Method and apparatus for optometry

Abstract

A system for obtaining diagnostic eye information is disclosed.SOLUTION: The system comprises at least one energy source for directing electromagnetic energy towards the eye of the subject, a plurality of sensory units, each sensory unit being associated with an associated position within the field of view of the eye, each sensory unit being adapted to obtain refractive information from the eye in response to the electromagnetic energy, and a processing system for determining refractive error information associated with each position of each sensory unit within the field of view of the eye and for determining refractive error composite information about the eye in response to the refractive error information associated with each sensory unit and independent of the gaze direction of the eye.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] Priority This application claims priority to U.S. Provisional Patent Application No. 63 / 270,907, filed October 22, 2021, which is incorporated herein by reference in its entirety. [Background technology]

[0002] An automated refractor, or autorefractor, is a device designed to quickly measure the aberrations, or refractive errors, of the eye. Autorefractors are often used by eye care professionals (ECPs) to determine a patient's eyeglass or contact lens correction. Historically, autorefractors were not accurate enough to directly determine lens correction and were used by ECPs as a pre-screening tool before manual or subjective refraction. Subjective refraction with a phoropter is a proven method for arriving at a final lens correction, but it is time-consuming and requires a well-trained ECP, and not all ECPs are able to perform it repeatedly with high accuracy.

[0003] The accuracy of conventional autorefraction techniques based on retinal reflex measurements (optometry, Scheiner, retinoscopy, or photorefraction) is generally limited by varying degrees of: (a) line of sight misalignment with the sensor optics, (b) poor control of the eye's state of accommodation during the measurement, (c) limited ability to detect higher-order aberrations of the eye, (d) inability to detect medial opacities, and (e) inability to detect anterior or posterior ocular diseases that affect vision other than refractive error. The problems with retinal reflex techniques are discussed in more detail below.

[0004] The issue of gaze misalignment is particularly problematic when only one camera is used. In a conventional autorefractor setup using a single camera sensor, the location probed on the retina likely does not coincide with the location of the fovea due to gaze misalignment between the subject's eye and the sensor's camera. A misaligned eye is essentially rotated within the orbit and points at some angle off the camera axis. The fovea is where central vision occurs, and probing refractive error outside the fovea, i.e., in the periphery, can result in measurement errors of more than 0.5 diopters. Several strategies exist for guiding the subject's gaze to the optical center of the camera, such as displaying visual cues and guides, audio prompts, or guidance from an ECP. However, these strategies are not always effective due to involuntary eye movements, difficulty understanding instructions, or discomfort or stress caused by the device interface.

[0005] The impact of higher-order aberrations (HOAs) on normal vision generally depends on pupil diameter. When the pupil diameter is large (usually in low-light conditions, e.g., driving at night), a larger area of ​​the eye's optical system participates in image formation, resulting in a greater impact of HOAs on normal vision. Individuals with significant HOAs (e.g., astigmatism, coma, trefoil, etc.) often complain of "halos" when viewing lights at night. Detecting the full range of HOAs can be difficult with conventional autorefraction techniques because they cannot map the eye's entire pupil diameter or refractive state. Some autorefraction systems attempt to adjust refraction measurements based on pupil diameter and other meta-inputs, such as age and gender, via empirically derived lookup tables, but this only corrects for population averages.

[0006] The eye uses the ciliary muscles to change refractive power to focus on near and far objects during a process known as accommodation. If the eye is not focused on the desired image plane relative to the sensor camera during a measurement, results can be significantly distorted, sometimes by more than 1.0 diopters. Conventional autorefractors have no way of determining or verifying whether the patient is focusing on the correct target distance during a measurement. Some autorefractors utilize fogging techniques to set the focal plane of the target image beyond optical infinity, thereby mitigating accommodation during the measurement. Fogging is most effectively achieved in systems where the autorefractor optics are relatively close to the subject's eyes, i.e., the device touches the subject's face.

[0007] Recent advances in automated refraction technology have begun to address some of the above issues. The Shack-Hartmann method or wavefront measurement method is suitable for determining HOA and has in some cases been clinically proven to provide more accurate results regarding the patient's desired lens correction than subjective refraction with mean ECP. However, to date, no automated refraction system has been developed that systematically addresses most of the above-mentioned issues that limit accuracy.

[0008] Furthermore, for ease of use, autorefractors are designed to be operated by ECPs in clinical settings, rather than by patients themselves. This effectively forces patients to visit an ECP's office to obtain lens correction readings for their new corrective glasses, creating a significant barrier to maintaining proper vision care for the general public due to the cost and time involved.

[0009] Thus, there remains a need for systems and methods for obtaining retinal reflex information of the eye using more efficient and more economical processes, and further, there remains a need for systems and methods that are more easily and economically accessible to a larger number of people. [Prior art documents] [Patent documents]

[0010] [Patent Document 1] European Patent Application Publication No. 3320830 Summary of the Invention

[0011] According to one aspect, the present invention provides a system for obtaining diagnostic eye information, the system comprising: at least one energy source for directing and delivering electromagnetic energy to an eye of a subject; a plurality of sensory units, each sensory unit associated with an associated position within a field of view of the eye, each sensory unit adapted to obtain refractive information from the eye in response to the electromagnetic energy; and a processing system for determining refractive error information associated with each position of each sensory unit within the field of view of the eye and for determining composite refractive error information about the eye in response to the refractive error information associated with each sensory unit, independent of gaze direction of the eye.

[0012] According to another aspect, the present invention provides a system for obtaining diagnostic eye information, comprising at least one energy source for directing and delivering electromagnetic energy to an eye of a subject, a perception system adapted to obtain refractive information from the eye in response to the electromagnetic energy and pupil diameter information representative of a pupil diameter of the eye, and a processing system for determining refractive error information of the eye and correlating the refractive error information with the pupil diameter of the eye.

[0013] According to a further aspect, the present invention provides a system for obtaining diagnostic eye information, the system comprising: at least one energy source for directing and transmitting electromagnetic energy toward a subject's eye; a perception system adapted to obtain refractive information from the eye in response to the electromagnetic energy; a partially reflective mirror through which the perception unit is directed toward the eye; an object image seen by the subject through the partially reflective mirror; a mirror control system for rotating the partially reflective mirror to vary the apparent distance of the object image between a first distance and a second distance; and a processing system for determining refractive error information of the eye and associating the refractive error information with either the first distance or the second distance.

[0014] According to a further aspect, the present invention provides an automated ophthalmic examination system for obtaining diagnostic eye information, the automated ophthalmic examination system comprising: an alignment system for providing alignment information regarding the alignment of a subject relative to an alignment camera system; a diagnostic analysis system for determining refractive error information associated with at least one eye of the subject within a field of view of the diagnostic analysis system; and an alignment correction system for adjusting the field of view of the diagnostic analysis system in response to the alignment information.

[0015] According to a further aspect, the present invention provides a method of obtaining diagnostic eye information, the method including: directing electromagnetic energy at an eye of a subject; obtaining refractive information from the eye at each of a plurality of sensory units in response to the electromagnetic energy, each sensory unit being associated with an associated location within a field of view of the eye; determining refractive error information associated with each location of each sensory unit within the field of view of the eye; and determining composite refractive error information for the eye, independent of a gaze direction of the eye, in response to the refractive error information associated with each sensory unit.

