WO2021164865A1

WO2021164865A1 - Vision testing

Info

Publication number: WO2021164865A1
Application number: PCT/EP2020/054377
Authority: WO
Inventors: Ola BARTHOLDSSON
Original assignee: Ieye Ab
Priority date: 2020-02-19
Filing date: 2020-02-19
Publication date: 2021-08-26

Abstract

A method (600) of controlling a subjective refraction system (100), comprising receiving (602) one or more control commands for a subjective refraction system, the control commands being input by a user at a user interface (304) and having a first format, receiving (604) information identifying a subjective refraction system to be controlled, converting (606) the one or more control commands from the first format to a second format, the second format associated with the subjective refraction system to be controlled, transmitting (608) the one or more control commands in the second format to the subjective refraction system to be controlled.

Description

VISION TESTING

Field

The present disclosure generally relates to vision testing. In particular, the disclosure relates to a system and method for controlling subjective refraction testing.

Background

The standard industry method for determining an individual's refractive error is a subjective refraction performed by an eye care professional ("ECP"), such as optometrists, ophthalmologists and eye doctors. A subjective refraction is a sequence of vision tests, each determining a different vision error and/or status of the eye. To operate existing subjective refraction methods, several years of optometry education and training are required. Generally, only ECPs have the knowledge, skills and education to conduct subjective refractions, diagnose vision errors and treat them accurately. In most EU countries and in the US, ECPs are the only profession legally allowed to diagnose and prescribe vision treatments. ECPs can legally delegate the subjective refraction process to people with no optometry education. In some third- world countries, subjective refractions are often performed by people with little to no optometry education (hereinafter named "technicians"). Hereinafter, ECPs and technicians are collectively named "operators".

A subjective refraction is generally provided by an operator to a patient in an eye clinic, an optical retail store or pharmacy selling prescription glasses, or other location with subjective refraction equipment. A subjective refraction is normally conducted in-person by an operator being in the same room as the patient. A subjective refraction is normally performed using a manually operated or computerised phoropter (the computerised version is hereinafter called “auto-phoropter”), containing trial lenses in different powers, combined with a paper or a computerised chart display to determine the ideal correction of various refractive errors.

The subjective refraction uses many vision tests to test various potential vision errors and vision related statuses of the eye(s) and each test uses an iterative process where the operator asks questions to the patient, receives responses, and asks further questions based on the responses. The operator sends instructions, using a controller, control-box or console (hereinafter called “controller”), to the auto-phoropter to adjust lenses in measurement windows and/or to change eye charts on an eye chart display. Typically, the patient will sit behind an auto-phoropter and look at an eye chart through windows with lenses. The operator uses a computerised controller to change lenses and other settings in the auto-phoropter and eye chart display while asking the patient for feedback on which set of lenses give the best vision. The operator repeats the iterative process until the operator determines that a particular combination of the responses received from the patient satisfy one or more conditions indicating that sufficient data has been collected and the test has arrived at an end-point. After such an end-point, the operator makes a decision on which vision test should be selected next. When a number of vision tests has been conducted, the operator may decide that an end-point for the entire subjective refraction has been reached. Thereafter the operator may make a diagnosis and prescribe a treatment for correcting the patient's vision errors.

A remote subjective refraction is when the subjective refraction is a subjective refraction conducted by an operator that is at a different location to the location where the patient and the refraction system are located. In some cases, a technician conducts a remote subjective refraction and the resulting data is sent to an ECP located at a third location for diagnoses and prescription. Remote subjective refractions normally utilise video/voice conferences to communicate with both the patient and/or in-store clinical staff; normally combined with a hardware or software based controller to remotely operate the refraction system.

An advantage with this approach is that one ECP can supply subjective refractions to many different locations, specifically to locations in rural areas that may not have any or few ECPs available. Another advantage is that an ECP can delegate the subjective refraction to people not being ECPs, people with limited training ("technicians") how to conduct subjective refractions and being supervised by ECPs. Legally, ECPs are normally allowed to delegate if the ECP is physically present at same location supervising people conducting the subjective refraction, and when ECPs issue the final prescription. The possibility to delegate has a huge efficiency potential when conducting remote refractions. In a remote office configuration, there may be 10 to 20 technicians on each ECP resulting in a 10 to 20 times supply increase in subjective refractions. Another advantage is that patient’s language preferences can be matched to technician’s languages. Current remote solutions are either asynchronous or synchronous. An asynchronous remote subjective refraction is normally done by a technician in the room of the patient and then the results are transmitted from the location to another location occupied by a licensed ECP legally allowed for diagnosis and prescription. A synchronous remote subjective refraction is performed in real-time using teleoptometry. This normally involves live remote operation of refraction system and video conferencing which permits live oral and visual discussion between the patient and the operator while located at different sites.

However, many remote subjective refractions still require the assistance of a person at the location of the subjective refraction. For example, nearly all modern eye examination room systems have an eye chart display being a computerised LED- monitor display placed at a fixed 500 to 600 cm distance from the patients eyes for distance vision tests. The near vision eye chart is a normally a plastic sheet placed manually, when needed, at 40 to 60 cm distance for near vision tests. When switched from distance to near vision tests, a person being in the examination room, must be instructed by the remote operator to manually switch from the distance to the near vision eye chart as the remote examiner shall start a near vision test following this switch. Then when the near vision test is finalised, the remote operator must instruct the local person to switch the eye chart back to the distance eye chart again. While this procedure seems to be simple, it cannot be done by the patient himself as it’s important that the eye chart is accurately positioned in from the eyes of the patient. A problem is that many optical testing locations only have one single person present in the store at certain times of the week. This person can then not leave the location, for example due to theft and service reasons, to be present in an examination room conducting a remote refraction on a patient.

To be able to conduct live synchronous remote subjective refractions, the location must have a controller, computer-controllable auto-phoropter, computer-controllable eye chart display, and a microphone, speaker and/or video-screen connected to a computer and the Internet. There must be an eye chart display for both near distance, normally at 40 cm, and at far distance that shall be at 500 to 600 cm. As the same equipment is normally used for both remote and in-store subjective refractions, the location normally uses existing equipment and invests only in a video-monitor. The controller needed is either a software application that can be installed on a computer or a hardware device that controls the auto-phoropter and computer eye chart display. Most hardware device controllers cannot be used for remote operation using the Internet as the controller must be directly connected using a cable, such as an R232 cable, to the refraction system. Others can be operated remotely as the controller can be installed on a remote computer with Internet access. Further, the ECP communicates with the patient using a voice-response system and in some cases also video conferencing system. There must then be a microphone and/or video-monitor installed at the location and a connection for voice and/or video must be set-up.

