Bio Medical Optics

Jayakumar D Swamy M.Sc., M.Tech.,

Optical Engineer
Definition of cataract
Opacity of the lens, which occurs when fluid gathers between
the lens fibers.
When eyes work properly:
Light passes through the cornea and the pupil to the lens.
The lens focuses light & producing clear, sharp images on the
retina.
As a cataract develops, the lens becomes clouded, which
scatters the light and prevents a sharply defined image from
reaching retina. As a result, vision becomes blurred.
Causes of cataract
Old age (commonest)
Ocular & systemic diseases
DM
Uveitis
Previous ocular surgery
Systemic medication
Steroids
Phenothiazines
Trauma & intraocular foreign
bodies
Ionizing radiation
X-ray
UV
Congenital
Dominant
Sporadic
Part of a syndrome
Abnormal galactose
metabolism
Hypoglycemia
Inherited abnormality
Myotonic dystrophy
Marfans syndrom
Rubella
High myopia
Cataract
Divided to :
Acquired cataract
Age - related cataract
Presenile cataract
Traumatic cataract
Drug induced cataract
Secondary cataract
Congenital Cataract
Systemic association
Non-systemic association


Age -related cataract
It is the Most commonly occurred.
Classified according to:
Morphological Classification
Nuclear
Cortical
Subcapsular
Christmas tree uncommon
Maturity classification
Immature Cataract
Mature Cataract
Hypermature Cataract
Nuclear cataract
Most common type
Age-related
Occur in the center of the lens.
In its early stages, as the lens changes the
way it focuses light, patient may become
more nearsighted or even experience a
temporary improvement in reading vision.
Some people actually stop needing their
glasses.
Unfortunately, this so-called 2
nd
sight
disappears as the lens gradually turns more
densely yellow & further clouds vision.
As the cataract progresses, the lens may
even turn brown. Advanced discoloration
can lead to difficulty distinguishing between
shades of blue & purple.
Cortical cataract
Occur on the outer edge of the lens (cortex).
Begins as whitish, wedge-shaped opacities or streaks.
Its slowly progresses, the streaks extend to the center and
interfere with light passing through the center of the lens.
Problems with glare are common with this type of cataract.
Symptoms
A cataract usually develops
slowly, so:
Causes no pain.
Cloudiness may affect only a
small part of the lens
People may be unaware of any
vision loss.
Over time, however, as the
cataract grows larger, it:
Clouds more the lens
Distorts the light passing
through the lens.
Impairs vision
Reduced visual acuity (near
and distant object)
Glare in sunshine or with
street/car lights.
Distortion of lines.
Monocular diplopia.
Altered colours ( white
objects appear yellowish)
Not associated with pain,
discharge or redness of the
eye
Signs
Reduced acuity.
An abnormally dim red reflex is seen when the eye is viewed
with an ophthalmoscope.
Reduced contrast sensitivity can be measured by the
ophthalmologist.
Only sever dense cataracts causing severely impaired vision
cause a white pupil.
After pupils have been dilated, slit lamp examination shows the
type of cataract.

Gradual loss of vision
DDX:
1. Cataract
2. Glaucoma
3. Diabetic retinopathy
4. Hypertensive retinopathy
5. Age related macular degeneration
6. Retinitis pigmentosa
7. Trachoma
8. Onchocerciasis (river blindness)
9. Vitamin A deficiency
Treatment
Glasses: Cataract alters the refractive power of the natural lens
so glasses may allow good vision to be maintained.
Surgical removal: when visual acuity can't be improved with
glasses.

Surgical techniques
Phacoemulsification method.
Extracapsular method.
Intracapsular method
Pre-op assesments
General health evaluation including blood pressure check
Assessment of patients ability to co-operate with the
procedure and lie reasonably flat during surgery
Instruction on eye drop instillation
The eyes should have a normal pressure, or any pre-existing
glaucoma should be adequately controlled on medications.
An operating microscope is needed, in order to reach the lens,
a small corneal incision is made close to the limbus for the
phaco-probe.
It is important to appreciate anterior chamber depth and to
keep all instruments away from the corneal endothelium in the
plane of the iris.
Phacoemulsification in cataract surgery
involves insertion of a tiny, hollowed tip that
uses high frequency (ultrasonic) vibrations to
"break up" the eye's cloudy lens (cataract). The
same tip is used to suction out the lens
.

Pupil conjugate plane
Lamp
Aperture
45 mirror
Practical Retinal Illumination System
Retinal Imaging System
stop in pupil plane
conjugate
circular aperture
in stop
optic
axis
optic
axis
observers pupil in
conjugate pupil plane
SUBJECT
OBSERVER
FIRST ATTEMPT AT BINOCULAR VIEW
Obs. L eye
Obs. R eye
Ss eye
Combine L and R eye views
Observers eyes have to be too close
GTT 05
20 D
lens
RI
60 D
eye
OPHTHALMOSCOPE MAGNIFICATION
Mag of RI
P
eye
P
lens
=
60 D
20 D
= 3.0
M =
42
40 mm
50 mm
20 D
1 mm dia exit pupil
2.0 mm
MONOCULAR FIELD OF VIEW
20 D
40
Area of binocular view
BINOCULAR FIELD OF VIEW
GTT 04
Clear Aperture: CLAP
Working Distance: WD
CLAP
2
WD
u
54.72 mm
51.04 mm
= 24 mm
47 mm
u
u
u
CLAP
WD
= tan
-1

( (
u
= 23.7 FOV = 47.4
u
= 25.2 FOV = 50.3
u
= 25.2 FOV = 50.3
Example: OI Maxlight 20 D
CLAP = 48 mm
WD = 47 mm
FOV = 50
ESTIMATING FIELD OF VIEW
Complete binocular
Indirect
ophthalmoscope
GTT 05
hole in 45
o
mirror

camera or CCD
Fundus camera
3. Optical Coherence Tomography (OCT)


