Note: Descriptions are shown in the official language in which they were submitted.
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PRESBYOPIC VISION IN1PROYEMENT
BACKGROUND OF THE INVENTION
Field of the Invention
The present invention relates generally to the field of presbyopic vision
correction and, more particularly, to the use of a wavefront sensor for the
measurement,
design, fit and dispensing of a vision altering optic or vision correcting
procedure to
improve presbyopic correction and visual performance.
Description of Related Art
A form of age-dependent vision deterioration experienced sooner or later by
100% of the population is called presbyopia, i.e.; the inability to
accommodate or focus
on objects close to the eye. Two well-known methods for dealing with
presbyopis
include alternating vision style correction and simultaneous vision style
correction.
In an example of an alternating vision style correction, two (or moreJmulti-
focal)
distinct optical regions of a translating style contact lens are designed, one
optimized for
distance vision and the other for near vision. Typically in an alternating
vision bifocal
contact lens, the lens will translate on the eye such that the pupil is mostly
covered by the
distance viewing portion of the lens; however, when eye gaze points downward,
such as
when a person reads a newspaper, the lens translates on the eye such that the
pupil is
mostly covered by the near distance viewing portion of the lens.
Alternatively, simultaneous style vision correction has been provided through,
e.g., contact lenses, IOLs, refractive surgery, etc. In this style of
correction, all light
from the object goes through the pupil at the same time, preferably with a
50/50 split
between near distance and far distance object light. Any one of a number of
refractive or
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diffractive bifocal or multifocal designs are used to focus light from objects
ranging in
the field of view from far distance (greater than about 7m) to near distance
(as close as
about .25m but typically about 40 cm) on the retina at the same time.
As a person gets older; not only do they lose the ability to accommodate, they
also experience an increase in what are known as higher order wavefrom
aberrations.
These include, but are not limited to, spherical aberration, coma, irregular
astigmatisms
(e.g. triangular astigmatism or trefoil), and others. The aberrations
corrected by
spectacles or single vision contact lenses are limited to defocus and
astigmatism which
are generally referred to as lower-order aberrations. An increase in spherical
aberration
brought about, for example, by advancing age, will decrease nighttime vision
quality.
This may manifest itself as halos or glare around headlights or other light
sources.
Unfortunately; for the presbyope hoping for better near distance vision with a
translating-
style contact lens, the correction of the spherical aberration for improved
fat distance,
night time vision results in a decrease in near vision depth of field; i.e.,
the amount an
object's distance can be shifted before the retinal image of the object has
too much blur.
There are also vision tradeoffs for the multifocal, simultaneous style
correction ,
lens wearer. Although there are claims of excellent clinical success with a
number of
simultaneous vision bifocal and multifocal designs, actual published success
rates with
refractive and dif&active contact lenses for presbyopic correction range only
from about
20% to 50% of the general presbyopic population. One of the apparent limiting
factors
of all current simultaneous style vision correction for presbyopia is lens
misalignment;
t. e., the lack of control of the centration of the lend relative to the
optical axis of the
patient. Unfortunately, the induced aberrations caused by the optical
misalignment of
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the eye with the simultaneous vision correction lens reduces visual
performance to the
point that vision quality is unacceptable to the patient at any viewing
distance:
One approach to alleviating vision performance problems is, presumably, to
eliminate all optical aberrations in the eye. In the first instance, this
sohrtion may not be
technically feasible, although correction of wavefront errors via customized
refractive
surgical techniques and/or customized contact lenses, inlays, onlays, and
IOLs, for
example, is becoming better understood each day. Moreover, the elimination of
all
optical aberrations in the eye may not be desirable. For example, reducing
spherical
aberration will adversely affect depth of field, as discussed above, thus some
residual
spherical aberration may be desirable for optimum vision quality.
Accordingly, there is a need for vision correcting methods and devices that
address the aforementioned problems. In particular, methods and apparatus are
needed
for providing multifocal lens correction of presbyopia with improvement, or at
least no
degradation, of other aspects of vision quality.
SUMMARY OF THE Il~'VENTION
The invention in general relates to methods and devices for optimizing
presbyopic vision correction, preferably with a contact lens, but not limited
as such and
including, as appropriate, IOLs, inlays, onlays, or refractive surgery. A
predominate
theme of all of the embodiments of the invention is the use of a wavefront
sensor in the
design and fitting of alternating vision and simultaneous vision style
corrective lenses, or
in refractive surgery, and in balancing various aberrations to achieve the
best objective
vision metric possible.