As discussed above, many currently installed refraction systems comprise proprietary refraction systems designed for in-house subjective refractions. Remote subjective refractions did not exist when most of the currently used equipment was installed, maybe 5 to 15 years ago. For example, leading suppliers such as Topcon, Nidek, Visionix, Zeiss, Rodentsock and Huvitz all have proprietary systems and controllers that are specifically configured to control exactly one associated controlled refraction system containing an auto-phoropter and computer eye chart display. The dedicated controller uses proprietary communication schemes to transmit signals via a wireless or wired link (e.g. , infrared, RF, R232, USB, LAN, Wi-Fi, Bluetooth) directly to the controlled refraction system. For instance, a controller can be designed with dedicated buttons to control one associated device by sending proprietary sphere dioptre, cylinder dioptre or cylinder axis up/down signals, eye chart display control signals, and so forth, in response to user activation of the buttons. These systems have operating systems that cannot be modified, the software applications and protocols operating the auto- phoropter functions and eye charts are proprietary closed-source software programs, file types are saved in proprietary formats and commands are proprietary and unique for each refraction system. The program source codes are not published and is normally available to be edited only by the company that developed it. Furthermore, manufacturers typically prohibit the user to install any other software applications on their refraction system computers. The APIs (application programming interfaces) are proprietary and specific and unique to each brand and version of each refraction system. These APIs are not published and generally not available to external companies. Therefore, many eye examination controllers cannot be used to control other manufacturers’ system devices.

This is a problem when the refraction system shall be managed remotely. Hardware controllers often cannot be used to communicate over the Internet. When software based controllers are used, a remote operator must switch controller application each time a different location shall be served having a different refraction system brand and/or version. Each new system requires extensive configurations before the controller can be used for controlling the system. As an example, if a software based remote controller application is installed on an operator’s computer device and the operator wants to switch between remote controlled refraction equipment systems, the operator must perform complicated configurations and also receive information about the system brand and version and connection at the location where the remote controlled refraction equipment is located for each switch. As operators generally have no advanced computer-network skills, it's practically impossible to switch often between remote controlled refraction equipment systems to control. This is then a barrier for ECPs and technicians to supply their services.

One solution to this is using a remote desktop sharing application to control the computer at the location that has the controller software application installed. However, there is a security problem with remote desktop as unknown people can access computers inside a company, whose computer-systems may be part of a large chain, and may access files and systems, such as confidential patient journals among others. The ECP may also use computers that are unsafe and infected by virus, and remote desktop applications can transfer infected files from the ECP’s computer to the location computer that can create damages. Due to these security issues, the remote desktop sharing solution is normally only used when employed ECPs shall access other company computers from a company computer.

Another related problem is that existing controllers or associated systems are not able to select and connect to one specific remote controlled refraction equipment system of a plurality of remote controlled refraction systems. When a proprietary software controller is installed on a remote device, it is only that specific device that can be used and the device is normally configured to connect to only one specific refraction system. These controllers have no functions how to select different locations to connect to.

The methods and systems disclosed herein attempt to mitigate at least some of these issues.

Summary

As discussed above, there is a need for a controller that can control different proprietary refraction systems. Such a controller should allow an operator to offer services to many different optical stores and eye clinics having different proprietary equipment systems without needing to install, configure and learn each optical store's and eye clinic's proprietary controller. The refraction systems should be configured with a computerised distance/near vision eye chart switching unit that can be controlled by a controller operated by the examiner.

To achieve this, methods and systems are disclosed which provide a controller that can remotely, over the Internet, control a plurality of different manufacturers’ proprietary refraction systems. This is done by transforming received information to the controlled subjective refraction system’s control commands format. The converted commands may be transmitted to the controlled subjective refraction system using the Internet. The controlled subjective refraction can then execute the received control commands.

In accordance with an aspect of the disclosure, there is provided a method of controlling a subjective refraction system, comprising receiving one or more control commands for a subjective refraction system, the control commands being input by a user at a user interface and having a first format, receiving information identifying a subjective refraction system to be controlled, converting the one or more control commands from the first format to a second format, the second format associated with the subjective refraction system to be controlled, and transmitting the one or more control commands in the second format to the subjective refraction system to be controlled.

Optionally, converting the control commands from the first format to the second format comprises converting the control commands having the first format to a third format, the third format not being associated with a subjective refraction system, and converting the control commands from third format to the second format. Optionally, the user interface is at a geographically different location from the subjective refraction system. Optionally, the subjective refraction system is configured to execute one or more functions based on the one or more control commands.

Optionally, the subjective refraction system comprises at least one of an auto- phoropter, an auto-refractor, an eye chart display, a mirror box and a wavefront aberrometer. Optionally, the eye chart display comprises a distance vision eye chart display and a near vision eye chart display.

Optionally, the method is implemented by a controller. Optionally, the controller is at a geographically different location from the subjective refraction system. Optionally, the controller is at a geographically different location from the user interface. Optionally, the one or more control commands comprises at least one of controlling an auto-phoropter sphere power lens, controlling an auto-phoropter cylinder power lens, controlling an auto-phoropter cylinder axis, controlling an auto-phoropter addition power lens, controlling an auto-phoropter cross cylinder lens, controlling an auto-phoropter polarisation lens, controlling an auto-phoropter prism lens, controlling an auto- phoropter pupillary distance, controlling an auto-phoropter vision modes, controlling the switch for near and far distance eye charts, controlling a Snellen visual acuity eye chart, controlling a cross grid eye chart, controlling a dots eye chart, and controlling a phoria eye chart.

In accordance with another aspect of the disclosure, there is provided a system for performing subjective refraction testing, the system comprising a user interface, a controller, and a subjective refraction system, wherein the controller is configured to receive one or more control commands for the subjective refraction system, the control commands being input by a user at the user interface and having a first format, receive information identifying the subjective refraction system, convert the one or more control commands from the first format to a second format, the second format associated with the subjective refraction system, and transmit the one or more control commands in the second format to the subjective refraction system, wherein the subjective refraction system is configured to perform one or more functions of a subjective refraction test based on the control commands in the second format.

