WO2013105915A1 - Système permettant une imagerie ophtalmique - Google Patents

Système permettant une imagerie ophtalmique Download PDF

Info

Publication number: WO2013105915A1
Authority: WO; WIPO (PCT)
Prior art keywords: display; image; images; ophthalmic device; eye
Prior art date: 2011-12-01
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.): Ceased

Application number

PCT/US2011/062866

Other languages

English (en)

Inventor

Jean-Marie A. Parel

Donald BUDENZ

Cornelis ROWAAN

William Lee

Alex GONZALEZ

Derek NANKIVIL

Mariela Caridad AGUILAR

Jagadeesh BANDI

Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)

University of Miami

Original Assignee

University of Miami

Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)

2011-12-01

Filing date

2011-12-01

Publication date

2013-07-18

2011-12-01 Application filed by University of Miami filed Critical University of Miami

2011-12-01 Priority to PCT/US2011/062866 priority Critical patent/WO2013105915A1/fr

2013-07-18 Publication of WO2013105915A1 publication Critical patent/WO2013105915A1/fr

2014-06-01 Anticipated expiration legal-status Critical

Status Ceased legal-status Critical Current

Classifications

- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
- A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
- A61B3/13—Ophthalmic microscopes
- A61B3/135—Slit-lamp microscopes
- G—PHYSICS
- G02—OPTICS
- G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
- G02B30/00—Optical systems or apparatus for producing three-dimensional [3D] effects, e.g. stereoscopic images
- G02B30/20—Optical systems or apparatus for producing three-dimensional [3D] effects, e.g. stereoscopic images by providing first and second parallax images to an observer's left and right eyes
- G02B30/34—Stereoscopes providing a stereoscopic pair of separated images corresponding to parallactically displaced views of the same object, e.g. 3D slide viewers
- G02B30/36—Stereoscopes providing a stereoscopic pair of separated images corresponding to parallactically displaced views of the same object, e.g. 3D slide viewers using refractive optical elements, e.g. prisms, in the optical path between the images and the observer
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H30/00—ICT specially adapted for the handling or processing of medical images
- G16H30/20—ICT specially adapted for the handling or processing of medical images for handling medical images, e.g. DICOM, HL7 or PACS
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices

