CATRA: Interactive Measuring and Modeling of Cataracts

We introduce an interactive method to assess cataracts in the human eye by crafting an optical solution that measures the perceptual impact of forward scattering on the foveal region. Current solutions rely on highly-trained clinicians to check the back scattering in the crystallin lens and test their predictions on visual acuity tests. Close-range parallax barriers create collimated beams of light to scan through sub-apertures, scattering light as it strikes a cataract. User feedback generates maps for opacity, attenuation, contrast and sub-aperture point-spread functions. The goal is to allow a general audience to operate a portable high-contrast light-field display to gain a meaningful understanding of their own visual conditions. User evaluations and validation with modified camera optics are performed. Compiled data is used to reconstruct the individual's cataract-affected view, offering a novel approach for capturing information for screening, diagnostic, and clinical analysis.Alfred P. Sloan Foundation (Research Fellowship)United States. Defense Advanced Research Projects Agency (Young Faculty Award

Tailored displays to compensate for visual aberrations

We introduce tailored displays that enhance visual acuity by decomposing virtual objects and placing the resulting anisotropic pieces into the subject's focal range. The goal is to free the viewer from needing wearable optical corrections when looking at displays. Our tailoring process uses aberration and scattering maps to account for refractive errors and cataracts. It splits an object's light field into multiple instances that are each in-focus for a given eye sub-aperture. Their integration onto the retina leads to a quality improvement of perceived images when observing the display with naked eyes. The use of multiple depths to render each point of focus on the retina creates multi-focus, multi-depth displays. User evaluations and validation with modified camera optics are performed. We propose tailored displays for daily tasks where using eyeglasses are unfeasible or inconvenient (e.g., on head-mounted displays, e-readers, as well as for games); when a multi-focus function is required but undoable (e.g., driving for farsighted individuals, checking a portable device while doing physical activities); or for correcting the visual distortions produced by high-order aberrations that eyeglasses are not able to.Conselho Nacional de Pesquisas (Brazil) (CNPq-Brazil fellowship 142563/2008-0)Conselho Nacional de Pesquisas (Brazil) (CNPq-Brazil fellowship 308936/2010-8)Conselho Nacional de Pesquisas (Brazil) (CNPq-Brazil fellowship 480485/2010- 0)National Science Foundation (U.S.) (NSF CNS 0913875)Alfred P. Sloan Foundation (fellowship)United States. Defense Advanced Research Projects Agency (DARPA Young Faculty Award)Massachusetts Institute of Technology. Media Laboratory (Consortium Members

Intraocular Lens

The first clinical application of intraocular lens (IOL) goes back to 1949 when Dr. Harold Ridley successfully implanted a PMMA IOL into an eye on 29 November 1949. This innovation is a big step forward for cataract surgery. With development of the IOL material and biocompatibility, more and more IOL types have been used in clinical ophthalmology. This book is the fruit of worldwide cooperation between clinical teams. In this book we discuss the IOL materials and design, aberration and astigmatism correction with IOL, entopic phenomenon of IOL, myopia and phakic IOL, and secondary IOL techniques. We believe that this content provides the readers with a comprehensive knowledge of the latest developments of IOL

Evaluating techniques to improve visual performance with and assessment of premium intraocular lenses

