The present invention relates generally to a method and apparatus for contact lens construction, and, more particularly concerns a method and apparatus for providing a universal construction for the non-optical peripheral area of a contact lens which rests on the eye, hereafter referred to as the “carrier.”
Most common defects in human vision are caused by the inability of the eye to focus incoming light to a common focal point on the retina. For example, nearsightedness can be attributed to an eye which focuses light anterior to the retina, farsightedness can be attributed to an eye which focuses incoming light posterior to the retina, and astigmatism can be attributed to an eye which does not have a common focal point. Human optical scientists frequently model the cornea as a portion of an ellipsoid defined by orthogonal major and minor axes.
Today, vision is commonly improved in one of two ways: either a lens is placed in front of the eye (e.g. a contact lens or a spectacle lens) or within the eye (e.g. an intraocular lens) to refocus incident light into the eye appropriately. Alternatively, the effective external surface shape of the cornea is changed, as by laser ablation surgery or other surgical means, to alter the anterior surface shape of the cornea. Such surgical procedures for correcting visual acuity are typically directed at increasing or decreasing the surface curvature of the cornea. Some procedures are intended to make the corneal shape more spherical, and others are intended to change the corneal shape to an “average” ellipse, or more recently, to making corrections based on wavefront analysis, a methodology that is intended to correct for the “higher order aberrations” of the eye.
In International Application PCT/US07/63572 (published under No. WO 2007/104013), owned by the assignee of the present patent application, the entire disclosure of which is incorporated herein by reference, we describe a method useful for optical lenses and operations performed on the eye to provide universal vision improvement at all distances. For example, a contact lens or corneal surgery that provides an effective reshaping of the cornea to have a “turtleback” will provide such universal improvement in vision. A “turtleback” shaped cornea exhibits the flattest surface curvature at a point lying at the edge closest to the nose, where surface curvature is determined along a half-meridian from that point to a central point on the cornea. Moving upwardly and about the perimeter of the cornea, the surface curvature will increase continuously until it reaches a maximum at the vertical extreme of the cornea. The surface curvature will then decrease continuously until it reaches an intermediate value at the edge of the cornea most distant from the nose, will increase continuously to a maximum at the vertically lowermost edge of the cornea, and will decrease continuously until it returns to its minimum at the edge of the cornea closest to nose. Such a shape was described in terms of an m-wave, a curve generally shaped like a lower case letter “M”, which represents the surface curvature of the modified cornea as a function of angular displaced about a reference point of the cornea known as the HIGH point.
Our prior surface analysis of the eye has concentrated on the cornea and particularly, a portion of the surface of the eye within an 8 mm diameter of the optical center. We are now seeking a universal shape for the posterior surface of a contact lens, to achieve optimal fit, and we are extending the analysis to the limbus, the transition to the sclera, and approximately the two proximal millimeters of the sclera. In addition to the posterior surface of the lens in the optical zone, of particular interest is an area of the eye corresponding to a portion of a contact lens constituting the non-optical peripheral area of the contact lens which rests on the eye. In conventional contact lenses, the optical portion of the lens falls to the surface of the eye. In a soft contact lens, the carrier area will generally begin at approximately 8 mm or 9 mm and extend to 12 mm or 15 mm. In a small corneal Rigid Gas Permeable (RGP or “hard”) lens, the carrier will typically cover an area peripheral to the optical zone and extending from a diameter of approximately 7 mm to 9 mm. It is also possible to manufacture an RGP lens that approximates the size of a soft contact lens. One of the objects of the present invention is to provide a contact lens with a posterior optical area or carrier area that is superior to existing lenses and that approximates the shape of the underlying topology of the eye. Another object is to provide a posterior surface structure which is universal or generic in that a single posterior optical area and carrier structure would be effective for most normal eyes.
What has been missing from contact lenses constructed in this manner is a universal construction for the posterior surface of a lens that will conform to virtually every eye. This would make it possible to fit any non-diseased eye with a universal contact lens or one of a small set of universal contact lenses.