Definitions

the present invention relates to ophthalmology, and more in particular, teleophthalmology and telemedicine in a manner that achieves optimized and clinically operative diagnostic and viewing capabilities by providing a practitioner ( s ) in a remote location a dynamic high quality and high resolution stereoscopic image of a patient's eye in real time while interviewing the patient.
a slit-lamp biomicroscope In ophthalmology, a slit-lamp biomicroscope is generally used as a fundamental diagnostic device to view and assess the anterior and posterior segments of the eye.
examination with a slit-lamp biomicroscope must be performed by a specialist, such as an ophthalmologist or optometrist, in person. That is to say, the specialist performing the examination and the patient must be at the same location since the specialist must be able to view into the eye of the patient with sufficient detail and clarity to perform the diagnosis.
telemedicine is a growing field utilizing information technology and telecommunications to provide health care from a distance. Although in a limited manner, this type of care has sought to be applied to the ophthalmology field as well.
teleophthalmology is the use of telecommunications to provide ophthalmological care at a distance.
the common approach to teleophthalmology is to capture still or video ,images of the patient acquired on-site by a technician who is familiar with the functions and purpose of a diagnostic device, such as a slit-lamp. These images are then subsequently sent minutes or days later to a different location to obtain a diagnosis from a practitioner and/or specialist, such as an ophthalmologist.
a well trained technician may fail to acquire pertinent images upon examination, may not obtain sufficient views needed for examination, or may acquire images having anomalies and/or artifacts which result in a failed or erroneous diagnosis, and/or which require follow up examination.
a remote operator is able to alter the angle between the stereo-microscope and the slit-lamp, a crucial function for adequate ophthalmic examination, and/or is able to control most if not all of the slit parameters (height, width, intensity) and the biomicroscope magnification changer, all functions that are necessary for adequate examination of details in the structures of the eyelid, eyelashes, conjunctiva, limbus, cornea, anterior chamber (cell/flare), its angle, the iris and the crystalline lens or artificial intraocular lens if the patient had undergone cataract extraction with intraocular lens (IOL) implantation .
IOL intraocular lens
Stereoscopy or the viewing of images or objects as three- dimensional, can be achieved through side-by-side stereoscopy or shared viewing stereoscopy.
the less common and much more rarely used type of viewing is side-by-side stereoscopy wherein the two images are displayed next to each other, and a stereoscopic (three-dimensional) image is seen by simply looking at the space between the images and letting the eyes relax, called free viewing, or with the use of a prismatic viewer which forces the two images to fuse into a single three-dimensional image.
the most common type of three dimensional viewing utilized is shared viewing stereoscopy, which requires the processing and overlay/overlap of the two images coupled with a filtration type viewer.
shared viewing each eye sees only one image as a result of a different filter being placed over each eye.
passive shared viewing the two images are projected through polarizing filters and are ⁇ superimposed on a screen, and an observer must utilize eyeglasses containing similarly polarizing filters to see the image.
Another passive shared viewing technique involves the commonly known anaglyph, an image made from the superimposition of two images of different colors, wherein complementary filters are worn by each eye to see the three-dimensional image.
Interference filters may' also be used, dividing the images up into two sets of narrow bands of different colors, one set for each eye.
Active shared viewing on the other hand, such as is employed in many commercially available "3-D" televisions, utilizes liquid crystal shutter glass to block and pass light in synchronization with the images on the screen .
a remotely operated ophthalmic device such as a slit-lamp biomicroscope that can enable examination in three- dimensional stereoscopy in real time, thus allowing the practitioner to identify contrasts and adjust their view to maximize their ability to identify aspects that are often difficult or impossible to discern from static images.
the present invention is directed to a system for ophthalmic imaging employing an ophthalmic device controlled over a network and utilizing stereoscopic, or three-dimensional, images.
the system can be used remotely by a practitioner or a plurality of practitioners simultaneously to dynamically control every aspect of an ophthalmic device in real-time over the network, capture three-dimensional images of the patient's eye(s), view those images, and verbally interact with the patient, all in real-time, and thereby conduct an eye exam on at least a portion of an eye, so that they may vary and refine images as they deem optimal to achieve the diagnosis.
the system for ophthalmic imaging of the present invention comprises an ophthalmic device structured to obtain at least two images of at least one eye of a patient and to transmit the images to a practitioner ( s ) who is at a predetermined location.
the predetermined location can be in the same room, although preferably is remotely located, such as in another room, building, city or state, or even another country from the patient being examined.
the system further comprises a control device disposed at each predetermined location and operatively connected in controlling relation to the ophthalmic device. Included as part of the control device is at least one control member.
the practitioner ( s ) uses the control member (s) to control the various components of the ophthalmic device, described in greater detail hereinafter, so as to achieve a desired image.
the control device communicates control messages generated at the direction of an operator, preferably the practitioner, to the ophthalmic device over a network, such as a computer network, in substantially realtime .
the display is structured to receive and display the images obtained by the ophthalmic device for viewing by the practitioner ( s ) .
the image generated by the display is sufficient to allow a stereoscopic or three dimensional image to be viewed by the practitioner ( s ) .
the practitioner ( s ) utilize a corresponding viewer through which the display is viewed and which results in the practitioner ( s ) seeing a three dimensional image.
the image data is preferably communicated to the display, either directly or indirectly through a processor associated with the display, via a network.
the practitioner can discern if peculiarities of the image are artifacts, such as air bubbles, or aspects of the patient's eye, such as a cellular flare, inflammation, particle aggregates, abnormal cells, plasma and or hemorrhages and other moieties as well as damaged structures in the depth of the eye's transparent tissues such as the cornea, anterior chamber and the lens.
artifacts such as air bubbles
aspects of the patient's eye such as a cellular flare, inflammation, particle aggregates, abnormal cells, plasma and or hemorrhages and other moieties as well as damaged structures in the depth of the eye's transparent tissues such as the cornea, anterior chamber and the lens.
the ophthalmic device in at least one embodiment it comprises an optic assembly disposable in viewing relation to the eye of the patient, at least one image capturing member, and a processing assembly disposable in operatively communicating relation to at least the image capturing member.
the ophthalmic device is a slit lamp biomicroscope including a positioning assembly, a slit assembly, an optic assembly, and an associated processing assembly.
the positioning assembly of the ophthalmic device is operative to adjust the position of the ophthalmic device in three dimensions, as well as to adjust all of the other parameters of the ophthalmic device.
it preferably comprises at least a first positioning member structured and disposed to position the ophthalmic device in a plurality of operative orientations along a first plane (such as along x-y axes) and a second positioning member structured and disposed to position the ophthalmic device in a plurality of operative orientations along a second plane (such as a z axis) .
the slit assembly is structured and collectively disposed to adjust at least one dimension of a slit of the ophthalmic device.
the slit assembly comprises adjustment members to adjust the slit width, height, and angle, as well as the lamp intensity and magnification of the ophthalmic device.
the optic assembly further comprises a magnifying objective associated with the image capturing member such that the image data of the at least one eye of the patient can be captured at an appropriate magnification.
the optic assembly therefore, is disposable in observing and image-obtaining relation to the eye of a patient.
the processing assembly associated with the ophthalmic device is configured and disposable to receive image data from the optic assembly. It includes transmission capabilities operative to transmit image and audio data, receiving capabilities operative to receive control messages from a control device over the network, and relay capabilities operative to relay the control messages and audio data to the various appropriate components of said ophthalmic device.
the present invention is further directed to a system for optimized stereoscopic viewing at various distances by one or more practitioners (In this regard, practitioners may be defined as trained medical personnel, students and/or other individuals who have a reason to view the images of the eye and recognize diagnostic characteristics) .
the display is preferably of sufficient size to allow for one or more practitioners to view the display simultaneously at a common location, each using their own or a shared viewer disposable at a predetermined distance from the display.
each viewer is preferably configured and operative for optimized stereoscopic viewing of the image (s) on the display at a certain distances .
the viewer comprises at least one prism having a prism angle, wherein the prism angle corresponds the predetermined distance from the viewer to the display and the size of the images presented so as to attain optimal viewing from that predetermined distance.
a high power prism is provided for viewing larger images or for shorter distances between the viewer and the display.
the system for optimized stereoscopic viewing includes a plurality of operative predetermined distances between the displayed image (s) and the one or more viewers.
the viewer may be disposable at a first predetermined distance from the display at which stereoscopic viewing of the image (s) is enabled or at a second predetermined distance from the display, for purposes of the example the first predetermined distance being less than the second predetermined distance.
a practitioner can utilize one viewer, or a viewer in a first adjustable configuration at a first predetermined distance, such as a close range as in front of a computer or control device where the image presented is small, such as to perform an eye examination of a patient as described above, or in the first few rows of an auditorium or a viewing room.
the same viewer can also be used by a person at a second predetermined distance, such as a long range as in an auditorium or at a presentation where the image presented is large, such as in an instructional and training capacity. However, it is preferred that a second viewer and/or an adjustment to the viewer be achieved to provide a different prism angle determined by the viewing conditions .
the present system may be used when it is impractical and/or unrealistic to get an ophthalmologist to a patient, or vice versa, such as: in emergency situations where travel time is prohibitive; when the patient is in a remote location such as a rural locale and/or places of restricted access such as military and combat zones; when the patient is quarantined for health or safety reasons, such as contagious infected individuals or prison inmates.
the present system is also useful for joint consultations, such as when multiple opinions are desired, as well as for presentation to a large number of people at once, such as in instruction and training during a seminar or class .
Figure 1 is a schematic representation of the system for ophthalmic imaging of the present invention.
