WO2016111851A1 - Systèmes de pondération de vergence et méthodes de traitement de la presbytie et d'autres troubles de la vision - Google Patents

Systèmes de pondération de vergence et méthodes de traitement de la presbytie et d'autres troubles de la vision Download PDF

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Publication number
WO2016111851A1
WO2016111851A1 PCT/US2015/067363 US2015067363W WO2016111851A1 WO 2016111851 A1 WO2016111851 A1 WO 2016111851A1 US 2015067363 W US2015067363 W US 2015067363W WO 2016111851 A1 WO2016111851 A1 WO 2016111851A1
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Prior art keywords
distance
vision
weighting
viewing distance
weighting value
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PCT/US2015/067363
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English (en)
Inventor
Guangming Dai
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Amo Development, Llc
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Priority to EP15826107.3A priority Critical patent/EP3242643A1/fr
Priority to CA2973345A priority patent/CA2973345A1/fr
Publication of WO2016111851A1 publication Critical patent/WO2016111851A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G02C7/024—Methods of designing ophthalmic lenses
    • G02C7/025—Methods of designing ophthalmic lenses considering parameters of the viewed object
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G02C7/024—Methods of designing ophthalmic lenses
    • G02C7/028—Special mathematical design techniques
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G02C7/04—Contact lenses for the eyes
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G02C7/04—Contact lenses for the eyes
    • G02C7/041—Contact lenses for the eyes bifocal; multifocal
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G02C7/06—Lenses; Lens systems ; Methods of designing lenses bifocal; multifocal ; progressive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • A61F9/00834—Inlays; Onlays; Intraocular lenses [IOL]

Definitions

  • Embodiments of the present invention relate generally to goal functions or visual function diagnostic metrics, and particular embodiments provide methods, devices, and systems for mitigating or treating vision conditions such as presbyopia, often by determining a treatment shape based on selected weighting values for certain viewing distances.
  • Presbyopia normally develops as a person ages, and is associated with a natural progressive loss of accommodation, sometimes referred to as "old sight.”
  • the presbyopic eye often loses the ability to rapidly and easily refocus on objects at varying distances. There may also be a loss in the ability to focus on objects at near distances.
  • the effects of presbyopia usually become noticeable after the age of 45 years.
  • the crystalline lens has often lost almost all elastic properties and has only limited ability to change shape.
  • Residual accommodation refers to the amount of accommodation that remains in the eye. A lower degree of residual accommodation contributes to more severe presbyopia, whereas a higher amount of residual accommodation correlates with less severe presbyopia.
  • presbyopia seeks to provide vision approaching that of an emmetropic eye.
  • an emmetropic eye both distant objects and near objects can be seen due to the accommodation properties of the eye.
  • reading glasses have traditionally been used by individuals to add plus power diopter to the eye, thus allowing the eye to focus on near objects and maintain a clear image. This approach is similar to that of treating hyperopia, or farsightedness.
  • Presbyopia has also been treated with bi-focal eyeglasses, where one portion of the lens is corrected for distance vision, and another portion of the lens is corrected for near vision.
  • IOLs intra-ocular lenses
  • SEBs scleral expansion bands
  • problems remain with such techniques, however, such as inconsistent and unpredictable outcomes.
  • ablation profiles In the field of refractive surgery, certain ablation profiles have been suggested to treat the condition, often with the goal of increasing the range of focus of the eye, as opposed to restoring accommodation in the patient's eye. Many of these ablation profiles can provide a single excellent focus of the eye, yet they do not provide an increased depth of focus such that optimal distance acuity, optimal near acuity, and acceptable intermediate acuity occur simultaneously. Shapes have been proposed for providing enhanced distance and near vision, yet current approaches do not provide ideal results for all patients.
  • the merit function may be objective, it may also desirable that the merit function have a good correlation with subjective test results such as visual acuity, contrast acuity, and the like.
  • optical metrics can be or have been used as possible optical metrics or merit functions: high order (HO) root mean square (RMS) error; Strehl ratio; modulation transfer function (MTF) at specific spatial frequencies; volume under MTF surface up to a certain spatial frequency; compound MTF; encircled energy; and wavefront refractions.
  • Other goal functions or visual function diagnostic metrics are available for characterizing lenses and other optical systems, including visual acuity such as logMAR, refractive error such as sphere and cylinder, and contrast sensitivity (CS).
  • visual acuity such as logMAR, refractive error such as sphere and cylinder, and contrast sensitivity (CS).
  • CS contrast sensitivity
  • Embodiments of the present invention encompass systems and methods for determining optimizer values that involve factoring in the variation of the optical metric over a range of testing points, or vergence, to account for the distance vision, intermediate vision, and near vision.
  • various weighting protocols can be implemented to that assign different weighting values for different viewing distances.
  • Such techniques can be used in various types of treatment modalities, including without limitation refractive surgery, contact lenses, intraocular lenses, spectacle lenses, and other vision correction approaches such as inlays, conductive keratoplasty, and the like.
  • systems or methods as disclosed herein can be used in conjunction with therapeutic protocols that involve providing a patient with a presbyopia treatment if the residual accommodation of the eye exceeds the threshold residual accommodation calculated for the eye, for example as discussed in U.S. Patent No. 7,762,668, the content of which is incorporated herein by reference.
  • systems or methods as disclosed herein can be used in conjunction with multifocal therapeutic protocols for presbyopia.
  • systems or methods as disclosed herein can be used for treating pre-presbyopic patients.
  • the vergence weighting protocols disclosed herein can be used on conjunction with vision treatment approaches such as those described in U.S. Patent Application No. 10/872,331 filed June 17, 2004, U.S. Patent Application No.
  • Embodiments of the present invention provide devices, systems, and methods that use improved goal functions for mitigating or treating vision conditions in a patient.
  • the goal function can reflect optical quality throughout a vergence range.
  • the goal function may also comprise a ratio of an optical parameter of the eye with a diffraction theory parameter.
  • the goal function may also comprise at least one parameter selected from the group consisting of Strehl Ratio (SR), modulation transfer function (MTF), point spread function (PSF), encircled energy (EE), MTF volume or volume under MTF surface (MTFV), compound modulation transfer function (CMTF), and contrast sensitivity (CS).
  • SR Strehl Ratio
  • MTF modulation transfer function
  • PSF point spread function
  • EE encircled energy
  • CMTF compound modulation transfer function
  • CS contrast sensitivity
  • these techniques can be carried out in conjunction with treatments provided by any of a variety of laser devices, including without limitation the WaveScan® System and the STAR S4® Excimer Laser System both by Abbott Medical Optics Inc., the WaveLight® Allegretto Wave® Eye-Q laser, the Schwind AmarisTM lasers, the 217P excimer workstation by Technolas PerfectVision GmbH, the Mel 80TM laser by Carl Zeiss Meditec, Inc., and the like.
  • embodiments provide techniques for using laser basis data during refractive surgery treatment procedures which can be implemented in such laser devices.
  • embodiments of the present invention encompass systems and methods for treating a vision condition of an eye in a particular patient.
  • Exemplary methods may include receiving a vision requirements specification selected for the particular patient, where the vision requirements specification includes a first weighting value for a first viewing distance within a vergence range and a second weighting value for a second viewing distance within the vergence range, and determining an optical surface shape for the particular patient.
  • the optical surface shape can be based on the vision requirements specification and an optical metric.
  • Methods can also include treating the vision condition of the eye of the particular patient by providing a treatment to the patient, where the treatment includes or is based on a shape that corresponds to the optical surface shape.
  • the first viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance (far) vision viewing distance.
  • the second viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance (far) vision viewing distance.
  • the first weighting value is different from the second weighting value and the first viewing distance is different from the second viewing distance.
  • the first weighting value is greater than the second weighting value.
  • the first weighting value is less than the second weighting value.
  • the first viewing distance is greater than the second viewing distance.
  • the first viewing distance is less than the second viewing distance.
  • the optical metric is a composite optical metric.
  • the optical metric includes a compound modulation transfer function (CMTF) parameter having a combination of modulation transfer functions (MTF's) at a plurality of distinct frequencies.
  • CMTF compound modulation transfer function
  • MTF's modulation transfer functions
  • the first and second weighting values are members of a weighting value distribution that is linear across a vergence range that includes the first and second viewing distances. In some cases, the first and second weighting values are members of a weighting value distribution that is non- linear across a vergence range that includes the first and second viewing distances.
  • a step of treating the vision condition of the eye of the particular patient can include a procedure such as ablating a cornea of the eye of the particular patient to provide a corneal surface shape that corresponds to the optical surface shape, providing the particular patient with a contact lens or a spectacle lens having a shape that corresponds to the optical surface shape, or providing the particular patient with an intra-ocular lens having a shape that corresponds to the optical surface shape.
  • embodiments of the present invention encompass systems and methods for generating an optical surface shape for use in treating a vision condition of an eye in a particular patient.
  • Exemplary methods can include receiving a vision requirements specification selected for the particular patient, where the vision requirements specification includes a first weighting value for a first viewing distance within a vergence range and a second weighting value for a second viewing distance within the vergence range.
  • methods can include generating the optical surface shape for the particular patient, where the optical surface shape is based on the vision requirements specification and an optical metric.
  • methods may also include determining a procedure for treating the vision condition of the eye of the particular patient based on the optical surface shape.
  • the procedure can include ablating a corneal surface of the eye of the particular patient to provide a corneal surface shape that corresponds to the optical surface shape, providing the particular patient with a contact lens or a spectacle lens having a shape that corresponds to the optical surface shape, or providing the particular patient with an intra-ocular lens having a shape that corresponds to the optical surface shape.
  • the first viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance vision viewing distance.
  • the second viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance vision viewing distance.
  • the first weighting value is different from the second weighting value and the first viewing distance is different from the second viewing distance.
  • the optical metric is a composite optical metric.
  • the optical metric includes a compound modulation transfer function (CMTF) parameter having a combination of modulation transfer functions (MTF's) at a plurality of distinct frequencies.
  • CMTF compound modulation transfer function
  • MTF's modulation transfer functions
  • the first and second weighting values are members of a weighting value distribution that is linear across a vergence range that includes the first and second viewing distances.
  • the first and second weighting values are members of a weighting value distribution that is non-linear across a vergence range that includes the first and second viewing distances.
  • embodiments of the present invention encompass systems and methods for establishing an optical surface shape for use in treating a vision condition of an eye in a particular patient.
  • Exemplary systems can include nn input that receives a vision requirements specification selected for the particular patient, where the vision requirements specification includes a first weighting value for a first viewing distance within a vergence range and a second weighting value for a second viewing distance within the vergence range.
  • Systems can also include a data processing module having a processor and a tangible non-transitory computer readable medium, where the computer readable medium is programmed with a computer application that, when executed by the processor, causes the processor to establish the optical surface shape for the eye of the particular patient.
  • the optical surface shape can be based on the vision requirements specification received by the input and an optical metric.
  • the computer application when executed by the processor, causes the processor to determine a protocol for treating the vision condition of the eye of the particular patient based on the optical surface shape.
  • the protocol includes a photodisruption procedure for a corneal tissue of the eye of the particular patient, where the photodisruption procedure is configured to provide a corneal surface shape that corresponds to the optical surface shape.
  • the protocol includes a contact lens or a spectacle lens procedure for the eye of the particular patient, where the contact lens or spectacle lens procedure involves a lens having a shape that corresponds to the optical surface shape.
  • the protocol includes an intra-ocular lens procedure for the eye of the particular patient, where the intra-ocular lens procedure involves a lens having a shape that corresponds to the optical surface shape.
  • the first viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance vision viewing distance.
  • the second viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance vision viewing distance.
  • the first weighting value is different from the second weighting value and the first viewing distance is different from the second viewing distance.
  • the first weighting value is greater than the second weighting value.
  • the first weighting value is less than the second weighting value.
  • the first viewing distance is greater than the second viewing distance. In some cases, the first viewing distance is less than the second viewing distance.
  • the optical metric is a composite optical metric.
  • the optical metric includes a compound modulation transfer function (CMTF) parameter having a combination of modulation transfer functions (MTF's) at a plurality of distinct frequencies.
  • CMTF compound modulation transfer function
  • MTF's modulation transfer functions
  • the first and second weighting values are members of a weighting value distribution that is linear across a vergence range that includes the first and second viewing distances.
  • the first and second weighting values are members of a weighting value distribution that is non-linear across a vergence range that includes the first and second viewing distances.
  • embodiments of the present invention encompass computer program products for generating an optical surface shape for use in treating a vision condition of an eye in a particular patient.
  • the computer program product is embodied on a tangible non-transitory computer readable medium and includes code for accessing a vision requirements specification selected for the particular patient. The vision requirements
  • the computer program product can also include code for generating the optical surface shape for the particular patient, where the optical surface shape is based on the vision requirements specification and an optical metric.
  • a computer program product can also include code for determining a protocol for treating the vision condition of the eye of the particular patient based on the optical surface shape. According to some embodiments the protocol can include a
  • the photodisruption procedure can be configured to provide a corneal surface shape that corresponds to the optical surface shape.
  • the protocol can include a contact lens or a spectacle lens procedure for the eye of the particular patient.
  • a contact lens or spectacle lens procedure can involve a lens having a shape that corresponds to the optical surface shape.
  • the protocol can include an intra-ocular lens procedure for the eye of the particular patient.
  • An intra-ocular lens procedure can involve a lens having a shape that corresponds to the optical surface shape.
  • the first viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance vision viewing distance.
  • the second viewing distance is a near vision viewing distance, an intermediate vision viewing distance, or a distance vision viewing distance.
  • the first weighting value is different from the second weighting value and the first viewing distance is different from the second viewing distance. In some cases, the first weighting value is greater than the second weighting value. In some cases, the first weighting value is less than the second weighting value. In some cases, the first viewing distance is greater than the second viewing distance. In some cases, the first viewing distance is less than the second viewing distance. In some cases, the optical metric is a composite optical metric. In some cases, the optical metric includes a compound modulation transfer function (CMTF) parameter having a combination of modulation transfer functions (MTF's) at a plurality of distinct frequencies.
  • CMTF compound modulation transfer function
  • the first and second weighting values are members of a weighting value distribution that is linear across a vergence range that includes the first and second viewing distances. In some cases, the first and second weighting values are members of a weighting value distribution that is non-linear across a vergence range that includes the first and second viewing distances.
  • Fig. 1 illustrates a laser ablation system according to an embodiment of the present invention.
  • Fig. 2 illustrates a simplified computer system according to an embodiment of the present invention.
  • Fig. 3 illustrates a wavefront measurement system according to an embodiment of the present invention.
  • Fig. 3A illustrates another wavefront measurement system according to an embodiment of the present invention.
  • Fig. 4A illustrates an example of the compound MTF (upper panel) versus its corresponding individual MTF curves at 15, 30, and 60 cycles per degree (lower panel).
  • Fig. 4B illustrate an example of the compound MTF (upper panel) versus its
  • Fig. 5 is a flow chart illustrating exemplary method steps for optimizing an optical prescription that treats or corrects a vision condition.
  • Fig. 6 illustrates a data flow process for shape optimization for correction or treatment of a vision condition.
  • Fig. 7 illustrates a comparison of Direction Set method and Downhill Simplex method.
  • Figs. 8A and 8B illustrate alternative prescriptions optimized for an eye of a particular patient, and their characteristics.
  • Fig. 8C illustrates a comparison of optimizer values using even-term polynomials and all power term polynomials for pupil sizes of 4mm, 5mm, and 6mm.
  • Figs. 9A-D show alternative presbyopia-mitigating prescriptions optimized for an eye of a particular patient.
  • Fig. 10 illustrates effects of random noise on prescriptions optimized for an eye of a particular patient.
  • Figs. 11A-C compare optimized prescriptions to alternative treatments for differing pupil sizes.
  • Figs. 12A-C compare optimized prescriptions to alternative treatments for a range of viewing distances.
  • Fig. 13 illustrates simulated viewing charts viewed at differing distances to compare optimized prescriptions to alternative treatments.
  • Figs. 14-16 illustrate graphical interface computer screen displays for a prescription optimizer and system.
  • Figs. 17 and 18 illustrate pupil sizes and changes at differing viewing conditions for a particular patient.
  • Fig. 19 graphically illustrates optimizer values for differing levels of residual accommodation.
  • Fig. 20 illustrates effects of pupil change and residual accommodation on optimized prescriptions for a particular patient.
  • Figs. 21A-C illustrate effects of pupil change and residual accommodation on optimized prescriptions for a particular patient.
  • Figs. 22-24 compare optical properties and results of eyes corrected with an optimized prescription to alternative treatments.
  • Fig. 25 schematically illustrates a system for determining a prescription for a particular patient and delivering that treatment using laser refractive surgery.
  • Fig. 26A illustrates a relationship between accommodation and pupil size when healthy eyes adjust to differing viewing distances.
  • Fig. 26B illustrates one exemplary relationship between effective power of an eye and pupil size for a patient, as can be provided from the presbyopia prescriptions of the present invention by generating an optical shape which effects desired changes in power with changes in pupil size of a particular patient under differing viewing conditions.
  • Fig. 26C illustrates a relationship between manifest power and pupil diameter, for example, as measured from patients having differing pupil diameters who have been successfully treated with a presbyopia-mitigating prescription. Such a relationship may be used to identify a desired change in optical power with changes in pupil diameter for a specific patient.
  • Figs. 27A and 27B graphically illustrate optical properties of an eye relevant to presbyopia.
  • Fig. 28 schematically illustrates a presbyopia-mitigating shape having a central add region.
  • Figs. 29 and 30 schematically illustrates residual accommodation and presbyopia treatments for increasing a focal range.
  • Figs. 31-37 graphically illustrate results from presbyopia-mitigating treatments for a population of individual patients.
  • Fig. 38 graphically illustrates accommodation through a range of differing patient ages.
  • Fig. 39 schematically illustrates another system for determining a presbyopia-mitigating prescription for a particular patient and delivering that treatment using laser refractive surgery.
  • Figs. 40 and 41 graphically illustrate a presbyopia-mitigating prescription derived so as to provide appropriate effective powers at two differing viewing conditions for a particular patient.
  • Figs. 42 and 43 graphically illustrate a presbyopia-mitigating prescription derived so as to provide appropriate effective powers at three differing viewing conditions for a particular patient.
  • Figs. 44 and 45 graphically illustrate a presbyopia-mitigating prescription derived so as to provide appropriate effective powers at four differing viewing conditions for a particular patient.
  • Figs. 46A and 46B graphically illustrate different presbyopia-mitigating prescriptions which provide differing effective power variation characteristics during pupil size changes under differing viewing conditions.