1

2

3
coherent
incoherent
partially coherent
Coherence of Light Waves
Laser Beam Coherence
Laser
coherence
length
fixed
mirror
movable
mirror
laser
negative lens
screen
interference
fringes
beam-splitting
prism
L
1
L
1
L
2
Michelson Interferometer
reference arm
sample arm
screen
plane waves
from fixed
mirror
plane waves
from movable
mirror
Interference Fringes in Michelson Interferometer
low coherence length
long coherence length
movable
mirror
laser
negative lens
fixed
mirror
Michelson Interferometer Optical Coherence Tomography
photodetector
electronics
video monitor
lateral (X)
scanning
mirror
negative lens
axial
(Z-axis)
scan
photodetector
sample
video monitor
electronics
reference arm
sample arm
Fringes form when reference mirror path length matches path
length of a reflective piece in the tissue in the sample arm.
Fringes only form when the path difference is within the
coherence length of the light source.
IN MICHELSON INTERFEROMETER
lateral (X)
scanning
mirror
negative lens
axial
(Z-axis)
scan
photodetector
video monitor
electronics
A SCAN
B SCAN
OCT using fiber optics
electronics
photodetector
SLD
sample
reference
GTT/98
MICROSCOPES
Apparent size of object depends on angle it subtends at eye.
ANGULAR MAGNIFICATION
u
100 m
100 m
u
10 m
10 m
25 cm
u
On average, an object cannot be closer than 25 cm from the eye to be seen clearly.
Average distance of
most distinct vision
ANGULAR MAGNIFICATION
25 cm
u
f
h
25 cm
u
f
h
tan u =
h
25
tan u =
h
f
Angular Magnification =
tan u
tan u
h
25
h
f
= =
25
f
virtual image
cm
(cm)
Eye
Eyepiece
Objective
Object
f
Real image
f
objective
eyepiece
BASIC MICROSCOPE
magnifier
real image
magnification
M
1
=
Im
Ob
M
2
=
25
f
M
total
=
Im
Ob
25
f
X
MICROSCOPE MAGNIFICATION
o
n
w.d.
D
NA = sin n
o
o
= 14
n = 1.00 (air)
EXAMPLE
NA = 1.00 x sin(14 )
NA = 0.24
OBJECTIVES
Numerical Aperture (NA)
Light gathering ability
Resolution
o = 28
n = 1.00
NA = 0.46
o = 35
n = 1.00
NA = 0.57
o = 60
n = 1.52 (oil)
NA = 1.32
OBJECTIVES
N.A. Examples
converging
rays from
objective
Real image
Real image
parallel rays from
eyepiece
Huygens Ramsden
EYEPIECES
(OCULARS)
D
Specimen
Objective
Real image
REAL MICROSCOPE
EXPERIMENT 4
Basic Microscope
onion skin
real image
on card
f
Produce real image of onion skin on card.
Mark distance of real image on base.
iris
diaphragm
EXPERIMENT 4--CONTINUED
View real image with magnifier (eyepiece)
real
image
plane
f
Adjust iris diaphragm. How does image change?
What is the total magnification?
M
total
=
Im
Ob
25
f
X
Slit-lamp Biomicroscope
The slit-lamp biomicroscope
begins with a microscope.
Objective
Specimen
Eyepiece
.turned on its side
subject
objective
Huygens
eyepiece
.fundamental slit-lamp biomicroscope
.change specimen, objective & eyepiece
image
plane
Build in magnification change without changing working
distance
f
obj

Galilean
telescope to
change mag
working
distance
no image in
image plane
Build in magnification change without changing working
distance
f
obj

Galilean
telescope to
change mag
working
distance
no image in
image plane
D
..add lens to form image in eyepiece image plane
astronomical
telescope
D
F
F
Porro
*
prism
2 right-angle prisms
180
0
image rotation

reduce length of
telescope
displace image
horizontally
Porro -Abbe
Slit-lamp with folded optical path
D
D
binocular slit-lamp viewing system
Anatomy of the Apodized
Diffractive Technology
Central 3.6 mm apodized
diffractive structure

Step heights
decrease peripherally from
1.3 0.2 microns

A +4 D at lens plane
equaling +3.2 at spectacle
plane

Outer refractive zone


Anterior
aspheric
optic
Anatomy of the Apodized
Diffractive Technology
13.0 mm
Anterior
Apodized
Diffractive Optic
6.0 mm
6.0 mm
Symmetric
Biconvex
Anterior Aspheric
Optic
Gradual reduction or blending
of the diffractive step heights.
Optimally manages light energy
delivered to the retina as it
distributes the appropriate
amount of light to near and
distant focal points, regardless
of the lighting situation.
Designed to improve image
quality while minimizing visual
disturbances.

Apodization
1.3 micron
step
Technology of the AcrySof

ReSTOR

IOL in Human Terms

Thickness of a Human Hair
= 60 microns

Thickness of a Red Blood Cell
= 7 microns

Step Height at periphery of
the diffractive portion of the
AcrySof

ReSTOR

Aspheric
IOL = 0.2 microns
Design considerations for the AcrySof

ReSTOR

Aspheric IOL:
Induce negative Spherical Aberrations
with the lens to compensate for positive
corneal Spherical Aberrations
Design Objective
Spherical aberration occurs when light rays are
over-refracted at the periphery of a lens system,
resulting in a region of defocused light which can
decrease image quality.
The Problem Spherical Optics
Spherical
Aberration
Marginal Rays
Paraxial Rays
Light Rays
Spherical IOL
*
Smith, G., Atchinson D.A., (1997) The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom, pp. 667.
Aspheric
Surface
Aspheric optics align the light rays to compensate for positive
corneal spherical aberration, resulting in enhanced image
quality.
The Solution Aspheric Optics
*
Smith, G., Atchinson D.A., (1997) The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom, pp. 667.
Light Rays
Aspheric IOL
73
AcrySof

