Stereo display with time-multiplexed focal adjustment

In stereo displays, binocular disparity creates a striking impression of depth. However, such displays present focus cues - blur and accommodation - that specify a different depth than disparity, thereby causing a conflict. This conflict causes several problems including misperception of the 3D layout, difficulty fusing binocular images, and visual fatigue. To address these problems, we developed a display that preserves the advantages of conventional stereo displays, while presenting correct or nearly correct focus cues. In our new stereo display each eye views a display through a lens that switches between four focal distances at very high rate. The switches are synchronized to the display, so focal distance and the distance being simulated on the display are consistent or nearly consistent with one another. Focus cues for points in-between the four focal planes are simulated by using a depth-weighted blending technique. We will describe the design of the new display, discuss the retinal images it forms under various conditions, and describe an experiment that illustrates the effectiveness of the display in maximizing visual performance while minimizing visual fatigue. © 2009 SPIE-IS&T.

Predicting the behaviour of micro-electronic displays using computational mechanics

Micro-electronic displays are indispensible devices used in high performance applications such as aerospace, medical, marine and industrial sectors.These devices provide an interface to real time mission critical devices and therefore require good optical visual performance and high reliability, all this within varied and challenging environments.

Mercury toxicity in the Amazon: contrast sensitivity and color discrimination of subjects exposed to mercury

We measured visual performance in achromatic and chromatic spatial tasks of mercury-exposed subjects and compared the results with norms obtained from healthy individuals of similar age. Data were obtained for a group of 28 mercury-exposed subjects, comprising 20 Amazonian gold miners, 2 inhabitants of Amazonian riverside communities, and 6 laboratory technicians, who asked for medical care. Statistical norms were generated by testing healthy control subjects divided into three age groups. The performance of a substantial proportion of the mercury-exposed subjects was below the norms in all of these tasks. Eleven of 20 subjects (55%) performed below the norms in the achromatic contrast sensitivity task. The mercury-exposed subjects also had lower red-green contrast sensitivity deficits at all tested spatial frequencies (9/11 subjects; 81%). Three gold miners and 1 riverine (4/19 subjects, 21%) performed worse than normal subjects making more mistakes in the color arrangement test. Five of 10 subjects tested (50%), comprising 2 gold miners, 2 technicians, and 1 riverine, performed worse than normal in the color discrimination test, having areas of one or more MacAdam ellipse larger than normal subjects and high color discrimination thresholds at least in one color locus. These data indicate that psychophysical assessment can be used to quantify the degree of visual impairment of mercury-exposed subjects. They also suggest that some spatial tests such as the measurement of red-green chromatic contrast are sufficiently sensitive to detect visual dysfunction caused by mercury toxicity.

Is blindsight like normal, near-threshold vision?

Blindsight is the rare and paradoxical ability of some human subjects with occipital lobe brain damage to discriminate unseen stimuli in their clinically blind field defects when forced-choice procedures are used, implying that lesions of striate cortex produce a sharp dissociation between visual performance and visual awareness. Skeptics have argued that this is no different from the behavior of normal subjects at the lower limits of conscious vision, at which such dissociations could arise trivially by using different response criteria during clinical and forced-choice tests. We tested this claim explicitly by measuring the sensitivity of a hemianopic patient independently of his response criterion in yes-no and forced-choice detection tasks with the same stimulus and found that, unlike normal controls, his sensitivity was significantly higher during the forced-choice task. Thus, the dissociation by which blindsight is defined is not simply due to a difference in the patients’ response bias between the two paradigms. This result implies that blindsight is unlike normal, near-threshold vision and that information about the stimulus is processed in blindsighted patients in an unusual way.

Environmental and Occupational Optometry. Lesson 2 (Course 2013-2014)

Tema 2. Actividad voluntaria nº 2.