  • Figs. 47 and 48 graphically illustrate effects of different pupil sizes on derived presbyopia-mitigating prescriptions and their optical characteristics.
  • Fig. 49 illustrates simulated eye-chart letters as viewed with a presbyopic eye treated with a presbyopia-mitigating prescription derived for a particular patient.
  • Figs. 50A and 50B illustrate an exemplary power/pupil correlation and corresponding presbyopia prescription.
  • Fig. 51 shows through-focus results for a 20/20 eye chart letter E convolved with certain point spread function models across a vergence range according to embodiments of the present invention.
  • Fig. 52 illustrates CMTF value curves according to embodiments of the present invention.
  • Figs. 53A and 53B depict point spread functions with ring-type and centrally- concentrated configurations, respectively, according to embodiments of the present invention.
  • Fig. 54 shows cross sections of the point spread function images according to
  • Figs. 55A and 55B illustrates cross-sections for point spread functions according to embodiments of the present invention.
  • Fig. 56 depicts cross sections of point spread functions according to embodiments of the present invention.
  • Fig. 57 illustrates aspects of a method of evaluating an image quality provided by a vision treatment shape, according to embodiments of the present invention.
  • Fig. 58 illustrates aspects of a method of determining a compound modulation transfer function (CMTF) threshold value for a CMTF spatial frequency set, according to embodiments of the present invention.
  • CMTF compound modulation transfer function
  • Fig. 59 depicts aspects of methods for determining an optical surface shape and providing a treatment to a patient according to embodiments of the present invention.
  • Fig. 60 depicts aspects of methods for generating an optical surface shape for a patient according to embodiments of the present invention.
  • Fig. 61 depicts aspects of a vision requirements specification, according to embodiments of the present invention.
  • Fig. 62 depicts aspects of a vision requirements specification, according to embodiments of the present invention.
  • Fig. 63 illustrates aspects of techniques for determining a merit function for a target or treatment shape based on an optical metric value for the shape at the various viewing or testing distances, according to embodiments of the present invention.
  • Figs. 64A and 64B illustrate aspects of weighting value distributions, according to embodiments of the present invention.
  • Figs. 65A, 65B, 65C, and 65D illustrate aspects of weighting value distributions, according to embodiments of the present invention.
  • Figs. 66A and 66B illustrate aspects of weighting value distributions, according to embodiments of the present invention.
  • Figs. 67A and 67B illustrate aspects of weighting value distributions, according to embodiments of the present invention.
  • Figs. 68A, 68B, and 68C illustrate example distance, intermediate, and near vision experienced by an eye without correction, respectively.
  • Figs. 69A, 69B, and 69C illustrate example distance, intermediate, and near vision experienced by an eye corrected for near vision viewing distances only, respectively.
  • Figs. 70A, 70B, and 70C illustrate example distance, intermediate, and near vision experienced by an eye corrected for intermediate and near viewing distances, respectively.
  • Figs. 71A, 71B, and 71C illustrate example distance, intermediate, and near vision experienced by an eye corrected for distance and intermediate viewing distances, respectively.
  • Exemplary systems and methods disclosed herein can be implemented via a variety of ophthalmic devices or solutions.
  • treatment techniques may be used for any of a variety of surgery modalities, including excimer laser surgery, femtosecond surgery, and the like.
  • a variety of forms of lasers and laser energy can be used to effect a correction or treatment, including infrared lasers, ultraviolet lasers, femtosecond lasers, wavelength multiplied solid-state lasers, and the like.
  • ophthalmic corrections can involve a cornea or lens reshaping procedure, such as, for example using a picosecond or femtosecond laser.
  • Laser ablation procedures can remove a targeted amount stroma of a cornea to change a cornea's contour and adjust for aberrations.
  • a treatment protocol can involve the delivery of a series of discrete pulses of laser light energy, with a total shape and amount of tissue removed being determined by a shape, size, location, and/or number of laser energy pulses impinging on or focused within a cornea.
  • a surgical laser such as a non-ultraviolet, ultra-short pulsed laser that emits radiation with pulse durations as short as nanoseconds and femtoseconds (e.g., a femtosecond laser, or a picosecond laser) can be used to treat the eye of a patient.
  • the laser systems can be configured to deliver near infrared light. Other wavelengths may be used as well.
  • the laser systems can be configured to deliver laser light focused at a focus depth (e.g. within corneal or other ophthalmologic tissue) which may be controlled by the system.
  • Laser surgery with ultra-short pulse lasers such as femtosecond lasers can be used to treat the eye. These pulsed lasers can make very accurate incisions of the eye and can be used in many ways to treat the eye. Additional types of incisions that can be performed with the short pulse lasers include incisions for paracentesis, limbal relaxing incisions, and refractive incisions to shape the cornea, for example.
  • vision treatments can include focusing femtosecond laser energy within the stroma so as to ablate a volume of intrastromal tissue.
  • femtosecond laser energy By scanning the focal spot within an appropriate volume of the stromal tissue, it is possible to vaporize the volume so as to achieve a desired refractive alteration.
  • embodiments of the present invention encompass laser surgical techniques that involve femtosecond laser photodisruption or photoalteration treatments.
  • a femtosecond laser can be used to perform the photodisruption, thus providing an easy, precise, and effective approach to refractive surgery
  • a femtosecond laser (or other laser) of the optical system can be used to incise the cornea or to cut a flap.
  • a femtosecond laser may be used to make arcuate or other incisions in the cornea, which incisions may be customized, intrastromal, stable, predictable, and the like. Likewise, corneal entry incisions may be made, which are custom, multiplane, and self-sealing.
  • Pulsed laser beams include bursts or pulses of light.
  • Pulsed lasers such as non- ultraviolet, ultra-short pulsed lasers with pulse durations measured in the nanoseconds to femtoseconds range, can be used in ophthalmic surgical procedures as disclosed herein.
  • a pulsed laser beam can be focused onto a desired area of ophthalmologic material or tissue, such as the cornea, the capsular bag, or the lens of the eye, to photoalter the material in this area and, in some instances, the associated peripheral area.
  • photoalteration of the material include, but are not necessarily limited to, chemical and physical alterations, chemical and physical breakdown, disintegration, ablation, photodisruption, vaporization, a the like.
  • Exemplary treatment systems can include a focusing mechanism (e.g. lens) and/or a scanning mechanism so as to guide or direct a focus of femtosecond energy along a path within the patient's eye (e.g. at one or more corneal subsurface locations).
  • vergence weighting systems and methods disclosed herein can be implemented in connection with software residing in a diagnostic device such as WaveScan® and iDesignTM devices.
  • Fig. 1 illustrates a laser eye surgery system 10 of the present invention, including a laser 12 that produces a laser beam 14.
  • Laser 12 is optically coupled to laser delivery optics 16, which directs laser beam 14 to an eye E of patient P.
  • a delivery optics support structure (not shown here for clarity) extends from a frame 18 supporting laser 12.
  • a microscope 20 is mounted on the delivery optics support structure, the microscope often being used to image a cornea of eye E.
  • Laser 12 generally comprises an excimer laser, ideally comprising an argon-fluorine laser producing pulses of laser light having a wavelength of approximately 193 nm.
  • Laser 12 will preferably be designed to provide a feedback stabilized fluence at the patient's eye, delivered via delivery optics 16.
  • the present invention may also be useful with alternative sources of ultraviolet or infrared radiation, particularly those adapted to controllably ablate the corneal tissue without causing significant damage to adjacent and/or underlying tissues of the eye.
  • sources include, but are not limited to, solid state lasers and other devices which can generate energy in the ultraviolet wavelength between about 185 and 205 nm and/or those which utilize frequency- multiplying techniques.
  • an excimer laser is the illustrative source of an ablating beam, other lasers may be used in the present invention.
  • Laser system 10 will generally include a computer or programmable processor 22.
  • Processor 22 may comprise (or interface with) a conventional PC system including the standard user interface devices such as a keyboard, a display monitor, and the like.
  • Processor 22 will typically include an input device such as a magnetic or optical disk drive, an internet connection, or the like.
  • Such input devices will often be used to download a computer executable code from a tangible storage media 29 embodying any of the methods of the present invention.
  • Tangible storage media 29 may take the form of a floppy disk, an optical disk, a data tape, a volatile or non- volatile memory, RAM, or the like, and the processor 22 will include the memory boards and other standard components of modern computer systems for storing and executing this code.
  • Tangible storage media 29 may optionally embody wavefront sensor data, wavefront gradients, a wavefront elevation map, a treatment map, a corneal elevation map, and/or an ablation table. While tangible storage media 29 will often be used directly in cooperation with an input device of processor 22, the storage media may also be remotely operatively coupled with processor by means of network connections such as the internet, and by wireless methods such as infrared, Bluetooth, or the like.
  • Laser 12 and delivery optics 16 will generally direct laser beam 14 to the eye of patient P under the direction of a computer 22.
  • Computer 22 will often selectively adjust laser beam 14 to expose portions of the cornea to the pulses of laser energy so as to effect a predetermined sculpting of the cornea and alter the refractive characteristics of the eye.
  • both laser beam 14 and the laser delivery optical system 16 will be under computer control of processor 22 to effect the desired laser sculpting process, with the processor effecting (and optionally modifying) the pattern of laser pulses.
  • the pattern of pulses may by summarized in machine readable data of tangible storage media 29 in the form of a treatment table, and the treatment table may be adjusted according to feedback input into processor 22 from an automated image analysis system in response to feedback data provided from an ablation monitoring system feedback system.
  • the feedback may be manually entered into the processor by a system operator.
  • Such feedback might be provided by integrating the wavefront measurement system described below with the laser treatment system 10, and processor 22 may continue and/or terminate a sculpting treatment in response to the feedback, and may optionally also modify the planned sculpting based at least in part on the feedback. Measurement systems are further described in U.S. Patent No.
  • Laser beam 14 may be adjusted to produce the desired sculpting using a variety of alternative mechanisms.
  • the laser beam 14 may be selectively limited using one or more variable apertures.
  • An exemplary variable aperture system having a variable iris and a variable width slit is described in U.S. Patent No. 5,713,892, the full disclosure of which is incorporated herein by reference.
  • the laser beam may also be tailored by varying the size and offset of the laser spot from an axis of the eye, as described in U.S. Patent Nos. 5,683,379, 6,203,539, and 6,331,177, the full disclosures of which are incorporated herein by reference.
  • Still further alternatives are possible, including scanning of the laser beam over the surface of the eye and controlling the number of pulses and/or dwell time at each location, as described, for example, by U.S. Patent No. 4,665,913, the full disclosure of which is incorporated herein by reference; using masks in the optical path of laser beam 14 which ablate to vary the profile of the beam incident on the cornea, as described in U.S. Patent No. 5,807,379, the full disclosure of which is incorporated herein by reference; hybrid profile- scanning systems in which a variable size beam (typically controlled by a variable width slit and/or variable diameter iris diaphragm) is scanned across the cornea; or the like.
  • the computer programs and control methodology for these laser pattern tailoring techniques are well described in the patent literature.
  • Additional components and subsystems may be included with laser system 10, as should be understood by those of skill in the art.
  • spatial and/or temporal integrators may be included to control the distribution of energy within the laser beam, as described in U.S. Patent No. 5,646,791, the full disclosure of which is incorporated herein by reference.
  • Ablation effluent evacuators/filters, aspirators, and other ancillary components of the laser surgery system are known in the art. Further details of suitable systems for performing a laser ablation procedure can be found in commonly assigned U.S. Pat. Nos. 4,665,913, 4,669,466, 4,732,148, 4,770,172,
  • Suitable systems also include commercially available refractive laser systems such as those manufactured and/or sold by Alcon, Bausch & Lomb, Nidek, WaveLight, LaserSight, Schwind, Zeiss-Meditec, and the like.
  • Basis data can be further characterized for particular lasers or operating conditions, by taking into account localized environmental variables such as temperature, humidity, airflow, and aspiration.
  • FIG. 2 is a simplified block diagram of an exemplary computer system 22 that may be used by the laser surgical system 10 of the present invention.
  • Computer system 22 typically includes at least one processor 52 which may communicate with a number of peripheral devices via a bus subsystem 54.
  • peripheral devices may include a storage subsystem 56, comprising a memory subsystem 58 and a file storage subsystem 60, user interface input devices 62, user interface output devices 64, and a network interface subsystem 66.
  • Network interface subsystem 66 provides an interface to outside networks 68 and/or other devices, such as the wavefront measurement system 30.
  • User interface input devices 62 may include a keyboard, pointing devices such as a mouse, trackball, touch pad, or graphics tablet, a scanner, foot pedals, a joystick, a touchscreen incorporated into the display, audio input devices such as voice recognition systems, microphones, and other types of input devices.
  • User input devices 62 will often be used to download a computer executable code from a tangible storage media 29 embodying any of the methods of the present invention.
  • use of the term "input device” is intended to include a variety of conventional and proprietary devices and ways to input information into computer system 22.
  • User interface output devices 64 may include a display subsystem, a printer, a fax machine, or non- visual displays such as audio output devices.
  • the display subsystem may be a cathode ray tube (CRT), a flat-panel device such as a liquid crystal display (LCD), a projection device, or the like.
  • the display subsystem may also provide a non-visual display such as via audio output devices.
  • output device is intended to include a variety of conventional and proprietary devices and ways to output information from computer system 22 to a user.
  • Storage subsystem 56 can store the basic programming and data constructs that provide the functionality of the various embodiments of the present invention. For example, a database and modules implementing the functionality of the methods of the present invention, as described herein, may be stored in storage subsystem 56. These software modules are generally executed by processor 52. In a distributed environment, the software modules may be stored on a plurality of computer systems and executed by processors of the plurality of computer systems. Storage subsystem 56 typically comprises memory subsystem 58 and file storage subsystem 60.
  • Memory subsystem 58 typically includes a number of memories including a main random access memory (RAM) 70 for storage of instructions and data during program execution and a read only memory (ROM) 72 in which fixed instructions are stored.
  • File storage subsystem 60 provides persistent (non- volatile) storage for program and data files, and may include tangible storage media 29 (Fig. 1) which may optionally embody wavefront sensor data, wavefront gradients, a wavefront elevation map, a treatment map, and/or an ablation table.
  • File storage subsystem 60 may include a hard disk drive, a floppy disk drive along with associated removable media, a Compact Digital Read Only Memory (CD-ROM) drive, an optical drive, DVD, CD-R,
  • Bus subsystem 54 provides a mechanism for letting the various components and subsystems of computer system 22 communicate with each other as intended.
  • the various subsystems and components of computer system 22 need not be at the same physical location but may be distributed at various locations within a distributed network.
  • bus subsystem 54 is shown schematically as a single bus, alternate embodiments of the bus subsystem may utilize multiple busses.
  • Computer system 22 itself can be of varying types including a personal computer, a portable computer, a workstation, a computer terminal, a network computer, a control system in a wavefront measurement system or laser surgical system, a mainframe, or any other data processing system. Due to the ever-changing nature of computers and networks, the description of computer system 22 depicted in Fig. 2 is intended only as a specific example for purposes of illustrating one embodiment of the present invention. Many other configurations of computer system 22 are possible having more or less components than the computer system depicted in Fig. 2.
  • wavefront measurement system 30 is configured to sense local slopes of a gradient map exiting the patient's eye.
  • Devices based on the Hartmann- Shack principle generally include a lenslet array to sample the gradient map uniformly over an aperture, which is typically the exit pupil of the eye. Thereafter, the local slopes of the gradient map are analyzed so as to reconstruct the wavefront surface or map.
  • one wavefront measurement system 30 includes an image source 32, such as a laser, which projects a source image through optical tissues 34 of eye E so as to form an image 44 upon a surface of retina R.
  • the image from retina R is transmitted by the optical system of the eye (e.g., optical tissues 34) and imaged onto a wavefront sensor 36 by system optics 37.
  • the wavefront sensor 36 communicates signals to a computer system 22' for measurement of the optical errors in the optical tissues 34 and/or determination of an optical tissue ablation treatment program.
  • Computer 22' may include the same or similar hardware as the computer system 22 illustrated in Figs. 1 and 2.
  • Computer system 22' may be in communication with computer system 22 that directs the laser surgery system 10, or some or all of the components of computer system 22, 22' of the wavefront measurement system 30 and laser surgery system 10 may be combined or separate.
  • data from wavefront sensor 36 may be transmitted to a laser computer system 22 via tangible media 29, via an I/O port, via an networking connection 66 such as an intranet or the Internet, or the like.
  • Wavefront sensor 36 generally comprises a lenslet array 38 and an image sensor 40.
  • the lenslet array separates the transmitted image into an array of beamlets 42, and (in combination with other optical components of the system) images the separated beamlets on the surface of sensor 40.
  • Sensor 40 typically comprises a charged couple device or "CCD,” and senses the characteristics of these individual beamlets, which can be used to determine the characteristics of an associated region of optical tissues 34.
  • image 44 comprises a point or small spot of light
  • a location of the transmitted spot as imaged by a beamlet can directly indicate a local gradient of the associated region of optical tissue.
  • Eye E generally defines an anterior orientation ANT and a posterior orientation POS.
  • Image source 32 generally projects an image in a posterior orientation through optical tissues 34 onto retina R as indicated in Fig. 3.
  • Optical tissues 34 again transmit image 44 from the retina anteriorly toward wavefront sensor 36.
  • Image 44 actually formed on retina R may be distorted by any imperfections in the eye's optical system when the image source is originally transmitted by optical tissues 34.
  • image source projection optics 46 may be configured or adapted to decrease any distortion of image 44.
  • image source optics 46 may decrease lower order optical errors by compensating for spherical and/or cylindrical errors of optical tissues 34. Higher order optical errors of the optical tissues may also be compensated through the use of an adaptive optic element, such as a deformable mirror (described below).
  • Use of an image source 32 selected to define a point or small spot at image 44 upon retina R may facilitate the analysis of the data provided by wavefront sensor 36. Distortion of image 44 may be limited by transmitting a source image through a central region 48 of optical tissues 34 which is smaller than a pupil 50, as the central portion of the pupil may be less prone to optical errors than the peripheral portion. Regardless of the particular image source structure, it will be generally be beneficial to have a well-defined and accurately formed image 44 on retina R.
  • the wavefront data may be stored in a computer readable medium 29 or a memory of the wavefront sensor system 30 in two separate arrays containing the x and y wavefront gradient values obtained from image spot analysis of the Hartmann-Shack sensor images, plus the x and y pupil center offsets from the nominal center of the Hartmann-Shack lenslet array, as measured by the pupil camera 51 (Fig. 3) image.