Premium Intraocular Lenses (IOLs) such as toric IOLs, multifocal IOLs (MIOLs) and accommodating IOLs (AIOLs) can provide better refractive and visual outcomes compared to standard monofocal designs, leading to greater levels of post-operative spectacle independence. The principal theme of this thesis relates to the development of new assessment techniques that can help to improve future premium IOL design. IOLs designed to correct astigmatism form the focus of the first part of the thesis. A novel toric IOL design was devised to decrease the effect of toric rotation on patient visual acuity, but found to have neither a beneficial or detrimental impact on visual acuity retention. IOL tilt, like rotation, may curtail visual performance; however current IOL tilt measurement techniques require the use of specialist equipment not readily available in most ophthalmological clinics. Thus a new idea that applied Pythagoras’s theory to digital images of IOL optic symmetricality in order to calculate tilt was proposed, and shown to be both accurate and highly repeatable. A literature review revealed little information on the relationship between IOL tilt, decentration and rotation and so this was examined. A poor correlation between these factors was found, indicating they occur independently of each other. Next, presbyopia correcting IOLs were investigated. The light distribution of different MIOLs and an AIOL was assessed using perimetry, to establish whether this could be used to inform optimal IOL design. Anticipated differences in threshold sensitivity between IOLs were not however found, thus perimetry was concluded to be ineffective in mapping retinal projection of blur. The observed difference between subjective and objective measures of accommodation, arising from the influence of pseudoaccommodative factors, was explored next to establish how much additional objective power would be required to restore the eye’s focus with AIOLs. Blur tolerance was found to be the key contributor to the ocular depth of focus, with an approximate dioptric influence of 0.60D. Our understanding of MIOLs may be limited by the need for subjective defocus curves, which are lengthy and do not permit important additional measures to be undertaken. The use of aberrometry to provide faster objective defocus curves was examined. Although subjective and objective measures related well, the peaks of the MIOL defocus curve profile were not evident with objective prediction of acuity, indicating a need for further refinement of visual quality metrics based on ocular aberrations. The experiments detailed in the thesis evaluate methods to improve visual performance with toric IOLs. They also investigate new techniques to allow more rapid post-operative assessment of premium IOLs, which could allow greater insights to be obtained into several aspects of visual quality, in order to optimise future IOL design and ultimately enhance patient satisfaction

Optical and visual characterization of multifocal contact lenses and multifocal intraocular lenses