Making use of the analysis of clinical measurements in accordance with the surface modeling techniques disclosed in U.S. Pat. No. 5,807,381 the applicants have discovered that the carrier region extending beyond the optical portion of a contact lens overlying the cornea of an eye can be modeled in one universal shape that will fit most normal eyes. That shape is characterized by a curve of radius of curvature versus distance from the High point which is substantially linear with a first slope below a 10 mm diameter of the eye as projected onto a plane perpendicular to the optical axis, is substantially linear above 10 mm with a second slope which is substantially greater than the first slope, and which has an inflection point in the vicinity of approximately 10 mm. Preferably the first linear portion has a radius of curvature of approximately 7.6 mm at a diameter of about 7 mm, with a slope of about 0.13 (the first slope) and a radius of curvature of about 9 mm at a diameter of 12 mm, with a slope of about 0.45 (the second slope).
Similarly, the applicants have found that the posterior surface of the optical zone of a lens can be modeled as an M-wave shape which is the same for all eyes. This will provide the closest fit of the lens over the cornea and minimize optical distortion due to the tear film between the lens and the cornea.
The foregoing brief description and further objects, features and advantages of the present invention will be understood more completely from the following detailed description of presently preferred embodiments, with reference being had to the accompanying drawings in which:
In conjunction with modern corneal procedures, such as corneal ablation surgery, for clinical applications, and for contact lens design and manufacture, high resolution cameras are used to obtain a digitized array of discrete data points on the corneal surface. One system and camera which have been available for mapping the cornea is the PAR Corneal Topography System (PAR CTS) of PAR Vision Systems. The PAR CTS maps the corneal surface topology in three-dimensional Cartesian space, i.e., along x- and y-coordinates as well as depth (Z) coordinate. Other systems that have worked successfully include the EyeShape system, provided by BioShape AG of Berlin, Germany and the Pentacam eye scanner, available from Oculus, Inc., of Lynnwood, Wash.
The “line-of-sight” is a straight line segment from a fixation point to the center of the entrance pupil. As described more fully in Mandell, “Locating the Corneal Sighting Center From Videokeratography,” J. Refractive Surgery, V. 11, pp. 253-259 (July/August 1995), a light ray which is directed toward a point on the entrance pupil from a point of fixation will be refracted by the cornea and aqueous humor and pass through a corresponding point on the real pupil to eventually reach the retina.
The point on the cornea at which the line-of-sight intersects the corneal surface is the “optical center” or “sighting center” of the cornea. It is the primary reference point for refractive surgery in that it usually represents the center of the area to be ablated in photorefractive keratectomy. The line-of-sight has conventionally been programmed into a laser control system to govern corneal ablation surgery. However, some surgeons prefer to use the pupillary axis as a reference line. Other surgeons center the ablation profile about the corneal apex usually defined as the area on the cornea of greatest curvature change. Experienced practitioners have employed various techniques for locating the sighting center. In one technique, the angle lambda is used to calculate the position of the sighting center relative to the pupillary (“optic”) axis. See Mandell, supra, which includes a detailed discussion of the angles kappa and lambda, the disclosure of which is incorporated herein by reference as if set forth in its entirety herein.
During the corneal ablation procedure, such as LASIK, a portion of the corneal surface is reflected and the ablation performed on the exposed surface. The gathered elevational data is used to direct an ablation device such as a laser, so that the corneal surface can be selectively ablated to more closely approximate a spherical surface of appropriate radius about the line-of-sight, or an “average” ellipse, or a wavefront fingerprint within the ablation zone. The use of the line-of-sight as a reference line for the procedures may reduce myopia or otherwise correct a pre-surgical dysfunction or a visual abnormality. However, a more irregularly shaped cornea may result, which may exacerbate existing astigmatism or introduce astigmatism or spherical aberration in the treated eye. This will complicate any subsequent vision correction measures that need be taken. Also, any substantial surface irregularities which are produced can cause development of scar tissue or the local accumulation of tear deposits, either of which can adversely affect vision.
Implicit in the use of the-line-of sight or the pupillary axis as a reference axis for surgical procedures is the assumption that the cornea is symmetric about an axis extending along a radius of the eye. The cornea, however, is an “asymmetrically aspheric” surface. “Aspheric” means that the radius of curvature along any corneal “meridian” is not a constant (a “meridian” could be thought of as the curve formed by the intersection of the corneal surface and a plane containing the pupillary axis). Indeed, the corneal curvature in most eyes tends to flatten progressively from the geometric center to the periphery. “Asymmetric” means that the corneal meridians do not exhibit symmetry about their centers. The degree to which the cornea is aspheric and/or asymmetrical varies from patient to patient and from eye to eye within the same person.