Figure 2A is a perspective view of one embodiment of the viewer of the present system.
Figure 2B is a perspective view of another embodiment of the viewer of the present system.
Figure 3 is a perspective view of the ophthalmic device of the present system.
Figure 4 is a perspective view of the optic assembly of the ophthalmic device of Figure 3.
Figure 5 is a side view of the ophthalmic device of Figure 3 disposed in relation to a patient.
Figure 6A is a perspective view of the slit width adjustment member of the slit assembly of the ophthalmic device of Figure 3.
Figure 6B is a perspective view of the slit height adjustment member of the slit assembly of the ophthalmic device of Figure 3.
Figure 6C is a perspective view of the slit angle adjustment member of the slit assembly of the ophthalmic device of Figure 3.
Figure 6D is a perspective view of the magnification control of the slit assembly of the ophthalmic device of Figure 3.
Figure 7 is a diagram of one embodiment of the display of the present system.
Figure 8 is a schematic representation of a system for optimized stereoscopic viewing of the present invention.
Figure 9 is a schematic representation of the stereoscopic viewing of Figure 8 optimized for distance viewing.
Figure 10 is a schematic representation of the prism angle.
the present invention is directed to a system for ophthalmic imaging employing an ophthalmic device controlled over a network and utilizing stereoscopic, or three-dimensional, images.
the system for ophthalmic imaging 100 comprises an ophthalmic device 10 structured to obtain stereoscopic images of at least one eye of a patient and to transmit these stereoscopic images to at least one practitioner at a predetermined location (s) so that the practitioner ( s ) may view a true three dimensional image of the eye.
the system 100 further comprises a control device 20.
the control device 20 is preferably also disposed at the predetermined location (s) and is connected in communicative relation with the ophthalmic device 10 over a network 30, such as a computer network and/or the Internet, so as to provide for effective control and manipulation of the ophthalmic device 10 as needed and directed by the practitioner ( s ) .
a network 30 such as a computer network and/or the Internet
the system 100 comprises at least one, but preferably a plurality of predetermined locations of the control device (s) 20 defined as the location where the practitioner ( s ) , who will preferably be operating .the control device 20, are present, and as such, are preferably locations that are separate and distinct from the location of the ophthalmic device 10, as well as from other practitioners. For example, one practitioner or a plurality of practitioners at disparate locations can simultaneously view and interact with the patient, as well as converse with each other.
any of the practitioners involved in remote examination utilizing the present invention may take control of and direct the movements of the ophthalmic device 10 at any time during the examination through the use of their respective control device 20, as described in greater detail hereinafter. Therefore, in preferred embodiments the practitioner ( s ) will be in a position to directly operate the control device 20, and as such both the practitioner ( s ) and the control device (s) 20 will be at a remote location (s), whether a few feet away from the ophthalmic device 10, in a different room or building from the ophthalmic device 10, or an entirely different state, country or continent.
the predetermined location may be the same location as that of the ophthalmic device 10 such that an operator controls the control device 20 at the direction of a practitioner.
each control device 20 is disposed in controlling relation to the ophthalmic device 10, such that a practitioner ( s ) , using the control device 20, can direct changes in the positioning and parameters of the various components of the ophthalmic device 10, as will be described in greater detail subsequently, thereby achieving the optimal views and images of the eye that they require.
the control device 20 includes a computer processor such as a desktop computer, a laptop, portable or mobile device such as a tablet or smartphone, or any other processor capable of receiving control inputs and audio data and communicating those in the form of control messages via a network to the ophthalmic device 10.
the display 21 is Operatively associated with the control device 20, and preferably at the same location as the control device 20 is at least one display 21 configured to present image data received from the ophthalmic device 10.
the display is sized appropriately to the viewing environment desired by the practitioner ( s ) .
the display 21 comprises a video monitor while in other embodiments, the display 21 comprises a screen that can receive a projected image thereupon, such as in an auditorium, classroom, or other appropriately sized screen for displaying the image to multiple people at once, as depicted schematically in Figure 9.
the display 21 is smaller, such as the screen of a laptop computer, tablet, smartphone, or other portable computing device.
the control device 20 further comprises at least one control member 22 having directing capabilities operative to control movement of the ophthalmic device 10 and its various components. Accordingly, the control device 20 also comprises software and/or firmware to interpret the movements and inputs of the control member 22 and convert such movements into control messages to be sent over the network 30 to direct movement of the ophthalmic device 10, as needed by the practitioner ( s ) . For example, individual or collective multi-step control messages are directed to the various different components of the ophthalmic device 10, such as to move the entire device in a particular manner, or to move one component in a particular manner, as described in further detail below.
the control member 22 comprises a keyboard, wherein different keys on the keyboard initiate different control messages to perform different functions.
the control member 22 may comprise, instead of or in addition to a keyboard, a joystick type control which is used to direct movement of the ophthalmic device 10 by moving the joystick in certain directions, and which may also include a number of buttons or inputs which may be selected to achieve certain functions and/or mark locations for comparative, recall or other purposes.
the control member 22 may comprise a mouse instead of or in addition to a keyboard and/or joystick, wherein movement of the mouse in particular directions and clicking of mouse buttons directs movement to adjust the ophthalmic device 10.
control members 22 can be used in the same embodiment, separately or in conjunction, and any of a variety of available or to be developed inputs, including voice command input devices, simulators or other input devices, could also be used independently and/or in conjunction with one another. Further in the case of multiple control members 22, each can be assigned different functions and/or some degree of overlap can be provided with either the practitioner and/or a set command priority dictating the control message and the resultant adjustment of the ophthalmic device 10. Regardless of the embodiment, the control membe (s) 22 is operable by a practitioner located at the control device 20 to direct movement of the ophthalmic device 10 regardless of the location of the ophthalmic device 10 relative thereto.
the control device 20 preferable utilizes a network to communicate the control messages to the ophthalmic device 10,- and to receive images generated by the ophthalmic device 10.
the network 30 utilized by the present system is a computer network, and as such may be a private or public network.
the network 30 may comprise an intranet, local area network (LAN), wide area network (WAN), Internet, Wi-Fi, Bluetooth, or other connection between devices structured for the transmission of data.
connections to the network 30 can be hardwired, such as through USB, Ethernet, or other connections achieved by physical tangible structure, or may be wireless, such as through wireless Internet connection, Wi-Fi, Bluetooth, satellite, etc.
the data contemplated to be transmitted over the network 30 in the present system 100 comprises information from the ophthalmic device 10 and information from the control device 20.
Data from the ophthalmic device 10 includes at least image data of at least one of the patient's eyes, although additional image data such as positional image data of the patient, audio of the patient such as his/her responses to questions and directions from a practitioner ( s ) , interface information such as may be generated by software utilized in the system 100 for the capture and presentation of patient information, and even patient biographic, demographic, and background material, such as patient identifying information and may be found and/or stored in a patient's individual file or chart.
Data from the control device 20 includes control messages such as discussed above, audio of the practitioner ( s ) directed to the patient or other practitioners, and other commands. Accordingly, the network 30 is operative to facilitate transmittal of data, such as image and audio data and control messages between the ophthalmic device 10 and the control device 20.
the image data communicated by the ophthalmic device 10 comprises at least one, but preferably two images of the same eye of a patient captured substantially simultaneously by the ophthalmic device 10 for transmission to and displayed on the at least one display 21 associated with the control device 20 such that a practitioner located at the control device 20 can see a three-dimensional stereoscopic image of the patient's eye.
one display may be provided at the control device and another for viewing by the practitioner.
a secondary display can be included such as when multiple people or practitioners are viewing the images but only one practitioner is controlling the ophthalmic device 10, such as in a lecture or instructional setting.
the image data can further comprise additional images of the patient, such as providing positional information of the patient in relation to the ophthalmic device 10 and/or positional information regarding the ophthalmic device.
the preferred embodiment of the present system 100 comprises side-by-side binocular fusion stereoscopy so as to achieve the maximum possible resolution and clarity of the image, and also to produce images that even if not viewed utilizing a corresponding viewer for stereoscopic diagnosis are still clear and viewable.
stereoscopic images including offset polarized images, multi color images and/or other types of 3-D imaging as may be developed, may also be utilized and communicated to correspondingly configured displays capable of displaying such images for three dimensional viewing utilizing corresponding integral, separate or wearable viewers.
overlapping image types of stereoscopic viewing must split resolution over the two images and are often difficult to view and/or are distorted if not viewed using a specific viewer from a specific angle.
a binocular fusion type of stereoscopic image is presently preferred in the present invention.
the image data from the ophthalmic device 10 includes high-definition resolution video.
high-definition means higher than standard or traditional definition.
high-definition may be 720p, which is a resolution of 1,280 x 720 pixels.
high-definition may also be 1080p, which is a resolution of 1,920 x 1,080 pixels and/or improved levels of definition as may be available and/or developed.
the high resolution allows the practitioner to discern the presence of cells and/or flare in the anterior chamber of the eye of a patient. It is contemplated that the image data of the patient's eye, and in particular each of the two preferred images have high- definition resolution.
image data of patient positional information may or may not be high-definition resolution.
the image data may be compressed and/or encoded into a single multiplexed signal comprising video, audio, and other data, such as with a hardware video encoder, in order to lower bandwidth requirements for transmission.
the data is then transmitted over the network 30, such as at a rate of 15 frames per second and/or other acceptable rates of transmission that the network can accommodate.