  • Such information contains all the available information on the wavefront error of the eye and is sufficient to reconstruct the wavefront or any portion of it. In such embodiments, there is no need to reprocess the Hartmann- Shack image more than once, and the data space required to store the gradient array is not large.
  • the wavefront data may be stored in a memory of the wavefront sensor system in a single array or multiple arrays.
  • a series of wavefront sensor data readings may be taken.
  • a time series of wavefront data readings may help to provide a more accurate overall determination of the ocular tissue aberrations.
  • a plurality of temporally separated wavefront sensor measurements can avoid relying on a single snapshot of the optical characteristics as the basis for a refractive correcting procedure.
  • Still further alternatives are also available, including taking wavefront sensor data of the eye with the eye in differing configurations, positions, and/or orientations.
  • a patient will often help maintain alignment of the eye with wavefront measurement system 30 by focusing on a fixation target, as described in U.S. Patent No. 6,004,313, the full disclosure of which is incorporated herein by reference.
  • a position of the fixation target By varying a position of the fixation target as described in that reference, optical characteristics of the eye may be determined while the eye accommodates or adapts to image a field of view at a varying distance and/or angles.
  • the location of the optical axis of the eye may be verified by reference to the data provided from a pupil camera 52.
  • a pupil camera 52 images pupil 50 so as to determine a position of the pupil for registration of the wavefront sensor data relative to the optical tissues.
  • An alternative embodiment of a wavefront measurement system is illustrated in Fig. 3A.
  • the major components of the system of Fig. 3A are similar to those of Fig. 3. Additionally, Fig. 3A includes an adaptive optical element 53 in the form of a deformable mirror.
  • the source image is reflected from deformable mirror 98 during transmission to retina R, and the deformable mirror is also along the optical path used to form the transmitted image between retina R and imaging sensor 40.
  • Deformable mirror 98 can be controllably deformed by computer system 22 to limit distortion of the image formed on the retina or of subsequent images formed of the images formed on the retina, and may enhance the accuracy of the resultant wavefront data.
  • the structure and use of the system of Fig. 3A are more fully described in U.S. Patent No. 6,095,651, the full disclosure of which is incorporated herein by reference.
  • the components of an embodiment of a wavefront measurement system for measuring the eye and ablations may comprise elements of a WaveScan ® , available from AMO
  • embodiments of the present invention encompass the implementation of any of a variety of optical instruments provided by WaveFront Sciences, Inc., including the CO AS wavefront aberrometer, the ClearWave contact lens aberrometer, the CrystalWave IOL
  • Embodiments of the present invention may also involve wavefront measurement schemes such as a Tscherning-based system, which may be provided by WaveFront Sciences, Inc.
  • Embodiments of the present invention may also involve wavefront measurement schemes such as a ray tracing-based system, which may be provided by Tracey Technologies, Corp.
  • the present invention is useful for enhancing the accuracy and efficacy of
  • the present invention can provide enhanced optical correction approaches by improving the methodology for scaling an optical shape, or by generating or deriving new optical shapes, and the like.
  • the techniques of the present invention can be readily adapted for use with existing laser systems, including the Excimer laser eye surgery systems commercially available from AMO Manufacturing USA, LLC in Milpitas, California.
  • Other suitable laser systems are manufactured by Alcon, Bausch & Lomb, Wavelight, Schwind, Zeiss-Meditec, Lasersight, Nidek and the like.
  • the present invention may allow enhanced treatment of patients who have heretofore presented difficult or complicated treatment problems.
  • the systems and methods may be implemented by calculating prescriptions for a range of patients, for example, by calculating discrete table entries throughout a range of patient characteristics, deriving or empirically generating parametric patient characteristic/prescription correlations, and the like, for subsequent use in generating patient-specific prescriptions.
  • a prescriptive shape for an eye treatment it is useful to select a mathematical gauge of optical quality appropriate for the vision condition for use as a goal function. This allows for quantification and optimization of the shape, and for comparison among different shapes.
  • the present invention provides methods for establishing a customized optical shape for a particular patient based on a set of patient parameters per the goal function. By incorporating iterative optimization algorithms, it is also possible to generate a shape having an optimized level of optical quality for the particular patient.
  • the goal function relates to optical quality, and it can be, for example, based on, or a function of (or related to) optical metrics such as Strehl ratio (SR), modulation transfer function (MTF), point spread function (PSF), encircled energy (EE), MTF volume or volume under MTF surface (MTFV), or contrast sensitivity (CS); and optionally to new optical metrics which are appropriate to vision conditions such as presbyopia; for instance, compound modulation transfer function (CMTF) as described below.
  • SR Strehl ratio
  • MTF modulation transfer function
  • PSF point spread function
  • EE encircled energy
  • MTFV MTF volume or volume under MTF surface
  • CS contrast sensitivity
  • new optical metrics which are appropriate to vision conditions
  • presbyopia for instance, compound modulation transfer function (CMTF) as described below.
  • CMTF compound modulation transfer function
  • the goal function should make sense. That is to say, minimization or maximization of the goal function should give a predictable optimized optical quality of the eye
  • SR Strehl ratio
  • MTF modulation transfer function
  • MTFV MTF volume or volume under MTF surface
  • CMTF compound modulation transfer function
  • CS contrast sensitivity
  • EE encircled energy
  • Monochromatic point spread function has been used for describing optical defects of optical systems having aberrations. Due to the simple relationship between wave aberrations and the PSF for an incoherent light source, Fourier transform of the generalized pupil function has been used in the calculation of point spread functions. Most optical applications, however, do not use a monochromatic light source. In the case of human vision, the source is essentially white light. Thus, there are limitations associated with the use of monochromatic PSF as a goal function.
  • Polychromatic point spread function (PSF) with correct chromatic aberrations, Stiles- Crawford effect as well as retina response function can be used for optical modeling of human eyes.
  • chromatic aberrations arise because light composed of different wavelengths will focus either in front of the retina or behind it. Only portions of the light will focus exactly on the retina. This gives the eye an extended depth-of-focus, i.e., if one has focusing error of some amount, the eye is still capable of focusing at least for some wavelengths. Therefore, chromatic aberrations in fact help the correction of presbyopia. If the depth-of-focus is sufficiently large, there would be no presbyopia problem. Unfortunately, the chromatic aberrations are not large enough and it also varies with the wavelength. Stiles-Crawford effect, also known as pupil apodization, is due to the waveguide property of the retinal cones.
  • Strehl ratio can be defined as the ratio of the peak of the point spread function (PSF) of an optical system to the peak of a diffraction-limited optical system with the same aperture size.
  • PSF point spread function
  • An example of a Strehl ratio is shown in Fig. 27A.
  • a diffraction-limited optical system is typically a system with no aberrations, or optical errors. It can be an ideal or perfect optical system, having a Strehl ratio of 1.
  • the goal function can also be a function of modulation transfer function (MTF).
  • MTF modulation transfer function
  • Modulation transfer function can be used to predict visual performance.
  • the MTF at one spatial frequency corresponds to one angular extend of features of targets.
  • the modulation transfer function (MTF) can be calculated with the following formulations:
  • u and v represent spatial frequencies
  • Re represents the real part of a complex number
  • FT represents a Fourier Transform
  • GPF represents a generalized pupil function
  • x and y represent position or field of view.
  • An example of an MTF is shown in Fig. 27B.
  • Modulation transfer function is a measure for how much spatial details are transferred from pupil space to imaging space (retina in the case of human eye).
  • MTF can be related to contrast sensitivity (CS).
  • MTF at a specific spatial frequency can represent the percentage of the sinusoidal wave of a specific spatial frequency that is preserved after going through the optical system.
  • MTF at 30 cycles/degree and at 60 cycles/degree are considered as important because 30 cpd corresponds to 20/20 visual acuity and 60 cpd corresponds to 20/10 visual acuity, the highest spatial resolution the cones in the retinal can process.
  • MTF at other spatial frequencies may also be useful.
  • the volume under the MTF surface up to a certain spatial frequency (such as 60 cpd) can be meaningful as it includes all spatial frequency information. In some cases, it is desirable to use the volume under MTF surface within a band (i.e. from one specific spatial frequency to another specific spatial frequency).
  • Compound MTF can be calculated as a linear combination of MTF at certain spatial frequencies, normalized at diffraction-limited MTF, and can be represented by the following formula
  • CMTF - ⁇ j a i h i ,
  • n is the number of MTF curves
  • a is the reciprocal of the z ' th diffraction-limited MTF
  • 3 ⁇ 4 is the z ' th MTF curve.
  • the selection of certain spatial frequencies can depend on the importance of each frequency. For example, in the case of presbyopia, 20/40 vision may be more important than 20/20 as the distance vision is often compromised by the improved near vision.
  • Figs 4A and 4B show an examples of an CMTF curve as well as its individual MTF curves at different specific spatial frequencies. In a perfect optical system, CMTF is equal to one.
  • the compound MTF can be calculated as
  • MTFi, MTF2, and MTF 3 are the MTF values at 10 cycles/degree, 20 cycles/degree and 30 cycles/degree, respectively. These correspond to Snellen eye chart of 20/60, 20/40 and 20/20 visions, respectively.
  • the weighting coefficients cci, ⁇ 3 ⁇ 4, «3 can be chosen so that l/cci, l/ ⁇ 3 ⁇ 4, l/ ⁇ 3 ⁇ 4 are the diffraction-limited MTF at these spatial frequencies, respectively. Therefore, in the diffraction-limited case, the compound MTF F(v) can have a maximal value of unity.
  • compound MTF can be calculated as linear combination of MTF at different spatial frequencies normalized by a diffraction-limited MTF, and can similarly be used to predict visual outcome.
  • CMTF CMTF for all possible vergence. In some cases, three MTF curves at 10, 20 and 30 cycles per degree are used. An ideal value of CMTF can be about 1. Good values can be about 0.2 or about 0.3. In a healthy eye, the spatial frequency limit can be about 60 cycles per degree due to the configuration of retina cones. However, in the treatment of presbyopia, for example, it may not be necessary to provide a treatment corresponding to this limit, as the treatment will often involve a compromise of good distance and near sight. Optionally, a minimum distance vision gauge desired target may be provided, with near sight being optimized and, as needed, compromised.
  • Fig. 4A illustrates an example of the compound MTF over a vergence of 3 diopters (upper panel) versus its corresponding individual MTF curves at 15, 30, and 60 cycles per degree (lower panel).
  • Fig. 4B illustrates an example of the compound MTF over a vergence of 3 diopters (upper panel) versus its corresponding individual MTF curves at 10, 20, and 30 cycles per degree (lower panel).
  • Compound MTF can correlate well with visual acuity and contrast sensitivity at the same time, at least optically.
  • the compound modulation transfer function is determined for individual MTF curves at 30, 45, and 60 cpd. The selection of the individual MTF curve values can involve a linear combination based on the optical response of the eye.
  • Cutoff spatial frequency can correspond to the maximum spatial frequency, above which information can no longer be used. Whereas most individuals can discern information from objects having very low spatial frequency, as the spatial frequency increases, it is typically increasingly more difficult for an individual to discern information from such objects. At some threshold, an increased spatial frequency no longer yields increased information.
  • a first type of cutoff spatial frequency is related to aperture dimension.
  • a system having a larger aperture e.g. an eye with a larger pupil
  • a system having a smaller aperture e.g. an eye with a smaller pupil
  • cutoff spatial frequencies will be linearly dependent on a pupil dimension, for example the pupil diameter.
  • Smaller pupil sizes typically correspond to an extended, or larger, depth of focus.
  • smaller pupil sizes often result in lower resolution. Assuming there are no aberrations, a larger pupil size is thought to confer increased resolution.
  • a second type of cutoff spatial frequency typically depends on the spacing of cones on the retina of the eye.
  • the standard value is 30 cpd, which corresponds to 20/20 vision.
  • Another value, 60 cpd corresponds to 20/10 vision and is often considered a physiological limit.
  • the retinal cones are very closely spaced. The spacing of retinal cones will vary among individuals.
  • a compound modulation transfer function can include individual MTF curves at various combinations of spatial frequencies, such as 15, 30, and 60 cycles per degree and 10, 20, and 30 cycles per degree.
  • An individual MTF can have a value ranging from about 5 cycles per degree to about 75 cycles per degree.
  • At least one individual MTF of a CMTF will range from about 10 cycles per degree to about 30 cycles per degree, and can often be about 20 cycles per degree.
  • a CMTF includes three individual MTF's, a first individual MTF can range from about 5 cycles per degree to about 20 cycles per degree, a second individual MTF can range from about 15 cycles per degree to about 45 cycles per degree, and a third individual MTF can range from about 30 cycles per degree to about 75 cycles per degree.
  • the upper limit of an individual MTF can be about 60 cycles per degree.
  • the CMTF will be based on an average of the individual MTF curves.
  • the present invention provides compound modulation transfer functions that correspond to three, four, five, or any number of individual modulation transfer functions.
  • a CMTF can include from about 2 to about 7 individual MTF's.
  • a CMTF can also include from about 3 to about 6 individual MTF's.
  • Individual MTF's can correspond to a curve through a certain vergence. Typically, a target at a far distance corresponds to a small vergence value. As a target moves closer to the eye, the vergence increases. The individual MTF's can be based on a value ranging from about zero to about three diopters.
  • the individual MTF's can be selected based on any number of criteria, such as empirical data or clinical observations. Relatedly, individual MTF's can be chosen for pure testing purposes.
  • the CMTF can provide a parameter to evaluate the effectiveness of a treatment for a vision condition, such as presbyopia. Often, the CMTF will correlate with a particular visual outcome.
  • at least one of the goal functions such as Strehl ratio, encircled energy, or MTF, MTF volume or volume under MTF surface (MTFV), compound modulation transfer function (CMTF), or contrast sensitivity (CS) should be maximized.
  • the optical metric can be maximized in all target vergence, that is, for targets at all distances. Furthermore, it is also desirable to minimize the fluctuation of the goal function. Therefore, the goal function, which is incorporated into the optimization algorithm of the optimizer, can be defined as
  • O is the goal function
  • c ⁇ , c 2 , ... are the polynomial coefficients
  • PAR presbyopia- add to pupil ratio (described below)
  • v is the vergence
  • F(v) is one of the optical metrics
  • ⁇ is the standard deviation of F(v)
  • PV is the peak-to-valley of F(v)
  • vo is the end point of the vergence range, which may be (for example) between 15 and 100 cm, such as 40 cm.
  • the compound MTF may reflect to what extent information is being modulated when passing through an optical system.
  • CMTF can represent the percentage of information at different spatial frequencies that is retained.
  • any of a number of optimization algorithms may be used by the optimizer to maximize, minimize, or otherwise globally or locally optimize the goal function. Because many numerical algorithms use function minimization concept, it is often convenient, but not necessarily required, to use minimization of the goal function. As examples, N-dimensional minimization algorithms such as the Downhill Simplex method, the Direction Set method, and the Simulated Annealing method can be used to optimize the goal function. Likewise, the algorithm described by Press et al., in "Numerical Recipes in C++", Cambridge University Press, 2002 can also be used.
  • Algorithms such as those listed above are often used for function optimization in multi- dimensional space.
  • the Downhill Simplex method starts with an initialization of N+l points or vertices to construct a simplex for an N-dimensional search, and in every attempt tries to reflect, stretch, or shrink the simplex by geometrical transformation so that a close-to-global minimum or pre-defined accuracy can be found.
  • Gaussian random noise of standard deviation of 0.02 ⁇ in optical path difference (OPD) is added, the algorithm still converges, with no degradation.
  • Direction Set method also known as Powell's method
  • N one-dimensional vectors are initialized and the N-dimensional search is split in such a way that a one N-dimensional vector is chosen and the minimization is done in that direction while other variables (N-l dimensions) are fixed. This process is continued until all dimensions are covered. A new iteration is initiated until the pre-determined criterion is met.
  • the Direction Set method can use a separate one-dimensional minimization algorithm such as a Golden section search.
  • the Simulated Annealing method which is useful for dealing with a large number of uncertainties, starts with an initial configuration.
  • the objective is to minimize E (analog to energy) given the control parameter T (analog to temperature).
  • Simulated Annealing is analogous to annealing, is a recent, proven method to solve otherwise intractable problems, and may be used to solve the ablation equation in laser ablation problem. This is more fully described in PCT Application No. PCT/USOl/08337, filed March 14, 2001, and in U.S. Patent No. 6,673,062, issued January 6, 2004, the entire disclosures of which are incorporated herein by reference.
  • Simulated annealing is a method that can be used for minimizing (or maximizing) the parameters of a function.
  • Simulated annealing can be applied in the same way regardless of how many dimensions are present in the search space. It can be used to optimize any conditions that can be expressed numerically, and it does not require a derivative. It can also provide an accurate overall minimum despite local minima in the search space, for example.
  • Fig. 5 shows the flow chart of an overall method for shape optimization for a vision condition treatment.
  • Each functional block may contain one or more alternatives.
  • an iterative function minimization algorithm can be employed such that the goal function, which could be a function of any suitable optical metrics (e.g. CMTF) is itself optimized to solve for an unknown shape.
  • the shape can be expanded into a set of even power term polynomials (EPTP) or non-EPTP (i.e. all power term polynomials).
  • the goal function should have good correlation with visual performance, at least optically.
  • Point spread function can be calculated to obtain additional and/or alternative optical metrics.
  • the vision condition prescription can refer to an optical surface that can be used to treat or mitigate the vision condition. It can correspond to, for example, the shape of a spectacle lens, a contact lens, an intra-ocular lens, a tissue ablation profile for refractive surgery, and the like. [0146] Another representation of the data flow process is depicted in the flow chart in Fig. 6, which shows data flow for shape optimization for presbyopia correction. Again, each functional block may contain one or more alternatives.
  • Fig. 7 shows a comparison of Direction Set method and Downhill Simplex method for the following inputs: pupil size 5.6 mm, vergence 3D and vergence step 0.1D.
  • Direction Set method uses 17 iterations and Downhill Simplex method uses 152 iterations.
  • Each Direction Set method iteration takes longer than each Downhill Simplex method iteration.
  • the optimizer value for the Direction Set method is 2.8 while that for the Downhill Simplex method is 2.658.
  • Shape for left panel is as -0.9055r 2 +6.4188r 4 -2.6767r 6 +0.5625r 8 with ratio of 0.7418.
  • the initial prescription often comprising an optical surface shape, may be defined by an expansion such as a polynomial (EPTP, non-EPTP), a Zernike polynomial, a Fourier series, or a discrete shape entirety.
  • a discrete shape entirety can also be referred to as a direct surface representation by numerical grid values.
  • the prescription shape may be assumed to be circularly or radially symmetric, with the aim of approaching an emmetropic eye.
  • the symmetric shape can be decomposed into a set of polynomials, such that it has one or more independent variables.