Analysis of clinical measurements in accordance with the surface modeling techniques of U.S. Pat. No. 5,807,381 reveals that the point on the surface of the cornea which is most distant from the reference plane of the PAR CTS (hereafter referred to as the HIGH point) is a far more effective reference point for corneal ablation and lens design than the center of the cornea or the pupillary center. Specifically, as demonstrated in U.S. Pat. No. 5,807,381 laser ablation about an axis passing through the HIGH point produces a much more regularly shaped cornea and removes less corneal material than the same operation performed about an axis close to the center of the eye, such as the pupillary axis.
Analysis of clinical measurements in accordance with the methods of U.S. Pat. No. 5,807,381 and International Application No. PCT/US03/1763 (published as WO03/101341), the disclosures of which are incorporated herein by reference in their entireties, raises questions about assumptions that have been made about the structure of the human cornea which are inherent in such well-known corneal analysis technologies as wave-front analysis and Placido disc technology. In particular, it was found that, unlike other optical systems, the central portion of the cornea (for example, out to a 3 mm diameter) is not necessarily optically superior to substantially greater portions of the cornea (for example, out to a 7 mm diameter) in its ability to focus. The central portion of the cornea exhibits a great deal of focus scattering. That is, different regions on the cornea do not focus to the same point on a focal axis. Indeed, they do not even focus on the same axis. This focus difference is usually most pronounced in the central portion of the cornea and decreases substantially at increasing diameters from the center.
A process for achieving corneal or contact lens shaping in accordance with the present invention is illustrated in block diagram form in
The Corneal Image Capturing System 610 and the Elevation Analysis Program 620 are preferably components of the PAR® Corneal Topography System (“the PAR® System”), which is available from PAR Vision Systems. The Elevation Analysis Program 620 is a software program executed by a processor, for example an IBM™ compatible PC. Program 620 generates a third dimension element (a Z coordinate representing distance away from a reference plane inside the eye) for each of a plurality of sample points on the surface of the cornea measured by system 610. Each point is defined by its X-Y coordinates as mapped into the reference plane, and its Z coordinate is determined from brightness of the point. One method of calculating the elevation of each point, i.e., the Z coordinate, is by comparing the X-Y and brightness values measured from the patient's cornea 14 with the coordinates and brightness of some reference surface with known elevation, e.g., a sphere of a known radius. The reference values can be pre-stored.
The final output of the Elevation Analysis Program 620 is the X-Y-Z coordinates for a multiplicity of sample points, commonly known as a point cloud, on the surface of the cornea 14. It will be apparent to those skilled in the art that any method can be used that can generate X, Y, Z corneal data providing both location and elevation information for points on the corneal surface with the required accuracy. In the preferred embodiment about 1200 points are spaced in a grid pattern, as viewed in the X-Y plane, so the projections of the points into the X-Y plane are about 200 microns apart.
The X-Y-Z data output from the Elevation Analysis Program 620 can be formatted in any number of well-known machine-specific formats. Preferably, the data are formatted in Data Exchange File (DXF) format, an industry standard format which is typically used for the inter-application transfer of data. A DXF file is an ASCII data file, which can be read by most computer aided design systems.
Referring now to
Cornea matching surface 108 is preferably produced by first generating a plurality of splines 102, each defined by a plurality of the data points of the point cloud 100. The generation of a spline that intersects a plurality of data points (i.e., knot points) is, per se, known to those skilled in the art and can be accomplished by the Anvil 5000™ program once the input data have been entered. For more information regarding the generation of a surface model, see U.S. Pat. No. 5,807,381, the disclosure of which is incorporated herein by reference. In a preferred embodiment, the known non-uniform rational B-spline formula is used to generate the splines, but they could be generated by other well-known mathematical formulas for splines, such as the cubic spline formula or the rational uniform B-spline formula. As illustrated in
Surface 108, which matches the corneal surface of the scanned eye, is then generated from splines 102. There are a number of well-known mathematical formulas that may be used to generate a surface from a plurality of splines 102. In the preferred embodiment, the well known nurb surface equation is used to generate a corneal surface from splines 102. In the embodiment, because the scanned area of the eye is approximately 12 mm×12 mm, approximately 50 splines 102 are created. As illustrated in
Neither the original data points, nor the knot points of splines 102 necessarily lie on-surface 108, owing to the mathematical generation of the surface when using the nurb surface equation formula. However, the surface 108 estimates those points within a predefined tolerance.