Optionally, the controller is configured to convert the control commands from the first format to the second format by converting the control commands having the first format to a third format, the third format not being associated with a subjective refraction system, and converting the control commands from third format to the second format,

Optionally, the user interface is at a geographically different location from the subjective refraction system. Optionally, the controller is at a geographically different location from the subjective refraction system. Optionally, the controller is at a geographically different location from the user interface. Optionally, the one or more control commands comprises at least one of controlling an auto-phoropter sphere power lens, controlling an auto-phoropter cylinder power lens, controlling an auto-phoropter cylinder axis, controlling an auto-phoropter addition power lens, controlling an auto-phoropter cross cylinder lens, controlling an auto-phoropter polarisation lens, controlling an auto-phoropter prism lens, controlling an auto- phoropter pupillary distance, controlling an auto-phoropter vision modes, controlling a switch for near and far distance eye charts, controlling a Snellen visual acuity eye chart, controlling a cross grid eye chart, controlling a dots eye chart, and controlling a phoria eye chart.

By taking this approach, many advantages are realised. For example, an operator may use a common user interface to control many different manufacturers’ SRS models and versions. This enables the control of a number of different SRSs, even if the input format of the commands is incompatible with the user interface inputting options, functions, algorithms, and predefined sequences of the particular SRS to be controlled. Therefore, an operator can easily perform subjective refractions using any manufacturers of SRS through a familiar interface. This provides a solution to current limitations for ECPs and technicians to supply remote subjective refractions to many different optical locations equipped with different refraction systems where each such system has an operating system that cannot be modified, the software applications and protocols operating the auto-phoropter functions and eye charts are proprietary closed-source software programs, file types are saved in proprietary formats and commands are proprietary and unique for each refraction system.

Brief Description of the Drawings

Exemplary embodiments of the disclosure shall now be described with reference to the drawings in which:

FIG. 1 schematically illustrates a subjective refraction system according to an embodiment of the disclosure;

FIG. 2 shows an example configuration of a subjective refraction system;

FIG. 3 schematically illustrates a controller according to an embodiment of the disclosure;

FIG. 4 schematically illustrates an SRS-neutral generator module according to an embodiment of the disclosure; FIG. 5 schematically illustrates an SRS-specific generator module according to an example embodiment of the disclosure;

FIG. 6 is a flow diagram showing a method of controlling an SRS; and

FIG. 7 is a block diagram illustrating an exemplary computer system.

Throughout the description and the drawings, like reference numerals refer to like parts.

Specific Description

Operations of various methods may be described as multiple discrete actions or operations in turn, in a manner that is most helpful in understanding the claimed subject matter. However, the order of description should not be construed as to imply that these operations are necessarily order dependent. In particular, these operations may not be performed in the order of presentation. Operations described may be performed in a different order than the described embodiments. Various additional operations may be performed and/or described operations may be omitted, split, or combined in additional embodiments.

The term “operator” is to be interpreted herein as a person performing a subjective refraction on a patient. An operator may be an eye care professional ("ECP"), such as an optometrist, ophthalmologist or eye doctor. The operator may also be any person that is not an ECP, for example, an optician or orthoptists, or another person trained to conduct subjective refractions such as a technician or a nurse. The patient is the individual person receiving a subjective and/or objective refraction conducted by the operator. More than one operator may be involved when performing a subjective refraction on a patient. For example, one operator may perform the subjective refraction while another operator may be supervising the subjective refraction in real-time or after the subjective refraction is completed. It is to be understood that the phrase "operator" may be the same as "operators", whereas one operator may perform a different task to another operator, while both are herein named "operators".

Where the description uses the terms "location" or "locations", it is to be understood that this refers to a physical location where one or a plurality of subjective refraction systems are installed. Typical locations are eye clinics, eye doctors, optical stores, offices, factories, department stores, supermarkets, pharmacies, self-service kiosks, freestanding kiosks, stands or units in shopping malls, airports, pharmacies, supermarkets, department store and the like. A location may also include private residences where a patient may conduct subjective refractions using a computing devices or other type of device configured for conducting such as subjective refraction. A location may have separate rooms with subjective refraction system or systems installed in each room, or a location may have one or more subjective refraction systems installed as freestanding units in the reception area, or at other places at the location.

Where the description uses the terms "remote" or "remote location", it is to be understood that this means that the operator is geographically at a different physical location to the location where both the patient and the subjective refraction system are physically located. Also included in the definition of a remote location is the case where an operator conducts a remote subjective refraction and the resulting data from the refraction is sent to an ECP located at a third physical location for diagnosis and prescription. Also included in the definition is the case where an ECP is at the same location as both the patient and the subjective refraction system, but an operator is at a different physical location. A different location address may be a different postal address that is not in the same building as the physical location of the subjective refraction system used by the patient. This includes all locations from another building on the same street to locations in other countries. The remote physical location of the operator may be an office, home, cafe or any physical type of location whereas the operator can access the Internet or a suitable data communication network using a device such as a desktop computer, laptop computer, tablet, mobile phone, etc.

Where the description uses the terms "computerised subjective refraction" or "automated computerised subjective refraction", it is to be understood that this means that computerised program code performs a subjective refraction without the assistance of a human person. As an alternative, the human person is only required to supervise, but not operate, one or a plurality of automated computerised subjective refractions. For example, the human person may be limited to diagnosing and prescribing vision correction treatments, such as corrective glasses, lenses or surgery, following the automated computerised subjective refraction.

Where the description uses the terms "refraction" or "refractometry", it is to be understood that this refers to a clinical examination used by the operator to determine a patient's need for refractive correction. The aim of a refraction is to improve current unaided vision or vision with current corrective measures. In some embodiments, a phoropter may be used by the operator to determine a patient's refractive error and the best vision correction treatment to be prescribed. A refraction may be classified as being a subjective or an objective refraction, but in some embodiments may be integrated in one combined subjective/objective refraction process.

The term "subjective refraction" is to be understood as a subjective refraction that, in certain embodiments, also includes an objective refraction. A subjective refraction is an attempt to determine, by trial and error using the patient's cooperation, the best vision correction treatment, for example the combination of lenses that will provide the best corrected visual acuity. The patient's cooperation may be by verbal response to questions, or by other response inputting methods, for example using a joystick, touch screen, mouse, keyboard or other suitable input device.