  • One of the variables can be the presbyopia-add to pupil ratio (PAR), or the ratio of the shape diameter to the pupil diameter.
  • PAR presbyopia-add to pupil ratio
  • the PAR can be the ratio of the radius of the presbyopia- add to the radius of the pupil. It will also be appreciated that the ratios discussed herein can be based on area ratios or on diameter or radius ratios. It should be assumed that when diameter or radius ratios are discussed, that discussion also contemplates area ratios. In certain cases, the PAR can range from about 0.2 to about 1.0.
  • the methods of the present invention can constrain the PAR to range from about 0.2 to about 1.0.
  • the other variables can be the coefficients of each polynomial term. For example,
  • Shape(r) ar + br 2 + cr 3 + dr 4 + er 5 + fr 6
  • the diameter of the shape can be larger than the pupil size, but if so special
  • considerations may need to be taken. For example, it may be necessary to only consider the net shape within the pupil.
  • the polynomials can be normal polynomials or polynomials with even power terms only.
  • even-power-term polynomials (EPTP) up to the 6 th or 8 th order can be used to obtain a practically good output, that is, a practical optimal shape for the particular patient.
  • Residual accommodation can also play an active role in presbyopia correction.
  • normal presbyopes can be treated with the prescription obtained in this approach together with a prescription for the correction of the refractive error.
  • a circularly or radially symmetric, pupil-size dependent shape for presbyopia- add can be assumed for emmetropic presbyopes.
  • the shape can then be expanded to polynomials up to the 6 th or 8 th order. With the optimization procedure, it is found that polynomial expansion of the shape up to the 6 th or 8 th order can be used to obtain a practical optimal shape for presbyopia correction.
  • the wavefront can be thought of as an optimal shape for vision correction.
  • the polychromatic PSF can be expressed as
  • R( ) is the retina spectral response function and can be approximated to
  • D( ) is chromatic aberration at wavelength ⁇ and is close to
  • V(l) is the vergence induced aberration at distance / meters
  • RA(l) is the residual accommodation induced aberrations with a different sign as compared to V(l).
  • RA(l) can cancel V(l) as long as there is enough residual accommodation in the eye.
  • the central wavelength ⁇ is taken as 0.55 ⁇ (as all wavelength units in the above formulae are in ⁇ ).
  • the pupil apodization strength parameter p is taken as 0.06.
  • a is the conversion factor from diopter to optical path difference (OPD).
  • FFT denotes a fast Fourier transform and 1*1 denotes the module of a complex number.
  • the polychromatic point spread function can be the point spread function of an eye as calculated with consideration of the polychromatic nature of the incident light. Further, the chromatic aberrations, the Stiles-Crawford effect, as well as the retinal spectral response function can also be considered.
  • the vergence induced aberration, or VIA can be equal to the reciprocal of the vergence distance. When a target at a certain distance is viewed by the eye, it is the same as viewing the target at infinity but the eye has an additional aberration, the vergence induced aberration.
  • EPTP even power term polynomials
  • t another parameter, to be the ratio of the radius of the wavefront R to the radius of the pupil R 0 . This is because both D(X) and V(l) can have the same size as the pupil and W(r) usually has a smaller size. When the calculated t is larger than 1, the shape can become larger than the pupil. In this case, only the portion of the shape up to the pupil size is used for optical quality evaluation.
  • FIG. 8A illustrates a comparison of shapes with normal polynomials (left panel) and with even-power-term polynomials (right panel).
  • the shape on the right panel can be expanded as -1.6154r + 1.7646r 2 + 1.2646r 3 + 1.9232r 4 + 0.1440r 5 + 0.1619r 6 with a ratio of 0.8 and the shape on the left panel can be expanded as -1.1003r 2 +8.2830r 4 +0.7305r 6 -2.2140r 8 with a ratio of 0.9106.
  • the left panel shows an optimal shape for 6 normal polynomial terms and the right panel shows an optimal shape with 4 EPTP terms. It has been found that polynomials up to the 8 th power (4 EPTP terms) appear to give highly satisfactory results.
  • Fig. 8B shows another comparison of EPTP and non-EPTP expansions.
  • the left panel shows an optimized shape based on an 8th order expansion (EPTP), whereas the right panel shows an optimized shape based on a 3rd order expansion (non-EPTP).
  • shapes derived from an EPTP have a smoother shape with a flat central zone. This flat central zone can correspond to good distance visual performance.
  • FIG. 8C shows optimized (minimized) values with EPTP and non-EPTP expansion for a 4, 5, and 6 mm pupil over a 3D vergence distance.
  • non-EPTP optimization gives a slightly smaller (more optimized) value than EPTP.
  • Sixth-order EPTP appears to give the smallest value for 4 mm and 5 mm pupils and eighth-order EPTP appears to give the smallest value for a 6 mm pupil.
  • Third-order non-EPTP appears to give the smallest value for 4 mm and 5 mm pupils and fourth- order non-EPTP appears to give the smallest value for a 6mm pupil.
  • Another way of surface expansion is by means of spectral expansion, or Fourier expansion.
  • the following formula presents an example of a Fourier expansion.
  • Discrete surface is another type of expansion that can be used in the present invention.
  • Discrete surface can be represented by the following formula
  • the set of patient parameters can also be referred to as the set of user input parameters.
  • the input parameters may provide certain patient characteristics, such as pupil size and its variations, desired power, and residual accommodation which can be modeled by factors such as gender, age, and race, or which can be measured by instruments.
  • Residual accommodation can be measured in diopters. Vergence can also be measured in diopters and typically is inversely related to distance, such that a distance of infinity corresponds to a vergence of zero. Similarly, a normal reading distance of 1/3 meters can correspond to a vergence of 3 diopters, and a farther distance of 10 meters can correspond to 0.1 diopters.
  • the visual quality of the shape can be optimized given a certain set of conditions such as vergence, residual accommodation, and chromatic aberrations.
  • RMS minimum root- mean-square
  • the amount of residual accommodation for different visual vergence may vary.
  • the eye may not need to accommodate until viewing a target at a distance of one meter.
  • the ID add-on can cover the first diopter of visual vergence, either entirely or partially.
  • the visual quality may be worse because the eye cannot accommodate in the reverse direction.
  • the techniques of the present invention can be adapted to enhance an optimizer value at low vergence when residual accommodation is assumed.
  • Shape optimization can be customized for a patient.
  • the customization can include the patient's pupil sizes at different lighting and viewing conditions, such as bright far viewing, bright near viewing, dim far viewing, and dim near viewing.
  • the optimization can also be based on the patient's residual accommodation, or predicted residual accommodation based on the patient's age, or the patient's vision preference due to for example, their employment or other requirements. That is to say, the customization can put more emphasis on far, near, or intermediate viewing. Similarly, the customization can put more emphasis on dim lighting condition, bright lighting condition or scotopic lighting condition. Further, the optimization can be based on how long the patient wishes to have the correction last. In many ways, presbyopia correction can be a management of compromise. If a patient needs to have excellent correction, he or she might need re-treatment after a couple of years as he or she gets older, when residual accommodation diminishes and/or the pupil size becomes smaller. Inputting A Set Of Initial Conditions Into an Optimizer
  • the output result, or optical surface shape can be sensitive to the choice of the initial condition.
  • the initial condition can be the initial N+l vertices as well as the corresponding initial optimizer values for an N-dimensional problem.
  • the conditions can be the initial vertices, as well as the value associated with these vertices, for N independent variables.
  • the initial condition can be the initial N direction's unit vector and an initial point for an N-dimensional problem.
  • Figs. 9A-9D show a variety of shapes determined using different initial conditions, as calculated by the Downhill Simplex method. Pupil size of 5.6 mm and vergence of 3D with 0.1D step are assumed. Shape for Fig. 9A is 4.12r-0.235r 2 +0.08r 3 -6.9r 4 +4.81r 5 +2.157r 6 ; for Fig.
  • the iterative optimization algorithm can be employed to calculate a shape that optimizes the optical quality for the particular patient.
  • the shape can be calculated to optimize distance vision and near vision.
  • the corrective optical surface shape corresponds to the set of output parameters provided by the optimizer.
  • the output parameters can be the coefficients of polynomials describing the shape, as well as the ratio of diameter of the shape to that of the pupil diameter. These output parameters can define the final customized or optimized optical surface shape.
  • This approach provides a numerical way for general optimization of the optical surface shape for correction or treatment of a vision condition, such as presbyopia. Whether it is for refractive surgery, contact lens, spectacle lens, or intra- ocular lens, the approach can be very beneficial.
  • the optimal shape can be combined with the shape that corrects for the refractive error, for example the patient' s measured wavefront error.
  • Gaussian distributed noise can be added into the shape so that when noise is present the stability of the algorithm can be tested.
  • Gaussian noise of standard deviation of 0.02 ⁇ OPD can be introduced. This corresponds to nearly 0.06 ⁇ in tissue depth in the case of laser surgery. This is larger than the general RMS threshold for the Variable Spot Scanning (VSS) algorithm for such a shape.
  • VSS Variable Spot Scanning
  • the noise-free case has an optimizer value of 3.008 with 184 iterations and the noisy case has an optimizer value of 2.9449 with 5000 iterations. Both use Downhill simplex method. Pupil size is 5 mm with 3D vergence and 0.1D step. Noise addition can also help to guarantee the stability of the algorithm.
  • one desirable optical surface shape has a central un-ablated zone and an outside zone that provides improved near vision or reading capability.
  • the central flat zone can be about 1.96 mm in diameter. Because the healing effect may reduce the central zone, the planned flat ablation may need to go beyond 2 mm in order to get a healed flat zone of about 1.96 mm. This can be for a pupil size of about 5.6 mm (natural size).
  • the present invention can also consider practical pupil dependency in the approach.
  • the optical zone can go to about 0.91 times the size of the pupil size, which is about 5.1 mm.
  • the present invention may also incorporate a transition zone such as the VISX standard transition zone technique, as used in variable spot scanning (VSS). What is more, the present invention can also provide a clear mathematical description for the optical surface shape outside of the un-ablated zone.
  • Fig. 11C illustrates that there can be a dependency between optimizer value and pupil size.
  • Fig. 11C also shows a preferred optimizer value (optimal).
  • An optimizer value can be a value of the goal function after it is optimized. Theoretically, this value should not be smaller than unity.
  • An optimization, or minimization, algorithm can be used to find values of free parameters such that the optimizer value is as close to unity as possible.
  • the present invention can incorporate varying pupil sizes, although presbyopes may tend to have smaller pupil size variation. Because an optimal shape for a fixed pupil size may no longer be optimized if the pupil size changes, the present invention can provide approaches that can allow for pupil size variations.
  • the final optical surface shape can be one that gives an optimal optical quality over a certain vergence range when the pupil size varies over a range.
  • the MTF can be shown at different spatial frequencies, as illustrated in Figs. 11A-C, which provides optimizer values for various corrections.
  • the optimal curve gives the minimum (optimized) value for all pupil sizes. Eyes with larger pupils can be more difficult to optimize. What is more, carefully designed multi-focal correction can be close to optimal, as further illustrated in Figs. 11A-C. That is, the optimizer value for the multi-focal correction can be close to that of the optimized correction, hence the results are quite similar. This outcome is also illustrated in Fig. 13.
  • the lower regression line in Fig. 11C can set the practical limit for the optimizer value.
  • the compound MTF can be plotted, as shown in Figs. 9A-B.
  • the compound MTF for various treatments for a 5 mm pupil over a 3D vergence is plotted. It can be beneficial to optimally balance the level of compound MTF at every vergence distance or over the desired vergence.
  • Fig. 9C shows a comparison of bi-focal and optimal corrections, with a simulated eye chart seen at different target distances, assuming a 5mm pupil with no accommodation.
  • the eye chart has 20/100, 20/80, 20/60, 20/40, and 20/20 lines, respectively.
  • Fig. 10 is a simulated eye chart seen at different target distances, and compares an optimized case (bottom) to no correction (top line); reading glasses (second line); bi-focal lenses (inner half for reading and outer half for distance, third line); and multi-focal lenses (pupil center for reading with maximum power and pupil periphery for distance with zero power and linear power change in between, four line).
  • the effects of the optimization can be clearly seen by the comparison. No accommodation or refractive error is assumed in any of the cases.
  • the eye chart has 20/100, 20/80, 20/60, 20/40, and 20/20 lines.
  • the approaches of the present invention can be implemented on a variety of computer systems, including those with a 200MHz CPU with 64MB memory, and typically will be coded in a computer language such as C or C++. Simulations have successfully been run on a laptop computer with a 1.2GHz CPU with 256 MB memory. The techniques of the present invention can also be implemented on faster and more robust computer systems.
  • the present invention includes software that implements the optimizer for practical applications in a clinical setting.
  • the optimizer will often comprise an optimizer program code embodied in a machine-readable medium, and may optionally comprise a software module, and/or a combination of software and hardware.
  • the software interface can comprise two primary panels: the parameter panel and the display panel.
  • the parameter panel can be split into two sub-panels: optimization and verification.
  • the display panel can also be split into two sub-panels: graph panel and image panel.
  • the software can also include a menu bar, a tool bar, and a status bar. In the tool bar, small icons can be used for easy access of actions.
  • the optimization sub-panel can include a number of parameter units.
  • a first parameter unit can be the pupil information group.
  • the user or operator can give four different pupil sizes for a specific eye. More particularly, the pupil information group includes the pupil size in (a) bright distance viewing condition, (b) bright near viewing condition (e.g. reading), (c) dim light distance viewing condition, and (d) dim light near viewing condition (e.g. reading). These different pupil sizes can be used in the optimization process.
  • a second parameter unit in the optimization sub-panel can be the display group.
  • the user or operator has three different choices for the display, including (a) none, (b) shape, and (c) metric.
  • the display group can provide instruction to the software regarding what kind of display is desired for each iteration. For instance, none can mean no display, shape can mean displaying the current shape, and metric can mean displaying the current optical metric curve over the desired vergence for this current shape.
  • the choices can be changed during the optimization procedure, and in this sense it is interactive.
  • a third parameter unit in the optimization sub-panel can be the optical metric group.
  • the user has five different choices for the metric, including (a) Strehl ratio, (b) MTF at a desired spatial frequency, (c) encircled energy at a desired field of view, (d) compound MTF (CMTF) with a set of specific combinations, which could be any number of MTF curves at different spatial frequencies, and when the "auto" check box is checked, it can use a default CMTF with three frequencies, such as, for example: 10, 20 and 30 cycles/degree, and (e) the MTF volume up to a specific spatial frequency. 25% CMTF over the vergence appears to be an example of a good target value for optimization.
  • a fourth parameter unit in the optimization sub-panel can be the optimization algorithm group.
  • the user has three different choices for the optimization algorithm employed by the optimizer, including (a) the Direction Set (Powell's) method, (b) the Downhill Simplex method, and (c) the Simulated Annealing method.
  • the optimizer can employ a standard or derived algorithm for function optimization (minimization or maximization). It can be a multi-dimensional, non-linear, and iterative algorithm.
  • a number of other parameters can be included in the optimization sub-panel. As shown in Figs. 14-16, these other parameters can be implemented separately (optionally as a ComboBox) with a number of choices for each. These can include parameters such as (a) the number of terms of the polynomial expansion, (b) the frame size, (c) the PSF type (monochromatic, RGB, or polychromatic), (d) whether the shape is EPTP or non-EPTP, (e) the vergence requirement, (f) the vergence step, and (g) the residual accommodation.
  • the software can include a StringGrid table that displays the polynomial coefficients, the PAR value, the optimizer value, as well as the current number of iterations. These numbers can be updated every iteration.
  • the verification sub-panel can include a number of parameter units.
  • a first parameter unit can be the "which" group. In the examples shown in Figs. 14-16, the operator can use this group to select whether to use built-in eye chart letters, or an entire eye chart or a scene.
  • a second parameter unit in the verification sub-panel can be the left image group. The user can make a selection in the left image group from PSF and imported scene.
  • a third parameter unit is the right image group, wherein the user can make a selection from imported scene, and blur at near.
  • the two image display groups are for the left and right subpanels in the image subpanel.
  • the ComboBox for letter can provide a list of different eye chart letters
  • the VA ComboBox can provide the expected visual acuity, from 20/12 to 20/250.
  • the Contrast ComboBox can provide a list of contrast sensitivity selections, from 100% to 1%.
  • Two check box can also be included.
  • the Add check box once checked, adds the presbyopia to the simulated eye.
  • the Test check box when checked, performs the distance (zero vergence). At the bottom, there is a slider with which all the saved images (e.g. PSF and convolved images) can be reviewed.
  • the shape can be customized for various lighting and accommodation conditions.
  • pupil size can change with lighting conditions.
  • Each of the presbyopia-mitigating and/or treating methods, devices, and systems described herein may take advantage of these variations in pupil size.
  • a pupil size of a particular patient will often be measured, and multiple pupil sizes under different viewing conditions may be input for these techniques.
  • a patient can also have a task-related vision preference that correlates with lighting conditions, such as those described in Table 3, and the customization can be based upon these task-related preferences.
  • Fig. 18 illustrates that pupil size can change with accommodation
  • Fig. 19 illustrates a comparison of corrections by providing optimizer values for various accommodations.
  • the optimizer value can achieve a limit of about 1.0, regardless of the pupil size.
  • a larger amount of residual accommodation can correspond to a smaller optimizer value after optimization.
  • the limit line can correspond to an optimizer value of about 5.0.
  • an optimizer value of about 5.0 can be viewed as a good practical limit. Either there can be a smaller pupil, or a larger amount of residual accommodation, in order to optimize such that all vergence distances have good visual performance.
  • Figs. 20 and 21 show optimizations under various accommodation conditions.
  • Figs. 21A and 21B show CMTF and optimizer values when pupil size changes and Residual Accommodation (RA) are modeled.
  • Fig. 21C shows simulated eye charts seen at different target distances after optimization, all assuming a 5mm maximum pupil size. Each eye chart has 20/100, 20/80, 20/60, 20/40, and 20/20 lines.
  • the top line simulates no accommodation and no pupil size changes.
  • the middle line assumes no accommodation but the pupil size changes from 5mm (dim distance) to 2.5mm (bright near).
  • the simulation assumes ID accommodation with pupil size changes from 5mm (dim distance) to 2.5mm (bright near).
  • Fig. 21 show optimizations under various accommodation conditions.
  • Figs. 21A and 21B show CMTF and optimizer values when pupil size changes and Residual Accommodation (RA) are modeled.
  • Fig. 21C shows simulated eye charts seen at different target distances after optimization, all
  • CMTF values for various corrections A 5mm pupil eye is assumed, along with a smallest pupil size of 2.5mm (bright light reading condition) and a ID residual accommodation.