[0016] The following description can be better understood with reference to the accompanying drawings. [Brief explanation of the drawings]

[0017] [Figure 1] 1 shows an exemplary schematic diagram of a non-line-of-sight dependent refractor system configuration for use in a system according to an aspect of the present invention. [Figure 2] 1 illustrates an exemplary schematic diagram of a cluster configuration for non-line-of-sight dependent photorefractive testing in an example of concentric ring lights for pupil diameter manipulation, according to an aspect of the present invention. [Figure 3] 1 shows an exemplary schematic diagram of an example of a pattern of probe locations on the retina formed by a cluster configuration where the gaze angle is the offset between the central axis and the gaze direction, according to an aspect of the present invention. [Figure 4] 1 shows an exemplary schematic diagram of an example of a fitted curve to a spatial map of probe positions, where the value V at the fovea can be determined by finding an extreme value (e.g., minimum) of the curve. [Figure 5] 1 shows an exemplary schematic diagram of one example of an alternative cluster configuration with eight camera positions, providing a configuration without a camera in the center of the cluster, and also including a separate pupil manipulation light. [Figure 6] 1 shows an illustrative schematic diagram of one example of an alternative configuration with a central camera and an off-center IR light, in which one or more separate camera(s) and IR light move along a path at defined intervals during acquisition, according to an embodiment of the present invention. [Figure 7] 1 shows an exemplary schematic diagram of an example camera cluster configuration having seven camera positions with an array of IR light sources arranged in a grid, according to an embodiment of the present invention. [Figure 8] 1 shows an exemplary schematic diagram of a vision testing kiosk housing a system according to one aspect of the present invention. [Figure 9] 1 illustrates an exemplary schematic diagram of one example of components of an input touch display and test window of a vision testing kiosk, in accordance with an aspect of the present invention. [Figure 10] 1 shows an exemplary schematic diagram of one example of a pupil diameter manipulation system with a feedback loop that can be used to converge a subject's pupil diameter to a target pupil diameter, according to an aspect of the present invention. [Figure 11]FIG. 10 shows an illustrative schematic diagram of one example of a virtual object (target) visualized within an inspection window, where the virtual object appears to be visually floating at a set distance within the inspection window interface, according to one aspect of the present invention. [Figure 12] FIG. 1 shows an exemplary schematic diagram of an example virtual object system for displaying graphical objects floating at a large distance (e.g., 20 feet (6.096 m)) from a subject within an examination window, in accordance with one embodiment of the present invention, which can be combined with a photorefractor. [Figure 13] 13 shows an illustrative schematic diagram of an example of the virtual object system of FIG. 12 in which the partially reflective mirror is rotated to display the virtual object at close range (e.g., 3 feet (0.9144 m)), according to one embodiment of the present invention. [Figure 14] 1 shows an exemplary schematic diagram of one example of a self-administered visual acuity chart that can be implemented in a vision testing kiosk, according to an aspect of the present invention. [Figure 15] 10 shows an exemplary schematic diagram of an alternative variation of an interactive self-administered visual acuity chart according to a further aspect of the present invention; [Figure 16] 1 shows an exemplary schematic diagram of a subject at an autonomous eye examination kiosk. [Figure 17] 1 shows an exemplary schematic diagram of components of a diagnostic system according to an aspect of the present invention. [Figure 18] 18 shows an exemplary schematic diagram of a tracking camera image in the system of FIG. 17. DETAILED DESCRIPTION OF THE INVENTION

[0018] The drawings are shown for illustrative purposes only.

[0019] According to various aspects, the present invention provides a new type of refraction testing technique and eye testing device that overcomes the accuracy limitations mentioned above while allowing laypersons to perform automated self-tests both in and out of clinical settings. The refraction testing technique outlined herein is rooted in the physics of decentered photorefraction, a subcategory of retinal reflex techniques. Combining the refraction testing technique with sensors in the kiosk allows for a fully automated refraction test after the subject presses a start button. In accordance with one aspect of the present invention, a novel vision testing technique is outlined that is included in or combined with the novel refraction testing technique described herein in a self-service eye testing kiosk.

[0020] Exemplary embodiments of the present invention overcome the aforementioned problems associated with conventional refraction testing, particularly photorefraction testing. In particular, according to one aspect, the present invention overcomes the problem of gaze misalignment during photorefraction testing. In exemplary embodiments, a camera cluster with multiple off-center light sources performs photorefraction testing to measure refractive aberrations in a manner independent of the subject's gaze direction. In some embodiments, the photorefractor is coupled to a pupil diameter control system that changes pupil diameter at a desired rate or sets pupil diameter to a desired value. Performing photorefraction measurements at multiple pupil diameters allows for the detection of high-order aberrations, and setting pupil diameter to a desired reduced value can limit the effects of high-order aberrations. In some cases, the non-gaze-dependent photorefraction testing or pupil diameter control system is combined with a visual acuity test self-administered by the subject. Photorefraction testing during a vision test can improve control of the subject's state of accommodation by focusing the subject at a real or virtual far point (e.g., 20 feet (6.096 m) according to the distance on a standard Snellen chart) or by providing more time to obtain multiple photorefraction measurements, which may allow the accommodation state of one or both of the subject's eyes to be determined simultaneously. In further cases, the visual target of the testing device can be set at different distances during a refraction or vision test to obtain measurements at the focal distance of the eye, thereby providing additional information about the refractive or accommodative state of the eye.

[0021] The entire system can be incorporated into a self-service or ECP-guided vision testing kiosk, or can be compact enough for other tabletop or handheld configurations.

[0022] Non-gaze-dependent photorefraction testing In an exemplary embodiment, a photorefractor camera cluster with multiple cameras and an off-center light source performs photorefractive testing to measure refractive aberrations in a manner independent of a subject's gaze direction, in accordance with one aspect of the present invention. The camera cluster can be used to measure retinal reflexes at multiple discrete locations (probe locations) on the retina. These probe locations can cover portions of the central and peripheral visual fields of the retina. The measurements and relative positions of each probe location can be spatially mapped into a scatter plot describing the refractive error or ocular information across the entire visual field of the eye. By fitting a three-dimensional surface to the map, a continuous curve can be found that models the refractive error in the central and peripheral visual fields. (This is because in almost all healthy human eyes, refractive power changes from central to peripheral vision, and the change is monotonically up to about 25 degrees toward the periphery. Due to individual differences in the human eye, refractive power increases, remains the same, or decreases monotonically, regardless of whether the eye is myopic, emmetropic, or hyperopic.) In an exemplary embodiment of the present invention, each of one or more types of refractive error in central vision is calculated by searching for an extremum of the fitted curve. The type of extremum (e.g., global minimum, global maximum, local minimum, or local maximum) searched for may depend, among other things, on the type of refractive error and the closeness of the fitted curve. As discussed herein, photorefraction testing can be performed regardless of the user's gaze direction to measure the subject's refractive error in central and peripheral vision.

[0023] The cluster of cameras may be positioned adjacent to each other, each facing toward the subject's eye. The cameras may be positioned along a curved geometric surface (e.g., concave or convex) and equidistant from the subject's eye. Alternatively, the cameras may be positioned on a geometric plane. Each camera may be paired with a combination of off-center light sources. The light sources may be infrared (IR) LEDs. The cluster configuration may form an acceptance cone between the subject's eye and the camera, and any gaze angle of the subject's eye within the acceptance cone may result in a valid measurement. The gaze angle may be the angle between (a) the visual axis of the eye and (b) a line from the eye to the center of the camera cluster (hereinafter, the "central axis"). The maximum gaze angle that results in reliable photorefraction measurement may occur when the subject's gaze direction is toward the outermost camera of the camera cluster.

[0024] Each camera may be surrounded by multiple energy sources (e.g., IR lights). In some cases, the cameras are positioned at equidistant angles to each other. In some cases, the IR lights are directed along the same geometric surface as the surface of the camera cluster, or parallel to or equidistant from that geometric surface. The IR lights may enter the eye being examined using decentered photorefraction and then emit IR light exiting the eye. The IR lights may be positioned at multiple meridians around the camera to probe the subject's eye for spherical and cylindrical (astigmatic) errors. This can be achieved by sequentially turning each IR light on and off while recording the double-pass retinal reflex in the subject's pupil. The retinal reflex can be extracted from the IR light pixel intensity of the pupil on the camera image. The refractive state from each IR light on / off cycle can be calculated using one of several common photorefractor image-to-diopter conversion methods, such as the intensity gradient-based method or the crescent method. The conversion of pupil pixel intensities to refractive error can also be performed by an image classifier from a trained neural network or other artificial intelligence (AI) image processing-based classifier techniques. In some cases, the refractive error result is determined by an empirically found lookup table that relates the values ​​extracted from the pupil pixels by the aforementioned methods to spherical refractive error (SP: defocus power error in diopters), cylindrical refractive error (CY: astigmatism power error in diopters), and the angle of cylindrical refractive error (AX: astigmatism angle in diopters or radians) in a specified range (e.g., SP or CY from -7 to +7 diopters).