The term “objective refraction” is used when the refractive error of a patient's eyes is determined without input by the patient. An objective refraction may use an auto refraction or retinoscope device. In some equipment embodiments, one or more objective refraction devices are incorporated in the same unit as a subjective refraction device. An objective refraction is normally considered as a preliminary test, where the objective measurements are used as reference values during a subjective refraction.

Where the description uses the terms "subjective refraction system (SRS)" or "controlled subjective refraction system", it is to be understood as a system configured to determine the refractive error of a patient, and optionally to prescribe corrective treatment. It shall be understood that any currently available and future available combination of equipment and refraction software applications that can be used to determine the refractive error of a patient's eyes shall be included in the terms "subjective refraction system", and "controlled subjective refraction system".

FIG. 1 schematically illustrates an SRS 100 for performing a subjective refraction, according to an example embodiment of the disclosure. The SRS 100 comprises one or more of an auto-phoropter 102, an auto-refractor 104, an eye chart display 106, and a mirror box 108. These are measurement instruments known in the art. Other known measurement instruments, such as one or more wavefront aberrometers, may also be implemented in the SRS 100. A wavefront aberrometer may be used as an alternative to an auto-refractor 104.

The auto-phoropter 102 may be a computerised auto-phoropter comprising different lenses used for refraction testing of the patient’s eyes. The major components of the phoropter are the battery of spherical and cylindrical lenses, auxiliary lenses such as Maddox rods, filtered lenses, prisms, and the JCC (Jackson Cross-Cylinder). Typically, the patient sits behind the phoropter, and looks through it at an eye chart placed at optical infinity (e.g. 6 metres), then at near (e.g. 40 centimetres) for patients needing near distance glasses. The operator then changes lenses and other settings normally using a controller, while asking the patient for subjective feedback on which settings gave the best vision. An auto-phoropter, or automated phoropter or digital phoropter or computerised phoropter is normally a standard phoropter that has additional computer processing features and automated systems that allows the operator to control the phoropter using a separate controller, control box or control pad and screen ("controller").

The auto-refractor 104 is a computer-controlled machine that may be used during an eye examination to provide an objective measurement of a patient's refractive error. This is achieved by measuring how light is changed as it enters a patient's eyes. Generally, an auto-refractor 104 is used as a separate preliminary measurement of the refractive error prior to the usage of an auto-phoropter 102, but in some configurations, an auto-refractor may be integrated with an auto-phoropter 102 in one unit.

The eye chart display 106 is an ophthalmic eye chart display used to measure distance and near visual acuity among other vision tests. The eye chart is placed at a standardised distance away from the patient whose vision is being tested. The patient then attempts to identify the symbols (or optotypes) on the eye chart, starting with the larger symbols and continuing with progressively smaller symbols until the patient cannot identify the symbols. The smallest symbols that can be reliably identified is considered the patient's visual acuity. The Snellen chart is the most widely used. Alternative types of eye charts include the logMAR chart, Landolt C, E chart, Lea test, Golovin-Sivtsev table, the Rosenbaum chart, Dots chart, Red-Green chart, and the Jaeger chart, among others. An eye chart is normally in the form of a paper-sheet, a projector, a computer monitor, a space saving eye chart incorporated within a mirror box. Chart codes and/or chart values may be stored as part of the eye chart display 106. The eye chart display 106 may be configured as two separate eye charts wherein one eye chart is for near distance visual acuity testing and the other for far distance visual acuity testing. The eye chart display 106 may be configured as an eye chart display that can be moved between a first position for testing near vision and a second position for testing distance vision. The mirror box 108 may contain a set of mirrors configured to achieve a refraction distance of normally 4 to 7 meters with a typical installation distance of 0.4 to 2 meters. The purpose of a mirror box to minimise the space needed for a subjective refraction.

A wavefront aberrometer (not shown in FIG. 1) is a computer-controlled machine used during an eye examination to provide an objective measurement of a patient's refractive error. This is achieved by measuring an optic system (eye) at a multitude of points based on wavefront methods. Generally, a wavefront aberrometer is used as a separate preliminary measurement of the refractive error priorto the usage of the auto-phoropter 102, but in some configurations, a wavefront aberrometer may be integrated with an auto-phoropter 102 in one unit.

The measurement instruments are communicatively coupled to an equipment computer 110, which is a computing device associated with the SRS 100, via a bus 114. The equipment computer 110 is communicatively coupled to a controller module 112. The controller module 112 can control one or more of the measurement instruments discussed above based on an operator input. The controller module 112 is either a software application that can be installed on a computer or a hardware device. The controller module 112 may contain control commands for the auto-phoropter 102 and eye chart display 106, as well as the manufacturer's subjective refraction software application(s).

It will be appreciated that a SRS 100 may have various different configurations used in different ways. Any configuration may include one or more computers, speakers, monitors, headphones and a furniture configuration for the devices and a chair for the patient. In one configuration, the SRS 100 may have a computerised auto-phoropter 102, one or two auto-refractors 104, an eye chart display 106 and one or two mirror boxes 108. The eye chart display 106 may be configured as two separate eye charts wherein one eye chart is for near distance visual acuity testing and the other for far distance visual acuity testing. This configuration may be used for a combined binocular objective and subjective refraction. In another configuration, the SRS 100 may be configured with a computerised auto-phoropter 102 and an eye chart display 106. The eye chart display 106 may be configured as two separate eye charts, wherein one eye chart is for near distance visual acuity testing and the other for far distance visual acuity testing. These are example configurations only, and other suitable configurations will be easily envisaged by the skilled person. The SRS 100 may additionally or alternatively comprise a subjective refraction software application 116. In this case, the refractive error of a patient may be determined without the use of a refractor lens assembly (i.e. without the use of a phoropter). The subjective refraction software application may be web based or an installed application on a computing device. The computing device may be a laptop, desktop, tablet or mobile phone. The refractive error is determined by the subjective refraction software application by presenting various vision tests and associated eye charts on a computerised screen and allowing the patient to enter responses by various inputting methods. In one embodiment, the subjective refraction software application may be combined with a remote operator that may operate the subjective refraction or supervise the remote refraction.