the ophthalmic device 10 is preferably configured to generate and transmit the image data over the available network 30 in substantially real-time relative to data generation, thus providing the practitioner ( s ) with the closest approximation to in-person viewing of the patient's eye. For example, as soon as images of the patient's eye are captured by the ophthalmic device 10, they are relayed to the display 21 for viewing by the practitioner ( s ) . Similarly, as soon as control messages are generated by a control member 22, they are sent to the ophthalmic device 10 which reacts to the control messages upon receipt.
substantially real-time means as close to instantaneously as possible, and is limited only by the limitations of the network and the speed of the processors in the ophthalmic device 10 and control device 20. For example, transmission may be slightly delayed due to the distance covered or the bandwidth available on the network 30. Similarly, transmission may be slightly increased with faster processors used in the ophthalmic device 10 and/or control device 20. However, it should be appreciated that “substantially real-time” means as near in time to the generation of the data as feasible. Accordingly, the network 30 facilitates real-time transmission of data and information, such that at least a portion of an eye examination can be conducted remotely as if the practitioner ( s ) were in the same room as the patient.
the system 100 further comprises a viewer 40 structured for stereoscopic viewing of the one or more images displayed on the display (s) 21.
the viewer 40 is mountable relative to the practitioner, wearable by the practitioner, and/or otherwise capable of being at least temporarily associated with the practitioner to enable viewing there through.
the viewer 40 is mountable to the head of a wearer through the use of a mounting assembly 43.
the viewer 40 comprises glasses that may be worn on a practitioner's head.
the viewer 40 can be hand-held by a practitioner during use.
the viewer 40 comprises at least one prism 42 to enable the combination of two images into a fusion three- dimensional image.
the preferred pair of prisms 42 are configured to direct one of the two images to each eye in a manner wherein each eye generally views only a single image and wherein the prisms 42 direct the images onto the eye in a manner that causes the two images to appear in the generally same place and thereby provide the stereoscopic appearance required by the practitioner ( s ) to effectively view the depths of the patient's eye and properly diagnose certain conditions.
the prism 42 may comprise any one of a multitude of different prism angles, as will be described in greater detail subsequently, and different viewers 40 may comprise different prisms 42 with different prism angles for various viewing requirements, such as dependent upon the size of the display 21 and/or the distance from the viewer 40 to the display 21.
the viewer 40 comprises two prisms 42, one prism 42 on each lens.
the prisms 42 which should each substantially cover one eye of the examiner or practitioner, are spaced apart, having an interpupillary distance varying from generally about 5.2 centimeters to 7.9 centimeters, with 5.4 centimeters being one example of optimal spacing.
the ophthalmic device 10 is structured to obtain and transmit at least two images of at least one eye of a patient for the purpose of generating a stereoscopic image for the practitioner to view.
ophthalmic device 10 is a biomicroscope, such as a microscope used to study living tissue, and may incorporate a slit lamp, as described in greater detail hereinafter, for eye examination and diagnosis of certain eye conditions.
the ophthalmic device 10 minimally comprises an optic assembly 50 disposable in viewing relation to the eye of the patient and a processing assembly 60 disposable in operatively communicating relation to at least the optic assembly 50. More in particular, the optic assembly 50 is disposed in observing and image-obtaining relation to at least one eye of a patient, so as to collect image data of the eye and transmit this image data to the processing assembly 60. Accordingly, the optic assembly 50 can take the place of or supplement the binocular lenses in a traditional biomicroscope, capturing a magnified image of the eye rather than merely magnifying it for direct viewing.
the processing assembly 60 is configured and disposable to receive image data from the optic assembly 50, and further comprises transmission capabilities operative to transmit the image data, such as to the display 21 via the network 30.
the optic assembly 50 comprises at least one image capturing member 51 structured to receive, capture and/or obtain the image data of the eye of a patient.
the image capturing member 51 comprises a camera, such as a video camera, which may be digital and is preferably a high-definition camera capable of acquiring high-definition video of the eye.
the image capturing member 51 may be a high resolution half inch color CMOS camera (NT59-367, Edmund Optics, Barrington NJ) , coupled to a 25 millimeter diameter, 50 millimeter focal length aspherized achromatic relay lens.
CMOS camera NT59-367, Edmund Optics, Barrington NJ
An additional example of a comparable camera is model UI-1460SE-C from IDS, Woburn,MA.
the invention is not, however, limited to the above example, but can comprise any number of cameras and lenses appropriate for obtaining high resolution and/or stereoscopic images.
different sized cameras and relay lenses can be used in various embodiments.
various heights (h) and focal lengths (f r ) of the relay lens are possible, as reported in the table below in millimeters:
the optic assembly 50 comprises a plurality of image capturing members 51, each disposed to obtain image data of the same eye from different perspectives, in order to allow for the generation of the stereoscopic image.
the optic assembly 50 comprises a first image capturing member 51' and a second image capturing member 51'', each disposed to receive image data of an eye from different objective lenses.
the optic assembly 50 comprises a first objective lens 52' and a second objective lens 52'' disposed in facing relation to a patient, such that an image of a patient's eye enters the optic assembly 50 through the first and second objective lenses 52' and 52''.
the first and second objective lenses 52' and 52'' are separated by a distance a, such as in the range of 21.7 millimeters to 21.9 millimeters, and preferably 21.8 millimeters, although other distances are possible as long as the images of the patient's eye may be obtained.
distance a is measured from the inner edges of the first and second objective lenses 52 ' , 52 ' ' .
distance a is measured from the center of the first and second objectives 52', 52''.
the optic assembly 50 may further comprise at least one beam splitter, such as a Zeiss prismatic beam splitter, structured to redirect the light, and therefore image data, entering the first and second objective lenses 52', 52'' to the first and second image capturing members 51', 51'', respectively, for image data capture and transmission.
the image capturing member 51 can be said to be interactive with the objective lens 52 to capture the image data of an eye. Accordingly, the first image capturing member 51' will capture and transmit a slightly different image from that captured and transmitted by the second image capturing member 51'', thus creating a stereoscopic image.
each image capturing member 51', 51'' obtains and transmits high-definition images, which may be encoded and/or multiplexed for more efficient transmission, and which may be combined at the ophthalmic device and/or at the display 21, although as noted, in the preferred embodiment each image is maintained separate and displayed independently such that a three dimensional image is attained by a fusion technique using the appropriate viewer.
the present system 100 permits a higher degree of quality and contrast in the live stereoscopic images, which enables accurate examination, stereopsis, and diagnosis.
the high-definition stereoscopic live image data of the present system 100 allows for a practitioner to, by way of example only and not limiting in any way: discern details in the structure of the eyelid, eyelashes, conjunctiva, limbus, cornea, anterior chamber, cells, flare, the iris, crystalline lens or artificial lens in the case of patients with cataract extraction and intraocular lens (IOL) implantation; discriminate particle aggregates; determine abnormal cells, abnormal growth such as in the case of nevus, tumors, and any thickness abnormalities in the tissues; identify plasma or hemorrhages and other moieties; discern damaged structures in the depth of an eye's transparent tissues, such as the cornea, anterior chamber, and lens; determine iris and cornea touch by the proximal tube of a glaucoma drainage implant; assess the postoperative status and health of implants, such as corneal transplants
the optic assembly 50 further comprises a fixation assembly 53 having directing capabilities to direct and maintain a patient's visual focus, so as to position the patient's eye appropriately for examination.
the fixation assembly 53 comprises at least one light source 54 disposable to direct a patient's eye during use.
the light source 54 is a light emitting diode (LED) , although other embodiments contemplate other types of light sources .
the light source 54 is structured to emit light in the visible range, and can emit light in any of a variety of colors . In some embodiments, the light source 54 emits light in a constant, uninterrupted fashion.
the light source 54 emits light in discreet packets, such as in flashes, bursts, ⁇ or blinking fashion, and may emit light in a particular pattern.
the fixation assembly 53 comprises a plurality of light sources 54, in which the various light sources 54 are structured to emit light of different colors and/or at different times, such as in a pattern, in order to facilitate the examination and direct the patient's eye to different positions during the examination, thus enabling a view of different portions of the eye.
the processing assembly 60 of the ophthalmic device 10 comprises hardware and software for operating the ophthalmic device 10, converting and transmitting data from the ophthalmic device 10 to the control device (s) 20 at any of a plurality of locations, for receiving, converting, and relaying control messages from the control device (s) 20 to the appropriate component parts of the ophthalmic device 10, and as needed, to provide control feedback to the control device (s) 20.
the processing assembly 60 comprises a computer processor, such as one including at least a central processing unit (CPU), a motherboard, memory, hard drive, and power supply, as in a typical computing device.
CPU central processing unit
the processing assembly 60 may comprise a plurality of computers and/or computing devices cooperatively disposed to maintain and transmit real-time image data and receive and relay control messages, as well as power the ophthalmic device 10.
a plurality of computing devices comprising the processing assembly 60 are multi-threaded to split the computational requirements among resources and thus speed the generation, processing and/or transmission of the real-time high definition images, while also achieving substantially real-time control of the parameters of the ophthalmic device 10 without any lag or delay.
the processing assembly 60 can comprise hyper-threading technology to disperse the multiple processes.
the power supply of the processing assembly 60 provides the power to run and operate the ophthalmic device 10.
the processing assembly 60 comprises a power stabilizing assembly including a sine wave converter and batteries.
the power stabilizing assembly comprises a 1500W pure sine wave converter (S1500-112B22, DonRowe Co., Monroe OR) and a plurality of 12V deep cycle batteries (D34M, Optima Batteries Co., Milwaukee WI ) .
the power stabilizing assembly can include four deep cycle batteries. Accordingly, the power stabilizing assembly is structured to maintain constant power to the ophthalmic device 10, even in remote locations where the power supply may be unstable, such as in a tactical location and/or an under developed location.
the power stabilizing assembly can also include a battery charger, such as a heavy duty battery charger (PM-42020, TurtleMarine.com Ltd., New York NY), which can be used in conjunction with a local AC supply to recharge the batteries.
the processing assembly 60 is configured and disposable in receiving relation to data from the rest of the ophthalmic device 10, such as the image data from the optic assembly 50.
the processing assembly 60 and the at least one image capturing member 51 are connected by a cable to facilitate the transmission of image data from the image capturing member 51 to the processing assembly 60.
Such connection cable has ' specifications sufficient for the rapid transmission of large amounts of data, such as high definition video.
