MXPA06005311A

MXPA06005311A - Ophthalmic binocular wafefront measurement system

Info

Publication number: MXPA06005311A
Application number: MXPA/A/2006/005311A
Authority: MX
Inventors: Warden Laurence; W Dreher Andreas; D Mills Gary; T Lai Shui; G Foote William; G Sandler David
Original assignee: W Dreher Andreas; Ferro John; G Foote William; Ophthonix Inc; Warden Laurence
Priority date: 2003-11-14
Filing date: 2006-05-11
Publication date: 2007-04-10

Abstract

Diagnostic instruments, systems and methods for performing measurements on eyes are disclosed. In one embodiment of the instrument, a left ocular is disposed in a portion of a left visual path for the left eye, the left ocular positioned to permit the left eye to view a target, a right ocular is disposed in a portion of a right visual path for the right eye, the right ocular positioned to permit the right eye to view a target. The instrument can also include a wavefront sensor disposed on a translation stage, the wavefront sensor having an optical path to an imaging sensor, the translation stage being movable to position the optical path of the wavefront sensor in alignment with the portion of the left visual path in a first state and in alignment with the portion of the right visual path in a second state. One or more light sources are optionally provided for propagating light along a least part of the left and right visual paths to illuminate the left and right eyes.

Description

BINOCULAR WAVE FRONT MEASUREMENT SYSTEM OFT LMICO BACKGROUND OF THE INVENTION FIELD OF THE INVENTION • The present invention is generally concerned with systems and methods for performing measurements on an eye. More particularly, the invention is concerned with systems and methods for taking wavefront measurements of the eye.

DESCRIPTION OF THE RELATED TECHNOLOGY A process to quantify all aberrations in the eye is known as wavefront analysis. In general, wavefront analysis involves illuminating an eye with a beam of light, collecting reflected light from the eye, and analyzing certain wavefront properties of the collected light to determine aberrations in the eye. While an advantage of wavefront analysis is its ability to measure higher order aberrations of the eye, wavefront measurement can be adversely affected in many ways which include, for example, state of accommodation of the eye . When taking accurate wavefront measurements of the eye, it is desirable that the subject's eye be stable and in a natural, comfortable state, reducing or minimizing errors due to the accommodation or movement of the eye. One way to ensure that the subject is comfortable and relaxed is to present an image to the eye that allows the subject to fix on a specific object. While observing this image, the subject's vision is preferably corrected to a level that allows it to be fixed on the object. For example, the subject is preferably measured as long as he observes a natural scene at the desired distance for which the prescription will be generated. In an eye exam, this may mean observing an eye board or scene image placed about 16 feet or greater from the subject. However, a distance from the subject to the 16-foot object poses a problem for some examination areas due to space constraints. Conventional wavefront measurement devices (examples include those available from Nidek, Tracy and * Wavefront Sciences) are monocular instruments. Some procedures for wavefront measurement employ the standard Shack-Hartmann detector commonly used in wavefront detector devices employing the standard Shack-Hartmann detector commonly used in ocular wavefront detector devices. The Shack-Hartmann procedure uses an optical element, such as an array of lenses, to divide the wave fronts of the pupil with abrasion to smaller non-overlapping sub-pupils and form the arrangement of a common image plane in a common image plane. focused points. of all sub-openings. This procedure has its conceptual root in geometric optics and can suffer from the well-known problems of dynamic range, limits to linearity, issues of sub-aperture alignment and increased complexity of large numbers of sub-apertures used to measure higher order abrasions. beyond the common order Zernike modes. Another problem is that typical wavefront measurement systems require that the patient be rigidly constrained due to the length of time required for the collection of wavefront measurements. Such unnatural restraints add to the patient's discomfort may result in increased eye movement as the discomfort increases. Additionally, using visible light for eye measurements also increases patient discomfort. Another problem when determining "visual acuity" is that some patients, for example children or the elderly, may have a difficult time to respond to these vision tests that require the patient to make a subjective determination of which prescription produces the best vision for them. Inappropriate responses by the patient can result in inaccurate prescription and frustration for the patient and the operator administering the test., commonly, wavefront systems require a skilled operator to properly position the patient and place the wavefront detector in XYZ to obtain a "good" wavefront measurement. Factors that can cause erroneous results include • for example, improper XYZ placement of the detector, eye movement, torn film, eye blinks, eyelashes, glare, and transient or uncontrolled accommodation. To effectively use wavefront systems and facilitate the wide use of this technology, less burdens could be placed on the subjective actions of the operator and patients and more sophisticated techniques could be used to detect and control these factors. Commonly, the operator must take multiple measurements and determine which measurements are valid for subsequent use. Certain methods to determine which images or processed results are similar and which false ones should be removed later could increase the effectiveness of the wavefront measurement process. What is needed is a wavefront measurement system that overcomes one or more of the problems stated above and other deficiencies in the art and that can be used in the widest possible patient population.