Clinical and quality of life data correlation with a single-optic accommodating intraocular lens

Purpose: To examine a single-optic accommodating intraocular lens (IOL) visual performance by correlating IOL implanted eyes’ defocus curve with the intraocular aberrometric profile and the impact on the quality of life (QOL). Methods: Prospective consecutive case series study including a total of 25 eyes of 14 patients with ages ranging between 52 and 79 years old. All cases underwent cataract surgery with implantation of the single-optic accommodating IOL Crystalens HD (Bausch & Lomb). Distance and near visual acuity outcomes, intraocular aberrations, the defocus curve and QOL (NEI VFQ-25) were evaluated 3 months after surgery. Results: A significant improvement in distance visual acuity was found postoperatively (p = 0.02). Mean postoperative LogMAR uncorrected near visual acuity was 0.44 ± 0.23 (20/30). 60% of eyes had a postoperative addition between 0 and 1.5 diopters (D). The defocus curve showed an area of maximum visual acuity for the levels of defocus corresponding to distance and intermediate vision (−1 to +0.5 D). Postoperative intermediate visual acuity correlated significantly some QOL indices (r ≥ 0.51, p ≤ 0.03; difficulty in going down steps or seeing how people react to things that patient says) as well as with J0 component of manifest cylinder. Postoperative distance-corrected near visual acuity correlated significantly with age (r = 0.65, p < 0.01). Conclusions: This accommodating IOL seems to be able to restore the distance visual function as well as to provide an improvement in intermediate and near vision with a significant impact on patient's QOL, although limited by age and astigmatism. Future studies with larger sample sizes should confirm all these trends.

The posterior chamber phakic refractive lens (PRL): a review

Implantation of phakic intraocular lenses (pIOLs) is a reversible refractive procedure, preserving the patient’s accommodative function with minimal induction of higher order aberrations compared with corneal photoablative procedures. Despite this, as an intraocular procedure, it has potential risks such as cataracts, chronic uveitis, pupil ovalization, corneal endothelial cell loss, pigmentary dispersion syndrome, pupillary block glaucoma, astigmatism, or endophthalmitis. Currently, only two models of posterior chamber pIOLs are commercially available, the implantable collammer lens (STAAR Surgical Co.) and the phakic refractive lens (PRL; Zeiss Meditec). The number of published reports on the latter is very low, and some concerns still remain about its long-term safety. The present article reviews the published literature on the outcomes after PRL implantation in order to provide a general overview and evaluate its real potential as a surgical refractive option.

Comparing a bifocal and trifocal diffractive IOL

With the recent development of trifocal diffractive IOLs, to overcome the potential limitation of a lack in intermediate distance vision, studies have been published confirming the benefit of these lenses. However, until now, there has been no comparative study between the visual performance achieved with a bifocal versus a trifocal diffractive IOL. In this article, the authors reveal the details and results of their recent comparative study of the AT LISA diffractive bifocal and trifocal lenses.

Nonlinearities in the binocular combination of luminance and contrast

We studied the rules by which visual responses to luminous targets are combined across the two eyes. Previous work has found very different forms of binocular combination for targets defined by increments and by decrements of luminance, with decrement data implying a severe nonlinearity before binocular combination. We ask whether this difference is due to the luminance of the target, the luminance of the background, or the sign of the luminance excursion. We estimated the pre-binocular nonlinearity (power exponent) by fitting a computational model to ocular equibrightness matches. The severity of the nonlinearity had a monotonic dependence on the signed difference between target and background luminance. For dual targets, in which there was both a luminance increment and a luminance decrement (e.g. contrast), perception was governed largely by the decrement. The asymmetry in the nonlinearities derived from the subjective matching data made a clear prediction for visual performance: there should be more binocular summation for detecting luminance increments than for detecting luminance decrements. This prediction was confirmed by the results of a subsequent experiment. We discuss the relation between these results and luminance nonlinearities such as a logarithmic transform, as well as the involvement of contemporary model architectures of binocular vision.