each image capturing member 51', 51'' connects to the processing assembly 60 independently.
each image capturing member 51', 51'' connects separately to the processing assembly 60, although it is contemplated that in other embodiments they may be connected in series or combined for unified transmission before being received in the processing assembly 60.
the processing assembly 60 includes a video encoder structured to combine the image data from the image capturing member (s) 51, 51', 51'' as well as other data, such as video and/or audio data from an external data capturing member 55, discussed in greater detail hereinafter, and an interface 23 into a single multiplexed stream.
“multiplexing” means the sending of multiple signals or streams of information on a carrier at the same time in the form of a single complex signal.
the video encoder comprises a CUBE-200 (Teradek, Irvine CA) using a H.264 High Profile (Level 4.1) video compression and including a video scaler to convert from 1080 to 720, 480, or 240 resolutions.
the image data is transmitted by the processing assembly 60 to the control device (s) 20, where it is presented on the associated display 21.
the image data from the image capture member (s) 51 can simply be transmitted by the processing assembly 60 as it is received. Regardless of the embodiment, however, the processing assembly 60 transmits in the aforementioned image data in real-time.
the transmission capabilities of the processing assembly 60 comprise an end-to-end latency, or lag time, of approximately one-eighth to one half of a second and facilitate the transmission of high-resolution image data at a bit rate in the range of about 2 to 4 megabytes per second.
the transmission capabilities of the processing assembly 60 facilitate the transmission of standard definition resolution image data, such as at a bit rate of approximately one megabyte per second or less. It should be appreciated that the above are approximate rates and times, and may vary slightly above or below the stated outer limits, such as by ⁇ 10 kilobytes per second or 5%.
the transmission capabilities of the processing assembly 60 are configured to transmit the image data, such as in a high-definition multiplexed signal, over the network 30 in the plurality of modes previously described, such as over the network 30 via satellite, Wi-Fi, wired Ethernet, wireless Ethernet, cellular connection such as 3G, 4G, or 5G and other wireless connections .
the processing assembly 60 further comprises receiving capabilities. Similar to the transmission capabilities which provide the image data and feedback as needed, and by way of example only, the receiving capabilities of the processing assembly 60 are configured to receive control messages via satellite, Wi-Fi, wired Ethernet, wireless Ethernet, cellular connection such as 4G, and other wireless connections.
the processing assembly 60 relays the control messages to the appropriate component of the ophthalmic device 10 for which the control message is intended.
the relay capabilities of the processing assembly 60 relay control messages and other information to the various components of the positioning assembly 70 and slit assembly 80.
the processing assembly 60 is disposed in interconnecting relation to the positioning assembly 70 and slit assembly 80, such as by a cable or other structure capable of transmitting data and information.
the relay capabilities comprise a microcontroller, such as, and by way of example only, a BASIC stamp development board (Parallax, Rocklin, California) with 24-pin BASIC stamp module and programmed with PBASIC.
the BASIC stamp module has 32 bytes of RAM and a processor speed of 50 megahertz, although these and all parameters can vary as optimal for miniaturization, portability or increased processing, and/or as may be dictated by advances in technology.
the processing assembly 60 can include a digital to analogue (D/A) converter configured to convert digital output from the computing device 10, such as control messages, into analog input for the DC/AC converter, which converts from frequency to voltage for a DC/AC controller such as the one discussed hereinafter.
D/A digital to analogue
the positioning assembly 70 preferably comprises a first positioning member 71 structured and disposed to position the ophthalmic device 10 in a plurality of operative orientations along an x-axis and a y-axis.
x-axis refers to the axis or imaginary line that runs lateral to the ophthalmic device 10 and the patient when situated in front of the device 10.
the first positioning member 71 therefore is structured to move the ophthalmic device 10 laterally, or in a side-to-side fashion.
the "y-axis" as used herein refers to the axis or imaginary line that runs depth-wise with respect to the ophthalmic device 10 and the patient when situated in front of the device 10.
the first positioning member 71 therefore is structured to move the ophthalmic device forward and back, such as closer or further from a patient during examination. Accordingly, the x-axis and y-axis collectively define a first plane disposed in lateral relation to the ophthalmic device 10 and perpendicular to a patient situated in front of the device 10.
the first positioning member 71 comprises an elongate configuration and is structured to adjust, such as telescopically, in order to create movement along the x-axis.
the first positioning member 71 is preferably fixedly secured at one end to the ophthalmic device 10 and at another location to a support structure such as a housing of the processing assembly 60 so that movement of the first positioning member 71 effects a change in the lateral position of the ophthalmic device 10. Accordingly, since the first positioning member 71 is interconnected to the ophthalmic device 10, movement of the first positioning member 71 in a front-to-back direction similarly effects movement and positioning of the ophthalmic device 10 along a y-axis.
the positioning assembly further comprises a positioning aperture 72 disposed along a side of the processing assembly 60 facing the ophthalmic device 10 and in receiving relation to the first positioning member 71 which extends through the aperture 72. Further, the positioning aperture 72 is dimensioned to provide the boundaries of movement of the first positioning member 71 along the x- and y-axes.
the positioning assembly 70 also comprises a second positioning member 73 structured and disposed to position the ophthalmic device 10 in a plurality of operative orientations along a z-axis.
the "z-axis" refers to the axis or imaginary line that runs vertically with respect to the ophthalmic device 10 and the patient when situated in front of the device 10. Accordingly the z-axis defines a second plane that lies parallel to front face of the ophthalmic device 10 which is disposed nearest a patient during examination.
the second positioning member 73 is structured to raise and lower the ophthalmic device 10.
the first positioning member 71 and second positioning member 73 are each preferably connected to different motors that respond to control messages from the control device 20 and drive motion in each of the three directions.
the first positioning member 71 connects to a stepper motor that controls lateral movement along the x-axis.
a NEMA 17 stepper motor and linear stage D-A.083-HT17-4-1NO-B/4 "The Digit", Ultra Motion Inc., Cutchogue NY) capable of producing up to 75 pounds of thrust and having a resolution of 0.00004 inches per step and a range of 4 inches is used as the stepper motor for x-axis movement.
the stepper motor is a NEMA 23 stepper motor.
the stepper motor is driven by a stepper motor encoder (EZHR17EN, All Motion Inc., Union City CA) .
a stepper motor controller such as a NEMA 17 stepper motor controller, having dual encoders and structured to operate from 12 volts to 40 volts, is secured to the stepper motor .
the first positioning member 71 also connects to a stepper motor controlling the front-and-back, or orthogonal, motion along a y-axis.
a stepper motor controlling the front-and-back, or orthogonal, motion along a y-axis.
a NEMA 17 stepper motor and linear stage capable of carrying a 10 pound load and having a resolution of 0.000009 inches per step in a range of 2 inches is provided.
the stepper motor for y-axis movement is driven by a stepper motor encoder, such as previously described.
a servo interconnects the second positioning member 73 with a slit height adjustment member, discussed in greater detail below.
This servo controls the vertical movement of the ophthalmic device 10.
the servo (HS-7950TH, Hitec RCD USA Inc., Poway CA) is part of a friction based system in which a friction member, such as rubber tire, is disposed around the servo actuator.
the vertical movement servo comprises a potentiometer, such as model 312-9100F-5K (Mouser Electronics, Mansfield TX) which is secured to the ophthalmic device 10 and provides mechanical stops at the limits of the stage of the ophthalmic device 10 while permitting continuous rotation there between.
the servo based on the diameter of the friction member and the diameter of the servo gear, such as 2.5 inches, the servo comprises a gear ratio of approximately 1:7. Accordingly, the vertical movement servo provides for slight movement along the z-axis . This servo is also driven by the microcontroller of the processing assembly 60.
the positioning assembly 70 further comprises a patient positioning assembly 75 structured and disposed to appropriately place a patient in relation to the ophthalmic device 10 for examination.
the patient positioning assembly 75 comprises a chin rest 76 configured to receive and support the chin of a patient, and thereby position the patient's eye in the approximate area of the optic assembly 50. Fine-tuned positioning for image collection is subsequently achieved by the first and second positioning members 71, 73 described previously.
the patient positioning assembly 75 further comprises a head rest 77 disposed above the chin rest 76 and in supporting relation to the forehead of a patient so as to stabilize the patient's head and minimize superfluous movement during examination.
the patient positioning assembly 75 is disposable for use with a patient lying in a supine position, rather than sitting up as in Figure 5, and attaches to the ophthalmic device 10 accordingly.
the positioning assembly 60 further comprises an external data capturing member 55 disposable to obtain positional data, such as image data, of the patient in relation to the ophthalmic device 10, preferably disposed above the patient.
the external data capturing member 55 comprises a video camera, and may take high-definition or standard-definition resolution video, as defined previously.
the external data capturing member 55 can also comprise audio capabilities to capture audio data from the patient, such as verbal responses to questions from remotely located practitioner ( s ) , in addition to video data.
the external data capturing member 55 comprises a web camera (Blue Microphones Inc., eatlake Village CA) having a 2 megapixel sensor and a condenser capsule for high quality sound with a frequency response in the range of 35 Hertz to 20 kiloHertz and a sample/word rate of 44.1 kiloHertz per 16 bits. Accordingly, the external data capturing member 55 is structured to obtain additional information about the patient, such as their position in relation to the ophthalmic device 10, as well as enable verbal communication with the patient .
a web camera Blue Microphones Inc., eatlake Village CA
the external data capturing member 55 is structured to obtain additional information about the patient, such as their position in relation to the ophthalmic device 10, as well as enable verbal communication with the patient .
the positioning assembly 70 can also further comprise an audio member 78 structured and operative to transmit and provide sound to the patient.
the audio member 78 comprises at least one speaker through which verbal directions and questions from the practitioner ( s ) located at the control device (s) 20 at disparate predetermined locations can be communicated to the patient.
a practitioner (s) may be able to determine if a patient should move his or her head in a particular direction for better imaging of the eye and direct the patient accordingly, instruct the patient to look in a particular direction ( s ) , instruct the patient not to blink, ask the patient questions, etc.
the audio member 78 is configured to relay this verbal information to the patient so they may respond according to the practitioner's instructions and provide answers to questions posed by the practitioner.