BRIEF DESCRIPTION OF THE INVENTION In one embodiment, the invention comprises a binocular wavefront measurement system for performing wavefront analysis on a patient's eyes, comprising an optical system for providing an image to a first eye at along a first optical path and an image to a second eye along a second optical path and a detector system, the detector system configurable "in a first mode for effecting a wavefront measurement of a first eye through of a portion of the first optical path and configurable in a second mode for effecting a wavefront measurement of a second eye at • through a portion of the second optical path. The system may further comprise a system of plates for positioning the detector system to receive light from the first eye in the first mode and to receive light from the second eye in the second mode. In some embodiments, the detector system may be, for example, a Hartmann-Shack wavefront detector or a beam-tracking wavefront detector. In some embodiments, the optical system may comprise a first internal target, a second internal target and a path splitter with a first mode for placing the first internal target on the first optical path and the second internal target on the second optical path and with a second mode for placing the first internal target outside the first optical path and the second internal target outside the second optical path, wherein the first and second optical paths extend to a site external to the wavefront system binocular when the optical path divider is placed in the first mode. In some modalities, the first and second internal objectives are a pair of stereoscopic images. In other embodiments, the position of the first internal target and the second internal target is adjustable to stimulate the accommodation of the eye when observing the first internal target and the second internal target by means of the binocular visual-optical system. In another embodiment, the optical system of the binocular wave front measurement system comprises a target light system for illuminating internal targets. In some embodiments, the intensity of the illumination of the target light system may be controllable to provide variable illumination of the internal targets. In some embodiments, the target light system provides illumination that stimulates one or more different lighting conditions, for example, daylight, tungsten, fluorescent, moonlight and / or nighttime driving. In another embodiment, the binocular wave front measurement system further comprises a computer connected to the detector system and the objective light system, the computer is configured to determine the diameter of a pupil of an eye and control the intensity of the illumination of the eye. the light source based on the diameter of the pupil. In another embodiment, a binocular wavefront measurement system for performing wavefront analysis on a patient's eyes comprises prisms placed between the beam splitter and the patient's eye to stimulate a specific angle of convergence. For example, the binocular wavefront measurement system may comprise a convergence device positioned to provide an image of at least one of the first optical path and the second optical path to at least one of the first and second eyes for invoke a state of convergence of the eyes. In some embodiments, the convergence device comprises at least one low angle prism. In another embodiment of the binocular wavefront measurement system, the system comprises elements that compensate for aberrations present in the eyes of a patient. For example, the optical system may comprise a first set of configurable optical elements for controlling aberrations in a first eye and a second set of configurable optical elements for controlling aberrations in a second eye. In another modality, the optical system comprises at least one adaptive optical mirror, having a movable mirror surface, the at least one adaptive optical mirror is placed in one of the first and second optical paths and the at least one adaptive optical mirror is configurable to correct an aberration when adjusting the movable mirror surface. In several modalities, the aberrations may comprise spherical, astigmatism and / or coma. In another embodiment, the detector system of the binocular wavefront measurement system comprises a light source for emitting a light beam along a source optical path, an obstruction element having a blocking portion, the obstruction arranged to place the blocking portion in the optical path of the source to obstruct a central portion of the light beam and produce an annular light beam to illuminate the retina of the eye, a modulation pattern element placed in a path of a beam of reflected light from the eye and detector positioned to receive at least a portion of the light passing through the modulation pattern element to detect a wavefront aberration of the eye. In some embodiments, the light source provides light having a beam diameter of approximately 2-3 mm in diameter. In some embodiments, the blocking portion of the obstruction element is approximately 1.5 to 2.5 mm in diameter. In some embodiments, the beam of light emitted is a beam of collimated light. In another embodiment, the detector system of the binocular wavefront measurement system comprises a light source that provides light along an optical path source to an eye, the light source placed in relation to the eye in such a way that the light of the reflected light source of the retina of the eye travels in a first direction and the reflected light of a cornea of the eye travels in a second direction, where the angle of the first direction in relation to the optical path source is different of the angle of the second direction in relation to the optical path of the source, such that the light traveling in the second direction does not enter an optical path to receive light in the detector system, a modulation pattern element placed for receiving light reflected in the first direction and a detector for detecting a wave front aberration of the eye, the detector positioned to receive at least a portion of the eye; uz that passes through the modulation pattern element. In some embodiments, the front-sensing system of the "wave" also comprises one or more optical elements positioned along the source optical path to decrease the spot diameter of the light in the retina of the eye. In various embodiments, the diameter of points of light in the retina may be less than about 1 mm, less than about 600 microns and / or less than about 400 microns. The invention also comprises a method for detecting aberrations in the eyes of a patient, the method comprising placing a binocular optical system in relation to the eyes of a patient to provide an image to a first eye of a patient and an image to a second eye of the patient, place a wavefront detector to receive light reflected from the retina of the first eye, illuminate the retina of the first eye with a light source, receive the light reflected from the retina of the first eye in a detector, in so much that the patient is observing the image with the first eye and detecting a wavefront aberration of the first eye with the detector. In some embodiments, the method may also include controlling the binocular optic system to affect the accommodation of the first eye and the second eye. In some embodiments, the method comprises providing one or more images with aberration to the first eye of the patient and to the second eye of the patient. In several modalities, the provision of one or more images with aberration invokes a state of accommodation of the eye which may for example provide one or more images with aberration comprising providing images invoking a state of accommodation distant from the eyes and / or providing one or more images with aberration that it comprises providing images that invoke a state of reading accommodation of the eyes. In other embodiments of the method for detecting aberrations in the eyes of the patient the method comprises placing the wavefront detector to receive light reflected from the retina of the second eye, illuminate the retina of the second eye with the light source, receive the light reflected from the second retina in the detector while the patient is observing the image with the second eye and detect a wavefront aberration of the second eye with the detector. Another embodiment of the invention comprises a method for identifying an