FIG. 2 illustrates an example configuration of the SRS 100. A subjective refraction unit 202 is shown on the left. In this embodiment, the subjective refraction unit 202 has a mirror box 108 integrated with an auto-phoropter 102 in a single unit to minimise space needed. The mirror box 108 may have both a near and distance eye chart display 106 that can be changed automatically using computing commands from a controller 112. A subjective refraction unit assembly 204 is shown on the right. The assembly 204 comprises the subjective refraction unit 202 mounted on a free-standing table-stand that is mounted on a moveable pillar that can be adjusted in height and is equipped with headphones and microphones for remotely conducted subjective refractions or refractions performed by computer applications without any human assistance.

FIG. 3 schematically illustrates a controller 300 according to an embodiment, for example the controller module 112. The controller 300 may also be referred to as a universal controller as it is able to send and receive commands relating to a number of different SRSs, as will be explained below. The controller 300 is communicatively coupled to an SRS-neutral GUI 304 which may receive commands from an operator 302. The controller may be located at a different location to the SRS-neutral GUI 304 and the operator 302. The controller 300 is also communicatively coupled to a controlled SRS 310, such as the SRS 100, used to perform a subjective refraction on a patient 312. The controlled SRS 310 and the patient 312 may be located at a different location to the controller 300 and/or the operator 302 and the SRS-neutral GUI 304.

An operator 302 inputs commands to the SRS-neutral graphical user interface (GUI) 304. The operator 302 may be a human operator or, in some embodiments, a computer program application. The content shown on the SRS-neutral GUI 304 may be generated by a web service application (not shown in the diagram) known to people skilled in the art. The SRS-neutral GUI 304 may be generated to allow the operator 302 to use any computing device with access to the Internet remotely. Examples of such devices are mobile phones, notepads, tablets, laptops, desktops of different brands and sizes or any other device with a processor, RAM memory and a display hosting a web-browser that can connect to the Internet. In one embodiment, the SRS-neutral GUI 304 may be an "app" suitable for iOS and Android mobile devices. As will be explained below, the SRS-neutral GUI 304 is independent of the controlled SRS 310, allowing the operator 302 to use the same user interface to control many different manufacturers’ SRSs, including different models and versions.

In some embodiments, a real-time voice and/or video connection between a device used by the operator 302 and a controlled SRS 310 may be initiated. The real-time voice and/or video connection may be implemented by a third party application. This application may be used on same or different device as the SRS-neutral GUI 304. For example, the voice and/or video call can be conducted using a mobile phone while the SRS-neutral GUI 304 is used using a tablet or laptop computer.

The SRS-neutral GUI 304 sends input data to an SRS-neutral generator module 306 of the controller 300. The SRS-neutral GUI 304 also receives data from the SRS-neutral generator module 306. The SRS-neutral GUI 304 sends the input data to the SRS- neutral generator module 306 in a first format. The SRS-neutral generator module 306 converts the input data into instruction code having a different format to the first format. The format of the instruction code may be generic, that is, not associated with any particular SRS. The SRS-neutral generator module 306 sends the instruction code to an SRS-specific generator module 308 of the controller.

The SRS-specific generator module 308 identifies a controlled SRS 310. The SRS- specific generator module 308 converts the instruction code received from the SRS- neutral generator module 306 into SRS-specific operating commands suitable for the controlled SRS 310. The SRS-specific operating commands have a different format from the input data from the SRS-neutral GUI 304 and the instruction code from the SRS-neutral generator module 306.

The controlled SRS 310 may then execute these new commands locally, for example, to instruct an auto-phoropter to change lenses or/and to instruct the eye chart to change chart or acuity row. In this way, the controlled SRS 310 can perform a subjective refraction on a patient 312 based on generic commands from an operator 302. In some embodiments, the controlled SRS 310 receive data representing performance of the one or more functions from the subjective refraction and transmit this data back to the SRS-neutral GUI 304 via the controller 300. As such, test results from a subjective refraction may be provided to the operator 302, which may inform the next commands to be entered.

By operating in this manner, the controller 300 may allow an operator to use same controller and user interface to control many different manufacturers’ SRS models and versions. The controller 300 enables the control of a number of different SRSs, even if the input format of the commands is incompatible with the user interface inputting options, functions, algorithms, and predefined sequences of the particular SRS to be controlled. Therefore, an operator can easily perform subjective refractions using any manufacturers of SRS through a familiar interface. As such, the operator is not required to be intimately familiar with the operational formats required for each type, model, and version of SRS.

FIG. 4 schematically illustrates an SRS-neutral generator module 400 according to an embodiment, for example the SRS-neutral generator module 306. As discussed in relation to FIG. 3, the purpose of the SRS-neutral generator module 400 is to receive input commands from an SRS-neutral GUI and output instruction code to an SRS- specific generator module.

An operator (not shown in FIG. 4) performing a subjective refraction may input commands using an SRS-neutral GUI 402, such as the SRS-neutral GUI 304. The commands are input in a first format. The commands may be, for example, commands to control an auto-phoropter sphere power lens, an auto-phoropter cylinder power lens, an auto-phoropter cylinder axis, an auto-phoropter addition power lens, an auto- phoropter cross cylinder lens, an auto-phoropter polarisation lens, an auto-phoropter prism lens, a pupillary distance, vision modes, a Snellen visual acuity chart, an addition chart, a dots chart or a phoria chart, switching the distance eye chart to a near vision eye chart. The input commands are transmitted to an SRS-neutral conversion module 404 of the SRS-neutral generator module 400, where they are converted into a second format. The SRS-neutral conversion module 404 may contain many predefined conversion rules and algorithms with the general purpose to transform received data into numeric data values or text data instructions. For example, the input commands may be a letter “L” that may be converted into a numeric value using the algorithm "New cylinder dioptre value = current cylinder dioptre value -0.25”. The inputted letter "L" on Ul 402 stands for "Left" meaning that the left symbol or image shown on the eye chart is preferred by the patient and as a result of this response the operator 302 inputs "L" on Ul 402. For example, the input commands may be a word "Next" that may be converted into "Next Vision Test" meaning that SRS-neutral generator module 400 shall analyse whether and/or which new vision test shall be selected. For example, the input commands may be the word "Upper" that may be converted into a numeric value using the algorithm "New sphere dioptre value = current sphere dioptre value +0.25”. The inputted word "Upper" has the meaning that the upper symbol or image shown on the eye chart is preferred by the patient and as a result of this response the operator 302 selects the Ul button "Upper" on Ul 402.