ReSTOR

Aspheric IOL
(SN6AD3) Specifications
13.0 mm
6.0 mm
OPTICS
Multifocal Apodized Diffractive Optic
Compensation for Positive
Corneal Spherical Aberration
Aspheric Optic
Optic Type Proprietary Symmetric Biconvex
Optic Diameter 6.0 mm
Overall Length 13.0 mm
MATERIAL
Optic/Haptic Material AcrySof

Hydrophobic Acrylic
Light Filtration UV and High-Energy Blue
DESIGN
IOL Design Single-Piece
Haptic Design STABLEFORCE

Modified-L
SPECIFICATIONS
Diopter Range +10 D +30 D in 0.5 D increments
+31 D +34 D in 1.0 D increments
Surgical Loupe
OCT: Basic Principles
Three-dimensional imaging technique with high
spatial resolution and large penetration depth even
in highly scattering media
Based on measurements of the reflected light from
tissue discontinuities
e.g. the epidermis-dermis junction.
Based on interferometry
interference between the reflected light and the reference
beam is used as a coherence gate to isolate light from
specific depth.

1 mm 1 cm 10 cm
Penetration depth (log)
1 m
10 m
100 m
1 mm
Resolution (log)
OCT
Confocal
microscopy
Ultrasound
Standard
clinical
High
frequency
OCT vs. standard imaging
OCT in non-invasive
diagnostics
Ophthalmology
diagnosing retinal diseases.
Dermatology
skin diseases,
early detection of skin cancers.
Cardio-vascular diseases
vulnerable plaque detection.
Endoscopy (fiber-optic devices)
gastroenterology
gynecology
Embryology/Developmental
biology
Functional imaging
Doppler OCT (blood flow)
spectroscopic OCT (absorption, high
speed)
optical properties
Polarization Sensitive-OCT
(birefringence).
Guided surgery
delicate procedures
brain surgery,
knee surgery
OCT: Principle of operation
OCT is analogous to ultrasound imaging
Uses infrared light instead of sound
Interferometry
is used to measure
small time delays
of scattered photons
Human skin
5 mm wide x 1.6 mm deep
SpatialResolution: 10-30 m
Time resolution: 30fs!!!
Speed of sound ~ 1480 m/sec (in water)
Speed of light 3x10
8
m/sec
Good OCT sources have small coherence length and large bandwidth
Axial resolution
The axial resolution is



notice that A is the 3dB-bandwidth!
The broader the bandwidth the shorter the
coherence length and the higher the resolution
2 2
0 0
2 ln 2 1 2ln 2
0.44
c
c
l

t v t
= = ~
A A A
Lateral resolution: Decoupled from
axial resolution
x A
2 x A
4 f
x
d

t
| |
A =
|
\ .
Lateral resolution
Az
Az
Az
High NA
Low NA
x A
b Az
Lateral resolution similar to that in a standard microscope
f=focal length
d= lens diameter
Light sources for OCT
Continuous sources
SLD/LED/superfluorescent fibers,
center wavelength;
800 nm (SLD),
1300 nm (SLD, LED),
1550 nm, (LED, fiber),
power: 1 to 10 mW (c.w.) is sufficient,
coherence length;
10 to 15 m (typically),
Example
25 nm bandwidth @ 800 nm
12 m coherence length (in air).
Superluminescent diodes (SLDs)

Definition: broadband semiconductor light sources based on
superluminescence
(Acronym: SLD)
Superluminescent diodes (also sometimes called superluminescence diodes or
superluminescent LEDs) are optoelectronic semiconductor devices which are
emitting broadband optical radiation based on superluminescence. They are
similar to laser diodes, containing an electrically driven p-n junction and an
optical waveguide, but lack optical feedback, so that no laser action can occur.
Optical feedback, which could lead to the formation of cavity modes and thus
to pronounced structures in the spectrum and/or to spectral narrowing, is
suppressed by means of tilting the output facet relative to the waveguide, and
can be suppressed further with anti-reflection coatings.

Superluminescence: amplified spontaneous emission

http://www.rp-photonics.com/superluminescent_diodes.html
Light sources for OCT
Pulsed lasers
mode-locked Ti:Al2O3 (800 nm),
3 micron axial resolution (or less).
Scanning sources
tune narrow-width wavelength over entire spectrum,
resolution similar to other sources,
advantage that reference arm is not scanned,
advantage that fast scanning is feasible.
Construction of image
Source of contrast: refractive
index variations

Image reconstructed by
scanning
Applications in ophthalmology
Normal patient
Patient with impaired vision (20/80):
The cause is a macular hole
Patients other eye (vision 20/25):
Impending macular hole, which can be
treated
http://rleweb.mit.edu/Publications/currents/cur11-2/11-2oct.htm
Applications in cancer detection
Loss of organization
Columnar epithelium: crypts
Squamous epithelium
http://rleweb.mit.edu/Publications/currents/cur11-2/11-2oct.htm
Applications in developmental biology
Ey=eye; ea=ear; m=dedulla; g=gills; h=heart; i=intestine
Ultra-high resolution OCT
Image through the skin of a living frog tadpole
Resolution: 3 m
http://rleweb.mit.edu/Publications/currents/cur11-2/11-2oct.htm
m
m
Ultra-high-resolution-OCT
versus commercial OCT
W. Drexler et al., Ultrahigh-resolution ophthalmic optical coherence
tomography, Nature Medicine 7, 502-507 (2001)
3-D Reconstruction: In vivo images of human eye
using spectral-domain OCT
RPE
NFL
I
T
N
S
I
S
T N
N. A. Nassif et al., Opt. Express 12, 367-376 (2004)



Applanation tonometry

Applanation tonometry is based on the Inbert-Fick
principle.
Which states that for an ideal sphere the pressure (P)
inside the sphere is equal to the force (F) required to
applanate (flatten) its surface, divided by the area (A)
of flattening:
P = F/A or F = PA.
The ideal sphere is dry, thin-walled, and readily
flexible.
The cornea, which is not even a true sphere, is none of
these three. Because of this, there are two other
significant forces at work.