aberration in a patient's eye, the method comprising placing a light source to emit a beam of light along an optical path source, placing an obstruction element having a portion blocking arranged in the optical path of the source to obstruct a central portion of the light beam and produce an annular beam of light to illuminate the retina of the eye, illuminate the eye with the light source, receive the reflected light of the mouse in a detector, detect a wavefront of the eye with the detector and identify an aberration in the eye based on the detected wavefront. Another embodiment of the invention includes a method for measuring aberrations in at least one of a patient's eyes, by using a wavefront detector system comprising placing a binocular optical system in relation to the eyes in such a way that a first eye is placed in a first optical path of the binocular optical system and a second eye is "placed in a second optical path of the binocular optical system, placing a light source in relation to the first eye, such that the light of the light source that is reflected from the retina of the first eye travels in a first direction and the light of the reflected light source of a cornea of the first eye travels in a second direction, where the angle of the first direction in relation with the optical path source is different from the angle of the second direction in relation to the optical path source, such that the light traveling in the second direction does not In an optical path to receive light in the detector system, illuminate the retina of the first eye with the light source, receive the light reflected from the retina in a first direction through a portion of the first optical path, the light includes a wavefront that represents an aberration in the first eye and identifies aberrations in the first eye based on the wavefront received. In another embodiment of the invention, a method for positioning a wavefront detector, in a wavefront detector system, for receiving light from an illuminated eye of a patient based on the location of the pupil of the eye is disclosed. , the method comprises illuminating the eye with a light source, placing a wavefront detector system in a first location in relation to the pupil of the eye, in such a way that the light reflected by the eye propagates along a optical path • of the wavefront detector to receive light, detect the light reflected by the eye in the wavefront detector, determine the position of the pupil of the eye based on the detected light and place the wavefront detector at a second site in relation to the pupil of the eye based on the determined position of the pupil, wherein the second location is a desired location for performing a wavefront measurement of the eye. In still another embodiment of the invention, a wavefront detector system comprises a modulation element having a two-dimensional sinusoidal pattern placed in a light path to be analyzed and a detector system which. has a detector positioned to receive at least a portion of the light passing through the modulation element, the detector is located substantially in a plane of diffraction image self-formation in relation to the modulation element and wherein the Detector system is able to emit a signal based on the light received by the detector. In another embodiment of the invention, a wavefront detector system comprises a modulation element having a two-dimensional chessboard pattern placed in a light path to be analyzed and a detector system having a detector positioned to receive at minus a portion of the light that passes through the modulation element, the detector is located substantially in a plane of diffraction image self-formation in relation to the modulation element and wherein the detector system is capable of emitting a signal based on the light received by the detector. In another embodiment, the invention comprises a method for determining aberrations in a reflective or internally reflective target system, which comprises passing reflected light from an object system through a modulation element having a two-dimensional sinusoidal pattern to produce a pattern. Near field diffraction in a Talbot plane, detect signals from the near-field diffraction pattern in the Talbot plane and use the detected signals to emit a measurement of an aberration in the object system. In still another embodiment, the invention comprises a method for determining an aberration in a reflective or internally reflective object system, comprising passing reflected light from an object system through a modulation element having a chipboard pattern. Two-dimensional chess to produce a near-field diffraction pattern in a Talbot plane, detect signals from the near-field diffraction pattern in the Talbot plane and use the detected signals to emit a measurement of an aberration in the object system. Another embodiment includes methods and systems for simulating the propagation of light through an eye. In one embodiment, the method comprises passing light through a lens disposed in front of a camera, focusing the light on an image forming surface in the camera by adjusting the distance between the lens and the image forming surface, making rotating the image forming surface and reflecting the light of the image forming surface out of the camera "and through the lens In another embodiment, the eye simulation system for testing wavefront detector systems comprises an -accommodation that has a chamber with a hole to allow light to enter the chamber, a fluid located in the chamber, the fluid has a known refractive index, a lens placed in relation to the housing in such a way that the light which enters through the hole of the camera passes through the lens and a rotating image forming surface placed in the camera, such that the light passing through the lens it propagates through the fluid and is incident on the rotating image forming surface. In yet another embodiment, a pupillary distance is determined by a method for measuring the pupillary distance with a binocular wavefront measurement system, the method comprising aligning an optical path of a wavefront detector system with a first pupil in a first position, analyzing the light received from the first pupil by the wavefront detector to determine position information of the first pupil relative to the first position, aligning the optical path of the wavefront detector with a second pupil in a second position, analyzing the light received from a second pupil by means of the wavefront detector to determine position information of the second pupil in relation to the second position, determining the pupillary distance based on the first position and the second position and in based on the position information of the first pupil in relation to the first position and information n of the second pupil position relative to the second position. In still another embodiment, the method includes a method for identifying aberrations of a patient's eye comprising illuminating a first objective with a light source configured to produce a first illumination condition, performing a first wavefront measurement of a pupil of a first eye of a patient while the first eye is observing the first illuminated objective with the light source configured to produce a first illumination condition, illuminating the first objective with a light source 'configured to produce a second illumination condition, making a second wavefront measurement of the pupil of the first eye while the first eye is observing the first illuminated objective with the source of light. light configured to produce a second lighting condition and determine the response of the pupil of the first eye to the second lighting condition, based on the first and second wavefront measurements of the second eye pupil. In some embodiments, the method comprises illuminating a second objective with a light source configured to produce a first illumination condition, performing a first wavefront measurement of a pupil of a second eye of a patient while the second eye is observing the second illuminated objective with the light source configured to produce a first illumination condition, illuminating the second objective with a light source configured to produce a second illumination condition, performing a second wavefront measurement of the pupil of the second eye while the second eye is observing the illuminated target with the light source configured