[0025] Each camera and its paired IR light in the cluster can form an independent photorefractor, probing a specific location (e.g., a very small area) on the retina. Light from the IR light source can enter the cornea, then pass through the pupillary opening, then the lens, land on a small area on the retina, reflect off the retina (retinal reflection), return through the lens, pupillary opening, and cornea, and finally reach the camera. This method is sometimes called a double-pass reflection or retinal reflection, because the IR light passes through the pupil twice. Using a cluster of cameras and IR light sources, multiple reflection locations on the retina can be probed simultaneously or within a single measurement session. The pattern of locations probed on the retina can form the same pattern as the configuration of cameras in the cluster. Each probe location on the retina can provide refractive error measurements of SP, CY, and AX, or higher-order aberrations such as trefoil or coma. These results can also be combined into a spherical equivalent value, SE, in diopters, defined as SE = SP + CY / 2 (AX can be discarded).

[0026] Obtaining the individual components of refractive error for each probe position allows the calculation of separate, discrete spatial maps that describe only the SP, CY, and AX results, respectively. Alternatively, a spatial map of SE for each probe position can be calculated. A spatial map, or "map," is a three-dimensional scatter plot in which each point has coordinates (X, Y, V), where X and Y are retinal locations and V is the value of a given probe point, SP, CY, AX, or SE. The units of X and Y may describe distance (e.g., mm) or angle (e.g., degrees or radians) on the retina. The unit of V may describe the refractive error in diopters, absolute power in diopters, or the difference in refractive error relative to a given calibration constant in the SP, CY, or SE map; the larger the refractive value, the larger the value of V. The unit of V may describe the angle in degrees or radians in the AX map.

[0027] Either the SP, CY, or SE discrete map can be used to fit a three-dimensional curve to the points on the map. Curve fitting can be performed separately and independently on the SP, CY, or SE discrete maps to generate an SP curve, a CY curve, or an SE curve.

[0028] Fitting can be performed by nonlinear least-squares fitting, linear least-squares fitting, least absolute residual fitting, squared fitting, polynomial regression fitting, or piecewise linear regression fitting. The surface function fitted to the map points can be a predefined polynomial, an nth-order polynomial, a cubic spline, or a 3D surface from a lookup table that forms a continuous spatial map of SP, CY, or SE values. The map can spatially describe the components of the central and peripheral refractive error of the eye. A curve can be fitted to one of these maps, and the extrema of the fitted curve may reveal the refractive error of central vision (at the fovea).

[0029] In most eyes, regardless of whether the eye is myopic, emmetropic, or hyperopic, the SP, CY, or SE refractive error increases or decreases monotonically from the fovea toward the periphery up to approximately 25 degrees (gaze angle). In other words, the peripheral vision of the eye generally has a different refractive power than the central vision. The gaze angle is the angle between the central axis and the visual axis of the eye. The central axis is the line connecting the center of the pupil and the center of the photorefractor cluster. The visual axis is the line connecting the center of the fovea and the center of the pupil. When the eye focuses on the center of the photorefractor cluster, the central axis coincides with the center of the fovea, and the gaze angle is zero. When the eye rotates relative to the central axis, the central axis may pass through a point on the retina outside the fovea, i.e., the periphery. As the eye rotates, the gaze angle to the periphery increases in all directions from the fovea. The center of gravity is a non-limiting example of each "center" of the regions referred to herein (e.g., pupil, fovea, or camera cluster).

[0030] For each type of refractive error, a curve describing the average central and peripheral refractive error may be found from empirical data sets and studies on a given population. This curve may resemble a three-dimensional conic or Gaussian surface, or may be a three-dimensional function with independent variables that allow scaling in the X, Y, and V directions. The empirically derived surface functions for central and peripheral vision can be fitted to the refractive error map as described above.

[0031] In some embodiments of the present invention, (a) values ​​at the extremes of the SP fitting curve are determined to determine the SP refractive error at the fovea in diopters; (b) values ​​at the extremes of the CY fitting curve are determined to determine the CY refractive error at the fovea in diopters; and / or (c) values ​​at the extremes of the SE fitting curve are determined to determine the SE refractive error at the fovea in diopters. Again, in exemplary embodiments, this approach can provide highly accurate calculations of refractive error for most people because most people's refractive power monotonically increases or decreases from central to peripheral vision by approximately 25 degrees, regardless of whether their central vision refractive error is myopic, emmetropic, or hyperopic. This approach does not require the subject to adjust their gaze direction toward the central camera to find the refractive error in central vision (fovea).

[0032] In some cases, instead of using a predefined polynomial, an nth-order polynomial can be fitted to the refractive error map. To find the refractive error (e.g., SP, CY, or SE) at the fovea, the location and value (e.g., SP, CY, or SE) at the extreme of the fitted curve may be determined.

[0033] In many use scenarios, one or more computers calculate a specific refractive error for central vision by finding a global maximum or minimum of the fitted curve. In some other use scenarios, one or more computers calculate a specific refractive error for central vision by finding a local minimum or maximum of the fitted curve. As a non-limiting example, in some use scenarios, the computer(s) calculate a very high resolution polynomial fit, and the point on the fitted curve that corresponds to the fovea is the local minimum or maximum of the fitted curve.

[0034] In some cases, three-dimensional interpolation may be performed on the map using nearest neighbor, cubic, or linear methods, or via Voronoi tessellation to form an upsampled discrete point map of SP, CY, or SE values. From the discrete point map, the location of the fovea and the refractive error value (SP, CY, or SE) may be found by calculating the center of mass of the map or by finding one or more extrema on the discrete upsampled point map. As previously mentioned, depending on the particular use scenario, the particular patient, and the particular refractive error, (a) the extrema used to calculate the particular refractive error may be a global minimum, a global maximum, a local minimum, or a local maximum, and (b) the computer may determine that the calculated extrema value is equal to the particular refractive error.

[0035] In some cases, the steps of determining the location and value of the refractive error in central and peripheral vision may be repeated over multiple measurement cycles to create sets of retinal probe position values, thereby creating multiple curves for each set of probe positions, which may be spatially averaged to improve the accuracy of the method.

[0036] In the illustrative example of Figure 1, multiple cameras are positioned adjacent to each other on a concave surface 400 and pointed toward the subject's eye. Each camera 401 is paired with a set of off-center infrared (IR) light sources 402. The cluster configuration forms an acceptance cone 403 between the subject's eye and the cameras. The gaze angle 404 is the angle between the eye orientation vector 405 and a central axis 406.

[0037] An illustrative example of a camera cluster configuration is shown in FIG. 2. In FIG. 2, multiple off-center infrared (IR) emitting light sources 501 surround each camera 500. Each of the IR light sources surrounding the camera may emit light that travels to a subject's eye (inspection target) along a path at a non-zero acute angle (e.g., an angle greater than 1 degree) relative to the camera's optical axis. Furthermore, depending on the gaze direction of the inspected eye, the optical axis of a particular camera in the cluster may, at a given time, (a) be coincident with the eye's visual axis or the eye's optical axis, or (b) be at a non-zero angle (e.g., an angle greater than 1 degree) relative to the eye's visual axis or the eye's optical axis, or both. Similarly, depending on the gaze direction of the inspected eye, IR light from a particular IR source in the cluster may, at a given time, emit light that travels to the eye along (a) a path that is coincident with the eye's visual axis or the eye's optical axis, or (b) be at a non-zero angle (e.g., an angle greater than 1 degree) relative to the eye's visual axis or the eye's optical axis, or both.

[0038] In some cases, the cameras may be arranged in the pattern illustrated in Figure 2 (positions p1-p7), with each camera surrounded by equally spaced IR light sources 501. With each on / off cycle of the IR light source, the paired cameras may capture the retinal reflection via the camera images and convert the reflection into a refractive error result. In Figure 2, multiple off-center IR light sources allow each camera to probe a different meridian of refractive error, resulting in spherical, cylindrical, and cylindrical axis components (SP, CY, AX) of the measured eye.