  • Fig. 23 compares bi-focal, optimal, and multi-focal corrections, under the assumption of a one diopter residual accommodation. These simulated eye charts are seen at different target distances after optimization. ID accommodation and a 5mm pupil changes from 5mm (dim distance) to 2.5mm (bright near) are assumed. The eye chart has 20/100, 20/80, 20/60, 20/40, and 20/20 lines, respectively.
  • Fig. 24 illustrates a simulated eye chart seen at different target distances. The data in this figure based on the assumption that the pupil size decreases from 5 mm to 2.5 mm, and there is a 1 diopter residual accommodation in all cases.
  • the customized shape methods and systems of the present invention can be used in conjunction with other optical treatment approaches.
  • U.S. provisional patent application number 60/431,634, filed December 6, 2002 (Attorney Docket No. 018158- 022200US)
  • co-pending U.S. provisional patent application number 60/468,387 filed May 5, 2003 (Attorney Docket No. 018158-022300US)
  • the approach involves determining a prescriptive refractive shape configured to treat the vision condition, the prescriptive shape including an inner or central "add" region and an outer region.
  • the approach also includes determining a pupil diameter of the particular patient, and defining a prescription shape comprising a central portion, the central portion having a dimension based on the pupil diameter, the inner region of the prescriptive refractive shape, and an attribute of at least one eye previously treated with the prescriptive refractive shape.
  • the present invention can include a method for determining a customized shape that includes a scaled central portion as described above, the customized shape giving results at least as good or better than previously known methods.
  • the present invention also provides systems for providing practical customized or optimized prescription shapes that mitigate or treat vision conditions such as presbyopia in particular patients.
  • the systems can be configured in accordance with any of the above described methods and principles.
  • a system 100 can be used for reprofiling a surface of a cornea of an eye 150 of a particular patient from a first shape to a second shape having correctively improved optical properties.
  • System 100 can comprise an input 110 that accepts a set of patient parameters, a module 120 that determines an optical surface shape for the particular patient based on the set of patient parameters, using a goal function appropriate for a vision condition of an eye, a processor 130 that generates an ablation profile, and a laser system 140 that directs laser energy onto the cornea according to the ablation profile so as to reprofile a surface of the cornea from the first shape to the second shape, wherein the second shape corresponds to the prescription shape.
  • a module 120 that determines an optical surface shape for the particular patient based on the set of patient parameters, using a goal function appropriate for a vision condition of an eye
  • a processor 130 that generates an ablation profile
  • a laser system 140 that directs laser energy onto the cornea according to the ablation profile so as to reprofile a surface of the cornea from
  • the present invention will often take advantage of the fact that the eye changes in two different ways with changes in viewing distance: the lens changes in shape so as to provide accommodation, and the pupil size simultaneously varies.
  • Accommodation and pupillary constriction work in unison in normal healthy eyes when shifting from a far to a near viewing distance, and a fairly linear relation may exist between at least a portion of the overlapping constriction and accommodation ranges, but the effect may vary significantly among subjects (from 0.1 to 1.1 mm per diopter).
  • the stimulus for accommodation is increased beyond the eye's ability to change its refraction, the relationship between
  • accommodation of the lens and pupillary constriction may be curvilinear as shown.
  • pupillary constriction and accommodation are not necessarily linked. These two functions may proceed independently, and may even work in opposite directions, particularly when the patient is simultaneously subjected to large variations in light intensity with changes in viewing distance. Nonetheless, prescriptions for presbyopia can take advantage of the correlation between pupil dimension and viewing distance for a particular patient.
  • the effective time span for a presbyopia-mitigating prescription may also be extended by accounting for gradual changes in pupil dimension over time (such as the gradual shrinkage of the pupil as one ages) with the concurrent gradual decrease in the accommodation. Details regarding constriction of the pupil were published in a book entitled The Pupil by Irene E. Loewenfeld (Iowa State University Press, 1993).
  • Fig. 26B and 26C if we assume that we can tailor a beneficial overall optical power for the eye as it changes to different pupil sizes, we may first want to identify a relationship between this desired optical power and pupil size. To determine what powers would be desirable for a particular patient at different viewing conditions, we might measure both the manifest sphere and corresponding pupil sizes of that patient at a variety of different viewing conditions. The manifest sphere may then be used as our desired or effective power to be used for treating presbyopia, as detailed below. The desired optical power might also be determined from the measured manifest, for example, with desired power being a function of the manifest to adjust for residual accommodation and/or anticipated aging effects or the like. In either case, these patient-specific measurements can be the basis for determining desired powers for associated pupil sizes of that patient, such as at the four points illustrated in Fig. 26B. Fewer or more points might also be used.
  • manifest sphere and pupil size for a population of different patients who have been successfully treated with a given presbyopia prescriptive shape may be plotted, and a correlation derived from this empirical data, as schematically illustrated in Fig. 26C.
  • Still further approaches may be employed, including combinations where a population of patients having differing pupil sizes are used to derive an initial correlation, which is subsequently refined with multiple measurements from at least one patient (and often a plurality of patients). Regardless, the relationship between our desired optical power and the pupil size can be determined.
  • constriction of the pupil at differing viewing distances then allows the overall power of the eye to be altered by the pupillary constriction, despite a loss in the flexibility of the lens.
  • prescriptive refractive shapes are effective in treating vision conditions, and it is possible to provide an efficient prescription shape by scaling a shape to the particular patient being treated.
  • Optical shapes can be scaled based on data collected from subjects previously treated with a uniform prescriptive optical shape, such as measured manifest powers for different pupil sizes. Shapes may also be scaled based on the desired overall optical power of the eye under differing viewing conditions.
  • prescriptive treatment shapes such as those shown in Fig. 28 have been found to provide a range of good focus to the eye so as to mitigate presbyopia.
  • This particular prescriptive shape is the sum of two component shapes: a base curve treatment defining an outer region having a diameter of about 6.0 mm, and a refractive add defining an inner region having a diameter of about 2.5 mm.
  • Prescriptive shapes such as this can provide a spherical power add ranging from between about 1.0 diopters to about 4.0 diopters at the inner region. Further, the spherical power add can be about 3.1 diopters.
  • the overall prescriptive refractive shape can be aspheric. It is appreciated, however, that the dimensions and properties of a prescriptive shape can vary depending on the intended purpose of the shape.
  • Treatment of presbyopia often involves broadening the focus range of the eye.
  • a focal length of the optical system results in a point of focus 10 that produces a sharp image.
  • the refractive power of the cornea and lens is matched to the length of the eye. Consequently, light rays 20 entering the eye converge on the retina 30. If there is a difference between the refractive power and the length of the eye, however, the light rays can converge at a point 40 in front of or behind the retina, and the image formed on the retina can be out of focus. If this discrepancy is small enough to be unnoticed, it is still within the focus range 50 or depth of focus. In other words, the image can be focused within a certain range either in front of or in back of the retina, yet still be perceived as clear and sharp.
  • the accommodative mechanism may not work sufficiently, and the eye may not be able to bring the focal point to the retina 30 or even within the range of focus 50.
  • One way to achieve this is by providing an optical system with an aspheric shape.
  • the aspheric shape for example, can be ablated on a surface of the eye, the surface often comprising a stromal surface formed or exposed by displacing or removing at least a portion of a corneal epithelium, or a flap comprising corneal epithelium, Bowman's membrane, and stroma.
  • the shape can be provided by a correcting lens.
  • only a portion of the shape may be aspheric.
  • an aspheric shape there is not a single excellent point of focus. Instead, there is greater range of good focus. The single best focus acuity is compromised, in order to extend the range of focus.
  • By extending the range of focus 50 to a broadened range of focus 50' there is an improvement in the ability to see both distant and near objects without the need of 3D or more in residual accommodation.
  • the power add of the inner region depicted in Fig. 28 provides a myopic effect to aid near vision by bringing the near vision focus closer to the retina, while the outer region remains unaltered for distance vision.
  • this prescriptive shape is bifocal, with the inner region being myopic relative to the outer region.
  • the eye can use the inner region for near vision, and can use the whole region for distance vision.
  • the prescriptive refractive ablation shape can have fairly abrupt changes, but post ablation topographies may show that healing of the eye can smooth the transitions.
  • the shape can be applied in addition to any additional required refractive correction by superimposing the shape on a refractive corrective ablation shape. Examples of such procedures are discussed in co-pending U.S. patent application number 09/805,737, filed March 13, 2001, the disclosure of which is herein incorporated by reference for all purposes.
  • Alternative presbyopia shapes may also be scaled using the techniques described herein, optionally in combination with other patient customization modifications, as can be understood with reference to U.S. Provisional Patent Application Nos. 60/468,387 filed May 5, 2003, 60/431,634, filed December 6, 2002, and 60/468,303, filed May 5, 2003, the disclosures of which are herein incorporated by reference for all purposes.
  • Alternative presbyopia shapes may include concentric add powers along a peripheral or outer portion of the pupil, along an intermediate region between inner and outer regions, along intermittent angular bands, or the like; asymmetric (often upper or lower) add regions, concentric or asymmetric subtrace or aspheric regions, and the like.
  • the present application also provides additional customized refractive shapes that may be used to treat presbyopia.
  • the pupil diameter of the particular patient it is helpful to determine the pupil diameter of the particular patient to be treated.
  • Several methods may be used to measure the pupil diameter, including image analysis techniques and wavefront measurements such as Wavescan ® (AMO Manufacturing USA, LLC in Milpitas, CA) wavefront measurements.
  • the size of the pupil can play a role in determining the amount of light that enters the eye, and can also have an effect on the quality of the light entering the eye.
  • the pupil is very constricted, a relatively small percentage of the total light falling on the cornea may actually be allowed into the eye.
  • the pupil is more dilated, the light allowed into the eye may correspond to a greater area of the cornea.
  • the central portions of the cornea have a more dominant effect on the light entering the eye than do the peripheral portions of the cornea.
  • Pupil size can have an effect on light quality entering the eye.
  • the amount of light passing through the central portion of the cornea is a higher percentage of the total light entering the eye.
  • the amount of light passing through the central portion of the cornea is a lower percentage of the total light entering the eye.
  • the central portion of the cornea and the peripheral portion of the cornea can differ in their refractive properties, the quality of the refracted light entering a small pupil can differ from that entering a large pupil.
  • eyes with different pupil sizes may require differently scaled refractive treatment shapes.
  • Experimental data from previously treated eyes can provide useful information for scaling a refractive treatment shape for a particular patient.
  • a refractive shape for a particular patient can be scaled based on certain characteristics or dimensions of the shape used to treat the eyes of the subjects.
  • One useful dimension of the above-described presbyopic prescriptive shape is a size or diameter of inner region or refractive add. It is possible to scale a treatment shape for a particular patient based on the diameter of the refractive add of the prescriptive shape. Alternative techniques might scale a power of an inner, outer, or intermediate region, a size of an outer or intermediate region, or the like.
  • the refractive add diameter is small, it can occupy a smaller percentage of the total refractive shape over the pupil. Conversely, if the refractive add diameter is large, it can occupy a greater percentage of the total refractive shape over the pupil. In the latter case, because the area of the periphery is relatively smaller, the distance power is diminished. In other words, the area of the add is taking up more of the total refractive shaped used for distance vision.
  • Figs. 31 and 32 illustrate the effect that pupil size can have on distance acuity and near acuity in subjects treated with a prescriptive refractive shape, for example a shape having a 2.5 mm central add zone of -2.3 diopters.
  • a prescriptive refractive shape for example a shape having a 2.5 mm central add zone of -2.3 diopters.
  • pupil size values were obtained from a group of subjects as they gazed into infinity under mesopic or dim light conditions.
  • the 6-month uncorrected distance acuity values were obtained from the same group of subjects under photopic conditions.
  • pupil size values were obtained from a group of subjects as they gazed at a near object under mesopic or dim light conditions.
  • the 6-month uncorrected near acuity values were obtained from the same group of subjects under photopic conditions.
  • One way to determine an optimal pupil diameter measure is by superimposing a near acuity graph over a distance acuity graph, and ascertaining the pupil diameter that corresponds to the intersection of the lines.
  • An optimum overlap can occur in a range from between about 4.0 mm to about 6.0 mm.
  • an optimum overlap can occur in a range from between about 5.0 mm to about 5.7 mm.
  • These measurements may correspond to a pupil diameter measure from the set of previously treated eyes that corresponds to both good distance and near vision when the diameter of the central add region is 2.5 mm.
  • the present invention provides methods and systems for defining a prescription for treating a vision condition in a particular patient, with the prescription optionally comprising a refractive shape.
  • a method can be based on the following features: (a) a prescriptive refractive shape configured to treat the vision condition, including an inner region thereof; (b) a pupil diameter of the particular patient, and (c) an attribute of a set of eyes previously treated with the prescriptive shape.
  • the prescriptive shape can be the shape described in Fig. 28.
  • the inner region of the shape can be a refractive add, having a diameter of 2.5 mm.
  • a pupil diameter of the particular patient of 7 mm is assumed.
  • the attribute of a set of previously treated eyes can be the pupil diameter of the eyes that corresponds to both good distance and near vision, such as the exemplary 5.3 mm treated pupil diameter shown in Figs. 31 and 32.
  • a ratio of the prescriptive refractive add to treated pupil (PAR) can be expressed as 2.5/5.3.
  • the PAR can be used in conjunction with the pupil diameter of the particular patient to scale the refractive shape.
  • this scaled central portion can correspond to the diameter of the refractive add of the defined refractive shape.
  • the refractive shape and the central portion of the refractive shape can alternately be spheric or aspheric.
  • the refractive shape can be aspherical, and the central portion of the refractive shape can be aspherical; the refractive shape can be spherical and the central portion of the refractive shape can be spherical; the refractive shape can be aspherical, and the central portion of the refractive shape can be spherical; or the refractive shape can be spherical, and the central portion of the refractive shape can be aspherical.
  • the PAR can be about 2.5/5.3, or 0.47. It will be appreciated that the PAR can vary. For example, the PAR can range from between about 0.35 and 0.55. In some embodiments, the PAR may range from about 0.2 to about 0.8. Optionally, the PAR can range from about 0.4 to about 0.5. Further, the PAR can range from about 0.43 to about 0.46. It will also be appreciated that the ratios discussed herein can be based on area ratios or on diameter ratios. It should be assumed that when diameter ratios are discussed, that discussion also contemplates area ratios.
  • the attribute of a set of previously treated eyes can be the pupil diameter of the eyes that correspond to both good distance and near values for spherical manifest.
  • a group of individuals with varying pupil sizes were treated with the same prescriptive refractive shape, the shape having a constant presbyopic refractive add diameter of approximately 2.5 mm. Pupil sizes were obtained on a Wavescan ® device.
  • the Spherical Manifest at 6 months post- treatment is shown as a function of the pupil size in Fig. 33.
  • the spherical manifest represents the effective distance power as the result from the total prescriptive shape, including the inner region and outer regions of the shape.
  • Fig. 33 illustrates, for a given prescriptive treatment shape, the effect that the shape has on the individual's manifest can depend on the individual's pupil diameter.
  • the refractive add will have different relative contribution to the power.
  • the prescriptive refractive add to treated pupil ratio may not be constant.
  • the effective power can vary among different patients.
  • the power change from the central portion of the treated eye to the periphery can be assumed to be linear. This simplification can be justified by the data.
  • the change in power can be represented by the following formula, expressed in units of diopters.
  • the rate change in effective power is 0.42D per mm for distance vision. It has been shown that the pupil diameter can change at a rate of approximately 0.45D per mm.
  • the add power is -2.87 diopters.
  • a PAR can be determined based on acuity measurements as a function of pupil size. In an analogous manner, it is possible to determine a PAR based on power measurements as a function of pupil size.
  • the Effective Distance Power Equation A above represents one approach to finding a good approximation to customize the refractive shape size.
  • the intersection of a distance version of the equation and a near version of the equation is solved to determine a pupil diameter measure, which forms the denominator for the PAR (prescriptive shape add diameter/pupil diameter of treated eye).
  • a pupil diameter measure forms the denominator for the PAR (prescriptive shape add diameter/pupil diameter of treated eye).
  • a treated pupil diameter of about 5.4 mm has a spherical manifest of about -0.6 diopters. If the size of the prescriptive shape add is made bigger, the line can be shifted downward. Consequently, the effect in a particular patient treated with the scaled refractive shape would be a more myopic spherical manifest of -2.0, for example. On the other hand, if the size of the add is made smaller, the line can be shifted upward, and the effect would be a spherical manifest of -0.2, for example. As the diameter of the add decreases, the manifest of the particular patient treated with the scaled refractive shape becomes more skewed to better distance sight. As the diameter of the add increases, the manifest becomes more skewed to better near sight. [0254] Fixing the PAR
  • a ratio of 2.5/5.3 mm can rotate these near and distance lines toward horizontal, about the 5.3 mm point.
  • an analysis of particular patients treated with a PAR of 2.5/5.3 is expected to result in manifest versus pupil size plots having lines that are more horizontally oriented.
  • each patient would be expected to have similar near manifest.
  • the effective distance power versus pupil diameter can also be expressed by the following non- linear equation.
  • Target manifest (acuity as a function of power)
  • the target manifest or desired power at a particular viewing distance may or may not be emmetropic (0 diopters).
  • near sight may be improved by a manifest which is slightly myopic.
  • an optimum target refraction can be calculated based on acuity as a function of power in a set of eyes treated with the prescribed refractive shape.
  • Figs. 34 and 35 show the distance and near acuity as a function of manifest, respectively.
  • Distance and near acuity versus manifest can be expressed by the following non- linear equations.
  • Dis tan ce _ Acuity A Q + A(Manif est) + B (Manifest) 1 + C '(Manifest) 3 + ...
  • Dist _ Acuity -0.04 - 0A3(Manifest)
  • the point where the two lines meet is about -0.5D. Therefore, it can be useful to set the target manifest to -0.5D.
  • the target manifest equations can be refined based on additional data collected from those patients that are treated with the refractive shape. As noted above in reference to Fig. 28, a prescriptive shape may be the sum of a base curve treatment and a central refractive add. It is possible to change the base shape to compensate for any power offset contributed by the central refractive add to the distance manifest. [0265] PAR refinements applied to particular patients
  • Equation B As additional data is accumulated, it is possible to calculate the higher order terms of Equation B. More particularly, it is possible to calculate the higher order terms from additional subjects who have been treated with refractive shapes corresponding to constant and linear term adjustments. For example, a group of patients can be treated according to the PAR of 2.5/5.3 discussed above, and based on their results, the PAR can be further refined.