the ophthalmic device 10 further comprises a slit assembly 80 structured and collectively disposed to adjust at least one dimension of a slit and to adjust the magnification of the ophthalmic device 10.
the slit assembly 80 comprises a slit lamp that is coupled to a biomicroscope for examination of a patient's eye.
“Slit lamp” as used herein refers to a slit lamp instrument commonly used in conjunction with a biomicroscope for eye examination as those of ordinary skill in the art will readily appreciate.
the slit assembly 80 comprises a slit lamp light source 81, at least one slit adjustment member, and a slit lamp magnification control 82.
the slit lamp light source 81 is a source of illumination and is disposed within the slit assembly 80 and in light-directing relation to the eye of a patient.
the light produced by the slit lamp light source 81 is therefore directed through the slit assembly 80 and ophthalmic device 10 to shine upon the eye of a patient sitting in front of the ophthalmic device 10 during examination, as shown in Figure 5, thereby illuminating the various parts of the eye, including the eyelid, eyelashes, conjunctiva, limbus, cornea, anterior chamber, iris, and lens of the eye.
the light reflects off these various components of the eye and back into the ophthalmic device 10 through the objective lenses 52', 52'', providing image data of the eye.
a slit lamp intensity control 83 is provided, such as within the housing of the processing assembly 60, and is structured to control the intensity of light emitted from the slit lamp light source 81.
a DC/AC converter such as model MCPC1225A (Crydom Co., San Diego CA) controls and/or limits the slit lamp intensity control 83.
the DC/AC controller is a control relay with 40-140 volts of alternating current (AC), a rated current of 35 amps, and a proportional load voltage input of 0-5 volts in direct current (DC) .
the DC/AC control relay is disposed within the processing assembly 60 and in driven relation to the microcontroller.
the processing assembly 60 directs the intensity of the slit lamp intensity ⁇ control 83 and therefore, the intensity of the light used in the slit lamp and ophthalmic device 10. Further, since control messages from the control device 20 are directed to the slit lamp intensity control 83, which are received and relayed by the processing assembly 60, a practitioner ( s ) at the control device (s) 20 can control and direct the intensity of the light used in the slit lamp during examination.
the slit assembly 80 preferably comprises at least one slit adjustment member to vary at least one dimension of the slit of the slit assembly 80.
the slit of a slit lamp is an aperture through which the light of the slit lamp passes.
the width, height, and angle of the slit may be varied to control the amount of light, dimension, and direction of the beam of light issuing from the slit lamp, so as to maximize the efficiency and accuracy of an eye examination.
the slit assembly 80 of the present invention comprises a slit width adjustment member 84 structured to adjust a lateral dimension (width) of the slit of the slit assembly 80.
the slit width adjustment member 84 comprises a gear system coupled to a dedicated servo motor, such as model HS-805BB (Hitec RCD USA Inc., Poway CA) having a three pole motor, dual ball bearing, and capable of generating a maximum torque of 343 ounce*inch, and is further disposed to physically adjust the width of the slit. For example, only 60° of rotation is required to adjust the slit width. Accordingly, the gear assembly of the slit width adjustment member 84 comprises an 84- teeth gear wheel attached to the servo which matingly engages the teeth of a partial gear wheel which, if whole, would have 114 teeth, thereby providing a gear ratio of 1:1.357.
a dedicated servo motor such as model HS-805BB (Hitec RCD USA Inc., Poway CA) having a three pole motor, dual ball bearing, and capable of generating a maximum torque of 343 ounce*inch
the gear assembly of the slit width adjustment member 84 comprises an 84- teeth
the slit width adjustment member 84 is securedly fastened to the gear wheel.
the servo is mounted to the slit lamp assembly 80. Accordingly, movement of the servo rotates the servo gear wheel, in turn rotating the partial gear wheel within 60° of rotation, thereby driving the slit width adjustment member 84 and correspondingly producing a narrowing or widening of the slit width.
the dedicated servo for the slit width adjustment member 84 is controlled by the processing assembly 60, such as a microcontroller, and is structured to respond to control messages from the control device 20. Accordingly, a practitioner at a control device 20 can control and direct the adjustment of the slit width.
the slit assembly 80 of the present invention also may comprise a slit height adjustment member 85 structured to adjust a vertical dimension (height) of the slit of the slit assembly 80.
the slit height adjustment member 85 comprises a gear system coupled to a dedicated servo motor, such as model HS-7950TH (Hitec RCD USA Inc., Poway CA) having a coreless motor, dual ball bearing, and capable of generating a maximum torque of 486 ounce*inch, and is further disposed to physically adjust the height of the slit. For example, only 135° of rotation is required to adjust the slit height.
the gear assembly of the slit height adjustment member 85 comprises an 80-teeth gear wheel attached to the servo which matingly engages the teeth of a partial gear wheel which, if whole, would have 94 teeth, thereby providing a gear ratio of 1:1.175.
the slit height adjustment member 85 is securedly fastened to the gear wheel.
the servo is mounted adjacent to the slit lamp assembly 80. Accordingly, movement of the servo rotates the servo gear wheel, in turn rotating the partial gear wheel within 135° of rotation, thereby driving the slit height adjustment member 84 and correspondingly producing a lengthening or shortening of the slit height.
the dedicated servo for the slit height adjustment member 85 is controlled by the processing assembly 60, such as a microcontroller, and is structured to respond to control messages from the control device 20. Accordingly, a practitioner at a control device 20 can control and direct the adjustment of the slit height.
the slit assembly 80 of the present invention also preferably comprises a slit angle adjustment member 86 structured to adjust the angle of direction of the slit assembly 80.
the slit angle adjustment member 86 comprises a gear system coupled to a dedicated servo motor, such as model HS-7950TM (Hitec RCD USA Inc., Poway CA) having a three pole motor, dual ball bearing, and capable of generating a maximum torque of 343 ounce*inch, and is further disposed to physically adjust the angle of presentation of the slit. For example, a range of ⁇ 60° of rotation is required to adjust the slit angle.
the gear assembly of the slit angle adjustment member 86 comprises an 54-teeth gear wheel attached to the servo which matingly engages the teeth of a 72- teeth gear wheel, thereby providing a gear ratio of 1:1.333.
the 72-teeth gear wheel is fixed to the central column of the slit lamp assembly 80, and the servo is mounted atop the axis of rotation of the slit. Accordingly, movement of the servo rotates the servo gear wheel, in turn rotating the fixed gear wheel within ⁇ 60° of rotation, thereby driving the slit angle adjustment member 86 about the axis of rotation and correspondingly producing a differing angle of presentation of the slit in relation to the axis of rotation.
the dedicated servo for the slit angle adjustment member 86 is controlled by the processing assembly 60, such as a microcontroller, and is structured to respond to control messages from the control device 20. Accordingly, a practitioner at a control device 20 can control and direct the adjustment of the slit angle.
the slit assembly 80 may further comprise a slit lamp magnification control 82 structured to adjust the magnification of the ophthalmic device 10.
the slit lamp magnification control 82 comprises a detented magnification lens carrying turret that is structured to be adjusted by the rotation of a rotation member 87, such as a knob.
the rotation member 87 is configured to rotate up to 360° in one direction. Accordingly, two servos each capable of rotating 180° are mechanically linked end to end, such as by an axle interface, to achieve 360° of rotation.
a first servo is fixedly secured to a mount and comprises an elongate axle disposed within the first servo and extending outwardly through the exterior of the servo.
a second servo similarly comprises an elongate axle disposed therein and extending outwardly through the exterior of the second servo.
the second servo is fixed to the rotation member 87.
the first and second servos are disposed so that the axle of the first servo is in opposing and facing relation to the axle of the second servo, such as in an end-to-end fashion. Each axle is received in an axle interface, thereby mechanically linking the first and second servos.
the first and second servos are each model HS-5055MG (Hitec RCD USA Inc., Poway CA) .
the magnification control 82 comprises a ruby lens positionable into and out of image capturing relation with the objective lenses 52', 52'', in order to enable increased patient evaluation.
the various components of the slit assembly 80 can be adjusted and controlled from the control device 20 via control messages received and relayed by the processing assembly 60.
the particular settings of the slit assembly 80 and its components permit maximized examination of the eye, as described above.
the adjustment of various settings of the slit assembly 80, positioning assembly 70, and optic assembly 50 provide optimized image data.
the ophthalmic device 10 may comprise an electronic or digital caliper for acquiring measurements of portions of the patient's eye.
control device 20 may comprise the electronic or digital caliper, which can be presented on the display 21 in conjunction with the images 24, 25.
the processing assembly 60 preferably comprises a setting memory structured to record the settings of the various components of the positioning assembly 70, optic assembly 50, and/or slit assembly 80 at a given configuration, and to return to these settings upon command.
the setting memory act as "shortcuts" that facilitate movement of the device to particular practitioners and/or patients and/or for certain desired views
the control member (s) 22 comprise setting memory actuators structured to initiate movement of the ophthalmic device 10 into any of a plurality of preset settings.
the setting memory can achieve certain intuitive control of the ophthalmic device 10 such as by predictively identifying or anticipating a progression of views or movements, suggesting adjustments and/or minimizing extraneous movements between positions.
the image data is sent to the control device 20 via a network 30, as discussed previously. It should be appreciated that other data, such as but not limited to audio data and patient information and feedback is also transmitted to the control device 20 via the network 30.
the control device 20 therefore comprises transceiver capabilities operative to receive such data, including image and audio data, from the ophthalmic device 10 and to send control messages and audio from each practitioner ( s ) to the ophthalmic device 10.
the display 21, which may include a single or multiple monitors, is structured to show image data 24, 25.
the image data preferably comes from the first image capturing member 51' and the second image capturing member 51'' and are displayed in adjacent non- overlapping relation to one another.
These two images 24, 25 are of the same eye of the patient, obtained from slightly different angles by virtue of the different positions of the objective lenses 52' and 52'', respectively.
a stereoscopic image is. generated by the fusion of the first image data 24 with the second image data 25.
the display 21 is further configured to present image data 26 from an external data capturing member 55, and therefore provide visual information to the practitioner ( s ) of the positioning of the patient in relation to the ophthalmic device 10. It should be appreciated that when multiple practitioners at different locations are using the present system 100, each practitioner is associated with a different control device 20 having its own display 21. Accordingly, practitioners can simultaneously view the same image data 24, 25, 26 on their respective displays 21.
the control device 20 further comprises an interface 23 disposed on the display 21, as shown in Figure 7.
the interface 23 comprises a visual representation of the current settings of the various components of the positioning assembly 70, slit assembly 80, and optic assembly 50 of the ophthalmic device 10.