to produce a second illumination condition, and determining the response of the pupil of the second condition to the second illumination condition based on the first and second wavefront measurements of the second eye pupil. In another embodiment, a wavefront measurement system for determining a response of the pupil of an eye of a patient to a specific lighting condition comprises means for illuminating a first objective with a light source configured to produce a first condition of illumination, means for effecting a first wavefront measurement of the pupil of a first eye of a patient while the first eye is observing the first objective illuminated with the light source configured to produce a first illumination condition, means for illuminating the first objective with a light source configured to produce a second illumination condition, means for effecting a second wavefront measurement of the pupil of the first eye while the first eye is "observing the first illuminated objective with the source of light set to produce a second lighting condition and means to determine the response of the p upila of the first eye to the second lighting condition based on the first and second measurements of the wavefront of the pupil. In some embodiments, the method also comprises means for illuminating a second objective with a light source configured to produce a first lighting condition, means for effecting a first wavefront measurement of the pupil of a second eye of a patient while that the second eye is observing the second illuminated objective with the light source configured to produce a first illumination condition, means for illuminating the second objective with a light source configured to produce a second illumination condition, means for effecting a second measurement wavefront of the pupil of a second eye while the second eye is observing the target illuminated with the light source configured to produce a second illumination condition and means to determine the response of the pupil of the second eye to the second illumination condition based on the first and second wavefront measurements of The pupil. Another embodiment includes a method for generating information to correct optical aberrations for a patient's eye, the method comprising placing the patient's eyes in relation to a binocular visual optical system having a first optical path and a second optical path, in such a manner that the line of sight of a first eye is aligned with the first optical path and the line of sight of a second eye is aligned with the second optical path, provide an image via the first optical path to the first eye and an image via the second path to the second eye; allow a wavefront detector to receive light reflected from the retina of the first eye, illuminate the retina of the first eye with a light source, receive light reflected from the retina of the first eye on the wavefront detector, measure a wavefront aberration of the first eye of the light received from the first eye, identifying at least one optical aberration in the first eye based on the measured wavefront aberration and generating information concerning at least one optical aberration for use in a process to correct the at least one optical aberration of the patient's first eye. In some embodiments, the process comprises generating a lens for correction of the identified optical aberration. In other embodiments, the process comprises changing an optical characteristic of the first or second eye by means of a surgical process to correct the identified optical aberration. In another embodiment, the method comprises a method for determining the range of accommodation of the patient's eyes comprising providing a plurality of images to the eye through a binocular optical system that invokes a plurality of states of accommodation of the eyes, receiving signals wave front that represents at least one aspect of the eyes in the .estates of accommodation invoked and from the signals of • wavefront, determine the range of accommodation of the eyes based on at least one of the aspects of the eyes in a plurality of states of accommodation invoked. In yet another embodiment, the invention comprises a method for providing optically aberrated controlled images to the patient's eyes, the method comprising providing images through a binocular optical system to a first eye and a second eye, receiving wavefront signals. which- represent at least one aberration in the first and second eyes, identify an aberration of the first eye and an aberration of the second eye based on wavefront signals, determine a correction for the identified aberration of the first eye and a correction for the aberration identified in the second eye and adjust the binocular optical system based on the corrections determined in such a way that the images provided to the eyes by means of the adjusted binocular optical system are optically compensated by the aberrations. In some modalities, the aberrations include spherical, astigmatism and / or coma. In another embodiment, the invention comprises a system for providing a patient with optically aberrated controlled images to the eyes of the patient comprising means for providing images by means of a binocular optical system to a first eye and a second eye, means for receiving signals from wavefront representing at least one aberration in the first and second eyes, means to identify an aberration of the first eye and an aberration of the second eye based on wavefront signals, means to determine a correction by the Identified aberration of the first eye and a correction for the aberration identified in the second eye and means for adjusting the binocular optical system based on the corrections determined in such a way that the images provided to the eyes by means of the adjusted binocular optical system are optically compensated as for the aberrations. In still another embodiment, the invention comprises a method for identifying aberrations in a patient's eye, the method comprising placing a binocular optic system in relation to the eyes of a patient, such that a first eye is placed along a patient's eye. a first optical path of the binocular optical system and a second eye is placed along a second optical path of the binocular optical system, receiving a first wavefront representing an aberration in the first eye through a portion of the first optical path and identify an aberration in the first eye based on the first wavefront received. In some embodiments, the method also comprises placing a wavefront detector at a first site to receive a first wavefront of the first eye through a portion of the first optical path, placing the wavefront detector in one second. site for receiving a second wavefront of the second eye through the second optical path, receiving a second wavefront representing an aberration in the second eye through a portion of the second optical path and identifying an aberration in the second. eye on the basis of the second wave wave received. In another embodiment, the invention comprises a method comprising analyzing an "image in the first group of wavefront images to determine a first location of the pupil in the image, wherein the image was generated using a wavefront detector. located in a first position in relation to the pupil, compare the primary location of the pupil with a predetermined location, and if the first location of the pupil is different from the predetermined location by a predetermined amount, make move the wavefront detector to a second position in relation to the pupil, such that a subsequent image draws the pupil in a second location where the second location of the pupil is closer to the predetermined location than the first location of the pupil. In some embodiments, the method also includes storing a plurality of wavefront images generated after the second wavefront image was generated, combining the stored images to form an averaged image and determining a wavefront measurement from average image. In other embodiments, the method further includes forming a set of wavefront measurements, each wavefront measurement is determined from an averaged image, comparing the set of wavefront measurements to identify anomalies in the plurality of measurements. Wave front and identify one or more wavefront measurements in the set of wavefront measurements to provide correction of aberrations in the object based on the anomalies identified.