[0039] A pattern of camera positions (e.g., FIG. 2, p1-p7) can be translated into a pattern of probe positions (e.g., FIG. 3, p1-p7) associated with locations on the retina. At each probe position, a refractive error measurement (SP, CY, AX) can be provided. In some cases, the subject's gaze direction 405 may not point toward the center of the camera 401 (e.g., FIG. 1), forming a gaze angle 404. In other cases, the subject's gaze direction 405 may not coincide with the central axis 406 of the cluster photorefraction test setup that forms the gaze angle 404. This gaze angle is translated into a probe position 505 on the retina 503, as illustrated in FIG. 3. In the illustrative example of FIG. 3, none of the camera probe positions p1-p7 coincide with the foveal region 504 on the retina.

[0040] Information (e.g., refractive error values) from each probe position 800 on the retina can be spatially mapped and plotted in coordinates (X, Y, V), where X and Y are retinal locations and V is the refractive error value. The value of V can be either spherical power (SP), cylindrical power (CY), or spherical equivalent (SE) (in diopters), or cylindrical axis (AX) (in degrees or radians). FIG. 4 illustrates an example of how measurements from probe positions p1-p7 of FIG. 3 can be spatially mapped and plotted as a scatter plot. In FIG. 4, a polynomial surface 801 is fitted to probe positions p1-p7. In FIG. 4, the extremum 802 of this curve is the minimum (e.g., global minimum) of the polynomial surface relative to axis V. In FIG. 4, (a) the measured refractive error can be the SP, CY, or SE refractive error in diopters at the central vision (fovea), and (b) the refractive error can be extracted by locating the extreme (e.g., global minimum 802) of the fitted curve in X and Y coordinates and recording the V value at that point. (In the preceding sentence, the fitted curves are (a) the SP curve when the refractive error being measured is an SP refractive error, (b) the CY curve when the refractive error being measured is a CY refractive error, and (c) the SE curve when the refractive error being measured is an SE refractive error.) In the example shown in FIG. 4, the V value identified (at the extreme 802 of the fitted curve) is the modeled refractive error value (in diopters) at the fovea. The computer can estimate that the refractive error of the subject's eye is equal to this V value at the extreme.

[0041] In some cases, the polynomial surface 801 after fitting to probe positions p1-p7 may be convex with respect to axis V, and the maximum 802 of the curve may then be found to determine the refractive error value for central vision.

[0042] In some cases, the surface 801 fitted to the probe positions p1-p7 may be a piecewise linear curve or a piecewise polynomial curve, or may be based on a function from a lookup table. In some cases, the surface 801 fitted to the probe positions p1-p7 may be a plane.

[0043] FIG. 5 shows an illustrative alternative example of a camera cluster configuration with camera positions p1-p8. In this example, no camera is located at the center of the cluster. In some cases, a fixed camera 500′ and IR light source 501 pair may be combined with a moving camera 507 and IR light source 508 pair. The moving camera and IR light source may follow a predefined path 509. The path may be a circle, a spiral path, an elliptical path, a rectangular path, as illustrated in FIG. 6, or the path may take any shape within the plane of the camera 400 or surface plane.

[0044] In other cases, the camera clusters and IR light sources may be arranged in a grid, as illustrated in FIG. 7. In this example, multiple cameras 500 are arranged in hexagonal clusters p1-p7, and the IR light sources 510 are arranged in a rectangular grid pattern. The camera arrangement can take any pattern or arrangement on the cluster surface 400. The number and arrangement of cameras and light sources within a cluster can vary and is not limited to that shown in FIG. 7. The number and arrangement of cameras can be arranged in a grid or pattern consisting of multiple cameras (e.g., 8x8, for a total of 64 cameras) with multiple adjacent light sources. The IR light sources can be arranged in a hexagonal grid.

[0045] In some embodiments of the photorefractor configurations disclosed herein, the light source can emit near-infrared light with wavelengths between 750 nm and 1000 nm, or ultraviolet light with wavelengths between 250 nm and 450 nm, or broadband white light across the visible spectrum, or a combination of specific wavelengths within the visible spectrum.

[0046] Testing Kiosk In some cases, a self-service vision testing kiosk 100 may house portions of the device and serve as a platform for administering the vision test. FIG. 8 illustrates one example of a kiosk. In FIG. 8, the kiosk 100 includes a touch display console 102 through which the subject inputs information and controls the system, an examination window 103, and a housing 104 for the vision testing device. The examination window 103 faces the user's eye and can interface with a self-service vision testing system (e.g., FIG. 14), a photorefractor system (e.g., FIG. 12), or a pupil diameter manipulation system (e.g., FIG. 10). The kiosk 100 may also include a lensmeter system 105 for measuring the setting of eyeglass lenses.

[0047] In FIG. 9, kiosk 200 includes an input touch display 102 and an examination window 103, both of which face the user during the examination. The touch display 102 can be used to enter the subject's demographic data and medical history, view the examination selection menu, enter payment data, enter the subject's contact information, schedule follow-up examinations with a vision care professional, view results, and enter examination procedure commands. Typically, the examination window 103 is where the subject views letters or symbols located at a virtual distance from the subject's eye (typically around 20 feet). The examination window 103 can also interface with embodiments of the non-gaze-dependent photorefraction examination system described in this invention. A photorefractor system can also be integrated with a vision system, in which case both systems interface with the same examination window 103. A light source 210 positioned at the border of the examination window 103 or installed within the kiosk behind the examination window 103 illuminates the subject's eyes with visible wavelength stimulating light and selectively adjusts its brightness (e.g., via a pupil diameter manipulation system described below), thereby causing the subject's pupil diameter to constrict in a controlled manner. Multiple cameras or sensors can be incorporated into the examination console 211 or behind the examination window 103 to track the subject's head position, eye movement, or pupil diameter relative to the kiosk. The incorporated cameras or sensors 308 can track body posture, head tilt, hand gestures, or the presence of specific items such as eyeglasses, contact lenses, or facial or eye obstructions. Detection in the above example can be achieved with artificial intelligence (AI) computer vision classifiers via one or more cameras integrated into the kiosk. Multiple cameras 308 can be used simultaneously to detect the distance of specific objects on the subject or their characteristics through stereoscopic computer vision techniques. Measuring the distance from the kiosk to the subject can also be achieved via dedicated time-of-flight (TOF) sensors, ultrasonic sensors, or pattern projection techniques via position sensor(s) 308. Detected features, objects, or distances on the subject or the subject can be used as input to refraction testing techniques, pupil diameter manipulation, or vision testing processes.

[0048] In a typical embodiment, the device may automate refraction or visual acuity testing using the kiosk's various cameras and sensors combined with refraction testing techniques. The subject or ECP simply presses a button on the display 102 to begin the test, and the system automatically completes the measurement for them. During the test, the subject may be asked to remain still while the kiosk adapts to the subject's position and the device automatically reads the refraction value, or the subject may be asked to follow prompts, as in a visual acuity test.

[0049] An audio feedback speaker bar 213 enables the kiosk to provide audio feedback of the virtual assistant. The virtual assistant's audio track entertains the user during tests performed at the kiosk and instructs them to perform specific tasks. The kiosk is therefore fully automated and includes a camera detection system that captures both refraction and vision information. The system can be activated by a single start button or simply by the presence of a subject standing in front of the system (e.g., a kiosk). Once activated, the system automatically adjusts to the subject, performing diagnostics and vision analysis (possibly simultaneously), as well as detecting various health issues related to the subject based, for example, on how the subject's pupils respond to changes in visible light.

[0050] Pupil diameter operation As described above, in some embodiments, the present invention manipulates the pupil diameter of an eye under examination. The system may include an adjustable intensity-controlled light facing the subject, a camera facing the subject to record the pupil diameter, and a control system that changes the current pupil diameter to a target pupil diameter. The control system may be implemented on a computer or microcontroller. In healthy eyes and subjects, high-intensity light entering the eye causes the pupil to constrict through a process called miosis, while low-intensity light entering the eye, or no light at all, causes the pupil to dilate through a process called mydriasis.