The HIGH point on the generated corneal matching surface 108 (i.e., the point having the greatest Z value) is determined. A cylinder 106 of a predetermined diameter is then projected onto the corneal matching surface 108 along an axis which is parallel to the Z-axis and passes through the HIGH point. Cylinder 106 preferably has a diameter of about 3 mm to about 8 mm, typically about 7 mm, and the closed contour formed by the intersection of cylinder 106 with surface 108 projects as a circle 106′ in the X-Y plane. On the matching surface 108, this contour defines the outer margin 26 of the working area of the cornea. The cornea is the most symmetric and spherical about the HIGH point and, therefore, provides the best optics at this point.
The outer margin 26 must fit within the point cloud, so that the surfaces of the cornea can be formed based on the measured corneal data. The computer aided design system 630 can then illustrate a default circle 106′ (in the X-Y plane) with respect to the point cloud, for example on a monitor screen, so that the operator can be assured that circle 106′ falls within the point cloud. Additionally, system 630 can be set up to determine if circle 106′ falls within point cloud 100 and, if it does not fall completely within point cloud 100, to alert the user to manipulate the circle (i.e., move the center point and/or change the radius of the circle) so that circle 106′ lies within the corneal data point cloud 100. In a worst case scenario, the eye should be rescanned if insufficient data is available from the scanned eye to ensure that the working area of the cornea will fit properly within the point cloud. Alternatively, the area of the point cloud can be made larger.
It is to be understood that circle 106′ is only a circle when viewed in the X-Y plane (i.e., looking along the Z-axis). Actually, the periphery 26 is approximately elliptical and lies in a plane which is tilted relative to the reference plane. A line Perpendicular to this tilted plane which passes through the HIGH point will be referred to as the “LOCAL Z-AXIS” or “tilted axis,” and the tilt of the tilted plane relative to the reference plane will be considered the tilt angle of the working area of the cornea.
Optical lenses manufactured in accordance with the present invention, will seek to correct the patient's vision in accordance with the required corrections established in a “refraction test.” When this test is performed, the patient sits in chair which is fitted with a special device called a “phoropter,” through which the patient looks at an eye chart approximately 20 feet away. As the patient looks into the phoropter, the doctor manipulates lenses of different strengths into view and, each time, asks the patient whether the chart appears more or less clear with the particular lenses in place. In practice, the doctor is able to vary the power or diopter correction about two orthogonal axes, as well as the degree of rotation of those axes about a Z-axis along the line-of-sight. The doctor continues to modify these three parameters until he achieves the optimum vision. The results of the refraction test are usually given in the form “a, b, c,” where “ a” is the diopter correction at the first axis, “b” is the additional diopter correction required at the second, orthogonal axis, and “c” is the angle of rotation of the first axis relative to the horizontal. This form of information is given for each eye and is immediately useful in grinding a pair of lenses for eyeglasses.
There will now be described a technique for generating characterizing curves on surface 108, which will be useful below. A plane 110 is constructed which contains the LOCAL Z-AXIS (See
Each of these characterizing curves is then estimated by a best-fit spherical (circular) arc. One manner of doing this is simply to select a circular arc which passes through three known points for each curve (e.g., the point at which it touches the contour 106′, the HIGH point, and that point which is halfway between those two points when viewed in projection along the local Z axis). The radius of such an arc is used as an estimate of the radius of curvature for the contour 106′ along the arc.
337.5/Arc Radius=Diopter Value
Ideally (for the best universal improvement of vision), waveform A should be shaped like a letter “M” and it is therefore referred to herein as the “M-wave” of the cornea. It is, in the present instance, a somewhat distorted M.