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An embodiment of the invention relates to a method for designing either a
customized, multifocal, alternating style translating contact lens or a
simultaneous vision
style correcting lens, and providing such a lens to a presbyopic patient. The
method
comprises the steps of positioning, with respect to a patient's eye, a
multifocal trial lens
that is representative of an actual lens to ~be provided to the patient,
wherein the trial lens
has a correction of approximately a distance defocus power of the patient's
eye; making
a first wavefront aberration measurement of the patient's eye with the trial
lens in
position, at a viewing distance equivalent to optical infinity; making a
second wavefront
aberration measurement of the patient's eye with the trial lens in position,
at an artificial
optical near point viewing distance; and using the first and second wavefront
aberration
measurements to approximate a best form wavefront correction to be applied to
the
contact lens, whereby the patient's presbyopic vision is improved. It will be
clear to a
person skilled in the art that the step of positioning the lens with respect
to the patient's
eye has alternative aspects. For example, if the lens to be provided is a
translating style,
alternating vision type contact lens, the position of the representative trial
lens will be on
the patient's eye. In a different aspect where the lens to be provided is a
simultaneous
vision style correcting lens element, the lens element can be a contact lens
that will be
positioned on the patient's eye; however, if the simultaneous vision style
correcting lens
element is an IOL, the representative trial lens will be suitably positioned
in an optical
path of the wavefront sensor device used to make the wavefront aberration
measurement.
The wavefront aberration measurements are preferably made along a central axis
of the
trial lens. The best form wavefront correction will provide an optimum retinal
image
metric, preferably a Point Spread Function (PSF) having a single intensity
peak or a
Strehl ratio having as large a value as possible, for example. Other retinal
image metrics
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known to those skilled in the art can also be used. The near point viewing
distance
wavefront measurement should be in the range of about 30-SOcm and will
typically be
approximately 40cm. For the case of a translating style, alternating vision
type
correcting contact lens, the near distance measurement is obtained by inducing
a down
gaze of the patient's eye to produce the trial lens translation similar to
that of an actual
translating multifocal contact lens when worn by the patient. In an aspect of
this
embodiment, use of the wavefront sensor in designing and fitting a translating
style
multifocal contact lens will allow the practitioner to monitor the retinal
image metric for
optimum presbyopic vision while adjusting, e.g., residual spherical aberration
in the lens
that will result in the best overall vision for the patient while providing an
acceptable
depth of field to the patient.
In another aspect of the embodiment for designing and providing a simultaneous
vision type correcting lens, use of the wavefront sensor facilitates the
optimum lateral,
vertical, and rotational placement of the lens to optimize the retinal image
metric. This
can be accomplished, e.g., by adjusting the position of the patient's head
and, therefore,
the patient's optical axis with respect to the measurement axis of the
wavefront sensor or,
alternatively, utilizing a feedback loop in the wavefront sensor to determine
the optimum
location in the lens for aberration correction. In a related aspect, wherein a
patient has
had photorefractive surgery such as LAS1K, for example, a retreatment may be
performed to correct for misalignment or decon of the original ablation
treatnnent
that resulted in vision degrading higher-order aberrations. Upon retreatment,
the surgeon
may choose not to fully eliminate the residual spherical aberration.
In another embodiment of the invention, a method for designing a lens or other
correction (e.g., refractive surgery correction) to improve a patient's vision
quality that is
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degraded by both rotationally symmetric and rotationally asymmetric
aberrations
involves designing the lens or the correction such that a residual amount of
the
rotationally symmetric aberrations are greater in magnitude than a residual
amount of
rotationally asymmetric aberrations, e.g., coma. Once again, exemplary metrics
for
evaluating the patient's visual quality include, but are not limited to, the
PSF and the
Strehl ratio. The amount of residual or uncorrected rotationally symmetric
aberrations
will vary in each patient, and guidance will be provided by the aforementioned
metrics.
Preferably, the distribution of light in the PSF will not contain multiple
peaks.
In another embodiment, a method for designing a lens or a correction for
enhancing the near vision performance of a presbyopic patient includes a
design that
eliminates less than the total amount of the spherical aberration in the
person's visual
optical system so as to increase the person's depth of field. Aspects of this
embodiment
include ocular corrections that apply to vision altering optics such as
contact lenses,
IOLs, inlays, onlays, and the like, to the cornea through laser ablation and
other
refractive surgical techniques, and to other components of the eye.
These and other objects and advantages of the invention will be further
apparent
in consideration of the drawings and the detailed description of the preferred
embodiments, and in view of the appended claims defining the invention.
