in the previous figure.
  • ray trace aberrometry devices
  • the iTrace Tracker Technologies, Houston, Texas
  • the wide field laser ray tracing aberrometer described by Mazzaferri and Navarro. See e,g, Mazzaferri J, Navarro R: Wide two- dimensional field laser ray-tracing aberrometer. J of Vision (2012) 12(2):2, 1-14, incorporated herein by reference.
  • IOL designs potentially fixate to the anterior capsule through the capsulotomy (Stevens Patent). Stevens, Julian Douglas: Intraocular Implant. European Patent Application #10251497.3, Filed August 26, 2010. Or fixate to the anterior and posterior capsules through two capsulotomies (BIL IOL).
  • corneal incisions to correct astigmatism are typically centered on the pupil or the 1 st Purkinje image, the latter of which is used to estimate the location of the visual axis at the cornea.
  • the pupil is always dilated so that centering the treatment on the pupil is not so precise.
  • femtosecond laser surgery with corneal arcuate incisions for astigmatism using the first Purkinje reflex may not be possible due to applanation of the cornea with the patient-laser interface device.
  • using the a priori determined coordinates of the visual axis at the cornea may be an ideal approach for centering arcuate incisional treatments during femtosecond laser cataract surgery with astigmatism correction.
  • FIG. 22 depicted here is a simple ray trace diagram of the retinal image formed from a distant object (arrow ABCDE).
  • the first principle rays are shown as dashed lines and, by definition, intersect the optical plane and the visual axis and are not refracted.
  • the second principle rays represent the paraxial rays that enter the eye parallel to the visual axis and are refracted to a focal point or plane on or near the retina.
  • the effect of positive residual spherical aberration on image formation has been estimated by considering the image plane formed by light entering the eye near the visual axis (Green) versus light entering the eye furthest from the visual axis (RED rays).
  • positive spherical aberration will focus peripheral incoming rays anterior to the focal plane of central incoming rays. Note that no specific amount of spherical aberration is considered here nor is retinal image size to scale. Further, this example only considers residual positive spherical aberration and does not consider and sphero-cylindrical residual errors.
  • the EA image plane shows that the periphery of the arrow abject is focused anterior to the central region of the arrow image that is focus to image plane DB, which is assumed to be tuned to focus exactly at the fovea.
  • residual positive spherical aberration of the eye creates curvature of the image plane that is similarly oriented to the curvature of the fovea. Since the fovea is not a planar image detector there could be an amount of positive residual spherical aberration that, for a given image size, produces retinal image curvature that exactly matches the foveal curvature of a given eye. In this scenario, image quality may be optimized.
  • retinal image quality may be optimized by producing a specific amount of residual positive spherical aberration of the eye that would result in image curvature that closely matches the eye's foveal curvature.
  • FIG. 24 depicted here is the potential impact of negative spherical aberration on foveal image curvature.
  • negative spherical aberration incoming peripheral rays are focused posteriorly to incoming central rays, which can be seen to create image curvature opposite to that of the fovea.
  • Focal length is the axial length (AL) and using a reduced schematic eye:
  • This axial difference represents an estimate of the distance between the anterior (EA) and posterior (D ) image planes
  • This assessment represents a simple example of how positive and negative spherical aberration create different image curvature at the fovea.
  • residual spherical error, astigmatism, and other higher order aberrations were assumed to be zero. These other aberrations can all interact to influence image curvature at the fovea. Only an individualized ray tracing calculation could predict the expected image curvature for each eye. Further, it may be useful clinically to measure the curvature of the fovea in each eye and then select vision correction parameters to optimize image curvature at the fovea.

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Abstract

L'invention concerne des systèmes et des procédés d'amélioration de la vue qui facilitent la détermination ou l'estimation d'un alignement optique d'une lentille par rapport à l'axe visuel de l'œil, et l'application d'un alignement optique à une action ou un processus consistant à fournir, faciliter et/ou présenter une ou plusieurs évaluations ophtalmiques.
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