  • These adjustments rotate the equation about the 5.6 mm line toward horizontal because the near effect is a constant.
  • a 5 mm pupil patient has the same near correction as a 6 mm pupil patient, which means that their near acuity should be the same, i.e. a plot of the near acuity versus pupil size will be a substantially flat line.
  • Figs. 36 and 37 show the result of these adjustment on this group of patients. As predicted, the lines rotated.
  • the distance acuity of 7 of 8 of these patients was 20/20 (logMAR 0) or better, and the 8th was 20/20+2. Their near acuity slopes have also flattened, with 7/8 patient having simultaneous 20/32 -2 acuity or better, and the 8th 20/40. Table 4 summarizes the acuity and power measures.
  • This PAR adjusted group has, which is a good result for a presbyopia treatment.
  • Optimizing A Refractive Shape For A Vision Condition It is possible to define customized refractive shapes such that they are optimized to treat a particular patient.
  • the power of the refractive shape may be based on the central power add of a prescriptive shape, and the power change requirement of the particular patient.
  • Other approaches may involve deriving an appropriate prescription so as to provide a desired overall effective power of the eye at different viewing conditions, again by taking advantage of the changes in pupil size.
  • a prescriptive shape can be selected for treating the vision condition of the particular patient.
  • the prescriptive shape shown in Fig. 28 can be selected for treating a particular patient having presbyopia.
  • the central power add of this exemplary prescriptive shape can be about -3.1 diopters.
  • the desired power change of a particular patient can vary widely, and often depends on the patient' s desired treatment or a recommendation from a vision specialist.
  • the desired power change of a particular patient having presbyopia can be about -2.5 diopters.
  • the desired power change may be linear or non-linear.
  • Pupil diameters can be measured by, for example, a pupillometer.
  • Pupil diameter parameters can involve, for example, the patient' s pupil diameter as measured under certain distance and lighting conditions, such as under photopic conditions while the patient gazes at infinity (distance-photopic).
  • Pupil diameter parameters can also involve pupil diameter measurements under other conditions such as distance- mesopic, distance-scotopic, near-photopic, near-mesopic, or near-scotopic. Still further additional measurements at other viewing conditions, such as at intermediate distances and/or moderate lighting conditions, may also be measured.
  • a pupil diameter parameter can be the value of the particular patient's pupil diameter at distance-photopic minus the patient's pupil diameter at distance scotopic. According to this example, if the distance-photopic pupil diameter is 0.7 mm and the distance-scotopic pupil diameter is 0.2 mm, then the pupil diameter parameter is 0.7 mm minus 0.2 mm, or 0.5 mm.
  • the power of the refractive shape can be a function of a given diameter, as expressed in the following formula.
  • Power/Shape Requirement is the power of the refractive shape at a particular
  • Co the central power add of the prescriptive refractive shape
  • A is calculated as
  • PRC the power change requirement for the particular patient
  • PDP the pupil diameter parameter (obtained, for example, by subtracting the diameter of the pupil measured when the patient is gazing at infinity from the diameter of the pupil measured when the patient is looking at a near object under identical light conditions).
  • PSR Power/Shape_Requirement
  • PSR -3.1 diopters + [(-2.5 diopters - -3.1 diopters)/0.5 mm)](pupil_diameter) or
  • a pupil diameter parameter based on a pupil diameter change slope as measured under certain distance and lighting conditions, for example, as the patient gazes at infinity while the lighting conditions change from photopic to scotopic
  • Pupil diameter parameters can also involve pupil diameter change slopes such as near-photopic to scotopic, photopic-distance to near, mesopic-distance to near, or scotopic-distance to near.
  • the effective power (e.g., linear power model or higher order model) can be used to calculate or derive a presbyopic shape, optionally based on the following parameters.
  • the F.2. Near can have an effective power of -2.5D (or more, if desired by the patient F.3.
  • the rate of change of power for the add-treatment combination can have one of the four:
  • the theoretical pupil size at emmetropia can vary within the population.
  • the pupil diameter can further vary when the eye is used for different tasks.
  • the pupil diameter can decrease as the eye's gaze changes from infinity to a near object.
  • the typical pupil diameter decreases. This change in pupil diameter may be linear with convergence and sigmoid with accommodation.
  • the pupil diameter at near gaze can typically have the inner region of the prescriptive shape as the dominant refractive component. Consequently, the change of pupil size from larger to smaller (distance gaze to near gaze) can be equivalent to a change in power.
  • the distance gaze pupil will have an effective power based on the combination of the inner region add and the outer region of the prescriptive shape, with the outer region becoming a more dominant refractive component. Therefore, each refractive shape can be customized to each particular individual because of the many different combinations available.
  • the power of the cornea for example, from emmetropia at the "distance" pupil size to within a range of about -1.0 diopters to about -4.0 diopters myopic for "near" pupil size, it may be possible to mitigate presbyopia.
  • a general prescription may go as follows. First, measure the continuous pupil size and/or size change at different distances and lighting conditions, such as for at least one (optionally two or more, in some cases all) of: Distance - Photopic; Distance - Mesopic, Distance - Scotopic, Near - Photopic, Near - Mesopic, and/or Near - Scotopic.
  • the pupil size can be affected by the lighting conditions as well as viewing distances.
  • the refractive shape can also include adjustments and/or optimization for lighting. In photopic conditions, the pupil is typically constricted. In scotopic conditions, the pupil is usually dilated. Under mesopic conditions, the pupil can be variably dilated or constricted depending on the specific type of mesopic condition.
  • the presbyopic lens power can compensate focus such that the lens is the inverse of the rate of pupil change. To do this, the power can change (for example -3D) for different pupil diameters.
  • the Power / Shape _Re quirement in the above equation may be effective power, and/or may be manifest power.
  • the power can change with changes in pupil diameter.
  • the target manifest can be targeted to the patient's request or a doctor's recommendation by using the effective distance power equation as described above in the "target manifest" section.
  • a good refractive shape may be at or near an optimum compromise between distance and near sight.
  • the near add has an "effective" power - it may not have a single power because of the multi-focal shape.
  • the sum of the peripheral and central add may give the distance power - again it may not have a single power because of the multi-focal shape.
  • the shape can be constant over, for example, a central 2.5mm and have a curvature gradient that will blend the central add to the peripheral region.
  • this shape it may be beneficial to choose the diameter of the central add to match the patients near pupil such that the near pupil will encompass only the central add when it's at its smallest, and the gradient will be customized to the patient's pupil size rate of change.
  • the range of pupil change may be shifted to optimize the "life" long presbyopic correction.
  • the present invention also provides systems for scaling refractive shapes and providing practical customized or optimized refractive shapes that mitigate or treat presbyopia and other vision conditions in particular patients.
  • the systems can be configured in accordance with any of the above described methods and principles.
  • a system 1000 can be used for reprofiling a surface of a cornea of an eye 1600 of a particular patient from a first shape to a second shape having correctively improved optical properties.
  • System 1000 can comprise an input 1100 that accepts a prescriptive shape specific for treating the vision condition, an input 1200 that accepts a pupil dimension of the particular patient, a module 1300 that scales a dimension of a central portion of a refractive shape based on the pupil dimension of the particular patient and an attribute of at least one eye previously treated with the prescriptive shape, a processor 1400 that generates an ablation profile, and a laser system 1500 that directs laser energy onto the cornea according to the ablation profile so as to reprofile a surface of the cornea from the first shape to the second shape, wherein the second shape corresponds to the refractive shape.
  • Methods, Systems, and Devices described herein can be used to generate prescriptions for treatment of refractive errors, particularly for treatment of presbyopia. Such treatments may involve mitigation of presbyopia alone, or may treat a combination of presbyopia with other refractive disorders.
  • presbyopia is a condition where the degree of accommodation decreases with the increase of age. Most people have some degree of presbyopia by the age of about 45.
  • Treatments of presbyopia may involve passive and/or active procedures.
  • passive procedures treatment or mitigation is performed in such a way that an improved balance between near vision and distance vision is provided and maintained.
  • an active procedure restoration of full or partial accommodation is a goal. So far, active procedures for the correction of presbyopia have not been fully successful.
  • effective power means the optical power that best matches the manifest sphere at a certain pupil size.
  • R stands for the pupil radius in mm when c 2 is the Zernike coefficient given in microns in order to get the effective power in diopters, and P e ff is effective power.
  • a power profile with pupil size can be given as a condition to obtain an optical surface for presbyopia correction.
  • Figs. 42 and 43 shows the presbyopia shape and the effective power as a function of pupil sizes.
  • Figs.44 and 45 show the presbyopia shape and the effective power as a function of pupil sizes. Note that both the presbyopia shape and the effective power are similar to those shown in Figs. 42 and 43. However, the shape and power given with 4- term solution is smoother and have a flatter power at larger pupil sizes.
  • the 4-power-term solution which tends to give a more favorable reverse Z-curve, should be used in the practical implementation.
  • the reverse Z- curve such as that shown in Fig. 46A, a positive power gradient region between two lower slope (or flat) regions within a pupil size variation range for a particular eye, may be a beneficial effective power characteristic for presbyopia mitigation.
  • choosing effective powers in-between dim distance pupil and bright reading pupil should be carefully considered. For instance, in order to satisfy restaurant menu reading, we might want to increase the power for dim reading.
  • Fig. 46A an unfavorable S-curve would exist, as is also shown in Fig. 46A.
  • Presbyopia-mitigation shapes corresponding to the S-curve and Z-curve shapes are shown in Fig. 46B.
  • Fig. 46B These results were generated for a 6mm pupil with the dim distance pupil at 6mm with a power of 0D, the bright distance pupil at 5mm with power of -0.2D and -0.7D, the dim reading pupil at 4.5mm with a power of -1.2D and the bright reading pupil at 3.5mm with a power of -1.5D.
  • Another parameter we can set is desired reading power.
  • the natural pupil size decreases with increasing age. Therefore, a shape well suited to a patient at the age of 45 could become deleterious at the age of 60.
  • too much asphericity can reduce the contrast sensitivity to a level that distance vision would deteriorate.
  • measurement of a patient' s residual accommodation becomes beneficial in the success of presbyopia correction.
  • the various pupil sizes at different lighting conditions and accommodation can be measured systematically and more accurately. Such measurements may employ, for example, a
  • pupilometer sold by PROCYON INSTRUMENTS LIMITED of London, United Kingdom, under the model number Procyon P-2000 SA.
  • a wide variety of alternative pupil measurement techniques might be used, including visual measurements, optionally using a microscope displaying a scale and/or reticule of known size superimposed on the eye, similar to those employed on laser eye surgery systems commercially available from AMO Manufacturing USA, LLC in Milpitas, California.
  • the influence of high order aberrations on the effective power may also be incorporated into the presbyopia-mitigating shape calculations. This may involve integration over the entire power map, i.e., the average power, with appropriate adjustment so as to avoid overestimating power (that may otherwise not agree with the minimum root-mean-square (RMS) criterion) and so as to correlate with patient data.
  • the influence of high order spherical aberrations on effective power calculation should not be entirely ignored.
  • the influence on the depth of focus, and hence to the blur range during manifest refraction test can be determined using clinical testing.
  • image quality of the presbyopia shape at different viewing conditions can be evaluated. To do so, optimization of the shape itself can be pursued. This can be done in several ways, such as using diffraction optics (wave optics) or geometrical optics (ray tracing). Because we are dealing with aberrations of many waves, it may be impractical to use point spread function based optical metrics. However, since the aberration we introduce belongs to high orders only, wave optics may still work well. In fact, a comparison of Zemax modeling with three wavelengths and using verification tools (wave optics), as shown in Fig. 16, with 7-wavelengths show almost identical results in both point spread function (PSF) and modulation transfer function (MTF). Fig.
  • PSF point spread function
  • MTF modulation transfer function
  • Fig. 47 shows some derived shapes for a 5mm and a 6mm pupil, while the corresponding MTF curves are shown in Fig. 48.
  • the simulated blurring of eye chart letter E for both cases is shown in Fig. 49.
  • These letters graphically illustrate verification of presbyopia shape using a goal function with 7-wavelengths polychromatic PSF and a 20/20 target.
  • the first image shows a target at 10m.
  • the second to the last image shows targets from lm to 40cm, separated by 0.1D in vergence.
  • One diopter of residual accommodation is assumed for each.
  • the optical surface shown gives almost 20/20 visual acuity over 1.5D vergence.
  • Figs. 50A and 50B illustrate exemplary desired power curves and treatment shapes for mitigating presbyopia of a particular patient.
  • the four power point solution was used to establish these shapes.
  • Table 5 describes the four conditions or set points from which the shape was generated: Table 5
  • Effective power Pupil size (mm)
  • Effective power Pupil size (mm)
  • Fig. 50A shows the effective power profiles
  • Fig. 50B shows the corresponding presbyopia shapes.
  • CMTF compound modulation transfer function
  • a CMTF value can be calculated in a variety of ways. For example, a CMTF value can be calculated based on a monochromatic point spread function (PSF). It is also possible to calculate a CMTF value based on a polychromatic point spread function (PSF).
  • PSF monochromatic point spread function
  • PSF polychromatic point spread function
  • a polychromatic PSF Techniques for obtaining a polychromatic PSF are discussed elsewhere herein, as well as in US 2010/0103376, which is incorporated herein by reference.
  • Fourier transform of the phase screen may be used for determining a point spread function, according to diffractive theory.
  • ray tracing may be used to determine a point spread function.
  • a point spread function can be used for diagnostic purposes, treatment purposes, analyzing optical acuity, and optimizing optical treatment shapes, such as shapes for treating presbyopia in a patient.
  • Given a particular polychromatic PSF it is possible to perform a Fourier transform of the PSF to obtain a modulation transfer function, which may involve determining the modulus.
  • CMTF Multiple modulation transfer functions obtained based on different spatial frequencies can be used to determine a CMTF.
  • Exemplary techniques for performing a Fourier transform of a PSF to obtain an MTF are described in J. W. Goodman, Introduction to Fourier Optics, 3rd ed (Roberts & Company, 2005), the content of which is incorporated herein by reference.
  • an MTF can be determined from a PSF in a manner which does not involve a Fourier transform of the PSF. For example, it is possible to calculate the integration of the overlap area of a pupil function (e.g. overlap area of two pupil apertures), to obtain an optical transfer function (OTF).
  • OTF optical transfer function
  • the MTF can be based on a modulus, or magnitude, of the OTF.
  • Exemplary integration techniques are describe in J. W. Goodman, Introduction to Fourier Optics, 3rd ed (Roberts & Company, 2005), previously incorporated. Where there are aberrations, it may be desirable to obtain the MTF based on the PSF Fourier transform approach, instead of the integration approach. According to these techniques, it is possible to obtain an MTF or CMTF based on a PSF or PPSF.
  • modulation transfer functions can be calculated based on point spread functions, it is desirable to obtain or provide point spread functions which are accurate and appropriate for the intended use. As described elsewhere herein, according to some embodiments polychromatic point spread functions are particularly well suited for use for applications involving the optics of the human eye.
  • Embodiments of the present invention encompass system and methods for evaluating an image quality provided by a vision treatment shape.
  • techniques may include obtaining a plurality of through-focus compound modulation transfer function (CMTF) values for the vision treatment shape, comparing these CMTF values to a CMTF threshold value, and evaluating the image quality based on the comparison.
  • CMTF through-focus compound modulation transfer function
  • CMTF threshold may represent a minimal CMTF value, below which the image quality may not be considered to be acceptable or desired.
  • the CMTF threshold can be used to evaluate whether a particular optical surface or shape may be effective for treating a particular vision condition.
  • a CMTF threshold can have a value of about 0.1. In some instances, a CMTF threshold can have a value of about 0.3.
  • FIG. 51 illustrates through- focus results for a 20/20 eye chart letter E convolved with certain point spread function models (e.g. monochromatic, polychromatic, and no aberration polychromatic) across a vergence range (e.g. -1.0 D to 3.0 D) for a 5.0 mm pupil size.
  • point spread function models e.g. monochromatic, polychromatic, and no aberration polychromatic
  • Such through- focus results can be obtained by moving a vision target throughout a range of vergence, for example, from a distant location (e.g. 0 D, which corresponds to infinity) to a near location (e.g. 3.0 D).
  • the polychromatic PSF provides improved image results over the monochromatic PSF at 0.5D (distant), and between 1.5D and 3.0 D (near).
  • FIG. 51 provides convolution images for the three different treatment shapes
  • FIG. 52 provides corresponding CMTF value curves for the three same shapes.
  • FIG. 52 shows the results of CMTF through-focus CMTF curves for one presbyopic correction shape using monochromatic and polychromatic PSF models, as compared with a diffraction-limited (no aberration) case.
  • the CMTF values here were calculated using spatial frequencies of 10, 15, 20, and 30 cpd (cycles per degree).
  • the peak CMTF is at or near the 0 Diopter vergence.
  • the presbyopia shapes were optimized with the noted set of cpd spatial frequencies.
  • CMTF curves of FIG. 52 can be directly compared with the convolved eye chart letters shown in
  • FIG. 51 in order to compare the various correction shapes at selected vergences. Based on the comparison, it is evident that CMTF values of 0.1 or more correspond with visually discernible letters. For example, at 0.5D as shown in FIG. 51, the monochromatic PSF convolved eye chart letter is not discernible, whereas the polychromatic PSF convolved eye chart letter is discernible.
  • exemplary embodiments may include calculating a through-focus curve, or through-vergence curve, with a particular optical metric, such as the compound modulation transfer function. Such techniques are well suited for use in identifying, generating, or evaluating treatment shapes.
  • CMTF curves such as these are useful to evaluating whether a particular treatment may be helpful for a particular vision condition.
  • a treatment shape may be evaluated with a through-focus CMTF curve to determine whether it might provide a suitable bifocal correction. If the through-focus CMTF curve indicates that the treatment shape provides CMTF values at or above a threshold (e.g. 0.1) for both distance vision (e.g. 0 D) and near vision (e.g. 3.0 D), it may be concluded that the treatment shape is a good candidate for the bifocal correction. In this case, the treatment shape may generate two peaks on the through-focus CMTF curve, one peak for distance vision and one peak for near vision.
  • a threshold e.g. 0.1
  • a treatment shape may provide a through-focus CMTF curve that meets or exceeds the threshold across an entire vergence range (e.g. 0 D to 3.0 D), in which case the treatment shape may be considered to provide a very desirable outcome.
  • the CMTF curve value is greater than about 0.3. Where the CMTF curve value is lower than about 0.1, however, the image quality is not as acceptable.
  • CMTF values can be obtained for each of the 30 incremental 0.1 D vergence locations, and the merit or goal function can be determined accordingly.