The force of capillary attraction (T) between the
tonometer head and the tear film is additive to
the external force.
In addition, a force (C), independent of IOP, is
required to flatten the relatively inflexible
cornea. Thus,
F = PA , becomes
F + T = PA + C , or
P =( F + T - C) / A

The A, is actually on the interior surface of the
cornea.
The Goldmann applanator is designed so that A
is equal to 7.35 mm 2.
To achieve this, the diameter of flattening of the
cornea is 3.06 mm.
With this value for A, the opposing forces of
capillary attraction and corneal inflexibility
cancel out.
P = F / 7.35 mm 2

In addition, with this value for A the IOP in
millimeters of mercury (mmHg) is equal to ten
times the force applied to the cornea in grams,
which is a convenient conversion.
Since only 0.5 m{mu} is displaced from the eye
and the additional increase in pressure induced
in the eye from its steady state by the
tonometer tip is negligible, applanation
tonometery is not significantly affected by
ocular rigidity.
Slit Lamp Imaging
UC Berkeley Retinal Reading Program
Diabetic Retinopathy Screening with EyePACS
Program Manual
10/07
EyePACS
Optic Disc
Macula
Superior temporal artery and vein
Inferior temporal artery and vein
Anatomy of the Retina
Macula
Superior temporal
artery and vein
Inferior temporal artery
and vein
RIGHT EYE
RIGHT EYE
GLAUCOMA
Sneak Thief of Sight
GLAUCOMA
13% of the blind in India have been
blinded due to Glaucoma
It may be
YOU
GLAUCOMA
PATIENT EDUCATION

Glaucoma: The Disease
Caused by increased pressure of fluid in the
eye
The fluid is known as aqueous humor.
Aqueous humor is not same as tears, which
bathe the outside of the eye.
Aqueous humor maintains the normal shape
of the eyeball and nourishes its internal
structure
Glaucoma: The Disease
Normal Drainage
Picture
The Trabecular meshwork is
the eyes drain
The Ciliary Body is the eyes faucet
or tap where fluid is made
When this drainage of the fluid gets blocked, excess
pressure is formed leading to Glaucoma
Lens
Glaucoma: Symptoms
Most patients with Glaucoma, especially Primary Open Angle Glaucoma
are asymptomatic i.e. without any symptoms, until late in the course of
disease. However, certain patients may have symptoms such as pain,
redness, halo vision, blurred vision.
Tunnel
vision
Red eye, pain in the
eye,
Halo around lights
Blurred vision
Vision
loss

SYMPTOMS
Glaucoma: Symptoms
Normal vision
Reduced side vision,
central vision intact
Tunnel
vision
How common is glaucoma and who gets it?
Any one at any age can get glaucoma,
but the older you are the more likely
you are to get it.
People above 45 years are more likely
to get Glaucoma.
Who is most likely to get glaucoma?
You are more likely to get glaucoma if you:
Have family members with glaucoma
Are over 45 years of age
Have poor vision
Have diabetes
Take steroid medication
Previous eye injury.
Glaucoma: Types of Glaucoma
Chronic or
Primary Open
Angle Glaucoma
Clogged Drainage holes
The angle between the iris and the cornea is normal,
but the drainage holes get clogged from the inside.
Lens
Glaucoma: Types of Glaucoma
Acute Angle
Closure Glaucoma
Blocked Drainage holes
The angle is narrower than normal. If fluid cant flow
easily through the opening in the pupil, the iris pushes
forward and blocks the drainage holes.
Lens
How can I find out if I have glaucoma?
A series of test performed by your eye doctor
will help to determine whether you have
glaucoma or likely to develop glaucoma.
Glaucoma: Diagnosis
1
st
History and General Examination
Glaucoma: Diagnosis
5th Perimetry
Actual measurement of visual field looking for any
dark areas in field of vision
Eye drops
Pills
Laser surgery
Eye operations
Combination
method
Treatment Options
Glaucoma: Treatment
MEDICAL
Drugs increase conventional outflow.
Lens
Glaucoma: Treatment
Drugs reduce production of fluid in the eye.
Lens
MEDICAL
The purpose of treatment is to
prevent further loss of vision.
This is important because loss of
vision due to glaucoma is
irreversible.
Glaucoma: Treatment
SURGERY
Trabeculectomy
New Drain
Sclera
Lens
Glaucoma: Treatment
SURGERY
Trabeculoplasty
Lens
Open Drainage hole
Laser
Glaucoma: Treatment
SURGERY
Iridotomy
Laser
Lens
Making a tiny opening in the
iris with a laser allows fluid to
drain freely
Will I go blind because of glaucoma?
If glaucoma is left untreated, damage increases,
which may eventually lead to blindness.