Vision is presented and universally accepted as the most precious of the human senses.lt is structured in three main parts: the optical system {eye), the photo-sensor {eye's retina), and the data processor (brain). If one of them is affected by any disease or dysfunction, vision will be terrible or even nonexistent One of the most common dysfunction is presbyopia.lt i s an age-related disorder that is undergone by all the population s ince their mid-late-40s and it is consists in the loss of the ability to focus near objects (accommodation). A huge number of possible corrections of it can be easily found. On one hand, there are temporary corrections ,as progressive spectacle tenses or multifocal contact tenses. On the other hand, permanent corrections as multifocal i ntraocular lenses, multifocal cornea! ablation, accommodating intraocular tenses, monovision systems, or scleral modifications are also applied to correct presbyopia. Another age-related dysfunction is cataract. Cataract is the opacification of the crystalline fens and decreases the quality of the visual function. Consequently, it is one of the leading visual impairments in adults over 60 years old, affecting the half of the adults aged between 75-85 years old. The only possible solution far cataract is the extraction of the opacified fibers of the crystalline lens and the replacement of them with an intraocular lens by surgery. Due to the fact that all the patients affected by an age-related cataract are also affected by presbyopia it is totally understandable that a number of patients choose mulltifocal introcular lens to substitute their crystalline tenses .This way, only one surgery is needed to salve both age-related dysfunctions. Usually, young presbyopes choose a temporary correction as a first option to correct presbyopia. Some presbyopia corrections are based on the simultaneous vision principie, as, far example, multifocal contact or intraocular lenses. The optical design of these kind of lenses is very complex. Consequently, It is characterization is also difficult When these lenses were launched into the market, it was only possible to characterize optical quality before the implantation or the adaptation of them (characterization in vitro) and the visual quality after the surgery or the clinical adaptation was performed (characterization) .M. present and thanks to the technological advances, different new commercial instruments that are to perform characterization in vivo of the visual quality before the implantation or the adaptation of simultaneous vis ion tenses. They are based on the simulation of the vision that these tenses give to the implanted eye. Some experimental prototypes and commercial aberrometers or double­ pass systems have used to perform an optical quality characterization in vivo, but some issues have been reported. Taking into account all this information, the main goal of this thesis is the design and the assembly of a new open-field double-pass system with asymmetric focus that is suitable to characterize invivo optical quality in patients implanted or adapted with multifocal intraocular or contact lenses. In order to achieve this aim, different studies and processes were carried out Review of presbyopia corrections and the characterization of them (Clinical study about objective over-refraction wearing multifocal contact lenses); Verification of the suitability of one commerciat simulator (Clinical study with the commercial simulator VirtlOL (10lens S.l.)); Design and assembly of the double-pass system with asymmetric focus (Opto-mechanical design/ Validation of all the elements included in the system/ Optical validation of the system); Programming of the softwares to manage the system; Validation of the new prototype (Two clinical studies characterizing eyes implanted with multifocal introcular tenses by using the new system were done).La visió és entesa i, universalment acceptada, com el sentit humà més valorat .Aquesta esta estructurada en tres parts principals: el sistema òptic (l'ull), el fot-sensor (la retina ocular) iel processador (el cervell). Si una d'aquestes parts es veu afectada per una disfunció o malaltia, la visió pot arribar a ser de molt baixa qualitat i, fins hi tot, inexistent Una de les disfuncions més comunes és la presbícia. La presbícia és una disfunció lligada a l'edat que pateix tota lla població a partir dels 40 anys, aproximadament. Consisteix en la pèrdua de la capacitat d'enfocar objectes propers (acomodació). Actualment, es troba un ampli nombre de possibles correccions. Per una banda, tenim les correccions temporals, com ulleres o lents de contacte progressives, i, per l'altre, correccions permanents, com lents intraoculars multifocals , ablacions corneals multifocals, lents intraoculars acomodatives, sistemes de monovisió, o modificacions esclerals, entre altres. Una altre disfunció associada a l'edat és la cataracta, la qual crea la opacificació del cristal·lí impedint una visió nítida. Conseqüentment, la cataracta és una de la deficiències visuals més estesa a partir dels 60 anys, afectant a la meitat de la població entre els 75 i els 85 anys . La única solució per eliminar les cataractes és eliminant les fibres opacificades i substituir-les per una lent intraocular quirúrgicament. Donat que tots els pacients amb cataractes són, a la vegada, prèsbites, està justificat que un nombre de pacients decideixi implantar-se lents intraoculars multifocals per substituir el seu cristal·lí. D'aquesta manera es solucionen dues degeneracions associades a l'edat en una sola cirurgia. Els joves prèsbites acostumen a optar per correccions prèsbites temporals, mentre que molts dels prèsbites amb cataractes opten per solucions permanents. Algunes de les correccions de la presbícia, com les lents de contacte o intraoculars multifocals , estan basades en el principi de visió simultània. Els dissenys òptics d'aquest tipus de lents són molt complexos, cosa que fa que la seva caracterització sigui molt complicada. Quan aquestes lents van aparèixer al mercat, només era possible caracteritzar-les òpticament abans de la seva implantació o adaptació de manera in vitro, i de caracteritzar-les visualment després de la seva adaptació o implantació de manera in vivo. Actualment, i gracies a tots els avenços tecnològics, diferents instruments clínics han estat desenvolupats per realitzar mesures de les qualitats visuals abans de la seva implantació. Tots ells, es basen en simular-li al pacient la visió que tindria després de ser implantat. Per un altre cantó, alguns prototips experimentals iaberrometres o sistemes de doble-pas comercials han estat utilitzats per dur a terme la caracterització de la qualitat in vim en pacients implantats o adaptats amb sistemes multifocals, pero diferents problemes han estat plantejats. Tenint en compte tota aquesta informació, el principal objectiu d'aquesta tesi ha estat la de dissenyar i muntar un nou sistema de doble-pas d'enfocament asimètric de camp obert que fos capaç de fer una caracterització de la qualitat òptica in vivo de pacients implantats o adaptats amb lents de contacte o intraoculars multifocals. I per arribar a aquest objectiu, s'han dut a terme els següents passos: Revisió de les correccions per a la presbícia i caracterització d'elles (Estudi clínic de la sobre-refracció objectiva de pacients adaptats amb lents de contacte multifocals); Validació de la capacitat de mesura d'un simulador comercial (Estudi clínic amb el simulador comercial VirtlOL (1OLens S.L); Disseny i muntatge del sistema de doble-pas amb enfocament asimètric (Disseny opto-mecànic/ Validació de tots els components del sistema/ Validació òptica del sistema); Programació dels programes informàtics que gestionen el sistema i processenPostprint (published version