Clinical evaluation of the Softec HD aberration-free aspheric intraocular lens

Purpose: To compare distance and near visual performance with a zero-aberration aspheric intraocular lens (IOL) (Softec HD, Lenstec, Inc. FL, USA) with that of an otherwise identical, but spherical IOL (Softec 1). Setting: Department of Ophthalmology, Solihull Hospital, West Midlands, United Kingdom. Methods: This prospective study comprised 37 patients with a Softec 1 spherical IOL implanted in one eye, who underwent phacoemulsification and received the Softec HD aspheric IOL in the fellow eye. One month post-operatively, unaided distance and near vision, residual refraction, best spectacle corrected distance and near visual acuity, reading speed, pseudoaccommodation and photopic contrast sensitivity were recorded. Wavefront analysis enabled comparison of higher order aberrations between the IOLs. Results: Prior to surgery, the Softec 1 and Softec HD eyes were not significantly different. Post-operatively, unaided vision, best spectacle corrected visual acuity and residual refraction were not significantly different between the eyes, nor were there significant differences observed between the measured wavefront aberrations. Once implanted, the range of focus was significantly better in the Softec HD IOL eye than the Softec 1 IOL eye and, although reading speed was equivalent to the Softec 1 eye, the print size at which this could be achieved was significantly smaller. Conclusions: Depth of field was significantly improved with the aspheric IOL compared with the spherical IOL, without any compromise in distance visual performance between the two IOLs.

Large diameter optic nerve axon fibres in Alzheimer's disease

A variety of visual symptoms have been associated with Alzheimer's disease (AD). These include delays in flash visual evoked potentials which indicate a disruption of the integrity of the visual pathway. Examination of the visual cortex has revealed the presence of both senile plaques and neurofibrillary tangles. The purpose of this study was to determine whether there were differences in the number and/or size of optic nerve axons between AD patients and non-demented age-matched controls. Five optic nerves from AD patients and five from age-matched controls were embedded in epon resin and 1 micron sections prepared on a Reichert ultramicrotome. The sections were then stained in toluidine blue and examined at x400 magnification. The numbers of axons were counted in photographs of three fields taken at random from each section. To evaluate the axon diameters, 70 axons were chosen at random from each patient and measured using a calibrated eyepiece graticule. The total axon counts revealed no significant differences between the AD optic nerves and the age-matched controls. However, the frequency distribution of axon diameters was significantly different in the two groups. In particular, there were fewer larger diameter axons in patients with AD as previously reported. Degeneration of the large diameter axons suggests involvement of the magnocellular as opposed to the parvocellular pathways. Hence, there could be differences in visual performance of AD patients compared with normals which could be important in clinical diagnosis.

Physical and psychophysical analysis of progressive addition lens embodiments

The extent to which the surface parameters of Progressive Addition Lenses (PALs) affect successful patient tolerance was investigated. Several optico-physical evaluation techniques were employed, including a newly constructed surface reflection device which was shown to be of value for assessing semi-finished PAL blanks. Detailed physical analysis was undertaken using a computer-controlled focimeter and from these data, iso-cylindrical and mean spherical plots were produced for each PAL studied. Base curve power was shown to have little impact upon the distribution of PAL astigmatism. A power increase in reading addition primarily caused a lengthening and narrowing of the lens progression channel. Empirical measurements also indicated a marginal steepening of the progression power gradient with an increase in reading addition power. A sample of the PAL wearing population were studied using patient records and questionnaire analysis (90% were returned). This subjective analysis revealed the reading portion to be the most troublesome lens zone and showed that patients with high astigmatism (> 2.00D) adapt more readily to PALs than those with spherical or low cylindrical (2.00D) corrections. The psychophysical features of PALs were then investigated. Both grafting visual acuity (VA) and contrast sensitivity (CS) were shown to be reduced with an increase in eccentricity from the central umbilical line. Two sample populations (N= 20) of successful and unsuccessful PAL wearers were assessed for differences in their visual performance and their adaptation to optically induced distortion. The possibility of dispensing errors being the cause of poor patient tolerance amongst the unsuccessful wearer group was investigated and discounted. The contrast sensitivity of the successful group was significantly greater than that of the unsuccessful group. No differences in adaptation to or detection of curvature distortion were evinced between these presbyopic groups.