Regular eye examinations
Regular intake of medications as
instructed by the ophthalmologist
Therefore, you should have
Dos and Donts of Glaucoma
Stock the medicine before they run out; it is
important to continue medication on schedule
If more than one drug is used, wait for 10 minutes
between drops
Do not increase the number or amount of
medication taken at one time.
Do not stop taking medication just because you
have no obvious symptoms
Dos and Donts of Glaucoma
Take all prescribed doses.
Remember to take medications with you when
you travel
Learn how to take eye drops properly ask your
doctor for help
Maintain a record with your medication schedule
and lists of treatments and doctors

Remember
Treatment for glaucoma requires a team made up of both
you and your doctor (ophthalmologist)
Your doctor can prescribe treatment for glaucoma, but only
you can make sure to put your eye drops regularly
Do not stop taking or changing your medications without
first consulting your doctor (ophthalmologist)
Frequent eye examinations and tests are critical to monitor
your eyes for any changes
Remember,
It is your vision, and therefore its your responsibility to maintain it
Focus
Knob
Monitor
Setting
Switches
Power
Lamp
Shutter Button
Joystick
Height Adjusting Dial
View Switching
Button
Fixation Target Button
Platform Locking
Knob
Diagram of the Canon CR6-45NM
Diagram of the Canon CR6-45NM
Small Pupil Knob
Infrared Ray Knob
Lamp Knob
Power Switch
Fuse Holders
Power Connector
Forehead Rest
Height
Adjustment Mark
Objective Lens
Chin Rest
Height Adjustment
Ring
RS422A Connector
Focus Knob
High Correction Sleeve
Fundus Reflex Photographs and 3 Standard Fields
Field 1: Macula
First Set: The Right Eye Invert if using Canon DGi
Field 2: Disc
Position the optic disc at the center. Use the
Fixation Target to position the optic disc (2 stops left
from default).
Position the macula to the far left of the optic
disc.
Field 3: Temporal to Macula
Position the optic disc to the far right until it has
disappeared from the screen. Use the Fixation Target
to position the optic disc off to the left (3 stops right
from default).
Position the macula a little lower and a little off to
the right of the center.
External: Fundus Reflex
High correction sleeve on right side of camera is pulled out;
set S.P. setting to on; F-stop set to F-1; head is positioned 1
inch from head rest bar; focus on iris detail.
High correction sleeve on right side of camera is pushed in;
set S.P. setting to off , F-stop set to ~F-4 F-5
The Optic Disc and Macula should be about equal
distances from the center. This is the default position of
the camera when it is turned on.
Fundus Reflex Photographs and 3 Standard Fields
Field 1: Macula
Second Set:The Left Eye Invert if using Canon DGi
Field 2: Disc
Field 3: Temporal to Macula
External: Fundus Reflex
High correction sleeve on right side of camera is pulled out;
set S.P. setting to on; F-stop set to F-1; head is positioned 1
inch from head rest bar; focus on iris detail.
The Optic Disc and Macula should be about equal
distances from the center. This is the default position of
the camera when it is turned on.
Position the optic disc at the center. Use the Fixation
Target to position the optic disc (2 stops right of default).
Position the macula to the far right of the
optic disc.
Position the optic disc to the far left until it has
disappeared from the screen. Use the Fixation Target to
position the optic disc off to the left (3 stops left of
default).
Position the macula a little lower and a little off
to the left of the center.
High correction sleeve on right side of camera is pushed in;
set S.P. setting to off , F-stop set to ~F-4 F-5
Using EyeScape
Once finished taking photos click End Procedure
Review your photos. Discard any poor quality photos by highlighting the photo tab and
clicking the Delete button. Once you have the best photos in order, click the Save all button.
Upload Instructions (continued)
Step Five: Uploading is not complete until you see the View Case Details page with thumbnail images
of the retinal images you captured.
D Wilson 2002
The effects of a smaller pupil
O'
O''
O'''
I'''
I''
I'
Blur
circles
Screen
Depth of focus
The pupil & aberrations
Spherical aberration and coma are reduced by the
eyes pupil
D Wilson 2002
E
E

(entrance pupil)

The pupil & spectacle
magnification
Spectacle magnification will occur at all positions
except at the entrance pupil
D Wilson 2002
E
E

(entrance pupil)

The pinhole & myopia
Lewis Williams 2002
Myopia
With pinhole
Without pinhole
Pinhole
aperture
Blur circles
Lewis Williams 2002
The pinhole & hyperopia
Blur circles
With pinhole
Without pinhole
Hyperopia
Pinhole
aperture
The effects of the pinhole
Without pinhole aperture
With pinhole aperture
F or P?
Lewis Williams 2001
The future of vision
Super
vision
The future of vision
Can we improve on creation?
Yes
The future of vision
Aberrations and the eye
The eye is subject to wavefront aberrations
These affect all eyes but are more significant in
cases of:
Keratoconus
Larger pupils
Corneal surgery (eg refractive surgery)
The future of vision
It is possible to correct these aberrations in the
laboratory but not yet clinically
Work is currently underway to correct the
aberrations for real subjects using:
The excimer laser to custom ablate (wavefront
guidance)
Customised, aberration correcting, contact lenses
but they may change the corneal curvature
The future of vision
What are the optical limits?
Diffraction
Changing aberrations with changing accommodation
Changing aberrations with changing direction of gaze
Changing aberrations with the ageing eye
Chromatic aberration
The future of vision
Are there other limits?
Image transmission
The cones are 0.5' of arc apart, meaning we have digital
vision!
So, the image may be too detailed for the receptors
creating the familiar TV tweed coat effect
Restoration of natural vision
The future of vision
Insert for ametropia
Accommodating
IOL



Radiation Wavelengths
193 nm - Excimer (Cornea)
488 - 514 nm - Argon (Retina)
694.3 nm - Ruby
780 - 840 nm - Diode
1064 nm - Nd Yag (Capsule)
10,600 nm - Carbon dioxide (Skin)


SURYA
Uses
Diagnostic
Therapeutic
SURYA
Diagnostic Uses
Laser Fluorescence Spectroscopy
Scanning Laser Ophthalmoscopy
Laser Interferometry
Fundus Fluorescein Angiography
Ffa PIC
SURYA
Therapeutic Uses
Widely Used -
Extra-ocular adnexae
Anterior Segment
Posterior Segment
SURYA
LASIK
Therapeutic Uses
SURYA
Suction Ring Microkeratome Flap Removed
LASIK
Therapeutic Uses
SURYA
LASIK Flap Replaced Post - Op.
Therapeutic Uses
B. Anterior Segment
SURYA
What is Glaucoma ?