BRIEF DESCRIPTION OF THE FIGURES The foregoing and other aspects, elements and advantages of the invention will be better understood by reference to the following detailed description, which should be read in conjunction with the attached figures in which: Figure IA is a schematic representation of an ophthalmic instrument. Figure IB is a schematic representation on the top floor of an ophthalmic instrument. Figure 2 is a perspective view of the visual optical elements of an ophthalmic instrument. Figure 3 is another perspective view of the visual optical elements of an ophthalmic instrument. Figure 4A is a front view of a portion of the visual optical elements of an ophthalmic instrument. Figure 4B is a side view of a portion of the visual optical elements of an ophthalmic instrument. Figure 5 is a perspective view of an ophthalmic instrument showing a game lever control system. Figure 6A is an example of a two-dimensional x-6 pattern used in a wavefront detector modulation instrument. Figure 6B is a side view of a modulation element of a wave source detector. Figure 6C illustrates an example of an x-y pattern used in a modulation element of a wavefront detector. Figure 7 is a graphic example of a continuous two-dimensional sinusoidal function. Figure 8 is a graphic illustration of a pattern resulting from the binary approximation of the threshold of a continuous sinusoidal function. Figure 9A is a side view of a model eye for testing wavefront detectors. Figure 9B is a side view of a model eye for testing wavefront detectors.