  • Table 6 shows the range of vergence below the CMTF threshold, for each of the shapes depicted in FIG. 52. As depicted here, the presbyopic correction shape using polychromatic PSF provides the least vergence range (about 0.8D) below threshold.
  • the CMTF for the presbyopic correction shape using monochromatic PSF is greater than the CMTF for the presbyopic correction shape using polychromatic PSF, at around the 0 D vergence value. It is also apparent that the CMTF for the presbyopic correction shape using monochromatic PSF and the presbyopic correction shape using polychromatic PSF diverge significantly at around 1.5 D vergence. For vergence values higher than 1.5 D, the presbyopic correction shape using polychromatic PSF provides markedly higher CMTF values than does the presbyopic correction shape using monochromatic PSF.
  • CMTF values below 0.1 D correspond to little or no image discemibility
  • CMTF values above 0.3 correspond to good image discemibility.
  • Beneficial optical correction surfaces provide good image discemibility (e.g. CMTF above threshold) across a large vergence, or across the through-focus range.
  • the PPSF provides the narrowest vergence range (0.8 D) below threshold.
  • the PPSF provides the broadest vergence range (1.8 D) above threshold.
  • PPSF can be considered to correspond to a more beneficial result, because it provides the least vergence range below 0.1 CMTF threshold (e.g. little image discemibility) and the greatest vergence range above 0.3 CMTF threshold (e.g. good image discemibility).
  • a CMTF through-vergence curve with values all above threshold is considered to provide a beneficial vision result.
  • the 0 D vergence value corresponds to distance vision (e.g. infinity), and the 1.5 D to 3.0 D vergence values (or in some cases, 2.0 D to 2.5 D) correspond generally to near vision.
  • 3 diopters corresponds to a viewing distance of about 33 cm, which is considered a true reading distance
  • 2 diopters corresponds to a viewing distance of 0.5 m
  • 1 diopter corresponds to a viewing distance of 1.0 m.
  • the polychromatic point spread function provides improved CMTF for near vision across a larger vergence range, while providing reduced CMTF for distance vision across a smaller vergence range.
  • a polychromatic point spread function can provide benefits over a monochromatic point spread function in terms of accuracy, particularly for near vision.
  • the polychromatic point spread function can also provide benefits over a monochromatic point spread function in terms of a wider depth of field, or greater through-focus range, for higher CMTF values. For at least these reasons, it has been discovered that CMTF values based on such polychromatic point spread function provide enhanced features over CMTF values based on a monochromatic point spread function.
  • through-focus CMTF values can be compared with a CMTF threshold value of 0.1 for purposes of evaluating image quality.
  • through-focus CMTF values can be compared with a CMTF threshold value of 0.3 for purposes of evaluating image quality.
  • a CMTF value of 0.1 may be considered a minimum threshold, below which it is difficult or impossible to discern the images, and above which may provide satisfactory results for most patients.
  • a CMTF value of 0.3 may be considered a sufficient threshold, above which provides very good results.
  • embodiments of the present invention encompass the use of other spatial frequency combinations to generate other CMTF curves.
  • Such through-focus CMTF curves can be compared with their corresponding convolved eye chart letters to determine at what level a CMTF value for a particular CMTF spatial frequency set can be considered a good threshold for 20/20 letter discernibility.
  • embodiments of the present invention encompass system and method for obtaining acceptable or threshold CMTF values for evaluating visual acuity based on an input set of spatial frequencies for an optical system.
  • the optical system is a human eye
  • a threshold CMTF value of 0.1 for discerning a 20/20 letter E is obtained based on input spatial frequencies of 10, 15, 20, 30 cpd. Correlations between the cpd frequency values and the threshold CMTF can be based on visual inspection of the convolved eye chart.
  • threshold CMTF values can be used for determining whether a particular shape design provides an acceptable vision treatment result for a patient.
  • Threshold CMTF values can be used for any general shape design, including shapes designed specifically for a presbyopia treatment.
  • a threshold CMTF value may be determined by a surgeon, optionally with feedback provided by a patient, or with computer models.
  • multifocal corrections may involve a compromise between distance and near vision. For example, some corrections may provide enhanced distance vision characteristics, while other corrections may provide enhanced near vision characteristics.
  • a treatment shape may provide a through- focus CMTF curve that meets or exceeds the threshold CMTF across an entire vergence range (e.g. 0 D to 3.0 D). Such treatment shapes may provide a true multifocal or omnifocal correction for a patient, where the patient has satisfactory vision throughout the vergence range, at all target distances. In such cases, the threshold may be considered to be the minimal acceptable range. In some cases, a treatment shape may provide a through-focus CMTF curve that meets or exceeds a threshold CMTF of 0.3 across an entire vergence range. In some cases, the threshold CMTF can have a value within a range from about 0.1 to about 0.3.
  • treatment shapes based on a polychromatic point spread function are better and more accurate than treatment shapes based on a monochromatic point spread function (MPSF).
  • MPSF monochromatic point spread function
  • the through-focus (or depth of field) for a treatment shape based on PPSF is wider than the through-focus for a treatment shape based on MPSF.
  • the vergence range above a 0.3 CMTF threshold is 0.6 D for MPSF and 1.8 D for PPSF (e.g. 1.8 D > 0.6 D).
  • Both monochromatic and polychromatic point spread functions can be used for simulating and evaluating the effects of optical systems.
  • a MPSF may not accurately reflect certain features associated with the human eye, such as the effect of chromatic aberrations, the Stiles-Crawford effect, and the retinal response function effect, for example.
  • a PPSF may be better suited for capturing such features.
  • FIGS. 53A and 53B illustrate a point spread function (PSF) with the use of
  • FIGS. 53A and 53B depict the cross sections of the PSF images of FIGS. 53A and 53B.
  • the normalized intensity for the PPSF has a peak value near the center, or zero arc minute field of view.
  • the normalized intensity for the MPSF is more diffused across the field of view, and presents a valley value near the center, or zero arc minute field of view.
  • the concentrated peak result associated with PPSF, as compared with the ring result associated with MPSF, is evidence that PPSF provides improved results over MPSF.
  • FIGS. 55A and 55B show the cross-sections for point spread functions with increasing defocus, using monochromatic and polychromatic models, respectively.
  • the range of defocus extends from a diffraction-limited situation (0 defocus) to a 0.200 D (maximum focusing error), with 0.025D increments disposed therebetween.
  • the PPSF of FIG. 55B provides smooth and regular transitions of the observed normalized intensity curve, when stepping from one level of defocus to an adjacent level of defocus.
  • the MPSF of FIG. 55A provides erratic transitions of the observed normalized intensity curve, when stepping from one level of defocus to an adjacent level of defocus.
  • the polychromatic point spread function of FIG. 55B is observed to become less and less crispy (e.g. shallower and broader peak of normalized intensity).
  • the monochromatic point spread function of FIG. 55A is observed to become wider and wider very quickly initially as additional focusing error is introduced, subsequently changing from a peak to a ring, and thereafter reverting back from a ring to a peak. This effect can also be seen in FIG. 56, where the curves are re-normalized.
  • FIG. 56 depicts cross sections of point spread functions calculated using a
  • polychromatic aberrations can be used to calculate point spread functions. What is more, polychromatic point spread functions can be used to convolve resolution targets.
  • polychromatic point spread functions can provide an improvement in accuracy as compared with the use of monochromatic point spread functions. This can be the case with the use of polychromatic aberrations, as compared with monochromatic aberrations, for the calculation of the point spread function. This can also be the case with the use of monochromatic point spread functions, as compared with polychromatic point spread functions, for convolving images.
  • FIG. 57 illustrates a method 5700 of evaluating an image quality provided by a vision treatment shape according to embodiments of the present invention.
  • method 5700 includes obtaining a plurality of through- focus compound modulation transfer function (CMTF) values for the vision treatment shape, as depicted by step 5710, comparing the plurality of through- focus CMTF values to a CMTF threshold value, as depicted by step 5720, and evaluating the image quality based on the comparison between the through focus CMTF values and the CMTF threshold value, as depicted by step 5730.
  • CMTF through- focus compound modulation transfer function
  • FIG. 58 illustrates a method 5800 of determining a compound modulation transfer function (CMTF) threshold value for a CMTF spatial frequency set.
  • method 5800 includes obtaining a plurality of through- focus CMTF values for a vision treatment shape, where the CMTF values are based on the CMTF spatial frequency set, as depicted by step 5810, obtaining a plurality of through- vergence convolved images based on the vision treatment shape and a point spread function, as depicted by step 5820, and determining the CMTF threshold value for the CMTF spatial frequency set based on the plurality of through- focus CMTF values and the plurality of convolved images, as depicted by step 5830.
  • Goal Functions Having Multiple Metrics or Parameters Goal Functions Having Multiple Metrics or Parameters
  • Treatment modalities for presbyopia and other vision conditions can be based on goal functions having multiple metrics or parameters.
  • composite optical metrics may include various combinations of metrics selected from a Strehl ratio, a modulation transfer function (MTF), an encircled energy, a compound modulation transfer function (CMTF), a point spread function (PSF), a volume under MTF surface (VMTF), a contrast sensitivity (CS), and the like.
  • MTF modulation transfer function
  • CMTF compound modulation transfer function
  • PSF point spread function
  • VMTF volume under MTF surface
  • CS contrast sensitivity
  • composite optical metrics may include linear combinations of individual optical metrics.
  • a composite optical metric may include individual weighting coefficients or functions associated with respective individual parameters of the composite optical metric.
  • a goal function or composite optical metric may be represented by the following formula,
  • k is a weighting coefficient or function for an z ' th optical metric M(J)
  • n represents the number of individual metrics or parameters
  • / is the vergence
  • m(l) is the composite metric.
  • the weighting function may be a weighting coefficient (a number, or a constant), or it may be a function, such as a two-dimensional function.
  • an individual metric of the composite metric may be two-dimensional.
  • a weighting function can be represented as ki (p, ⁇ ) in a polar coordinate system.
  • a weighting function can be represented as ki (x,y) in a Cartesian coordinate system.
  • a weighting function may be represented by a spatial function.
  • an optical metric is a single number (e.g. Strehl Ratio) then it may be desirable that the weighting function also be a number (e.g. as opposed to a two dimensional function).
  • an optical metric is in the frequency domain (e.g. CMTF) then it may be desirable that the weighting function also be in the frequency domain, or optionally as a constant.
  • an optical metric is in the spatial domain (e.g. PSF or encircled energy) then it may be desirable that the weighting function also be in the spatial domain, or optionally as a constant.
  • Both frequency domain and spatial domain metrics can be expressed in two dimensional representations, such as k; (p, ⁇ ) in a polar coordinate system or ]3 ⁇ 4 (x,y) in a Cartesian coordinate system.
  • An optical metric may be represented by a spatial function.
  • optical metrics such as a two dimensional point spread function may be represented in normal space (x,y), and optical metrics such as an optical transfer function or compound modulation transfer function may be represented in Fourier space or frequency domain (k x , k y ).
  • optical metrics represented in normal or real space may be represented in distance units, such as millimeters or microns.
  • optical metrics represented in the frequency space may be expressed in cycles per degree (e.g. an indication of oscillation behavior).
  • an optical metric may not be represented by a spatial function.
  • optical metrics such as a Strehl Ratio may be represented as a number or a constant.
  • optical metrics When summing or combining optical metrics, it may be helpful to have the optical metrics be represented in the same space or expressed in similar units. In some cases, it may be possible to convert an optical metric from one space or representation to another, so that it can conveniently be combined with other optical metrics. For example, a composite optical metric that combines Strehl Ratio and
  • Compound Modulation Transfer Function may be straightforward, because Strehl Ratio can be expressed as a single number.
  • a composite optical metric that combines Point Spread Function and Compound Modulation Transfer Function may involve a conversion of one of the individual parameters, so that both parameters are represented in the same space.
  • a composite optical metric may include parameters that are originally in the Fourier or frequency domain.
  • a weighting function may be normalized. In some cases, a weighting function may not be normalized. Goal functions or composite optical metrics, or individual components thereof, can be minimized or maximized as discussed elsewhere herein.
  • optimizer values may be used, where the optimizer value is minimized (e.g. determining a minimum value in two dimensional space) such that the optical metric is maximized.
  • an optimizer value can correspond to an optical metric, as the mean of the reciprocal of the optical metric.
  • a goal function or composite optical metric may include a CMTF parameter as one of the individual parameters of the composite.
  • a combination may include CMTF with Strehl ratio, or CMTF with encircled energy.
  • composite optical metrics disclosed herein can include any of the individual metrics described in Thibos, et al,
  • optical vergence can refer to certain vision testing conditions, for example calculated as the reciprocal of the testing or viewing distance in meters. Such testing conditions can also be referred to as a testing points. According to some embodiments of the present invention, optimization of an optical shape may involve factoring in such testing point preferences for individual customization.
  • FIG. 59 depicts aspects of an exemplary method 5900 for treating a vision condition of an eye in a particular patient.
  • the method includes receiving a vision requirements specification selected for the particular patient, as indicated by step 5910.
  • the vision requirements specification can include a first weighting value for a first viewing distance within a vergence range and a second weighting value for a second viewing distance within the vergence range.
  • the method also includes determining an optical surface shape for the particular patient, as indicated by step 5930. The optical surface shape can be based on the vision requirements specification and an optical metric 5920.
  • the method can include treating the vision condition of the eye of the particular patient by providing a treatment to the patient, as indicated by step 5940.
  • the treatment can include a shape that corresponds to the optical surface shape.
  • embodiments of the present invention encompass systems and methods for determining a procedure for treating a vision condition of an eye of a particular patient based on an optical surface shape.
  • a procedure can include ablating a corneal surface or subsurface of the eye of the particular patient to provide a corneal surface shape that corresponds to the optical surface shape.
  • a procedure can include providing the particular patient with a contact lens or a spectacle lens having a shape that corresponds to the optical surface shape.
  • a procedure can include providing the particular patient with an intra-ocular lens having a shape that corresponds to the optical surface shape.
  • FIG. 60 depicts aspects of an exemplary method for generating an optical surface shape for use in treating a vision condition of an eye in a particular patient.
  • the method includes receiving a vision requirements specification selected for the particular patient, as indicated by step 6010.
  • the vision requirements specification can includes a first weighting value for a first viewing distance within a vergence range and a second weighting value for a second viewing distance within the vergence range.
  • the method also includes generating the optical surface shape for the particular patient, as indicated by step 6030.
  • the optical surface shape can be based on the vision requirements specification and an optical metric 6020.
  • FIG. 61 depicts aspects of a vision requirements specification 6100, according to embodiments of the present invention.
  • the vision requirements specification can include a first weighting value VI for a first viewing distance Dl within a vergence range 6110 and a second weighting value V2 for a second viewing distance D2 within the vergence range.
  • the first viewing distance can correspond to a near vision viewing distance 6120 (or near vision viewing distance range), an intermediate vision viewing distance 6130 (or intermediate vision viewing distance range), or a distance vision viewing distance 6140 (or distance vision viewing distance range).
  • the second viewing distance can correspond to a near vision viewing distance 6120 (or near vision viewing distance range), an intermediate vision viewing distance 6130 (or intermediate vision viewing distance range), or a distance vision viewing distance 6140 (or distance vision viewing distance range).
  • the first weighting value VI can be different from the second weighting value V2, and the first viewing distance Dl can be different from the second viewing distance D2. In some cases, the first weighting value VI can be greater than the second weighting value V2. In some cases, the first viewing distance Dl is less than the second viewing distance D2. In some cases, the first viewing distance Dl is greater than the second viewing distance D2. [0388] In some cases, as depicted in FIG.
  • the first weighting value VI can be less than the second weighting value V2.
  • the vision requirements specification 6100 depicted here may be suitable for an individual who needs or desires excellent distance (or far) vision, and where good near vision is not as important.
  • FIG. 62 depicts a vision requirements specification 6200 that is suitable for an individual who needs or desires excellent near and intermediate vision, and where distance vision is not as important.
  • the weighting values corresponding to near and intermediate distances are greater in value, as compared to the weighting value corresponding to far distance.
  • the weighting values corresponding to intermediate and far distances are greater in value, as compared to the weighting value corresponding to near distance.
  • the weighting values corresponding to near and far distances are greater in value, as compared to the weighting value corresponding to intermediate distance. In some cases, weighting values corresponding to different distances (e.g. near and far) can be balanced to have the same value.
  • weighting values corresponding to different distances can be unbalanced so as to have the different values.
  • weighting values can be selected or customized according to a particular patient preference or treatment protocol.
  • the weighting can be 0.5 for near, 2.0 for intermediate (e.g. at 0.5 meters or a range including 0.5 meters), 0.5 for distance, or the like.
  • Such a weighting regime can be well suited for use for treating an individual who desires good vision for viewing a computer screen (e.g. higher weighting values for the viewing distance).
  • the weighting values for other occupations may vary.
  • the weighting can be 0.5 for near, 0.5 for intermediate, and 2.0 for distance.
  • the weighting can be 2.0 for near, 0.5 for intermediate, and 0.5 for distance.
  • the weighting values can be provided in a normalized format (e.g. the values have a mean of 1.0). In some cases, the weighting can correspond to a linear function of viewing distance (or vergence), or to a nonlinear function, depending on the need or desired treatment.
  • the weighting values for different viewing distances can be used in conjunction with an optical metric for evaluating or determining an optical surface shape (which may correspond to a target or a treatment shape), for example based on a merit function or optimizer value.
  • a merit function 6310 for a target or treatment shape can be determined based on an optical metric value for the shape at the various viewing or testing distances, for example 6320a, 6320b, and 6320c, as applied to the various weighting values for the various viewing or testing distances, for example [VI, Dl], [V2, D2], and [V3, D3].
  • a merit function can capture information about the optical surface shape, where the information varies as a function of 1 (e.g. CMTF values at different distances/vergence), and the optical metric information can be modified according to weighting values for various distances/vergences.
  • CMTF compound modulation transfer function
  • Exemplary optical metrics e.g. such as composite optical metrics
  • an optical metric can include a compound modulation transfer function (CMTF) parameter having a combination of modulation transfer functions (MTF's) at a plurality of distinct frequencies.
  • the optimizer value or merit function 6310 for an optical surface shape can be calculated based on various parameters associated with the optical metric.
  • the distance values are selected for every 0.1 Diopter or 0.1 meter and the vergence range is 3.0 Diopters, then there will be 30 data points or values to be considered (e.g. one optical metric value for each of the distance values). Based on those 30 values, it is possible to calculate the mean, standard deviation, and peak-to- valley for the optical metric.