Therapeutic Uses
SURYA
iv. Reopen failed
filtering blebs
v. Iridoplasty,
Gonioplasty
vi. Iris cyst,
Pupilloplasty

Therapeutic Uses
B. Anterior Segment
SURYA
vii. Posterior Capsular Opacification
Therapeutic Uses
B. Anterior Segment
SURYA
Therapeutic Uses
C. Posterior Segment
SURYA
What is Diabetic Retinopathy ?

Therapeutic Uses
SURYA
What is Diabetic Retinopathy ?

Therapeutic Uses
SURYA
What is Diabetic Retinopathy ?

Therapeutic Uses
SURYA
What is Diabetic Retinopathy ?

Therapeutic Uses
SURYA
What is Diabetic Retinopathy ?

Therapeutic Uses
SURYA
What is Diabetic Retinopathy ?

Therapeutic Uses
SURYA
i. Diabetic Retinopathy

Therapeutic Uses
SURYA
i. Diabetic Retinopathy

Therapeutic Uses
Focal

Grid

Panretinal

SURYA
ii. Retinal Haemorrhage
Therapeutic Uses
SURYA
iii. Retinal Breaks or Tears
Therapeutic Uses
SURYA
iv. Subretinal neovascularisation
v. Central serous retinopathy

Therapeutic Uses
C. Posterior Segment
SURYA
vi. Vitreolysis in cystoid macular edema
Therapeutic Uses
C. Posterior Segment
SURYA
vii. Vitreous traction bands, to free
encapsulated foreign bodies

Therapeutic Uses
C. Posterior Segment
SURYA
viii. Drainage of subretinal fluid / haem.


Therapeutic Uses
C. Posterior Segment
SURYA
ix. Intraocular tumors (RB)

Therapeutic Uses
C. Posterior Segment
SURYA
ix. Intraocular tumors (Choroidal Melanoma)

Therapeutic Uses
C. Posterior Segment
SURYA
x. Laser scleral buckling

Therapeutic Uses
C. Posterior Segment
SURYA
i. Neovascular stimulation
ii. Aseptic phototherapy for pre-op
preparation
iii. Laser asepsis for diagnosed infectious
corneal ulcers
iv. Endonasal DCR
Therapeutic Uses
D. Miscellaneous Uses
SURYA
What is the Latest ?
PDT (Photo Dynamic Therapy)
TTT (Transpupillary Thermo Therapy)
SURYA
What is ARMD ?
SURYA
Two types -
Dry ARMD
Wet ARMD
What is ARMD ?
SURYA
Wet ARMD -
Rare
More devastating
Drusen
SRNVM
What is ARMD ?
SURYA
Drusen
What is ARMD ?
SURYA
SRNVM
What is ARMD ?
SURYA
Vision in ARMD
What is PDT ?
Visudyne (Verteporfin)
Smart Bomb for wet ARMD
Selective Damage
of SRNVM
Costly
SURYA
Rear Mirror
Adjustment Knobs
Safety Shutter Polarizer Assembly (optional)
Coolant
Beam
Tube
Adjustment
Knob
Output
Mirror
Beam
Beam Tube
Harmonic
Generator (optional)
Laser Cavity
Pump
Cavity
Flashlamps
Nd:YAG
Laser Rod
Q-switch
(optional)
NEODYMIUM YAG LASER
Laser-Professionals.com
Light Detection - The Retina
Layer of light sensitive cells on inner surface
of the eye
Fovea
Retina
Blind Spot
Optic Nerve
Light Detection - The Retina
There are two types of photoreceptor cells in the retina:
cones and rods. The cones are responsible for sharp
colour vision in daylight. The rods provide vision in dim
light.
Near the centre of the retina is a small depression
about 0.3 mm in diameter which is called the fovea. It
consists entirely of cones packed closely together. Each
cone is about 2m in diameter. Most detailed vision is
obtained on the part of the image that is projected on
the fovea. When the eye scans a scene, it projects the
region of greatest interest onto the fovea.
Light Detection - The Retina
The region around the fovea contains both cones and
rods. The structure of the retina becomes more coarse
away from the fovea. The proportion of cones
decreases until, near the edge, the retina is composed
entirely of rods.
In the fovea, each cone has its own path to the optic
nerve. This allows the perception of details in the
image projected on the fovea.
Away from the fovea, a number of receptors are
attached to the same nerve path. Hence the resolution
decreases, but the sensitivity to light and movement
increases.
Light Detection - The Retina
With the structure of the retina in mind, let us examine
how we view a scene from a distance of about 2 m.
From this distance, at anyone instant, we can see most
distinctly an object only about 4 cm in diameter. An
object of this size is projected into an image about the
size of the fovea. Objects about 20 cm in diameter are
seen clearly but not with complete sharpness. The
periphery of large objects appears progressively less
distinct.
Thus, for example, if we focus on a person's face 2 m
away, we can see clearly the facial details, but we can
pick out most clearly only a subsection about the size
of the mouth. At the same time, we are aware of the
persons arms and legs, but we cannot detect, for
example, details about the persons shoes.
Light Detection - The Retina
Receptors
Sensitivity:
Receptors
Dark Adaptation
Summary of Properties of Cones
Cones
Colour receptors (three types red, blue & green)
Respond in high illumination (daylight)
About 6.5 million per eye, concentrated at the
fovea (i.e., high resolution in this region)
In the fovea, each cone connects to one nerve
fibre. Elsewhere, several to one fibre
Overall peak response at ~ 550 nm