Figure 9C is a bottom view of a model eye for testing wavefront detectors. Figure - 9D is a front view of a model eye for testing wavefront detectors. Figure 10 is an illustration showing a light beam that is displaced from an optical axis incident on a pupil of an eye. Figure 11 is - a perspective view of an optical element having a central obstruction. Figure 12 is an illustration of the optical element of Figure 11 placed in a bundle. of incident light on the pupil of the eye. Figure 13 is a perspective view of a cross section of a light beam formed using the optical element shown in Figure 11. Figure 14 is a flow diagram illustrating the process of wavefront image. .

DETAILED DESCRIPTION OF CERTAIN MODALITIES OF THE INVENTION Modes of the invention will now be described with reference to the appended figures, in which similar numbers refer to similar elements from beginning to end. The terminology used in the description presented herein is not intended to be construed in any limited or restrictive manner, it is simply used in conjunction with a detailed description of certain specific embodiments of the invention. In addition, embodiments of the invention may include several novel elements, none of which individually is solely responsible for their desirable attributes or which is essential to carry out the invention as described herein. One embodiment of an ophthalmic instrument 10 shown in Figures IA and IB and described herein may meet the requirements of an eye wave measurement system for use by eye care professionals and at the same time be so that it can be deployed in many thousands of OD and MD offices around the world. What has been rather a dark technology in the hands of a few experts, can now be transformed into a widely used technology for the benefit of eye care. In particular, by keeping the instrument as simple as possible and carefully consider issues of patient comfort, one embodiment of the instrument described herein is designed to be used in the broadest possible patient population, which includes diagnosing vision problems and abnormalities in children. Ophthalmic instrument 10 includes binocular visual optical elements 12 and a wavefront detector assembly 14, according to one embodiment. Measurements of the eye taken under binocular conditions are preferred as they are generally more accurate than those taken under monocular conditions. In some embodiments, the ophthalmic instrument 10 may also include a computer 51 connected to the visual optical elements 12 and / or the wavefront detector assembly 14. Figure IA shows a side view of the ophthalmic instrument 10 and a visible optical path. right 16 of a system of objects (eg, an Eye) 18 through the visual optical elements 12 to an external objective 70. An "object system" as used herein refers to an object which may be be aligned with a left and right optical path through the binocular visual optical elements 12. Once aligned, a wavefront measurement can be made by the wavefront detector assembly 14 when it is also aligned with a portion of the wavefront detector. the desired left or right optical path and the object. Generally in the present, the object will be referred to as an eye, however, the "object" or "object system" should not be construed as limited to one eye, since there are other types of appropriate objects (for example, an eye model or any other device that is appropriate for wavefront measurement). Figure IB shows a top plan view of an ophthalmic instrument 10 and shows the right visible optical path 16 for the object system or right eye 18 and a left visible optical path 16 'for the object system or left eye 18'. The right visible optical path 16 and the left visible optical path 16 'include similar optical elements and function similarly. Although only the right visible optical path 16 is shown in Figure 1A and described, the description is similar for the left visible optical path 16 '. As in Figure 1A, the visual optical elements 12 can include an infrared (IR) / visible beam splitter 20 disposed opposite the right eye 18. In this exemplary design, the IR / visible beam splitter 20 has a surface oriented to approximately an angle of 45 ° with respect to an optical axis 22 of the wavefront detector assembly 14 when it is shown as aligned with the right eye 18. The reflective surface of the IR / visible beam splitter 20 -is disposed towards the right eye 18 along the right visible optical path 16 and reflects visible light to the right eye 18. The reflective surface of the IR / visible beam splitter 20 is nevertheless substantially transparent to the selected IR wavelengths that can be used in the instrument ophthalmic 10 to illuminate the eye 18 while making wavefront measurements. One or more prisms 49 are placed in the right visible optical path between the eye 18 and the IR / visible beam splitter 20 to simulate convergence angles to objects (eg targets).