Optical and visual characterization of multifocal contact lenses and multifocal intraocular lenses

Vision is presented and universally accepted as the most precious of the human senses.lt is structured in three main parts: the optical system {eye), the photo-sensor {eye's retina), and the data processor (brain). If one of them is affected by any disease or dysfunction, vision will be terrible or even nonexistent One of the most common dysfunction is presbyopia.lt i s an age-related disorder that is undergone by all the population s ince their mid-late-40s and it is consists in the loss of the ability to focus near objects (accommodation). A huge number of possible corrections of it can be easily found. On one hand, there are temporary corrections ,as progressive spectacle tenses or multifocal contact tenses. On the other hand, permanent corrections as multifocal i ntraocular lenses, multifocal cornea! ablation, accommodating intraocular tenses, monovision systems, or scleral modifications are also applied to correct presbyopia. Another age-related dysfunction is cataract. Cataract is the opacification of the crystalline fens and decreases the quality of the visual function. Consequently, it is one of the leading visual impairments in adults over 60 years old, affecting the half of the adults aged between 75-85 years old. The only possible solution far cataract is the extraction of the opacified fibers of the crystalline lens and the replacement of them with an intraocular lens by surgery. Due to the fact that all the patients affected by an age-related cataract are also affected by presbyopia it is totally understandable that a number of patients choose mulltifocal introcular lens to substitute their crystalline tenses .This way, only one surgery is needed to salve both age-related dysfunctions. Usually, young presbyopes choose a temporary correction as a first option to correct presbyopia. Some presbyopia corrections are based on the simultaneous vision principie, as, far example, multifocal contact or intraocular lenses. The optical design of these kind of lenses is very complex. Consequently, It is characterization is also difficult When these lenses were launched into the market, it was only possible to characterize optical quality before the implantation or the adaptation of them (characterization in vitro) and the visual quality after the surgery or the clinical adaptation was performed (characterization) .M. present and thanks to the technological advances, different new commercial instruments that are to perform characterization in vivo of the visual quality before the implantation or the adaptation of simultaneous vis ion tenses. They are based on the simulation of the vision that these tenses give to the implanted eye. Some experimental prototypes and commercial aberrometers or double­ pass systems have used to perform an optical quality characterization in vivo, but some issues have been reported. Taking into account all this information, the main goal of this thesis is the design and the assembly of a new open-field double-pass system with asymmetric focus that is suitable to characterize invivo optical quality in patients implanted or adapted with multifocal intraocular or contact lenses. In order to achieve this aim, different studies and processes were carried out Review of presbyopia corrections and the characterization of them (Clinical study about objective over-refraction wearing multifocal contact lenses); Verification of the suitability of one commerciat simulator (Clinical study with the commercial simulator VirtlOL (10lens S.l.)); Design and assembly of the double-pass system with asymmetric focus (Opto-mechanical design/ Validation of all the elements included in the system/ Optical validation of the system); Programming of the softwares to manage the system; Validation of the new prototype (Two clinical studies characterizing eyes implanted with multifocal