Summary of Properties of Rods
Rods
Respond to intensity only (monochrome)
Respond to low illumination (night vision)
About 120 million per eye, their highest concentration is at about 20 from the fovea
Hundreds of rods connect to each nerve fibre, hence low resolution
Peak response at 510 nm
Resolution of the Eye
So far in our discussion of image formation we
have used geometric optics, which neglects the
diffraction of light.
Geometric optics assumes that light from a point
source is focused into a point image. This is not
the case. When light passes through an aperture
such as the iris, diffraction occurs, and the wave
spreads around the edges of the aperture.
As a result, light is not focused into a sharp point
but into a diffraction pattern consisting of a disk
surrounded by rings of diminishing intensity.
Diffraction from a circular aperture (Airy disc)
Diffraction Intensity from a square aperture
Resolution of the Eye
If light originates from two point sources that are close
together, their image diffraction disks may overlap,
making it impossible to distinguish the two points.
An optical system can resolve two points if their
corresponding diffraction patterns are distinguishable.
This criterion alone predicts that two points are
resolvable if the angular separation between the lines
joining the points to the centre of the lens is equal to or
greater than a critical value given by sin = 1.22/d
where is the wavelength of light and d the diameter of
the aperture.
For an iris diameter of 0.5 cm and green light (500nm),
= 1.22x10
-4
radians.
Resolution of the Eye
Experiments have shown that the eye does not
perform this well.
Most people cannot resolve two points with an
angular separation of less than 5 x10
-4
radians.
Clearly there are other factors that limit the
resolution of the eye.
Imperfections in the lens system of the eye
certainly impede the resolution. But perhaps
even more important are the limitations
imposed by the structure of the retina.
Resolution of the Eye
The cones in the closely packed fovea are about 2 m in
diameter. To resolve two points, the light from each point
must be focused on a different cone and the excited cones
must be separated from each other by at least one cone
that is not excited.
Thus at the retina, the images of two resolved points are
separated by at least 4 m. A single unexcited cone
between points of excitation implies an angular resolution
of about 3 x 10
-4
radians (using nodal point 15mm from
retina).
Some people with acute vision do resolve points with this
separation, but most people do not. We can explain the
limits of resolution demonstrated by most normal eyes if
we assume that, to perceive distinct point images, there
must be three unexcited cones between the areas of
excitation. The angular resolution is then, as observed, 5 x
10
-4
radians.
Resolution of the Eye
Let us now calculate the size of the smallest detail that
the unaided eye can resolve. To observe the smallest
detail, the object must be brought to the closest point
on which the eye can focus. Assuming that this
distance is 20 cm from the eye, the angle subtended
by two points separated by a distance x is:
tan
-1
(/2) = (x/2)/20.
If is very small, this becomes = x/20. Because the
smallest resolvable angle is 5 x 10
-4
radians the
smallest resolvable detail x is 0.1 mm (5 x 10
-4
x 20).
Using the same approach facial features such as the
whites of the eye are resolvable from as far as 20m.
Sensitivity of the Eye
The sensation of vision occurs when light is absorbed
by the photosensitive rods and cones.
At low levels of light, the main photoreceptors are
the rods. Light produces chemical changes in the
photoreceptors which reduce their sensitivity.
For maximum sensitivity the eye must be kept in the
dark (dark adapted) for about 30 minutes to restore
the composition of the photoreceptors.
Sensitivity of the Eye
Under optimum conditions, the eye is a very sensitive
detector of light.
The human eye, for example, responds to light from a
candle as far away as 20 km.
At the threshold of vision, the light intensity is so small
that we must describe it in terms of photons.
Experiments indicate that an individual photoreceptor
(rod) is sensitive to 1 quantum of light. This, however,
does not mean that the eye can see a single photon
incident on the cornea. At such low levels of light, the
process of vision is statistical.
Sensitivity of the Eye
In fact, measurements show that about 60
quanta must arrive at the cornea for the eye to
perceive a flash.
Approximately half the light is absorbed or
reflected by the ocular medium.
The 30 or so photons reaching the retina are
spread over an area containing about 500 rods.
It is estimated that only 5 of these photons are
actually absorbed by the rods.
It seems, therefore, that at least 5
photoreceptors must be stimulated to perceive
light.
Sensitivity of the Eye
The energy in a single photon is very small.
For green light at 500 nm, it is (using E=hc/)
4 x 10
-19
Joules
This amount of energy, however, is sufficient to
initiate a chemical change in a single molecule
which then triggers the sequence of events that
leads to the generation of the nerve impulse
Vision
Vision cannot be explained entirely by the physical
optics of the eye.
There are many more photoreceptors in the retina than
fibres in the optic nerve. It is, therefore, evident that
the image projected on the retina is not simply
transmitted point by point to the brain.
A considerable amount of signal processing occurs in
the neural network of the retina before the signals are
transmitted to the brain.
The neural network "decides" which aspects of the
image are most important and stresses the
transmission of those features
Vision
It has been shown that movement of the image
is necessary for human vision.
In the process of viewing an object, the eye
executes small rapid movements, 30 to 70 per
second, which alter slightly the position of the
image on the retina.
Under experimental conditions, it is possible to
counteract the movement of the eye and
stabilize the position of the retinal image. It has
been found that, under these conditions, the
image perceived by the person gradually fades
Limits of Detection
Lower limit of illumination
about 30 photons spread over about 500 rods
Resolution
Diffraction effects and structure of retina limit
resolution to about 8m under optimal conditions
Blind Spot
Caused by region where nerve fibres enter the
optic nerve - edited out by the brain
Understanding Vision
The cornea & lens work together to
focus images in the eye
Distance Vision
Cornea
Lens
Focal
Point
The Human Eye = The Camera
Understanding Vision
Your eye focuses on what you are looking directly at
Central vision is sharp & clear peripheral vision blurred
Your eye is continually refocusing as you look from far to near
Near vision focusing is called ACCOMMODATION
Near
Lens shape for
distance vision
Normal Accommodation
When looking at arms length, the lens changes
shape & moves forward to focus images
Intermediate Vision
Near images
focus behind retina
Intermediate vision is clear
Distance & near vision out of focus
Lens changes
shape & position
Intermediate images
focus on retina
Lens shape for
distance vision
Normal Accommodation
When looking at near objects, the lens continues to
change shape & move forward to focus image
Near Vision
Near images
focus behind retina
Lens changes
shape & position
Near images
focus on retina
Near vision is clear
Distance vision
out of focus
The Ageing Eye
The ageing lens loses its ability to change shape
Reading glasses or bifocals are required
Loss of Accommodation is called PRESBYOPIA
Near Vision
Lens unable
to focus image
Focal
Point
IF YOU HAVE A CATARACT, YOURE NOT
ALONE
2.5 million cataract surgeries per year
Number-one therapeutic surgical procedure
for Americans over 65
TODAYS CATARACT SURGERY
Greatly improved technology
Usually no hospital stay or long recovery
period
Safer, faster and more comfortable
than ever
WHAT IS A CATARACT?
The lens focuses light on the retina
As we age, the lens hardens and cant
focus at close distances
As we continue to age, the lens may
become cloudy
The cloudiness is the cataract
HOW DOES A CATARACT AFFECT
VISION?
A cataract scatters light in the eye
instead of focusing it
The cloudier the lens,
the more light is
scattered
HOW DOES A CATARACT AFFECT
VISION?
Simulated Cataract Vision
Simulated Normal
Vision
Photos courtesy of the National
Eye Institute
Gradually, vision
becomes dimmer
Objects lose their
color
PEOPLE WITH CATARACTS HAVE DIFFICULTY:
Seeing in the distance or reading
Distinguishing road signs at dusk
Recognizing colors
Recognizing friends and family at
a distance
Driving at night
WHO GETS CATARACTS?
Almost everyone sooner or later
Half of all people between the ages
of 52 and 64
*