An SRS-neutral data collection module 406 may collect data from a plurality of data sources 408 continuously and in real-time. The data sources 408 may vary with different configurations. One example data source may provide data received from patient's objective refraction measurements, for example sphere, cylinder power, cylinder axis and pupil distance. Another example data source may provide data received from patient's current glasses measurements, for example sphere, cylinder power, cylinder axis, addition powers and pupil distance. Yet another example data source may provide data received from previous vision tests performed during a current subjective refraction, for example sphere, cylinder power, cylinder axis, addition powers. Yet another example data source may provide data received from a current, ongoing vision test, for example sphere, cylinder power, cylinder axis, addition powers. Yet another example data source may provide data received from patient responses during an on going vision test. Yet another example data source may provide data received from patient's vision complaints that may be received during a subjective refraction or prior to a subjective refraction being initiated. Yet another example data source may provide data received from an age related addition power database comprising expected addition power values for each possible age of a patient. Yet another example data source may provide data received from an accommodation related database comprising expected accommodation power values for each possible age of a patient. Yet another example data source may be a database comprising a plurality of predefined threshold values determining if collected data may be unexpected. Yet another example data source may be historical statistical data from a large number of patients with similar vision errors and vision complaints that may be used for predictions, data analytics and machine learning. An SRS-neutral vision test module 410 contains a plurality of stored vision test content and other types of content that may be used during a subjective refraction of a patient. The vision test content contained in the SRS-neutral vision test module 410 is part of a subjective refraction with the purpose of determining a specific vision error and/or status of the eye, for example astigmatism and vision anomalies. Examples of vision test contents are an unaided visual acuity test, best vision sphere, cylinder power tests, red- green test, binocular balance test, addition measurement, near visual acuity test, phoria test, and a stereo test. Any number of vision tests may be stored in the SRS-neutral vision test module 410. The number of different vision tests available at the SRS-neutral vision test module 410 is not fixed. It may vary dependent on the current and future scope of subjective refractions.

Vision tests in the SRS-neutral vision test module 410 are generated in a generic format meaning that the SRS-neutral GUI 402 and communication commands and instructions transmitted from the SRS-neutral GUI 402 to the controller are independent of the program code used by the controlled SRS 308. The same SRS-neutral GUI 402 can then be used to operate and control a plurality of different manufacturers’ SRSs.

An SRS-neutral data analytics module 412 contains a number of algorithms that either update an ongoing vision test or, if a vision test is complete, select the following vision test. The SRS-neutral data analytics module 412 may operate continuously and in real time with the purpose of assisting an operator conducting a subjective refraction. The SRS-neutral data analytics module 412 may be configured to select a vision test sequence automatically, or may be limited to proposing a vision test to the operator who then makes the final decision on whether to use such a proposed vision test. Optionally, the operator selects the vision test. The SRS-neutral data analytics module 412 may have different configurations in terms of the level of computer automation and support given to the operator conducting the subjective refraction. The algorithms may be changed manually or updated by machine learning. An example of an algorithm may be used to update, in real-time, an on-going cylinder axis vision test, for example: “Change cylinder axis by (current axis + 4) if the axis to be changed is the third movement and if cylinder power is between 0.25 to 0.50 dioptres”. The SRS-neutral data analytics module 412 may also be configured to detect vision anomalies, i.e. data values received that are not expected that may lead to real-time vision test interventions. An SRS-neutral processing engine 414 updates vision test content in real-time. For example, a vision test may be updated with new values following an operator input or may be changed to another vision test. In another example, a controlled SRS may be updated with new data. In some cases, only the SRS-neutral GUI 402 is updated. In other cases, only a controlled SRS is updated. In other cases, both are updated. If the controlled SRS shall be updated, then the SRS-neutral processing engine 414 sends such instructions, in a generic SRS-neutral format, to an SRS-specific generator module 416, such as the SRS-specific generator module 308.

FIG. 5. Illustrates a diagram of a SRS-specific generator module 500, such as the SRS- specific generator module 308, 416. The SRS-specific generator module 500 receives instructions from an SRS-neutral processing engine 414 of the SRS-neutral generator module 306, 400, 502. The instructions may be received in a generic, SRS-neutral format. The SRS-specific generator module 500 performs a conversion of the instruction code into SRS-specific commands suitable for a controlled SRS 504, such as the controlled SRS 310. The SRS-specific generator module 500 transmits the SRS- specific commands to the controlled SRS 504 and, in some embodiments, receives information back from the controlled SRS 504.

To generate SRS-specific commands from SRS-neutral instruction code, an SRS- specific identifier module 506 of the SRS-specific generator module 500 identifies the manufacturer, model and version of the controlled SRS 504. The SRS-specific identifier module 506 identifies the manufacturer, model and version of the controlled SRS 504 by utilising data received from an SRS-specific network configurator 508. The SRS- specific network configurator 508 stores information relating to the controlled SRS 504 as part of a connection procedure between the controlled SRS 504 and the SRS-specific generator module 500. The SRS-specific network configurator 508 may initiate and managing the connection between the controller 300 and the controlled SRS 310. In one embodiment, the connection between the controller 300 and the controlled SRS 310 uses the Internet and the controller 300 is hosted on one or more cloud-servers.

In one embodiment, the SRS-specific identifier module 506 may have a database with pre-registered physical locations with installed SRSs that may be controlled by the universal controller 300. Each such location and sub-locations (i.e. rooms at a location) may have registered the SRS manufacturer, model and version allowing the SRS- specific identifier module 506 to identify the controlled SRS 504 merely by knowing the physical location of the SRS. In one embodiment, individuals at the location of a SRS may login into a website associated with the universal controller thus allowing the SRS- specific identifier module 506 and the SRS-specific network configurator 508 to receive information about a SRS, for example the manufacturer, model, version and connection information, etc.

Command data relating to different SRS manufacturers, models and versions is stored in an SRS-specific schema manager 510. The SRS-specific schema manager 510 may contain a storage of one, or a plurality of schemas related to SRS-specific models and versions. The purpose of an SRS-specific schema is to operate a controlled SRS in all its aspects. The SRS-specific schema manager 510 is a collection of stored database tables, sequences, functions, triggers and contains information such as native language, operating systems, network connections, etc. associated with unique SRS- specific manufacturers, models and versions. A system administrator could change, add or delete schemas. For example, a schema may be changed if the manufacturer of a controlled SRS changes, adds or deletes control commands or functions. The SRS- specific schema manager may contain a number of schemas to be able to operate a number of different SRS models and versions. SRS models and versions may include those manufactured by, for example, Topcon, Nidek, Rodenstock, Essilor, Hoya, Zeiss, and Visionix. Example of models and versions that may have stored schemas are Nidek RS-610 and/or Topcon CV-5000.