Functional near vision assessment in presbyopia

The aim of this thesis was to develop standards of best practice for the subjective assessment of near visual function in presbyopia. Near visual acuity (VA) is a quick and simple measure but an assessment of the maximum reading speed and the smallest print size that can maintain this are equally important, to gain a better reflection of real world visual function. These metrics are dependent on the amplitude of accommodation (AoA) and often this must be evaluated using subjective techniques. Defocus curves are less susceptible than the push-up/push-down test to the influence of blur tolerance but their implementation must be standardised such that letter sequences and the order of lens presentation are randomised, to avoid memory effects, whilst the AoA should be quantified as the range of defocus for which only the best VA is maintained. In addition to such clinical assessments, subjective questionnaire evaluations are also important, to determine whether at least an individual’s needs are met. The Near Activity Visual Questionnaire (NAVQ) developed in this thesis can be used for this. Using these standardised near vision metrics it is shown that visual performance with monovision and multifocal contact lenses is comparable whilst initial outcomes of single optic ‘accommodating’ intraocular lens implantation are unlikely to be sustained in the long-term.

Requirement for and optimisation of premium intraocular lenses

Premium intraocular lenses (IOLs) aim to surgically correct astigmatism and presbyopia following cataract extraction, optimising vision and eliminating the need for cataract surgery in later years. It is usual to fully correct astigmatism and to provide visual correction for distance and near when prescribing spectacles and contact lenses, however for correction with the lens implanted during cataract surgery, patients are required to purchase the premium IOLs and pay surgery fees outside the National Health Service in the UK. The benefit of using toric IOLs was thus demonstrated, both in standard visual tests and real-world situations. Orientation of toric IOLs during implantation is critical and the benefit of using conjunctival blood vessels for alignment was shown. The issue of centration of IOLs relative to the pupil was also investigated, showing changes with the amount of dilation and repeat dilation evaluation, which must be considered during surgery to optimize the visual performance of premium IOLs. Presbyopia is a global issue, of growing importance as life expectancy increases, with no real long-term cure. Despite enhanced lifestyles, changes in diet and improved medical care, presbyopia still presents in modern life as a significant visual impairment. The onset of presbyopia was found to vary with risk factors including alcohol consumption, smoking, UV exposure and even weight as well as age. A new technique to make measurement of accommodation more objective and robust was explored, although needs for further design modifications were identified. Due to dysphotopsia and lack of intermediate vision through most multifocal IOL designs, the development of a trifocal IOL was shown to minimize these aspects. The current thesis, therefore, emphasises the challenges of premium IOL surgery and need for refinement for optimum visual outcome in addition to outlining how premium IOLs may provide long-term and successful correction of astigmatism and presbyopia.

The vision strategy of golf putting

Golfers, coaches and researchers alike, have all keyed in on golf putting as an important aspect of overall golf performance. Of the three principle putting tasks (green reading, alignment and the putting action phase), the putting action phase has attracted the most attention from coaches, players and researchers alike. This phase includes the alignment of the club with the ball, the swing, and ball contact. A significant amount of research in this area has focused on measuring golfer’s vision strategies with eye tracking equipment. Unfortunately this research suffers from a number of shortcomings, which limit its usefulness. The purpose of this thesis was to address some of these shortcomings. The primary objective of this thesis was to re-evaluate golfer’s putting vision strategies using binocular eye tracking equipment and to define a new, optimal putting vision strategy which was associated with both higher skill and success. In order to facilitate this research, bespoke computer software was developed and validated, and new gaze behaviour criteria were defined. Additionally, the effects of training (habitual) and competition conditions on the putting vision strategy were examined, as was the effect of ocular dominance. Finally, methods for improving golfer’s binocular vision strategies are discussed, and a clinical plan for the optometric management of the golfer’s vision is presented. The clinical management plan includes the correction of fundamental aspects of golfers’ vision, including monocular refractive errors and binocular vision defects, as well as enhancement of their putting vision strategy, with the overall aim of improving performance on the golf course. This research has been undertaken in order to gain a better understanding of the human visual system and how it relates to the sport performance of golfers specifically. Ultimately, the analysis techniques and methods developed are applicable to the assessment of visual performance in all sports.