Younger people, due to injury, excessive
sunlight, metabolic changes, or drugs
*American Academy of Ophthalmology
DETECTING A CATARACT
Visual acuity test
Slitlamp examination
Glare test
TREATING A CATARACT
Is vision impaired?
Is quality of life affected?
The eye care practitioner and
the patient decide:
TODAYS CATARACT SURGERY
A marvel of medical technology
Outpatient procedure
Local anesthesia
Tiny incision heals rapidly
Little of no discomfort
THE CATARACT PROCEDURE
The clouded natural lens is removed
A man-made lens is inserted
The new lens is an intraocular lens
(IOL)
CHOICES FOR RESTORING VISION
Todays technology offers two
different types of intraocular
lenses (IOLs)
Monofocal ReZoom
MONOFOCAL
MONOFOCAL
Good vision at one distance
usually far
Most people need glasses for close-up
activities like reading or crafts
Good vision when you go to a
ballgame or read road signs
The ReZoom

Multifocal Lens
The ReZoom and Crystalens

IOL
Designed for good
distance vision
and near vision
Can reduce the need for
glasses in activities like
reading, watching
television, or watching a
movie

ReZoom

RANGE OF VISION EXAMPLES

If youre golfing, you may be able to
see where your drive lands, sink your
putt, and write down the score,
without glasses
When shopping, you may be able to
read the aisle signs and the package
labels, and count your change,
without glasses
EQUAL SAFETY FOR BOTH IOL TYPES
Identical surgical procedures
The real difference is the type of vision
ReZoom

Balanced View Optics

Technology
Pictorial representation
Source: Product labeling.
ReZoom
TM
IOL Spectacle Independence
%
93%
93%
81%
0%
20%
40%
60%
80%
100%
Distance Intermediate Near
ReZoom IOL

ReZoom

IOL Visual Outcomes

Patient
Brochure
Which Lens Is Best For You?
We will help you decide which lens is the best
alternative for your specific refractive need
Not everyone is a candidate for CrystaLens Vision
Enhancement Surgery
Lifestyle
Expectations
A thorough examination will be performed
Multiple diagnostic tests will be performed
Expectations
All surgery involves risk

Not everyone responds to the surgery in the same
way

Other medical & eye diseases may influence your
ability to see
clearly &/or accommodate

Vision After Accommodative Surgery
1 to 10 days after surgery
Distance vision is typically excellent in the
majority of patients
Near & intermediate vision may be excellent
after surgery, however varies from patient to
patient
Typically continues to improve over time
Vision After Accommodative Surgery
One year after surgery*
98.4% were able to drive, watch TV, participate in sports &
perform normal activites
98.0% were able to work on their computer, read product
labels & read the speedometer
98.4% were able read newspapers, magazines, recipes; sew
& dial their cell phone
*FDA Clinical Study
Without Glasses
73.5% do not depend on glasses at
all or wear them only occasionally
Are You A Candidate For
crystalens

Vision Enhancement?
Schedule a eye examination

Talk with people who have had cataract surgery

Research lens replacement after lens removal surgery

Find a qualified & certified crystalens

Vision
Enhancement Surgeon
Non- Contact Tonometers
- Invented by Dr. Bernie Grolman in the 1960s (American Optical)
- To enable ODs in the USA to perform tonometry
- Introduced in 1971
- Uses rapid air pulse technology
- Easy to use
- Strong Goldmann correlation
- Objective: no operator bias
- No anesthetic required
- No risk of cross-contamination
Modern NCT - AT555
NCT Traditional Method of Operation
Method of Operation
Applanation Signal Plot
Definitions
Hysteresis
The phenomenon was identified, and the term coined, by
Sir James Alfred Ewing in 1890.

Hysteresis is a property of physical systems that do not
instantly follow the forces applied to them, but react
slowly, or do not return completely to their original state.
Corneal Hysteresis
The difference in the inward and outward pressure
values obtained during the dynamic bi-directional
applanation process employed in the Ocular Response
Analyzer, as a result of viscous damping in the cornea.