[0051] In an exemplary embodiment of the present invention, increasing the intensity of the control light can reduce pupil diameter. Decreasing the intensity of the control light can increase pupil diameter. Ambient light can be reduced by turning off the lights in the room or shielding the eyes from ambient light via designing a booth or kiosk with side blinds or a room with an enclosure that blocks light from the subject. The wavelength of the control light is within the visible range of the human eye, so miosis can occur and can be characterized as a chromatic color, such as red, green, or blue, or an achromatic color, such as white or gray. The control light can propagate diffusely and enter both eyes simultaneously, or the control light can be focused and illuminate one eye at a time.

[0052] The method for manipulating pupil diameter can include a control system that sets the intensity of the control light to cause the pupil to reach a target pupil diameter. The control system can include an open-loop controller that takes the target pupil diameter and sets the intensity of the control light from a look-up table relating light intensity to pupil diameter. The look-up table can take into account age, gender, race, wavelength, spatial configuration of the light source, and whether the light is directed to one eye or both eyes simultaneously. The open-loop controller can wait an estimated time for the pupil diameter to reach a desired range.

[0053] In some cases, the control system includes a closed-loop feedback controller that takes a target pupil diameter value, compares it to the current pupil diameter value measured by the camera, and actively drives the intensity of the control light. The closed-loop feedback controller can be a proportional controller, a proportional-integral-derivative controller (PID), a state-space feedback controller, or a fuzzy logic controller. The feedback controller can also be a multi-loop closed-loop feedback controller. In certain applications, the control system takes a value for the rate of change of the target pupil diameter and drives the control system to change the subject's pupil diameter at the target rate of change.

[0054] FIG. 10 illustrates an example of a PID closed-loop feedback controller driving a pupil diameter manipulation method. A target pupil diameter value r(t) is input to the control loop. Each camera 500 records an image of the subject's eye 602, and image processing techniques extract the current pupil diameter y(t). The PID closed-loop feedback controller 600 takes the target diameter r(t) and subtracts the current diameter y(t) to generate e(t). The controller attenuates or amplifies e(t) to generate a signal u(t) that drives the intensity of the control light 501 / 504. In some cases, the pupil diameter manipulation system includes multiple cameras facing the subject's eye, allowing eye and pupil diameters to be recorded from multiple perspectives. Examples with multiple cameras are illustrated in FIGS. 2, 5, 6, and 7. Here, a photorefractor camera also functions as a pupil diameter recording device and provides y(t) to the feedback controller.

[0055] In further applications, the control light comprises multiple diffuse surface light sources spaced adjacent to one another, as illustrated in Figure 5 (s1, s2), or a cluster of point light sources arranged in a grid, as illustrated in Figure 7 (510), or one or more laser light sources directed at one or both of the subject's eyes. The control light may be a ring light, as illustrated in Figure 2, comprising a series of LEDs arranged in a circle and covered with a diffusing plastic or glass material to smooth the uniformity of the emitted light. The control light may take the form of a triangular or circular surface LED light, as illustrated in Figure 5 (506). Significant monochromatic high-order aberrations within the eye can cause undesirable shifts in the retinal reflex-to-diopter conversion table used in photorefraction testing, which can significantly affect the accuracy of the measurement.

[0056] According to certain aspects of the present invention (e.g., non-line-of-sight dependent photorefractors), pupil diameter manipulation is used to detect high-order aberrations. In some embodiments, high-order aberrations are detected as follows: a computer can (a) determine whether the cylinder axis angle map indicates that the AX values ​​at the retinal probe positions point in different directions, and (b) if so, determine that there is significant coma or trefoil aberration. This approach produces accurate results because in a typical eye with spherical (SP) and cylindrical (CY) refractive errors (low-order aberrations) but no significant high-order aberrations, the cylinder axis angles (AX) in central and peripheral vision tend to point in the same direction.

[0057] In some embodiments, high-order aberrations are detected by intentionally reducing the pupil diameter of the subject's eye during measurement (e.g., through a series of different pupil diameter steps). Reducing the pupil diameter tends to make the photorefractive measurement less susceptible to the high-order aberrations of the eye. This effect can be used to compare the refractive error between a dilated pupil and a constricted pupil via a pupil diameter manipulation system. A large difference in the refractive error between a constricted pupil and a dilated pupil may indicate the presence of high-order aberrations.

[0058] In some embodiments, the magnitude of the high-order aberrations is determined by taking the cylindrical refractive error CY from the center or curve fit of the map and comparing it to the peripheral CY value. The difference in diopters between the central and peripheral CY values ​​may be correlated to a table of the magnitude of trefoil and coma-type residual aberrations.

[0059] According to certain aspects of the present invention (e.g., with a non-gaze-dependent photorefractor), pupil diameter manipulation is used to detect symptoms of ocular diseases or neurological disorders, such as asymmetry in pupil diameter between the eyes (i.e., anisocoria), unresponsive pupils, abnormal rates of pupil diameter change, or pulsating pupil diameter.

[0060] Virtual Objects In some implementations, the user can view a graphic ("virtual object" 306) displayed within the examination window 300. The virtual object can be a fixed graphic, an animated graphic, or a combination of both. The virtual object can be used to guide the subject's attention, focus, or eye gaze direction to a specific location when looking into the examination window. To the subject, the virtual object may appear to be at a given distance behind the examination window 300, as if "floating" within it. In some implementations of the kiosk, the virtual object can be combined with a photorefractor, or a non-gaze-dependent photorefractor configuration, or a vision system, as disclosed herein, to serve as a display target to assist in administering the test.

[0061] FIG. 12 illustrates an embodiment of an optical system for creating a virtual object. The system may consist of an inspection window 300, a parabolic mirror 301, a partially reflective mirror 302, and a virtual object display 303. In this embodiment, as shown in FIG. 11, a virtual object 306 can be made to appear at a large distance from the subject (e.g., 20 feet (6.096 m)) in a kiosk with an outer dimension shorter than the distance of the virtual object. This can be achieved by the optical path compression configuration illustrated in FIG. 12. The optical path of the system begins at the virtual object display 303 and is folded and refocused until it reaches the subject's eye. More specifically, light rays travel from the virtual object display 303 through a partially reflective mirror 302 positioned at a 45-degree angle relative to the optical axis of the system, then encounter a concave parabolic mirror 301 that focuses the light rays, then change direction from the partially reflective mirror 302, and pass through the inspection window 300, finally reaching the subject's eye. This configuration creates a "hovering" effect, where the virtual object appears in front of you when you look into the examination window, even though the image source (the virtual object display) is not in the same visual location. The advantage of this configuration is that it allows for a volumetrically compressed kiosk form factor while maintaining the ability to display virtual objects at a distant viewing distance.

[0062] In some implementations, the partially reflective mirror can be rotated to cause the virtual object to appear at different distances. Figure 13 illustrates an example in which a virtual object is displayed approximately 3 feet (0.9144 m) away from the subject. More specifically, a light ray travels from the virtual object display 303 to the partially reflective mirror 302, passes through the examination window 300, is redirected, and reaches the subject's eye. This configuration creates a "hovering" effect, whereby looking into the examination window causes the virtual object to appear directly in front of you, even though the source of the image (the virtual object display) is not in the same visual location.

[0063] The partially reflecting mirror 302 is a slab of glass or plastic that may be coated on one or both sides with special materials, films, or optical coatings. The slab may be coated with optical filter coatings that transmit and reflect light of specific wavelengths, or anti-reflective coatings, or light-absorbing coatings, or polarizing films or coatings. The partially reflecting mirror may be a beamsplitter mirror or a teleprompter mirror with anti-reflective coatings on one or both sides. In some embodiments, the slab's reflection and transmission ratios for a given wavelength are 50% reflection and 50% transmission, or 40% reflection and 60% transmission, although any combination of reflection and transmission ratios may be used.