As an initial step in redesigning the shape of a cornea to exhibit universal vision improvement, an idealized M-wave is generated for the cornea. Starting with a polar representation of the patient's cornea showing the surface curvature along the natural half-meridian arcs of the particular corneal surface, such as waveform A, an idealized waveform is generated. This waveform is not related to waveform A, except the lowest diopter values are preferably approximately the same in the two waveforms, but waveform B does need to meet certain criteria. First of all, the peak-to-peak diopter variation of the waveform is adjusted to be approximately 3 diopters, preferably about 2.875 diopters. It has been found that there is substantial deterioration in near vision correction if this diopter range drops below about 2 diopters or exceeds about 4 diopters. In addition, the dip D in the M-wave is adjusted so as to lie between approximately 40% and 60% of the peak-to-peak amplitude of the M-wave. Preferably, it is approximately 50%. Then, the entire waveform is adjusted so as to transition smoothly between values. Preferably, the peaks occur at about 90° and 270° and the dip at approximately 180°, while producing a smooth curve. This results in the ideal M-wave to represent the patient's cornea. This wave is represented by waveform B in
It will be appreciated that waveform B exhibits the flattest surface curvature at 0° (a point corresponding to the edge of the cornea that would be closest to the nose in waveform B). Increasing the polar angle, the surface curvature increases continuously until it reaches a maximum at about 90° (corresponding to the vertically uppermost edge of the cornea). The surface curvature then decreases continuously until it reaches an intermediate value, the dip, at about 180° (corresponding to the edge of cornea most distant from the nose), and it increases continuously to a maximum at about 270° (corresponding to the vertically lowermost edge of the cornea), and it decreases continuously until it reaches 0°, where it returns to its minimum. Thus, the surface described by this M-wave has the idealized turtleback shape discussed previously.
In the preceding paragraph it was assumed that the M wave for the patient's left eye was being considered. The reference or 0° angle was selected as the point closest to the nose and the polar angle increased in a counterclockwise direction.
In order to gain a better understanding of the requirements for a universal or generic contact lens carrier, we will first analyze the shape of a cornea in the nominal carrier region between 8 mm and 12 mm. For this purpose, corneal models were generated for 10 patients with normal corneas exhibiting corrected distance vision in the range of 20/20 or better and near vision in the range of Jaeger 2. For each patient, a graph of radius of curvature as a function of “Top Down Diameter of Regard” was provided at four different angular orientations about the HIGH point. The four angular orientations were axis 0 (0°), axis 90 (90°), axis 180 (180°) and axis 270 (270°). As a convention, the portion of the edge of the cornea closest to the nose was designated as 0°, and, looking at the left eye, angle would increase counterclockwise.
The “Top Down Diameter of Regard” at a particular point is the distance between the HIGH Point and the a particular point (the Point of Regard) as measured in a plane perpendicular to the tilted Z-axis (this will be referred to as the X-Y plane). The radius of curvature is estimated at a particular Diameter of Regard and angular orientation by generating a best-fit circular arc which contains the HIGH point and the Point of Regard. The best-fit arc will also include that point on the corneal model which is halfway between the HIGH point and Point of Regard in the X-Y plane. The radius of that circular arc is then used as an estimate of the radius of curvature at the Point of Regard.
Each graph of curvature versus Diameter of Regard was generated at a particular angular orientation at 0.5 mm increments of Diameter of Regard, ranging from 7 mm to 12 mm. At each angular orientation and Diameter of Regard, the radii of curvature of ten eyes were average, thus, the graphs to be discussed below represent the average of the ten eyes.
The foregoing information would permit the generation of a useful generic carrier model if the cornea were rotationally symmetric. However, it is not. In order to analyze the circumferential variation of the radius of curvature, we generated a set of graphs of radius of curvature as a function of angular orientation.
We have determined above that it might be preferred to have a set of lenses with three different size carriers, although the use of a single generic carrier may be possible. In order to determine the quality of fit of a carrier, we will perform a Z-depth analysis. This involves determining the variation in the carrier surface along the tilted Z-axis. Additionally, we will consider radial variation.
Referring to
A slight improvement in the fit of the carrier portion may be achieved by imposing an inverted M-wave shape on the circumferential variation of the radius of curvature. The M-shape would have an amplitude of about 0.2 mm and central dip (actually a rise) of approximately 0.05 mm at a polar angle of approximately 180°.
Comparisons of the analysis results for left and right eyes suggest that the carrier areas for the two eyes should be mirror images of each other.
Accordingly, the graph of
Preferably, a contact lens in accordance with the present invention would have a carrier region having a shape described above and a posterior optical zone shaped in accordance with the graph of
Although preferred embodiments of the invention have been disclosed for illustrative purposes, those skilled in the art will appreciate that many additions, modifications, and substitutions are possible without departing from the scope and spirit of the invention. For example, the present invention is applicable not only to corneal ablation and contact lenses, but to any other kind of lens, including cataract, phakic, intraocular, intracorneal and spectacle lenses.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US09/38939 | 3/31/2009 | WO | 00 | 10/28/2010 |
Number | Date | Country | |
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61041409 | Apr 2008 | US |