Each stored schema may contain hundreds of control commands for each SRS-specific manufacturer, model and SRS version. A schema may include SRS-specific root commands, sibling commands, parent commands, child commands, optional containers, required containers, data types, etc. A single control command may be linked and/or configured with other control commands. As examples, a delivered command may cause a controlled SRS auto-phoropter device to change left eye pupil distance, change the lens power of left sphere, change the lens axis of a cylinder lens, change mode from far distance to near distance vision, or change lens configuration from subjective lens powers to objective lens powers. Furthermore, a single command may cause the eye chart display to change an eye chart to a dots chart, phoria chart, or red-green chart, etc. Stored sequences may include a plurality of SRS-specific commands that are forced to be executed in a predefined sequence. For example, such a stored SRS-specific sequence may include SRS-specific commands to change a controlled SRS eye chart device, following a changed auto-phoropter device right and left spherical lens dioptres. For example, such a stored SRS-specific sequence may include stored SRS-functions to instruct the controller to transmit SRS-specific commands in one second delayed time-intervals as the receiving controlled SRS model and version may not be able to process and accept a plurality of commands to be transmitted at same time. Different schemas may not include the same commands as other schemas for a different SRS models and versions. For example, different SRSs may have different hardware and/or software that do not perform all the same functions. In such case, SRS-specific commands may instead include a different sequence of commands, for example, a) "deliver a message to the location of the SRS with instructions to manually change the eye chart to near vision eye chart" and b) "delay the next delivery of command until the distance eye chart is manually changed to a near vision eye chart".

Once the manufacturer, model and version of the controlled SRS 504 has been identified, the relevant command data is located from the SRS-specific schema manager 510. The commands in the SRS-specific schema manager 510 provide information allowing the correct SRS-specific commands to be generated for the controlled SRS 504 from the SRS-neutral instruction code. While the SRS-neutral instruction code is always in the same format, different controlled SRS models and versions require unique instruction code, formats and SRS-specific commands. The exact form may depend upon how the controlled SRS 504 is configured in terms of both hardware and software systems. For example, SRS-neutral instruction code may contain a generic instruction code to start a “binocular addition near vision test” including instruction code for specific values for sphere, cylinder and addition. A schema selected from the SRS-specific schema manager 510 may then include SRS- specific commands that may instruct the controlled SRS 504 to change a distance eye chart to a near vision eye chart. This may be done using computerised and motorised functions of the controlled SRS 504.

Once an appropriate piece of SRS-specific code has been located in the SRS-specific schema manager 510, a command assembler 512 determines whether any SRS-neutral code remains to be converted to the SRS-specific format. If any code remains to be converted, the next portion of code is selected, and the conversion process is restarted. Otherwise, the generated SRS-specific commands are assembled in the order and form and in the controlled SRS native language expected by the controlled SRS 504, and then delivered to the controlled SRS 504 by the SRS-specific network configurator 508. The controlled SRS 504 may execute these new commands locally, for example, to instruct an auto-phoropter to change lenses or/and to instruct the eye chart to change chart or acuity row. In this way, the controlled SRS 504 can perform a subjective refraction on a patient 312 based on generic commands from an operator 302.

FIG. 6 is a flow diagram of a method 600 of controlling an SRS 100, 310, 504. The method 600 may be implemented by the controller 300. The method allows an operator 302 to use a common user interface 304, 402 to perform a subjective refraction on a patient 312 using many different manufacturers’ SRS models and versions. The controller 300 may be located at a geographically different location from the SRS 100, 310, 504.

At step 602, one or more control commands for an SRS 100, 310, 504 are received. The control commands are input by a user at a user interface 304, 402 and have a first format. The user interface 304, 402 may be located at a geographically different location from the subjective refraction system 100, 310, 504 and/or the controller 300.

At step 604, information identifying a subjective refraction system 100, 310, 504 to be controlled is received. An SRS-specific identifier module 506 of an SRS-specific generator module 500 of the controller may identify the manufacturer, model and version of the controlled SRS 504. In some embodiments, this is achieved using data received from an SRS-specific network configurator 508. In some embodiments, the SRS-specific identifier module 506 may have a database with pre-registered physical locations with installed SRSs.

At step 606, the one or more control commands are converted from the first format to a second format. The second format is suitable for use with the subjective refraction system 100, 310, 504 to be controlled. The control commands may first be converted into a generic format, that is, not associated with any particular SRS. This may be performed by an SRS-neutral generator module 400. The control commands in the generic format are then converted to the second format suitable for use with the SRS 100, 310, 504 to be controlled. This may be performed by an SRS-specific generator module 500.

At step 608, the one or more control commands in the second format are transmitted to the SRS 100, 310, 504. The SRS 100, 310, 504 is configured to execute one or more functions based on the one or more control commands. In this way, the SRS 100, 310, 504 can perform a subjective refraction on a patient 312 based on generic commands from an operator 302. The systems and methods disclosed above allow an operator to use a common user interface to control many different manufacturers’ SRS models and versions. The controller 300 enables the control of a number of different SRSs, even if the input format of the commands is incompatible with the user interface inputting options, functions, algorithms, and predefined sequences of the particular SRS to be controlled. Therefore, an operator can easily perform subjective refractions using any manufacturers of SRS through a familiar interface. As such, the operator is not required to be intimately familiar with the operational formats required for each type, model, and version of SRS.

FIG. 7 is a block diagram illustrating an exemplary computer system 700 in which embodiments of the present invention may be implemented. This example illustrates a computer system 700 such as may be used, in whole, in part, or with various modifications, to provide the functions of the disclosed system. For example, various functions may be controlled by the computer system 700, including, merely by way of example, receiving, generating, converting, transmitting, a controller, and various modules.