[0064] The optical path compression configurations illustrated in FIG. 12 or FIG. 13 may be used in a self-administered vision testing system (described in more detail below), or may be combined with a common photorefractor 304 or a photorefractor embodiment 304 described herein to simultaneously test vision and eye refraction, or may be used to display a virtual object at a location of interest for refraction testing with the photorefractor 304. The photorefractor may be combined with an optical filter 305 to filter out unwanted wavelengths of light entering the photorefractor sensor. In some implementations, the distance to the virtual object seen by the subject may be the same as the optical distance from the subject to the photorefractor. This may be achieved by rotating the partially reflective mirror 302 to the position illustrated in FIG. 13 and setting the light beam distance between the partially reflective mirror 302 and the virtual object display 303 to the same distance as the light beam distance between the partially reflective mirror 302 and the photorefractor sensor 304.

[0065] The optical systems illustrated in Figures 12 and 13 can be combined simply by actuating the partially reflective mirror 302 to rotate it during or before the test to create two separate virtual object distances. This allows the photorefractor to deflect the subject's eye at two distinct accommodation states (focal lengths). In one implementation, the virtual object is at a distance of 3 feet (0.9144 m), which can then be switched to a distance of 20 feet (6.096 m) by simply rotating the partially reflective mirror 90 degrees. The photorefractor can take multiple measurements at both virtual object distances.

[0066] The position of the virtual object display 303 or parabolic mirror 301 may also be moved relative to the optical axis or other components to create additional virtual object distances and accommodation states of the subject's eyes.

[0067] The size of the virtual object on the display 303 may be linked to values ​​received from the position sensor 308. This allows the size of the virtual object 306 to be adjusted regardless of the subject's position relative to the kiosk, i.e., the virtual object 306 may appear the same size regardless of where the subject is standing (e.g., if the subject is standing closer to the examination window 300, the size of the virtual object 306 may be reduced, and if the subject is standing further away from the examination window 300, the size of the virtual object may be increased).

[0068] The angle of the partially reflective mirror 302 may also be coordinated with values ​​received from the position sensor 308 to ensure that the virtual object 303 is always displayed at a particular position within the examination window 300, regardless of the subject's head height or position relative to the kiosk. For example, if the subject is short, the partially reflective mirror 302 may be rotated to cause the virtual object 306 to move upward, and if the subject is tall, the partially reflective mirror 302 may be rotated to cause the virtual object 306 to move downward.

[0069] In some implementations, the dynamic virtual object placement methods described above may be used during visual acuity testing, or during photorefractor autorefraction testing, or during non-gaze-dependent photorefractor autorefraction testing. Thus, the size and position of the virtual object displayed within the test window can be adjusted depending on where the subject is standing or otherwise located. This ensures that all users, regardless of height or location near the test window, see the same object.

[0070] Monitoring and managing accommodation In some implementations, a combination of virtual objects and photorefractors can be used to monitor a subject's accommodation state. As the subject performs a test routine, the photorefractor can continuously measure the refractive state of the subject's eye and record the results over time. The time series may show relative changes in refractive power as the subject's accommodation state changes. In a vision test, the subject may be prompted to demonstrate their best focusing ability on a virtual object displayed in a test window. By tracking the time series of refractive error, the subject's best focusing ability can be estimated by identifying maximum or minimum values ​​on the time series graph.

[0071] By taking photorefractor measurements at multiple virtual object distances and utilizing the virtual object positioning method described above, multiple accommodation states can be monitored during a measurement session. For example, the virtual object distance is first set to 3 feet (0.9144 m) from the subject, and then a refraction measurement is taken. Next, the virtual object distance is set to 20 feet (6.096 m), and then a refraction measurement is taken. If both refraction measurements are the same or similar, this may indicate that the user is focusing on the correct distance and that the results are likely to be valid. If the refraction measurements are not the same between the two virtual object distances, this may indicate an accommodation issue for the subject.

[0072] Depending on the type of refractive error a subject has, correctly accommodating to the virtual object's target distance can be problematic. For hyperopic subjects (hyperopia), a virtual object 3 feet (0.9144 m) away may appear blurry and they may be unable to focus properly at that distance. Alternatively, the virtual object can be set at a greater distance, such as 16 feet (4.8768 m) or 20 feet (6.096 m), the common Snellen eye chart distances. This allows the subject to focus reliably on the virtual object, and as a result, the photorefractor is more likely to obtain valid measurements. For nearsighted subjects (myopia), the opposite strategy can be employed. Because a virtual object distance of 20 feet (6.096 m) may be too blurry to focus properly, the virtual object distance can instead be set to 3 feet (0.9144 m) to facilitate focusing and improve measurement reliability.

[0073] Self-administered vision screening As shown in FIG. 14, a self-administered vision test can be conducted by having the subject (kiosk user) follow instructions from the kiosk and input responses into the kiosk. The subject's visual acuity can be determined from the responses. The system may include a dynamic eye chart 208 created by a virtual object 306 that the subject views through the test window 103 at a simulated set distance (e.g., 20 feet (6.096 m)). Although the letters or symbols of the virtual object 306 appear to the subject to be far away, the system is actually compacted by an optical path compression method (e.g., as shown in FIG. 12) that displays objects at a virtual distance. The vision test can be conducted virtually without the assistance of an ECP, under the guidance of an ECP standing next to the kiosk, or by the ECP communicating with the subject via the kiosk's video conferencing system.

[0074] During the test, the subject may be asked to perform an action or series of actions received as input from the kiosk, where this input may be used to adjust the size, shape, or position of the virtual object 306 displayed in the test window 103.

[0075] In one embodiment, the subject may be instructed to rotate the input wheel 205 via voice commands transmitted through the kiosk console's speaker 213 after observing the virtual object 306. Rotating the input wheel or pressing a button on the wheel may cause the letter(s), symbol(s), or graphic(s) of the virtual object 306 to adjust to new letter(s), symbol(s), or graphic(s) and / or to a new size, position, or initiate a prompt for a new step of the test.

[0076] Instead of providing the subject with a voice command to proceed to the next step, the kiosk may prompt the subject to perform a new inspection action via graphics or text on the kiosk's display or via letters, symbols (e.g., arrows), or graphics displayed by virtual object 306. A central computer 214 housed within the kiosk 200 responds to the subject's input by progressing the test steps and outputting voice commands or changes in the state of the virtual display. Figure 15 illustrates a different implementation of a dynamic visual acuity test using the configuration shown in Figure 14.

[0077] In one embodiment, instead of using the input wheel 205, the subject can input a response to the test by pressing a button on the kiosk's touch display, or performing a "swipe" action on the touch display, or pressing a touchpad with buttons on the kiosk, or performing a gesture that can be detected by the camera or sensor 308 (e.g., nodding, turning the head, waving, hand position, lifting all or part of a finger, blinking, opening or closing the mouth).

[0078] According to further aspects, the system can detect any of a wide variety of gestures that indicate (positively or negatively) whether the subject can clearly see the information during the vision test. Such gestures may include, for example, nodding, shaking the head, giving a thumbs-up, or moving a horizontal hand from side to side with the palm facing down. According to further aspects, the system can detect the subject's voice answering "yes / no" questions and / or reading inline text during the vision test.

[0079] In the example of FIG. 15 , the subject is instructed to fixate their gaze on the window 208 and view a list of displayed characters via the audio 213 or touch display 103. The characters are displayed in smaller increments per line, and the subject is prompted via the audio 213 or touch display 103 to select a line that is barely legible using the input wheel 205 or a button on the touch display 103. The position is selected by the subject pressing the button 205 on the input wheel or a button on the touch display 103. The line of letters or symbols selected by the subject can be used to determine the visual acuity of the eye. To test one eye at a time, the subject is instructed to close one eye with their hand and use their other hand to operate the input wheel 205 or a button on the touch display 103. To test the other eye, the subject reverses their hand position, covering the other eye with their other hand and gripping the input wheel 205 or pressing a button on the touch display 103 with their free hand. Alternatively, the letters or symbols may all be the same size in each row, in which case the audio 213 or touch display 103 prompts the subject to select the row that matches the series of letters played via the audio 213. Once the subject selects the correct row, a new list of letters or symbols is displayed, and the subject is again asked to select a row with that particular combination of letters or symbols. This may be repeated until the subject can no longer reliably select the correct row. The subject's rate of correct selections determines the test cutoff point, which determines the size of objects at a distance that the subject's eyes can distinguish (visual acuity). The final determined letter or symbol size is then converted into a numerical value for the visual acuity of the tested eye.