BRIEF DESCRIPTION OF TIC DRAWINGS
The accompanying drawings, which are incorporated in and constitute a part of
this specification, illustrate embodiments of the present invention and,
together with the
description, serve to explain the objects, advantages and principles of the
invention. In
the drawings,
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Figure 1 is a flow chart diagram illustrating a preferred embodiment of the
invention; and
Figure 2 is a flow chart diagram illustrating another preferred embodiment
according to the invention.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
r,
An embodiment of the invention describes, with reference to Figure 1, a method
100 for designing either a customized mufti-focal, translating style,
alternating vision
contact lens, or, a simultaneous style vision correcting lens, and providing
the lens to a
patient. In step 114, a mufti-focal trial lens is first positioned
appropriately with respect
to the patient's eye. The trial lens is representative of the customized lens
ultimately to
be provided to the patient, and should provide correction for the defocus
aberration
experienced by the patient. In an aspect of the embodiment where the lens
ultimately to
be provided to the patient is a translating style, alternating vision type
multifocal contact
lens, the appropriate positioning of the trial lens will be on the patient's
eye in the form
of a trial contact lens. In an alternative aspect of the embodiment where the
lens to be
provided to the patient is a correcting lens element not worn on the surface
of the cornea
such as an IOL or inlay providing simultaneous style presbyopic vision
improvement to
the patient, the appropriate positioning of the trial lens will be in the
optical measurement
path of a wavefront sensor to simulate the optical effect as if the lens
element was in situ.
Wavefront aberration measurements are then made at step 120 through the trial
lens in
such as manner that the patient is imaging at optical infinity and at an
optical near point
distance, preferably 30 - SO cm from the patient's eye and, more preferably,
approximately 40 cm from the patient's eye. A down gaze of the patient's eye
can be
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induced by using a front surface mirror in the measurement apparatus or by any
of a
number of known means, for making the near vision measurement. In step 130,
the
near distance and infinite distance aberration measurements are then used to
approximate a best form wavefront correction to a customized lens ultimately
to be
provided to the patient. The best form wavefront correction is preferably
determined
by optimizing a retinal image metric such as, for example, a point-spread
function
(PSF) or a Strehl ratio: ,Simply, the PSF corresponds to the energy
distribution in the
image of a point source of light object. An optimized PSF, for instance, would
have
only a single intensity peak representing the light distribution of the imaged
spot. The
Strehl ratio can be defined as the ratio of the area under the point spread
function of
the actual optical system wavefront (i.e., aberrated wavefront) to that for
the
diffraction limited case (i.e., no wavefront aberration in the optical
system). Thus a
Strehl ratio of 1.0 would describe a substantially perfect optical imaging
system.
Further information may be obtained from the text by Warren J. Smith entitled
Modern
Optical Engineering, McGraw Hill, Inc. (1966).
Generally speaking, as people age their vision deteriorates. Older individuals
often report poor nighttime vision. There is also a known correlation between
increases
in higher order aberrations and increasing age. One conclusion that can be
drawn from
this evidence is that poorer night vision in older individuals is due to an
increase in
higher order aberrations naturally experienced by older individuals.
Presbyopia is an
additional age-related visual deterioration. Although correcting spherical
aberration
tends to improve nighttime vision problems, it is well known that reducing
spherical
aberration reduces a person's depth of field. Thus, a presbyopic bifocal
wearer may
need to choose between better night vision and reduced depth of field for near
distance
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viewing, or vice-versa. Advantageously, the inventors have recognized that in
many
cases a person's corrected eyesight may be better when there is some residual
spherical
aberration after correction. This will provide the added benefit of
maintaining or
increasing a depth of field for the presbyopic lens wearer. Accordingly; an
aspect of the
present embodiment of the invention is directed to a correction design process
that
involves providing a Down amount of residual spherical aberration in order to
improve
visual quality and increase or at least maintain depth of field. Preferably,
in the presence
of rotationally symmetric higher order aberrations (e.g., spherical
aberration) and
rotationally asymmetric higher order aberrations (coma, higher order
astigmatism); a
method of for improving a person's vision involves providing a correction
design having
a residual amour of rotationally symmetric higher order aberrations that
exceed the
residual amount of rotationally asymmetric higher order aberrations. This is
illustrated
with respect to Example 1 below. This may be accomplished preferably through
the
design of a contact lens or an IOL, or alternatively, in an inlay, onlay, or
refi-active
surgery procedure.