introcular tenses by using the new system were done).La visió és entesa i, universalment acceptada, com el sentit humà més valorat .Aquesta esta estructurada en tres parts principals: el sistema òptic (l'ull), el fot-sensor (la retina ocular) iel processador (el cervell). Si una d'aquestes parts es veu afectada per una disfunció o malaltia, la visió pot arribar a ser de molt baixa qualitat i, fins hi tot, inexistent Una de les disfuncions més comunes és la presbícia. La presbícia és una disfunció lligada a l'edat que pateix tota lla població a partir dels 40 anys, aproximadament. Consisteix en la pèrdua de la capacitat d'enfocar objectes propers (acomodació). Actualment, es troba un ampli nombre de possibles correccions. Per una banda, tenim les correccions temporals, com ulleres o lents de contacte progressives, i, per l'altre, correccions permanents, com lents intraoculars multifocals , ablacions corneals multifocals, lents intraoculars acomodatives, sistemes de monovisió, o modificacions esclerals, entre altres. Una altre disfunció associada a l'edat és la cataracta, la qual crea la opacificació del cristal·lí impedint una visió nítida. Conseqüentment, la cataracta és una de la deficiències visuals més estesa a partir dels 60 anys, afectant a la meitat de la població entre els 75 i els 85 anys . La única solució per eliminar les cataractes és eliminant les fibres opacificades i substituir-les per una lent intraocular quirúrgicament. Donat que tots els pacients amb cataractes són, a la vegada, prèsbites, està justificat que un nombre de pacients decideixi implantar-se lents intraoculars multifocals per substituir el seu cristal·lí. D'aquesta manera es solucionen dues degeneracions associades a l'edat en una sola cirurgia. Els joves prèsbites acostumen a optar per correccions prèsbites temporals, mentre que molts dels prèsbites amb cataractes opten per solucions permanents. Algunes de les correccions de la presbícia, com les lents de contacte o intraoculars multifocals , estan basades en el principi de visió simultània. Els dissenys òptics d'aquest tipus de lents són molt complexos, cosa que fa que la seva caracterització sigui molt complicada. Quan aquestes lents van aparèixer al mercat, només era possible caracteritzar-les òpticament abans de la seva implantació o adaptació de manera in vitro, i de caracteritzar-les visualment després de la seva adaptació o implantació de manera in vivo. Actualment, i gracies a tots els avenços tecnològics, diferents instruments clínics han estat desenvolupats per realitzar mesures de les qualitats visuals abans de la seva implantació. Tots ells, es basen en simular-li al pacient la visió que tindria després de ser implantat. Per un altre cantó, alguns prototips experimentals iaberrometres o sistemes de doble-pas comercials han estat utilitzats per dur a terme la caracterització de la qualitat in vim en pacients implantats o adaptats amb sistemes multifocals, pero diferents problemes han estat plantejats. Tenint en compte tota aquesta informació, el principal objectiu d'aquesta tesi ha estat la de dissenyar i muntar un nou sistema de doble-pas d'enfocament asimètric de camp obert que fos capaç de fer una caracterització de la qualitat òptica in vivo de pacients implantats o adaptats amb lents de contacte o intraoculars multifocals. I per arribar a aquest objectiu, s'han dut a terme els següents passos: Revisió de les correccions per a la presbícia i caracterització d'elles (Estudi clínic de la sobre-refracció objectiva de pacients adaptats amb lents de contacte multifocals); Validació de la capacitat de mesura d'un simulador comercial (Estudi clínic amb el simulador comercial VirtlOL (1OLens S.L); Disseny i muntatge del sistema de doble-pas amb enfocament asimètric (Disseny opto-mecànic/ Validació de tots els components del sistema/ Validació òptica del sistema); Programació dels programes informàtics que gestionen el sistema i processe