  • the merit function value may be calculated as:
  • Q(l), ⁇ , and ⁇ are the mean, standard deviation, and peak-to-valley (maximum to minimum), respectively, of the optical metric for CMTF or other metrics like Strehl Ratio (SR), modulation transfer function (MTF), point spread function (PSF), encircled energy (EE), MTF volume or volume under MTF surface (MTFV), contrast sensitivity (CS), or various combinations thereof.
  • SR Strehl Ratio
  • MTF modulation transfer function
  • PSF point spread function
  • EE encircled energy
  • CS contrast sensitivity
  • a merit function can be constructed so that a function minimization algorithm can be applied to maximize the optical metric.
  • the merit function is inversely proportional to the optical metric.
  • An exemplary merit function or optimizer value is provided by Eq. 1.
  • different weighting values can be associated with the different distances/vergence. The different weighting values can be applied to the optical metric values when calculating the merit function.
  • Eq. 1 in some embodiments uses the mean Q(l) of the optical metric over the entire vergence range, it is possible to construct a merit function that replaces the mean Q(l) with the following expression:
  • the optical metric Ci can be any desired optical metric (e.g. CMTF), (m) can be the number of spatial frequencies (e.g. for calculating MTF), and (/) can refer to the vergence.
  • the summation ⁇ in the denominator indicates that the weighting coefficients or values S; are summed.
  • the sampling points can correspond to a linear distribution.
  • the sampling points can correspond to a bell curve distribution.
  • the sampling points can correspond to a quadratic distribution. Where the distribution is non- linear, it may be desirable to use a greater number of sampling points, according to some embodiments.
  • certain approaches for the treatment of presbyopia and other vision conditions can involve the use of a shape that is optimized based on the optimizer value as a function of an optical metric such as Strehl ratio, modulation transfer function (MTF), encircled energy, compound modulation transfer function (CMTF), and the like.
  • an optical metric such as Strehl ratio, modulation transfer function (MTF), encircled energy, compound modulation transfer function (CMTF), and the like.
  • Related vision treatment modalities may include the use of one or more combinations of multiple optical metrics for the calculation of an optimizer value, for example as described in U.S. Patent Publication No.
  • first and second weighting values can be members of a weighting value distribution (e.g. 6410a, 6410b) that is linear across a vergence range that includes first and second viewing distances (e.g. Dl, D2).
  • linear or nonlinear functions can be used for a weighting value distribution.
  • quadratic functions quartic functions, Gaussian distribution functions, and the like, may be used.
  • first and second weighting values can be members of a weighting value distribution (e.g. 6510a, 6510b, 6510c, 6510d) that is non-linear across a vergence range that includes first and second viewing distances (e.g. Dl, D2).
  • FIGS. 66A and 66B depict aspects of various weighting value distributions (e.g. 6610a, 6610b) according to embodiments of the present invention.
  • a weighting value distribution 6610a can be defined by a function having one or more peaks (e.g. 6620a, 6630a) within a vergence range.
  • the weighting value distribution 6610a can be defined by two sub-distributions or sub-functions 6612a, 6614a.
  • a weighting value distribution 6610b can be defined by a step function having one or more steps (e.g. 6620b, 6630b, 6640b) within a vergence range.
  • the weighting value distribution depicted in FIG. 67B is preferred over the weighting value distribution depicted in FIG. 67A, for example because of lower peak weighting value, and broader distribution across vergence range.
  • a more gentle change in the weighting function or weighting value distribution can provide less fluctuation of the values, thereby reducing the possibility of having too low or insufficient weighting for a given vergence. For example, if a 2.8 weight is assigned for intermediate and 0.1 weights are assigned for near and distance, respectively, then both near and distance vision may not be sufficient, and the patient may not effectively be able to read and see distance objects.
  • weighting values can be provided in a normalized format (e.g. the values have a mean of 1.0).
  • a scaling operation can be applied. Accordingly, the ratio or relationship between different weighting values for different distances may be more relevant that the magnitude of the individual weighting values themselves.
  • a weighting at intermediate can be 2 times (double) a weighting at near and far, or a weight at far can be 3 times (triple) a weight at near and 2 times (double) a weight at intermediate.
  • FIGS. 68-71 provide example distance, intermediate, and near vision experienced by an eye pre- and post-treatment according to some embodiments of the present invention.
  • FIGS. 68A, 68B, and 68C illustrate example distance, intermediate, and near vision experienced by an eye without any vision correction, respectively.
  • FIG. 68A illustrates an example distance view down a street
  • FIG. 68B illustrates an example intermediate view of a computer screen
  • FIG. 68C illustrates an example near view of news text.
  • each of distance, intermediate, and near vision experienced by the eye will be out of focus or otherwise blurry without any vision correction.
  • FIGS. 69A, 69B, and 69C illustrate example distance, intermediate, and near vision experienced by an eye corrected with an optimization or emphasis for near vision viewing distances with less emphasis on far and intermediate viewing distances, respectively.
  • the distance, intermediate, and near viewing distances are each corrected for, however the distance and intermediate viewing distances are corrected with less optimization or emphasis compared to the optimization or emphasis for near vision viewing distances.
  • the example near view of the news text is now in focus with the optimization for near vision correction.
  • the example intermediate view of the computer screen in FIG. 69B for the eye corrected with optimization for near vision is more in focus or less blurry than the intermediate view of the computer screen shown in FIG.
  • the example distance view of the street in FIG. 69A for the eye corrected with the optimization for near vision distance only is more in focus or less blurry than the example distance view of the street in FIG. 68A for the eye without correction, but is also out of focus and more out of focus than the example intermediate view of the computer screen in FIG. 69B for the eye corrected with optimization for near vision correction only.
  • FIGS. 70A, 70B, and 70C illustrate example distance, intermediate, and near vision conditions experienced by an eye corrected with an optimization or emphasis on both intermediate and near viewing distances and with less of an emphasis on far viewing distances, respectively.
  • the optimization for both intermediate and near viewing distance correction may correspond to the vision requirements specification graph shown in FIG. 62, where the weighting values corresponding to near and intermediate distances are greater in value, as compared to the weighting value corresponding to far distance.
  • the distance, intermediate, and near viewing distances are each corrected for, however the far viewing distances are corrected with less optimization or emphasis compared to the optimization or emphasis for both intermediate and near vision viewing distances.
  • the weighting values for intermediate and near vision viewing distances may be the same or may be different in some embodiments.
  • the example near view of the news text when the eye is corrected with optimization or emphasis for both intermediate and near viewing distances is less in focus compared to the example near view of the news text shown in FIG. 69C when the eye is corrected with optimization for near vision viewing distances only; however, the example near view of the news text when the eye is corrected with optimization for both intermediate and near viewing distances in FIG. 70C is still more in focus than the example near view of the text shown in FIG. 68C, when the eye is without any vision correction. While the example near view of the text is slightly less in focus when the eye is corrected with optimization for both intermediate and near viewing distances compared to when the eye is corrected with optimization for near vision viewing distances only, the example intermediate view of the computer screen shown in FIG.
  • the example distance view of the street for the eye corrected with emphasis for both intermediate and near vision is more out of focus that the example intermediate view of the computer screen in FIG. 70B for the eye corrected with optimization for both intermediate and near vision viewing distances only, but is in more focus or otherwise less blurry than the example distance view of the street in FIG. 68A for the eye without any correction.
  • the example distance view of the street for the eye corrected with optimization for both intermediate and near vision as shown in FIG. 70A may be, in some instances, of similar quality as the example distance view of the street for the eye with
  • FIGS. 71A, 71B, and 71C illustrate example distance, intermediate, and near vision conditions experienced by an eye corrected with optimization or emphasis for both distance and intermediate viewing distances and less emphasis on near viewing distances, respectively.
  • the optimization for both distance and intermediate viewing distance correction may be associated with a vision requirements specification where the weighting values corresponding to distance and intermediate are greater in value, as compared to the weighting value corresponding to near distance.
  • the example distance view of the street for the eye corrected with optimization for both distance and intermediate viewing distances is more in focus than the example distance view of the street for the eye corrected with optimization for near viewing distances only as shown in FIG.
  • the intermediate view of the computer screen for the eye corrected with optimization for both distance and intermediate viewing distances as shown in FIG. 71B may be comparable to the example intermediate view of the computer screen for the eye corrected with optimization for both intermediate and near vision shown in FIG. 70B.
  • the example near view of the news text for the eye corrected with optimization for both distance and intermediate viewing distances may be more blurry than the example near view of the news text experienced by the eye corrected with optimization for both intermediate and near distances shown in FIG. 70C and by the eye corrected with optimization for near distances only shown in FIG. 69C. While the example near view of the news text for the eye corrected with optimization for both distance and intermediate viewing distances may be more blurry than the example new views of the news text experienced by the eye corrected with optimization for near distances or corrected with optimization for both intermediate and near distances, the example near view of the news text for the eye corrected with optimization for both distance and intermediate viewing shown in FIG. 71C may nevertheless be less blurry or more in focus than the example near view of the news text experienced by the eye that has no correction as shown in FIG. 68C.
  • a weighting function may not be applied to distance/far, intermediate, and near vision specification. Instead, the correction may be based on a function that applies to a portion of or the entire range of the vision field or vergence range.
  • the weighting function may have values at various target distances.
  • the weighting function may have values associated with one or more of 100 m, 10 m, 5 m, 4 m, 3 m, 2 m, 1 m, 50 cm, 40 cm, 30, cm, 20 cm, etc.
  • the weighting function may have values at various vergences.
  • the weighting function may have values associated with one or more of 0D, 0.2D, 0.4D, 0.6D, 0.8D, ID, 1.5D, 2D, 2.5D, 3D, 3.5D, 4D, etc. Therefore, the application of the vergence weighting is more general than just 2 or 3 target distances. This idea may be applied to both eyes similarly or differently. [0412] It should understood that these example views are provided by way of illustration only and that eye corrections may be customized with preferred optimization or emphasis in many other manners per the embodiments disclosed herein. For example, an eye may be corrected with an emphasis for far viewing distances only or with an emphasis for intermediate distances only.
  • the weighting values corresponding to near and far distances may be greater in value, as compared to the weighting value corresponding to intermediate distance.
  • weighting values corresponding to different distances e.g. near and far
  • the same correction may be applied to both eyes of a patient or different corrections with different emphases may be applied to each eye to provide additional treatment customization.
  • one eye may be optimized for distance viewing while the other eye may be optimized for near viewing distances (e.g., monovision).
  • one eye may be optimized for distance, and the other eye may be optimized for both near and intermediate viewing distances (e.g., FIGS. 70A-70C).
  • one eye may be corrected with an emphasis for near viewing distances (e.g., FIGS. 69A-69C), and the other eye may be corrected with an emphasis for both distance and intermediate viewing distances (e.g., FIGS. 71A-71C).
  • one eye may be optimized for a particular vergence weighting function and the other eye may be corrected for another particular vergence weighting function.
  • one eye may be corrected with an emphasis for both distance and intermediate viewing distances (e.g., FIGS. 71A-71C) and the other eye may be corrected with an emphasis for both intermediate and near viewing distances (e.g., FIGS. 70A-70C).
  • a correction applied to one eye may be customized based on eye dominance.
  • the patient eye may be corrected with a weighting function having values associated with a number of target distances or vergences.
  • the vergence weighting may be more general than just 2 or 3 target distances or vergence ranges.
  • a method for treating a vision condition of a particular patient may be provided in some embodiments.
  • the method may include receiving a vision requirement specification selected for the particular patient.
  • the vision requirement specification may include a first weighting function for a first viewing distance within a first vergence range for the first eye and a second weighting function for a second viewing distance within a second vergence range for a second eye.
  • the method may further include determining an optical surface shape for each eye of the particular patient.
  • the optical surface shape may be based on the vision requirements specification of the particular eye and an optical metric.
  • the method may include treating the vision condition of the eyes of the particular patient by providing a treatment to each eye of the patient.
  • the treatment may include a shape that corresponds to the optical surface shape.
  • the first weighting function includes a first weighting value associated with a far distance and a second weighting value associated with a near distance.
  • the first weighting value of the first weighting function may be greater than the second weighting value of the first weighting function.
  • the second weighting function may include a first weighting value associated with the far distance and a second weighting value associated with the near distance. The second weighting value may optionally be greater than the first weighting value.
  • the first weighting function may include a first weighting value associated with a far distance, a second weighting value associated with an intermediate distance, and a third weighting value associated with a near distance.
  • the first weighting value of the first weighting function may be greater than the second and third weighting value of the first weighting function.
  • the second weighting function may include a first weighting value associated with the far distance, a second weighting value associated with the intermediate distance, and a third weighting value associated with the near distance.
  • the first weighting value of the second weighting function may be less than the second and third weighting values of the second weighting function in some embodiments.
  • the second and third weighting values of the second weighting function may be the same.
  • the first weighting function may include a first weighting value associated with a far distance, a second weighting value associated with an intermediate distance, and a third weighting value associated with a near distance.
  • the third weighting value of the first weighting function may be greater than the second and third weighting value of the first weighting function.
  • the second weighting function includes a first weighting value associated with the far distance, a second weighting value associated with the intermediate distance, and a third weighting value associated with the near distance.
  • the third weighting value of the second weighting function may be less than the first and second weighting values of the second weighting function.
  • the first and second weighting values of the second weighting function may be the same.
  • the first vergence weighting function and the second vergence weighting function may be different.
  • embodiments of the present invention encompass systems and methods that involve determining an optical surface shape for a particular patient (e.g. where the optical surface shape is based on a vision requirements specification and an optical metric), and treating a vision condition of an eye of the particular patient by providing a treatment to the patient, where the treatment is based a shape that corresponds to the optical surface shape.
  • exemplary systems and methods can involve generating a treatment shape for treating the eye of the patient, where the treatment shape is based on the optical surface shape.
  • the treatment shape can be an intraocular lens treatment shape.
  • the treatment shape can be a contact lens shape.
  • the treatment shape can be a spectacle lens shape.
  • the treatment shape can correspond to a laser ablation or
  • Each of the above calculations may be performed using a computer or other processor having hardware, software, and/or firmware.
  • the various method steps may be performed by modules, and the modules may comprise any of a wide variety of digital and/or analog data processing hardware and/or software arranged to perform the method steps described herein.
  • the modules optionally comprising data processing hardware adapted to perform one or more of these steps by having appropriate machine programming code associated therewith, the modules for two or more steps (or portions of two or more steps) being integrated into a single processor board or separated into different processor boards in any of a wide variety of integrated and/or distributed processing architectures.
  • These methods and systems will often employ a tangible media embodying machine-readable code with instructions for performing the method steps described above.
  • Suitable tangible media may comprise a memory (including a volatile memory and/or a non- volatile memory), a storage media (such as a magnetic recording on a floppy disk, a hard disk, a tape, or the like; on an optical memory such as a CD, a CD-R/W, a CD-ROM, a DVD, or the like; or any other digital or analog storage media), or the like.
  • a memory including a volatile memory and/or a non- volatile memory
  • a storage media such as a magnetic recording on a floppy disk, a hard disk, a tape, or the like; on an optical memory such as a CD, a CD-R/W, a CD-ROM, a DVD, or the like; or any other digital or analog storage media, or the like.
  • This exemplary embodiment comprises code which performs the Zernike coefficient calculation, shape combination (combining a regular aberration treatment prescription as well as the presbyopia shape), and provides graphical output for reporting purpose. It was written in C++ with Borland C++ BuilderTM 6, and it is run with a laptop of 1.13GHz CPU having 512Mb of memory.
  • output data can be generated by the systems and methods of the present invention. Such outputs may be used for a variety of research, comparison, prediction, diagnostic, and verification operations. The outputs may be evaluated directly, or they may be used as input into the system for further analysis. In some embodiments, the outputs will be used to model the effect of an ocular treatment prior to application. In other embodiments, the outputs will be used to evaluate the effect of an ocular treatment after application. The outputs may also be used to design ocular treatments. Relatedly, it is possible to create treatment tables based on outputs of the instant invention.

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Abstract

L'invention porte sur des procédés, des dispositifs et des systèmes permettant d'établir une forme de surface optique destinée à atténuer ou à traiter un trouble de la vision chez un patient. Une forme de surface optique pour un patient spécifique peut être déterminée à l'aide d'un ensemble de paramètres de patient pour ce patient spécifique en faisant appel à une mesure optique telle qu'une fonction de transfert de modulation complexe (CMTF).
PCT/US2015/067363 2015-01-09 2015-12-22 Systèmes de pondération de vergence et méthodes de traitement de la presbytie et d'autres troubles de la vision WO2016111851A1 (fr)

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CA2973345A CA2973345A1 (fr) 2015-01-09 2015-12-22 Systemes de ponderation de vergence et methodes de traitement de la presbytie et d'autres troubles de la vision

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EP3821851A4 (fr) * 2018-07-13 2022-01-26 Eyebright Medical Technology (Beijing) Co., Ltd. Lentille intraoculaire et son procédé de fabrication
US11766324B2 (en) 2018-07-13 2023-09-26 Eyebright Medical Technology (Beijing) Co., Ltd. Intraocular lens and manufacturing method therefor
US11583389B2 (en) 2019-04-05 2023-02-21 Amo Groningen B.V. Systems and methods for correcting photic phenomenon from an intraocular lens and using refractive index writing
US11529230B2 (en) 2019-04-05 2022-12-20 Amo Groningen B.V. Systems and methods for correcting power of an intraocular lens using refractive index writing
US11564839B2 (en) * 2019-04-05 2023-01-31 Amo Groningen B.V. Systems and methods for vergence matching of an intraocular lens with refractive index writing
US11583388B2 (en) 2019-04-05 2023-02-21 Amo Groningen B.V. Systems and methods for spectacle independence using refractive index writing with an intraocular lens
US11678975B2 (en) 2019-04-05 2023-06-20 Amo Groningen B.V. Systems and methods for treating ocular disease with an intraocular lens and refractive index writing
US11931296B2 (en) 2019-04-05 2024-03-19 Amo Groningen B.V. Systems and methods for vergence matching of an intraocular lens with refractive index writing
US11944574B2 (en) 2019-04-05 2024-04-02 Amo Groningen B.V. Systems and methods for multiple layer intraocular lens and using refractive index writing
WO2021240465A3 (fr) * 2020-05-28 2022-01-20 Sifi S.P.A. Lentille à usage ophtalmique pour faire varier la profondeur de champ
CN115867850A (zh) * 2020-05-28 2023-03-28 司斐股份有限公司 眼科晶状体
IT202000012721A1 (it) * 2020-05-28 2021-11-28 Sifi Spa Lente ad uso oftalmico
CN113080842A (zh) * 2021-03-15 2021-07-09 青岛小鸟看看科技有限公司 一种头戴式视力检测设备、视力检测方法及电子设备
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