Example 1
This example illustrates the concept that under the ability to manipulate the
spherical aberration of an ocular correction, due to the ability to only
change rotationally
symmetric surfaces or parameters such as, e.g., a contact lens, an IOL, or a
broad beam
laser, it is more beneficial not to correct all of the spherical aberration
when there are
significant amounts of non-rotationally symmetric aberrations (e.g., coma,
trefoil)
present. Patient X had refractive surgery. Her measured post-operative Zernike
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coefficient values measured with a Zywave~ (Bausch & Lomb, Rochester, N.Y.)
wavefrout sensor were:
Z7 Coma 0.068 Z15 Secon Coma -0.183
Z8 Coma -0.540 Z16 (Sewn Coma -0.071
Z9 refoil 0.103 Z17 Secon Coma 0.021
Z10 (S herical)-0.371 Z18 (S Coma 0.018
Z11 (S herical-0.782 Z19 Secon Coma 0.010
Z12 S herical-0.308 Z20 Sewn Coma -0:026
Z13 S herical-0.135 Z21 Seco S herical 0.023
Z14 S herical-0.007
One can see that there is significant coma and triangular astigmatism. In
Table I, below,
the left-most value is the multiplication factor of the Zernike coefficient Zl
l that
represents the majority of the measured spherical aberration Looking at
the.various
values of the corrected spherical aberration, it is seen that correcting all
of the spherical
aberration is actually deleterious to the retinal image quality as measured by
the Strehl
ratio: The highest Strehl ration is obtained when 25% of Z11 remains. In fact,
leaving .
50% of the Z11 spherical aberration results in a similar retinal image quality
to
correcting all of the spherical aberration as defined by the Strehl ratio.
Residual Strehl Ratio RMS Peak-Vall waves
Z11
0.00 Z 11 0.023 0.77 8.34
0.25 Zll 0.036 0.79 8.34
0.50 Z11 0.024 0.87 8.35
0.75 Zl l 0.016 0.96 8.68
1.00 Z1I 0.007 1.099 9.55
table t
The optimum amount of corrected spherical aberration will vary in each eye,
and may be
guided by the Strehl ratio, i.e., the distribution of light within the PSF
such that there are
not multiple peaks, or by other appropriate retinal image quality metrics well
known in
the art. The remaining residual spherical aberration will have the additional
benefit of
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enhancing the near visual performance for presbyopic patients by extending the
depth of
field for the patient.
It is assumed that one of the major limiting factors o1: all current
simultaneous
vision methods for correcting presbyopia is the failure to control the
centration of these
designs relative to the~optical axis~of the patient, and that the induced
aberrations caused
by the optical misalignment of the eye with simultaneous correction reduces
the visual
r
performance of the patient being corrected to the point that their visual
quality is
unacceptable to them at near or far viewing distances. There is speculation
that the
actual published success rates with refractive and di~'ractive contact lenses
range from
20% to 50% of the general presbyopic population due to the centration issue.
This
problem is easily exasperated when the lens purposely contains residual
spherical
aberration as discussed above. Recognition of the centration problem gives
rise to
another embodiment of the invention described with reference to Figure 2. In
this
embodiment 200, a wavefront sensor is used not only to measure the patient's
higher
order aberrations but also to monitor the fitting of a lens element subject to
decentration
in the person's optical system With respect to a simultaneous style bifocal
contact lens,
for example, at step 210 both near distance and far distance higher order
aberration
measurements are made with a trial lens appropriately positioned on the
patient's eye.
The optimum lateral, vertical, and/or rotational placement of the simultaneous
style lens
is then determined at 220 to optimize a retinal image metric. The lens
ultimately to be
provided to the patient can then be customized in terms of location of
aberration
correction on the lens and/or for the,proper placement of the lens on the
patient's eye. In
one aspect of this embodiment, the proper measuremem coordinates can be
explored by
displacing the patient's eye relative to the measurement axis of the wavefront
sensor viar
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an adjustable chin mount or other appropriate means, or alternatively, by
utilizing a
feedback loop in the wavefront sensor to determine the optimum placement of
the lens
on or in the patient's eye. A wavefront sensor equipped with a deformable
mirror, for
example, as described in Williams U. S. patent 5,777,719 illustrates the basic
technology
for making such measurements. In an associated aspect of this embodiment shown
in
step 230, a trial lens having a known amount of spherical aberration is
positioned with
respect to the patient's eye. Decentering of the lens having spherical
aberration 'induces
coma. A customized lens corrected for this induced coma can be designed at 240
by
monitoring the wavefront aberrations based on the trial lens. It will be
appreciated that
the lens itself need not be decentered on the patient's eye or with respect to
the patient's
optical axis as the decentering, which creates spherical aberration, is
equivalent to a
properly positioned lens on the patient's eye with residual spherical
aberration in the
lens. Alternatively, this result may also be accomplished in a refractive
surgery
retreatrnent procedure where less than the entire residual spherical
aberration is
corrected
Notwithstanding the preferred embodiments specifically illustrated and
described
herein, it will be appreciated that various modifications and variations of
the instant
invention are possible in light of the description set forth above and the
appended claims,
without departing from the spirit and scope of the invention.
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