[0080] In some cases, by rotating the input wheel 205 or a button on the touch display 103, the subject can move the letter or symbol displayed in the window 208 along a circular path or rotate the orientation of the letter or symbol, where the letter or symbol located at the top is the one selected by the subject, as illustrated, for example, at 208' in FIG. 15 . Alternatively, the subject can rotate the selection box to the letter or symbol of the target object indicated by the voice command 213. The position is selected by the subject pressing the button 205 of the input wheel or a button on the touch display 103. The subject can repeat these steps, decreasing the size of the letter or symbol with each repetition, until the numerical value of the visual acuity of the tested eye is determined.

[0081] For example, the subject can rotate the input wheel 205 or press a button on the touch display 103 to adjust the size of the letters or symbols seen through the window 208 depending on the direction of rotation of the input wheel, as illustrated at 208'' in FIG. 15. The subject can select a setting by rotating the input wheel or pressing a button on the touch display 103 until the letters are barely readable, and then pressing a button on the input wheel 205 or a button on the touch display 103. The selected rotational position can determine the visual acuity of the tested eye.

[0082] In some cases, the camera or sensor 308 may detect whether the subject is holding their hand in front of their eye at the appropriate time during the test. If their hand is not in the correct position, the kiosk may instruct the subject to return their hand to their eye. Additionally, the camera or sensor 308 may detect that the subject is not wearing glasses or contact lenses when required for the test, and the kiosk may prompt the subject to put on their glasses or contact lenses. In some cases, the camera or sensor 308 may detect that the subject is wearing glasses or contact lenses when they should not be wearing glasses or contact lenses for the test, and the kiosk may prompt the subject to remove their glasses or contact lenses.

[0083] Self-administered vision testing can also be combined with the automated refraction testing techniques described above. In one example, a subject can undergo a vision test while a refraction testing sensor continuously records refraction data for several seconds or minutes. According to a further aspect, the system can determine whether the subject is wearing eyeglasses and, when prompted during the automated vision test, check whether the subject is blocking one eye or the other.

[0084] FIG. 16 shows a subject in front of an autonomous testing kiosk 650 according to one embodiment of the present invention. The kiosk includes an examination window 602 through which the subject can view target images, perform eye diagnostics, and undergo a vision test, for example, using an input screen 604. FIG. 17 shows the internal components of the kiosk 650, including an optical alignment system including a tracking mirror, face, eye, and gesture cameras 608, a visual target generator 610, and an automated refraction test sensor (e.g., a GIPR, or conventional photorefractor). Referring to FIG. 18, the system uses artificial intelligence tracking software, as described above, to track and locate the subject's face, and then locates the subject's eyes using GPIR sensors, also as described above.

[0085] definition When modifying a noun, the terms "a" and "an" do not imply the presence of only one of that noun. For example, the sentence "An apple is hanging from the branch" (i) does not mean that there is only one apple hanging from the branch, (ii) is true if there is one apple hanging from the branch, and (iii) is true if there is more than one apple hanging from the branch.

[0086] A computation is said to be "according to" a first equation means that the computation involves (a) solving the first equation or (b) solving a second equation that is derived from the first equation. Non-limiting examples of "solving" an equation include solving the equation in closed form, by numerical approximation, or by optimization.

[0087] Computing "based on" specified data means performing a computation using the specified data as input.

[0088] Non-limiting examples of a "camera" include (a) a digital camera, (b) a digital grayscale camera, (c) a digital color camera, (d) a video camera, (e) a light sensor, imaging sensor, or photodetector, (f) a set or array of light sensors, imaging sensors, or photodetectors, (h) a light field camera or plenoptic camera, (i) a time-of-flight camera, and (j) a depth camera. In some cases, the camera includes a computer or circuitry to process data captured by the camera.

[0089] The word "comprise" (and grammatical variations thereof) shall be construed as if followed by the word "without limitation." If A includes B, then A includes B, and possibly other things.

[0090] The following are non-limiting examples of the term "computer" as used herein: (a) digital computer, (b) analog computer, (c) computer that performs both analog and digital calculations, (d) microcontroller, (e) microprocessor, (f) controller, (g) tablet computer, (h) notebook computer, (i) laptop computer, (j) personal computer, (k) mainframe computer, and (l) quantum computer. However, a human being is not a "computer" as the term is used herein.

[0091] "Defined Term" means a term or phrase enclosed in quotation marks in this Definitions section.

[0092] An event does not have to occur for the entire period to occur "during" a period. For example, an event that occurs only part of a particular period occurs "during" that particular period.

[0093] The term "eg" means, for example.

[0094] The fact that an "example" or examples of something are given does not mean that they are the only examples of that thing. The example (or examples) are merely illustrative, not exhaustive or limiting.

[0095] "For instance" means for example.

[0096] Saying that X is "given" is simply a way of identifying X so that it can later be specifically referred to. Saying that X is "given" does not create any implications about X, e.g., saying that X is "given" does not create the implication that X is a gift, assumption, or known fact.

[0097] "Herein" means within this document, including the text, specification, claims, abstract, and drawings.

[0098] As used herein, (1) "embodiment" means an embodiment of the present invention; (2) "embodiment" means an embodiment of the present invention; (3) "case" means an embodiment of the present invention; and (4) "usage scenario" means a usage scenario of the present invention.

[0099] The term "include" (and grammatical variations thereof) shall be construed as if followed by the word "without limitation."

[0100] Unless the context clearly indicates otherwise, "or" means "and / or." For example, if A is true, or if B is true, or if both A and B are true, then A or B is true. Also, for example, the computation of A or B means the computation of A, or the computation of B, or the computation of A and B.

[0101] The term "such as" means, for example,

[0102] Unless the context clearly indicates otherwise, when method steps are recited herein, the method includes the following variations: (1) the method steps occur in any order or sequence, including orders or sequences different from those described herein; (2) any step in the method occurs multiple times; (3) any two steps occur the same number of times during the method or different numbers of times; (4) one or more steps of the method are performed in parallel or sequentially; (5) any step of the method is performed iteratively; (6) a particular step of the method is applied to the same subject each time the particular step occurs, or to different subjects each time the particular step occurs; (7) one or more steps occur simultaneously; or (8) the method includes other steps in addition to those described herein.

[0103] Headings are included solely to facilitate the reader's reading of this document. Section headings do not affect the meaning or scope of those sections.

[0104] This definitions section supersedes and takes precedence over any other definitions of the defined terms. The applicant or applicants act as their own lexicographer with respect to the defined terms. For example, definitions of the defined terms set forth in this definitions section take precedence over common usage and external dictionaries. If a particular term is explicitly or implicitly defined within this document, that definition takes precedence and supersedes any definition of the particular term arising from any source external to this document (e.g., a dictionary or common usage). If this document provides an explicit explanation of the meaning of a particular term, that explanation, to the extent applicable, supersedes any definition of the particular term arising from any source external to this document (e.g., a dictionary or common usage). Unless the context clearly dictates otherwise, a definition or explanation of a term or phrase herein applies to all grammatical variations of that term or phrase, taking into account differences in grammatical forms. For example, grammatical variations include nouns, verbs, participles, adjectives, possessives, various declarative forms, and various tenses.

[0105] Variations The present invention can be implemented in a variety of ways.

[0106] Each description of a method, apparatus, or system of the present invention herein describes a non-limiting example of the invention, and the invention is not limited to these examples and may be practiced in other ways.

[0107] The descriptions of any prototypes of the invention herein are intended to illustrate non-limiting examples of the invention, and the invention is not limited to these examples and may be practiced in other ways.

[0108] Each description herein of any implementation, embodiment or example of the invention (or any use scenario of the invention) describes a non-limiting example of the invention, and the invention is not limited to these examples, as the invention may be practiced in other ways.