such visual representation is a schematic representation, and if desired, the various adjustable aspects of the ophthalmic device 10, such as the slit width, slit height, slit angle, magnification, and slit lamp intensity are presented as individual sliding scales or bars, each having an indicator showing the current setting of the various aspects along their respective scales.
the slit width scale and indicator shows schematically the current setting for the slit width in relation to the range of possible settings for the width.
the interface 23 also depicts information on the positioning of the ophthalmic device 10 as effected by the positioning assembly 70.
the settings of the various adjustable aspects of the ophthalmic device 10 are depicted diagrammatically or symbolically, such as by an odometer-type icon.
the position of the ophthalmic device 10, the nose and eyes of a patient, and the slit angle are represented symbolically, as depicted by the x-y box shown in Figure 7, wherein the dot indicates the position of the ophthalmic device 10, the nose of the patient is represented as a triangle, the eyes of the patient are represented as the arrows, and the slit angle is indicated with an arc.
the interface 23 further comprises patient information, such as patient name, age, biographical information, medical history, medications, allergies, etc., and is supported by appropriate data entry software of the control device 20.
each of the indicators of the interface 23 are interactive, such that selecting and moving an indicator on the display 21 with a control member 22 results in the instantaneous creation of control message (s) that are transmitted in real-time over the network 30, where it is received by the processing assembly 60 of the ophthalmic device 10 and relayed to the appropriate component of the ophthalmic device 10 to dynamically adjust the settings of the various components, in substantially real-time to the generation of the control message(s) .
the control members 22 have directing capabilities operative to control movements of the components of at least the positioning assembly 70, slit assembly 80, optic assembly 50, and processing assembly 60.
an operator can effectively "jump" to desired or known parameters for a desired view rather than having to gradually manipulate to those parameters by sight.
a practitioner at the control device 20 uses a control member 22 (such as keyboard, computer mouse, and/or joystick) to slide the indicator for the slit height to the right, corresponding control message (s) to increase the slit height is generated and transmitted by the control device 20.
the slit height adjustment member 85 Upon receipt of the control message (s) the slit height adjustment member 85 will react and move to lengthen the slit height accordingly, in substantially real-time to the practitioner actuating the indicator on the interface 23 of the display 21.
a practitioner can dynamically control and direct the adjustment of any movable component of the ophthalmic device 10 in real-time, even when separated by a great distance from the ophthalmic device 10.
any one of them can, at any time, interactively adjust or move any of the indicators of the interface 23 to send corresponding control messages from that particular control device 20 to the ophthalmic device 10, to interactively vary the settings of the components thereof.
Such changes would then be reflected on the displays 21 of the other practitioners so that all practitioners can see any changes in the settings of the ophthalmic device 10 and corresponding changes in the image data 24, 25, 26 obtained thereby.
Such changes would be realized in real-time as previously described.
the interface 23 comprises duplicate and slightly different images structured to induce binocular disparity. Accordingly, the interface 23 controls may also be stereoscopic, and appear to "float" in front of the stereoscopic image of the eye of the patient. In a further embodiment, the interface 23 is positioned in unobscured view of the images 24, 25 of the patient eye, such as at a bottom edge or corner of the display 21. In one embodiment, the interface 23 is configured to fade away, become transparent or hidden, or otherwise not be visible when not in use.
the display 21 is accessible, such as over the network 30, to a plurality of computing devices 20 that can view the image data 24, 25, 26 and/or the interface 23, as well as control ophthalmic device 10.
a plurality of computing devices 20 that can view the image data 24, 25, 26 and/or the interface 23, as well as control ophthalmic device 10.
such an embodiment enables remote teaching and instruction to a group of people, as well as consultation with fellow practitioners, such as to seek advice, posit a question, and corroborate a diagnosis, for example.
each of the plurality of displays can be disposed at different locations from one another, and may be remotely connected via the network 30, such as the Internet or world-wide-web, and all practitioners located in various different locations can simultaneously view image data from the ophthalmic device 10, verbally interact with the patient and each other, and take control of and operate the ophthalmic device 10 remotely.
the network 30 such as the Internet or world-wide-web
the ophthalmic device 10 further comprises a clutch mechanism that is structured to increase the efficiency of the movement of the various components of the ophthalmic device 10, including the positioning assembly 70, slit assembly 80, optic assembly 50, and processing assembly 60.
the clutch mechanism is structured to actuate motion of a particular component of the ophthalmic device 10 from one position to a subsequent position only when the previous position is identified and returned to prior to moving to a subsequent position.
the clutch mechanism acts something like the neutral drive in a vehicle.
the clutch mechanism comprises an electronic engagement mechanism to actuate motion only when the previous engagement position is selected.
a controlled actuator may be selected by the push of a button and switching between actuators will result in a large change in the commanded action of the newly selected actuator.
the electronic clutch mechanism eliminates these jumps, and allows for more precise control of all actuators linked to the mechanical interface.
the clutch mechanism is responsive to control messages from the control device (s) 20, since control messages are relayed through the clutch mechanism to effect movement of the various components .
the ophthalmic device 10 is structured for remote activation such that the ophthalmic device 10 can be turned on from a command sent over the network 30 from any originating location.
the processing assembly 60 of the ophthalmic device 10 comprises activation capabilities configured to respond to control message (s) generated by a control device 20 directing the device 10 to activate.
the activation capabilities comprise a motherboard configured to support the Ethernet networking standard Wake-on-LAN (WOL) , although it should be appreciated that any structure and/or interface providing sufficient activating capabilities to enable remote activation of the ophthalmic device 10 is contemplated herein.
WOL Wake-on-LAN
a technician or attendant need not be present to turn the ophthalmic device 10 on for examination.
a practitioner, system administrator, or other person can turn on the ophthalmic device 10 from any control device 20, or in some embodiments from any location accessible to the ophthalmic device 10 via a network 30, in order to, for example, provide updates and patches to the processing assembly 60, monitor and/or adjust the power management of the ophthalmic device 10, and prepare the ophthalmic device 10 for examination.
the system for ophthalmic imaging 100 can also be configured with the ophthalmic device 10 being structured for autonomous operation for select local data collection.
the ophthalmic device 10 can be structured to perform certain "pre- examination" procedures without instruction or control from a practitioner. Accordingly, the autonomous operation can occur even when there is reduced, limited, or no connectivity to the network 30 from which control messages can be received.
the ophthalmic device 10 includes a series of audio commands that are transmitted through the audio member 78 to instruct the patient regarding the procedure, when and how to position their head on the patient positioning assembly 75, and distinct locations at which to look to facilitate obtaining image data of the various angles of the eye. For instance, the audio commands will direct the patient to look up, down, left, and right at designated times in order to obtain image data of the bottom, upper, right, and left sides of the eye, respectively.
the ophthalmic device 10 is structured and configured to record and save a plurality of video clips for later evaluation by the practitioner ( s ) .
These video clips coincide with the audio instructions, and comprise image data of the eye including, for example: direct illumination of the cornea and parts of the upper and lower eyelids, direct illumination of the upper eyelid, direct illumination of the lower eyelid, slit illumination focusing on the cornea at 45 degrees from the left side, slit illumination focusing on the lens at 45 degree from the left side, slit illumination focusing on the cornea at 45 degrees from the right side, and slit illumination focusing on the lens at 45 degrees from the right side.
the ophthalmic device 10 is further configured to automatically focus on particular portions of the eye, such as the cornea, lens, and eyelids to acquire sharp image data.
the processing assembly 60 also comprises image pattern recognition capabilities to guide the movement of the various servos and motors of the ophthalmic device 10 along the x-, y-, and z-coordinates according to a preset program. This preset program and the series of audio commands cooperatively guide the patient and the ophthalmic device 10 through the autonomous operation mode.
the ophthalmic device 10 of the present system 100 can comprise a mounting stage structured to support the ophthalmic device 10 thereon and provide adjustment and positioning of the ophthalmic device 10 about multiple degrees of freedom.
the mounting stage is structured for secure rotation, tipping, tilting, and other movements, and may comprise a tri-axis goniometric cradle and rotation and tip-tilt stages. Accordingly, the mounting stage enables the ophthalmic device 10 of the system 100 to be used in examining a patient from a supine or reclined position. This can be particularly beneficial when the patient is unable to sit up and position himself/herself in the patient positioning assembly 75, such as an injured soldier on the battlefield or a patient in a hospital bed.
the mounting stage also comprises at least one support member, which is structured to support the mounting stage from a floor, ground, or other surface.
the support member (s) are adjustable, such as telescopically, and may be independently adjustable of other support members to accommodate various terrains.
the mounting stage and its various components- are responsive to and controllable by control messages sent from a control device 20 over a network 30.
the present invention is further directed to a system for optimized stereoscopic viewing 200 at various distances, as depicted schematically in Figure 8.
the system for optimized stereoscopic viewing 200 comprises a display 21 comprising at least one image, but preferably a pair of images, at least one viewer 40 comprising at least one prism 42 defining a prism angle and disposable a predetermined distance b, b' from the display, wherein the viewer 40 is operative for stereoscopic viewing of the image (s) and the prism angle is dependent on the predetermined distance b, b' between the viewer 40 and display 21 and/or the size of the image(s).
the display 21 comprises a first image 24 disposed in adjacent relation to a second image 25.
the first and second images 24, 25 are presented in non-overlapping fashion on the display 21. Accordingly, the system for optimized stereoscopic viewing 200 is structured to optimize side-by-side stereoscopy, and the viewer 40 is structured and operative to facilitate fusion of the first and second images 24, 25 into a single stereoscopic image at the predetermined distances b, b' .
the display 21 of the system for optimized stereoscopic viewing 200 is structured to present image data from any image source 210 capable of producing stereoscopic images.
an "image source” refers to the originating location of the image (s), such as the location of the physical object represented in the image data and/or the location where the image is generated.