The computer system 700 is shown comprising hardware elements that may be electrically coupled via a bus 790. The hardware elements may include one or more central processing units 710, one or more input devices 720 (e.g., a mouse, a keyboard, etc.), and one or more output devices 730 (e.g., a display device, a printer, etc.). The computer system 700 may also include one or more storage device 740. By way of example, the storage device(s) 740 may be disk drives, optical storage devices, solid- state storage device such as a random-access memory (“RAM”) and/or a read-only memory (“ROM”), which can be programmable, flash-updateable and/or the like.

The computer system 700 may additionally include a computer-readable storage media reader 750, a communications system 760 (e.g., a modem, a network card (wireless or wired), an infra-red communication device, Bluetooth™ device, cellular communication device, etc.), and a working memory 780, which may include RAM and ROM devices as described above. In some embodiments, the computer system 700 may also include a processing acceleration unit 770, which can include a digital signal processor, a special-purpose processor and/or the like.

The computer-readable storage media reader 750 can further be connected to a computer-readable storage medium, together (and, optionally, in combination with the storage device(s) 740) comprehensively representing remote, local, fixed, and/or removable storage devices plus storage media for temporarily and/or more permanently containing computer-readable information. The communications system 760 may permit data to be exchanged with a network, system, computer and/or other component described above.

The computer system 700 may also comprise software elements, shown as being currently located within the working memory 780, including an operating system 788 and/or other code 784. It should be appreciated that alternative embodiments of a computer system 700 may have numerous variations from that described above. For example, customised hardware might also be used and/or particular elements might be implemented in hardware, software (including portable software, such as applets), or both. Furthermore, connection to other computing devices such as network input/output and data acquisition devices may also occur.

Software of the computer system 700 may include code 784 for implementing any or all of the function of the various elements of the architecture as described herein. For example, software, stored on and/or executed by a computer system such as the system 700, can provide the functions of the disclosed system. Methods implementable by software on some of these components have been discussed above in more detail.

It is to be understood that other embodiments may be utilised and structural or logical changes may be made without departing from the scope of the present disclosure. Therefore, the following detailed description is not to be taken in a limiting sense, and the scope of embodiments is defined by the appended claims.

Claims

1. A method (600) of controlling a subjective refraction system (100, 310, 504), comprising: receiving (602) one or more control commands for a subjective refraction system, the control commands being input by a user at a user interface (304, 402) and having a first format; receiving (604) information identifying a subjective refraction system to be controlled; converting (606) the one or more control commands from the first format to a second format, the second format associated with the subjective refraction system to be controlled; and transmitting (608) the one or more control commands in the second format to the subjective refraction system to be controlled.

2. The method (600) of claim 1 , wherein converting the control commands from the first format to the second format comprises: converting the control commands having the first format to a third format, the third format not being associated with a subjective refraction system; and converting the control commands from third format to the second format.

3. The method (600) of any preceding claim, wherein the user interface (304, 402) is at a geographically different location from the subjective refraction system.

4. The method (600) of any preceding claim, wherein the subjective refraction system (100, 310, 504) is configured to execute one or more functions based on the one or more control commands.

5. The method (600) of any preceding claim, wherein the subjective refraction system (100, 310, 504) comprises at least one of an auto-phoropter (102), an auto-refractor (104), an eye chart display (106), a mirror box (108) and a wavefront aberrometer.

6. The method (600) of claim 5, wherein the eye chart display (106) comprises a distance vision eye chart display and a near vision eye chart display.

7. The method (600) of any preceding claim, wherein the method is implemented by a controller (300).

8. The method (600) of claim 7, wherein the controller (300) is at a geographically different location from the subjective refraction system (100, 310, 504).

9. The method of claim 7 or 8, wherein the controller (300) is at a geographically different location from the user interface (304, 402).

10. The method (600) of any preceding claim, wherein the one or more control commands comprises at least one of: controlling an auto-phoropter sphere power lens; controlling an auto-phoropter cylinder power lens; controlling an auto-phoropter cylinder axis; controlling an auto-phoropter addition power lens; controlling an auto-phoropter cross cylinder lens; controlling an auto-phoropter polarisation lens; controlling an auto-phoropter prism lens; controlling an auto-phoropter pupillary distance; controlling an auto-phoropter vision modes; controlling the switch for near and far distance eye charts; controlling a Snellen visual acuity eye chart; controlling a cross grid eye chart; controlling a dots eye chart; and controlling a phoria eye chart.

11 . A system for performing subjective refraction testing, the system comprising: a user interface (304, 402); a controller (300); and a subjective refraction system (100, 310, 504); wherein the controller is configured to: receive one or more control commands for the subjective refraction system, the control commands being input by a user at the user interface and having a first format; receive information identifying the subjective refraction system; convert the one or more control commands from the first format to a second format, the second format associated with the subjective refraction system; and transmit the one or more control commands in the second format to the subjective refraction system; wherein the subjective refraction system is configured to perform one or more functions of a subjective refraction test based on the control commands in the second format.

12. The system of claim 11 , wherein the controller (300) is configured to convert the control commands from the first format to the second format by: converting the control commands having the first format to a third format, the third format not being associated with a subjective refraction system; and converting the control commands from third format to the second format;

13. The system of claim 11 or 12, wherein the user interface (304, 402) is at a geographically different location from the subjective refraction system (100, 310, 504).

14. The system of any of claims 11 to 13, wherein the subjective refraction system (100, 310, 504) comprises at least one of an auto-phoropter (102), an auto refractor (104), an eye chart display (106), a mirror box (108) and a wavefront aberrometer.

15. The system of claim 14, wherein the eye chart display (106) comprises a distance vision eye chart display and a near vision eye chart display.

16. The system of any of claims 11 to 15, wherein the controller (300) is at a geographically different location from the subjective refraction system (100, 310, 504).

17. The system of any of claims 11 to 16, wherein the controller (300) is at a geographically different location from the user interface (304, 402).

18. The system of any of claims 11 to 17, wherein the one or more control commands comprises at least one of: controlling an auto-phoropter sphere power lens; controlling an auto-phoropter cylinder power lens; controlling an auto-phoropter cylinder axis; controlling an auto-phoropter addition power lens; controlling an auto-phoropter cross cylinder lens; controlling an auto-phoropter polarisation lens; controlling an auto-phoropter prism lens; controlling an auto-phoropter pupillary distance; controlling an auto-phoropter vision modes; controlling a switch for near and far distance eye charts; controlling a Snellen visual acuity eye chart; controlling a cross grid eye chart; controlling a dots eye chart; and controlling a phoria eye chart.