[0109] Each diagram, diagram, schematic, or drawing in this specification (or preliminary version) illustrating features of the invention is intended to illustrate non-limiting examples of the invention, and the invention is not limited to these examples, as it may be practiced in other ways.

[0110] The above description (including but not limited to the accompanying drawings and figures) describes exemplary embodiments of the present invention. However, the present invention may be embodied in other ways. The methods and apparatus described herein are merely exemplary applications of the principles of the present invention. Other configurations, methods, modifications, and substitutions by those skilled in the art are within the scope of the present invention. Numerous changes may be made by those skilled in the art without departing from the scope of the present invention. The present invention also includes, without limitation, one or more combinations and permutations of the items described herein (including hardware, hardware components, methods, processes, steps, software, algorithms, functions, and technologies).

Claims

1. 1. A system for obtaining diagnostic eye information, comprising: at least one energy source for directing and transmitting electromagnetic energy to the subject's eye; a plurality of sensory units, each sensory unit associated with an associated location within a field of view of the eye, each sensory unit adapted to obtain refractive information from the eye in response to the electromagnetic energy; a processing system that determines refractive error information associated with each position of each sensory unit within the field of view of the eye, and that determines composite refractive error information for the eye, independent of the eye's gaze direction, in response to the refractive error information associated with each sensory unit; The system comprising:

2. 10. The system of claim 1, wherein at least one energy source is provided among a plurality of energy sources positioned at a plurality of locations within the field of view of the eye.

3. The system of claim 2 , wherein the plurality of energy sources are spaced apart from one another, and each energy source is associated with at least one sensory unit.

4. The system of any one of claims 1 to 2, wherein each energy source is individually operable.

5. 4. The system of claim 1, wherein the composite refractive error information includes any of spherical error (defocus) information, cylindrical error (astigmatism) information, and cylindrical axis information, as well as high-order aberration errors including any of trefoil error and coma error.

6. 6. The system of claim 5, wherein the composite refractive error information for the eye generally includes spatial mapping information corresponding to the refractive error of the inner visual field and the peripheral visual field.

7. 7. The system of claim 6, wherein the spatial mapping is performed by any of nonlinear least squares fitting, linear least squares fitting, least absolute residual fitting, squares fitting, polynomial regression fitting, or piecewise linear regression fitting.

8. 7. The system of claim 6, wherein the surface function fitted to the map points of the spatial mapping may be a predefined polynomial, an nth order polynomial, a cubic spline, or a 3D surface from a lookup table that forms a continuous spatial map of spherical error, cylindrical error, cylinder axis, coma error, trefoil error, or equivalent spherical error information.

9. The system of any of claims 1 to 8, wherein the composite refractive error information describes medial and peripheral refractive error components of the eye's visual field.

10. 1. A system for obtaining diagnostic eye information, comprising: at least one energy source for directing and transmitting electromagnetic energy to the subject's eye; a perception system adapted to obtain refraction information from the eye in response to the electromagnetic energy and pupil diameter information indicative of a pupil diameter of the eye; a processing system that determines refractive error information for the eye and associates the refractive error information with the pupil diameter of the eye; The system comprising:

11. 11. The system of claim 10, wherein the processing system further comprises a control system in communication with the at least one energy source and pupil camera to achieve a target pupil diameter in the eye of the subject.

12. 1. A system for obtaining diagnostic eye information, comprising: at least one energy source for directing and transmitting electromagnetic energy to the subject's eye; a perception system adapted to obtain refractive information from the eye in response to the electromagnetic energy; a partially reflecting mirror by which the sensory unit is directed towards the eye; an object image seen by the subject through the partially reflecting mirror; a mirror control system that rotates the partially reflecting mirror to vary the apparent distance of the object image between a first distance and a second distance; a processing system that determines refractive error information for the eye and associates the refractive error information with either the first distance or the second distance; The system comprising:

13. 13. The system of claim 12, wherein the system includes a partially reflective mirror through which at least one perceptual unit is directed toward the eye, an object image visible to the subject through the partially reflective mirror, and a mirror control system that rotates the partially reflective mirror to change the apparent distance of the object image.

14. The system of claim 13 , wherein the system further comprises a parabolic mirror capable of selectively reflecting the object image by rotating the partially reflecting mirror.

15. 1. An automated ophthalmic examination system for obtaining diagnostic ophthalmic information, comprising: an alignment system that provides alignment information regarding the alignment of the subject relative to the alignment camera system; a diagnostic analysis system for determining refractive error information associated with at least one eye of the subject within a field of view of the diagnostic analysis system; an alignment correction system that adjusts the field of view of the diagnostic analysis system in response to the alignment information; 1. The automated ophthalmic examination system comprising:

16. 16. The automated ophthalmic examination system of claim 15, wherein the composite refractive error information includes any of spherical error (defocus) information, cylindrical error (astigmatism) information, and cylindrical axis information, as well as higher order aberration errors including any of trefoil error and coma error.

17. 17. The automated eye examination system of claim 16, wherein the composite refractive error information for the eye generally includes spatial mapping information corresponding to the refractive error of the inner visual field and the peripheral visual field.

18. 20. The automated ophthalmic examination system of claim 17, wherein the spatial mapping is performed by any of nonlinear least squares fitting, linear least squares fitting, least absolute residual fitting, squares fitting, polynomial regression fitting, or piecewise linear regression fitting.

19. 20. The automated ophthalmic examination system of claim 18, wherein the surface function fitted to the map points of the spatial mapping may be a predefined polynomial, an nth order polynomial, a cubic spline, or a three-dimensional surface from a lookup table that forms a continuous spatial map of spherical error, cylindrical error, cylinder axis, coma error, trefoil error, or equivalent spherical error information.

20. 20. The automated eye examination system of claim 15, wherein the composite refractive error information describes medial and peripheral refractive error components of the eye's visual field.

21. The automated ophthalmic examination system of any of claims 15 to 20, wherein the alignment correction system comprises a tracking mirror.

22. The automated eye examination system of any of claims 15 to 21, wherein the alignment system further aligns the subject with a field of view of a visual target.

23. The automated eye examination system of any of claims 15 to 22, wherein the automated eye examination system is provided in a stand-alone kiosk.

24. 1. A method for obtaining diagnostic eye information, comprising: directing electromagnetic energy at the subject's eye; acquiring refraction information from the eye at each of a plurality of sensory units in response to the electromagnetic energy, each sensory unit being associated with an associated location within the field of view of the eye; determining refractive error information associated with each position of each sensory unit within the field of view of the eye; determining composite refractive error information for the eye, independent of gaze direction of the eye, in response to the refractive error information associated with each perceptual unit; The method comprising:

25. 25. The method of claim 24, wherein at least one energy source is provided from a plurality of energy sources positioned at a plurality of locations within the field of view of the eye.

26. The method according to any of claims 24 to 25, wherein the plurality of energy sources are spaced apart from one another, and each energy source is associated with at least one sensory unit.

27. The method of any of claims 24 to 26, wherein each energy source is individually operable.

28. 28. The method of any of claims 24 to 27, wherein the composite refractive error information includes any of spherical error (defocus) information, cylindrical error (astigmatism) information, and cylindrical axis information, as well as higher order aberration errors including any of trefoil error and coma error.

29. 30. The method of claim 28, wherein the composite refractive error information for the eye generally includes spatial mapping information corresponding to the refractive error of the inner visual field and the peripheral visual field.

30. 30. The method of claim 29, wherein the spatial mapping is performed by any of nonlinear least squares fitting, linear least squares fitting, least absolute residual fitting, squares fitting, polynomial regression fitting, or piecewise linear regression fitting.

31. 30. The method of claim 29, wherein the surface function fitted to the map points of the spatial mapping may be a predefined polynomial, an nth order polynomial, a cubic spline, or a three-dimensional surface from a lookup table that forms a continuous spatial map of spherical error, cylindrical error, cylinder axis, coma error, trefoil error, or equivalent spherical error information.

32. A method according to any of claims 24 to 31, wherein the composite refractive error information describes medial and peripheral refractive error components of the visual field of the eye.

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