the image source 210 comprises an ophthalmic device 10 as described above.
the image source 210 is not limited to an ophthalmic device 10.
the image source 210 is disposable in interconnecting relation with the display 21 and connects to the display 21 either directly or indirectly. Accordingly, in some embodiments, the system for optimized stereoscopic viewing 200 further comprises transmission capabilities operative to transmit at least one image from an image source 210 to a device having a display 21 over a network in substantially real-time relative to the generation of the image (s) at the image source 210, such as described above. Indeed, in one embodiment, the image source 210 is disposable in remote relation to the display 21, such that the image source 210 is located at a point distant from the display 21. "Remote relation" can refer to locations in different rooms, different buildings, different cities, and even different countries.
the image source 210 comprises an ophthalmic device 10, and the display 21 of the system for optimized stereoscopic viewing 200 is structured to present image data 24, 25 from an ophthalmic device 10, as described above.
the system for optimized stereoscopic viewing 200 comprises an image (s) not from an ophthalmic device 10, but from another image source 210.
the system for optimized stereoscopic viewing 200 further comprises at least one viewer 40 as described previously.
the viewer 40 is disposable at a predetermined distance b, b' from the display 21. More specifically, the viewer 40 is disposable a first predetermined distance b from the display 21.
the first predetermined distance b is defined as a short-range distance.
the first predetermined distance b is defined as in the range of about 50.8 centimeters to 88.9 centimeters. It should be appreciated that the limits of any range provided herein should not be interpreted strictly, and that distances falling slightly outside the range are still within the intended scope of the invention.
first predetermined distance b is defined as in the range of about 55.9 centimeters to 76.2 centimeters.
a comfortable viewing distance for a laptop computer is approximately 55.9 centimeters
a comfortable viewing distance for a desktop computer is approximately 76.2 centimeters.
the first predetermined distance b is the typical distance in which a user sits in relation to a computer monitor, such as a desktop or laptop computer.
the first predetermined distance b is defined as less than 50.8 centimeters, such as in the case of viewing a display 21 on a smartphone, tablet device, or other handheld computing device.
the viewer 40 is also disposable at a second predetermined distance b' from the display 21, which is defined as a long-range distance.
the first predetermined distance b is less than, or shorter than, the second predetermined distance b' .
the second predetermined dis'tance b' is defined as at least 88.9 centimeters.
the second predetermined distance b' is defined as at least 4.1 meters.
the second predetermined distance b' is defined as in the range of about .4.1 meters to 13.9 meters, such as when the system for optimized stereoscopic viewing 200 is used in a large space, such as a classroom or auditorium, as depicted schematically in Figure 9.
the display 21 comprises a screen, such as a projection screen, presentation board, or other similar surface having sufficient dimensions for presenting images of a large size for simultaneous viewing by multiple people and/or viewers 40.
the second predetermined distance b' comprises any of a variety of distances from the display 21. Further, it is expected that different viewers used by practitioners at different locations will have different optimal prism parameters.
the viewer 40 is disposable along a line of sight and at a predetermined distance b, b' .
a "line of sight” is an imaginary line from the eye to a perceived object.
the "line of sight” refers to the visual path between the display 21 and image (s) 24, 25 presented thereon and the viewer 40 for stereoscopic viewing of the image (s) 24, 25.
the line of sight is expanded to a viewing area 220 in which an observer implementing a viewer 40 can position himself/herself in order to view the stereoscopic image.
this stereoscopic viewing area is defined as the space between rays Cj and c 2 . Areas lying outside of the viewing area 220 do not permit or enable stereoscopic viewing of the image (s) 24, 25, even with a viewer 40.
the image (s) 24, 25 comprise a size appropriate for the dimensions of the display 21 on which they are presented.
the image (s) 24, 25 comprise a size in the range of about 12.7 centimeters to 81.3 centimeters.
the image (s) comprise a size of up to about 20.3 centimeters to 40.6 centimeters as limited by the actual lateral display size of the laptop display 21.
the image (s) comprises a size in the range of up to about 12.7 centimeters to 71.1 centimeters, depending on the actual lateral display size of the computer monitor as a display 21.
the image (s) 24, 25 comprise a size in the range of up to about 1.5 meters to 4.1 meters. It should be appreciated that the image (s) 24, 25 can comprise a smaller size than stated, such as when the display 21 comprises a plurality of images, so that the plurality of images can fit on the same display 21.
the viewer 40 preferably comprises at least one prism 42 structured to enable stereoscopic viewing of the image (s) 24, 25.
a prism is a transparent optical element having at least one side for deviating light at a particular angle, such as by refraction, reflection, polarization, or dispersion. The angle of deviation depends on a number of considerations, including the angle of incidence of incoming light (chief ray angle), the refractive index of the material through which the incident light travels to the prism, and the refractive index of the material comprising the prism.
the prism(s) 42 may comprise a material transparent to a particular desired wavelength of light.
the prism(s) 42 may comprise a glass material, such as BK7, crown glass, fused silica (quartz), flint glass, heavy flint glass, plastics such as polymethylmethacrylate (PMMA) , polystyrenes, polycarbonates, etc.
a glass material such as BK7, crown glass, fused silica (quartz), flint glass, heavy flint glass, plastics such as polymethylmethacrylate (PMMA) , polystyrenes, polycarbonates, etc.
each prism 42 comprises any shape sufficient to bend and/or deviate the incident light in a predetermined desired manner.
each prism 42 comprises a triangular wedge shape having a triangular base and rectangular sides, and is disposed within the viewer 40 in order to direct the deviated light into the eyes of a person looking through the viewer 40.
the thicker dimension of the prisms 42 are disposed at the outer edges of the viewer 40, thereby deviating light inward toward the eyes of a person utilizing the viewer 40.
the prism (s) 42 comprises any shape necessary to deviate the incident light as desired and/or required.
a partitioning element Preferably disposed between the prisms is a partitioning element. This element helps to ensure that each eye sees a different image, thus optimizing the stereoscopic effect and minimizing the possibility of cross over effects.
the prism(s) 42 of the viewer 40 define a prism angle.
the prism angle comprises the wedge angle of the prism ( ⁇ ) which intrinsic index of refraction of the prism's material (n p ) creates the angle of deviation of light produced by the prism ( ⁇ ) .
Figure 10 shows a schematic depiction of a prism 42 in relation to an eye of an observer looking through a viewer, showing the relationship between the interpupillary distance (P D ) , the distance from the eye to the object (d) , the distance from the prism 42 to the object (d p ) , the horizontal size or width of the object (w) , the refractive index of the medium (n) and the prism (n p ) , the prism angle ( ⁇ ) , the optical path length within the prism ((), and the chief ray angle ( ⁇ ) .
Formula I demonstrates the relationship between the chief ray angle, prism refractive index, interpupillary distance, the distance from the eye to the object, and the prism angle for optimized stereoscopic viewing at a number of different viewing distances:
the prism angle ⁇ is dependent on at least one of the predetermined distance b, b' , i.e. the distance from the eye to the object, represented as (d) in Figure 10, and the size of the image, i.e. the width of the object, represented as (w) in Figure 10. Therefore, based on Formula I and with reference to Figures 8 and 10, the prism angle ⁇ is proportional to the size of the image (s) 24, 25 in that a larger prism angle ⁇ is required for larger sized image (s) 24, 25. Similarly, the prism angle ⁇ is inversely proportional to the predetermined distance b, b' (also shown as (d) in Figure 10) between the viewer 40 and the display 21. That is to say, a larger prism angle ⁇ is required when the predetermined distance b, b' is smaller, such as when the observer is closer to the display 21.
the prism is made of plastic (PMMA) , which has a prism angle ⁇ in the range of about 9° to 30° and an index of refraction of 1.49.
PMMA plastic
this range is not meant to be strictly interpreted, and in fact slight variations above and below the outer limits are contemplated.
a prism angle ⁇ of 8.7°or 30.3° are still within the spirit and scope of the present invention.
the prism angle ⁇ is chosen from the group consisting of generally about 10°, 16°, 20°, 25°, and 30°.
prism angles ⁇ are approximations, such that slight variations therefrom are contemplated.
a prism angle ⁇ of 10.2° or 24.7° are within the spirit and scope of the present system 200.
prisms 42 made of different materials with different indices of refraction different ranges of prism angles ⁇ will apply.
a particular prism angle ⁇ will be most appropriate, such as based on Formula I, although other prism angles ⁇ may be used effectively at the same predetermined distances b, b' , albeit with less optimal depth impression.
a viewer 40 having prisms 42 with prism angles ⁇ in the range - of 9.2° to 10.8°, but preferably 10° will enable optimal stereoscopic viewing at predetermined distances falling in a first viewing area 222, which is defined as between approximately 10 meters and 14 meters from the display 21, although in some embodiments this limit may extend beyond 14 meters.
a viewer 40 having a prism angle ⁇ of 16° may also be used in parts of the first viewing area 222 and will produce a fused image, but the stereoimage produced will not have as much depth detail as other prism angles ⁇ could produce in that viewing area. Accordingly, there is an overlap of prism angles ⁇ possible for each viewing area.
a viewer 40 having prisms 42 with prism angles ⁇ in the range of 13.6° to 18.4°, but preferably 16°, will optimally enable stereoscopic viewing at predetermined distances falling in second viewing area 224, which is defined as between approximately 8 meters and 10 meters from the display 21.
a viewer 40 having prisms 42 with prism angles ⁇ of 25° will optimally enable stereoscopic viewing at predetermined distances falling in third viewing area 226, which is defined as between approximately 4 meters and 8 meters from the display 21 " .
third viewing area 226, which is defined as between approximately 4 meters and 8 meters from the display 21 " is defined as between approximately 4 meters and 8 meters from the display 21 " .
stereoscopic viewing is not enabled for area 228, which is defined as distances falling between the display 21 and approximately 4 meters therefrom .
a viewer 40 having prisms 42 can be used for shorter predetermined distances b as well as longer predetermined distances b' .
a viewer 40 having a prism angle ⁇ of approximately 16° can be used for viewing images 24, 25 on a desktop computer having a 19 inch advertised size monitor as a display 21, as well as in a larger room at a distance of between b2 r and wherein the images 24, 25 are presented on a presentation screen as a display 21.
viewing stereoimages located a short predetermined distance such as in the range of about 50.8 centimeters to 88.9 centimeters, can be accomplished with viewers having a prism angle in the range of about 9° to 29°.
viewers having a prism angle in the range of about 18° to 22° can be used. And generally for distances in the range of up to about 12.7 centimeters to 81.3 centimeters, viewers having a prism angle in the range of about 9° to 29° can be used. Finally, for distances in the range of 1.5 meters to 2 meters, viewers having a prism angle of about 9.2° to 10.8° are preferred.

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