Provision of spectacle lens correction to elderly people at risk of falls

Falls have a major impact on the quality of life of fallers and on the health and social economy of the nation. An evidence base of predominantly laboratory studies exists, which suggests bifocal and progressive addition lens designs increase falls risk. Findings either lacked discrimination between bifocal and progressive addition lenses, were not powered to differentiate between them, or were based on the premise that gaze direction when walking or using stairs is through the lower, near powered zones. This has led to single vision lenses being recommended to those at falls risk. The primary aim of the studies described in this thesis was, therefore, to investigate whether field trials in the form of a retrospective case control and a prospective cohort study of community-dwelling elderly persons supported previous recommendations. A survey of GOC registered optometrists and dispensing opticians was undertaken before the main study. Single vision lenses were the lens design of choice for patients deemed at risk of falls.The main study uniquely differentiated between single vision, bifocal and progressive addition lenses in a UK-based population study of well habituated wearers. A measure of visual attention (Global Measure of Vision) was designed and evaluated specifically for the study. Established “Timed up and Go” and SF12v2 provided measures of participants’ balance, mobility, and physical and emotional wellbeing. Logistic regression analysis showed no variable demonstrated statistically significant influence on falls risk in the retrospective study, including spectacle lens design. In the prospective study, previous fall history was the only significant predictor of falls (Odds Ratio: 2.71, p = .01), aligning with levels reported in a recent meta-analysis. This study did not confirm that bifocal or progressive addition lens wear increases falls risk in well-habituated community-dwelling older people, and indicates that changing to single vision lenses may not be necessary

Aberraciones cromáticas, monocromáticas y diseños multifocales: interacción e impacto en la visión

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Óptica y Optometría, leída el 21/01/2021An important part of the information that we receive from the world is through the sense of vision: the eye projects images on the retina, which transforms them into nerve impulses that reach the neuronal cortex, where these impulses are interpreted. However, the images projected onto the retina are not perfect, as they are affected by diffraction, scattering, and aberrations, which degrade contrast and decrease the resolution limit of the eye. To understand the effect of aberrations on vision, it is necessary to develop technologies and experiments that allow objectively and subjectively assess their interaction. In this sense, Adaptive Optics (AO) has played an important role in increasing our knowledge about the neural processes of vision, since AO can be used to measure, correct and induce aberrations. Understanding what role aberrations play and what their impact is on vision will help to develop better correction designs for the eye. The manipulation of the wavefront using AO also allows to induce a certain visual correction, so it can be used as a basis for visual simulators. As AO allows studying a new lens design or comparing across different lens designs even before they are manufactured, this is an excellent tool to test and improve optical corrections before they are implanted in the eye of a patient. Different technologies including deformable mirrors (DM), spatial light modulators (SLM), or temporal multiplexing by an optotunable lens (SimVis), are currently being validated and launched into the clinical practice. In this thesis, AO technologies have been implemented and used both to study the effect of aberrations and to cross-validate different simulator modalities...Una importante parte de la información que recibimos del mundo lo hacemos a través del sentido de la visión: el ojo proyecta las imágenes en la retina, la cual las transforma en impulsos nerviosos que llegan hasta el córtex neuronal, donde se interpretan estos impulsos. Sin embargo, las imágenes proyectadas en la retina no son perfectas, ya que están afectadas por la difracción, la dispersión y las aberraciones, que degradan el contraste y reducen el límite de resolución del ojo. Para entender el efecto de las aberraciones en la visión es necesario desarrollar tecnologías y experimentos que permitan valorar objetiva y subjetivamente su interacción. En este sentido, la Óptica Adaptativa (AO) ha jugado un papel importante en el incremento de nuestro conocimiento acerca de los procesos neuronales de la visión, ya que la AO se puede utilizar para medir, corregir e inducir aberraciones. Comprender qué papel juegan las aberraciones y cuál es su impacto en la visión, ayudará a desarrollar mejores diseños de corrección para el ojo, sin embargo, aún no se entiendo completamente. La manipulación del frente de onda mediante AO permite, además, inducir una cierta corrección visual, por lo que se puede utilizar como base de simuladores visuales. Estudiar un nuevo diseño o comparar varios diseños entre ellos antes incluso de que sean fabricados, plantea la AO como una excelente herramienta para probar y mejorar una corrección antes de que sea implantada. Para ello, diferentes tecnologías como los espejos deformables, los Moduladores Espaciales de Luz (SLM), la multiplexación temporal inducida por una lente optoajustable (SimVis), están siendo en la actualidad validados y lanzados a la práctica clínica. En esta tesis se ha utilizado la AO tanto para estudiar el efecto de las aberraciones como comparar diferentes simuladores visuales...Fac. de Óptica y OptometríaTRUEunpu