The optical elements 12 also include a fixed lens 24, an inverting prism 26, and a movable lens assembly 28 disposed along the right visible optical path 16. The fixed lens 24 is disposed between the IR / visible beam splitter. 20 and the inverting prism 26, and focuses the light of the prism 26 in such a way that the eye 18 can perceive an image (for example, of the external objective 70) in the reflected light of the IR / visible beam splitter 20 and propagates to the right eye 18. The movable lens assembly 28 includes a set of one or more lenses that can be placed along the visible optical path 16 to correct errors (e.g., spherical, in the eye 18). The set of lenses can also be placed to control the accommodation of the eye, allowing an eye 18 to be fixed on an object at a particular perceived distance and to place its accommodation in a known state. In some embodiments, the movable lens assembly 28 includes a set of lenses (e.g., one or more lenses) to correct the astigmatism. In some embodiments, the movable lens assembly 28 includes two-cylinder lenses that can be used in conjunction with the spherical correction lens. The two cylindrical lenses can have equal power and could be rotated independently around the visual optical axis 16 using either manual or using computer controlled motors, a computer 51 and an optical element control module 53. In such mode, if the Eye 18 does not require correction of astigmatism, the two cylindrical lenses can be placed at 90 ° to each other, which cancels the effect of each lens. To correct astigmatism in the eye, each lens can be placed at a specified axis location with respect to each other, resulting in astigmatism correction of a given power on the required axis. In other embodiments, the movable lens assembly 18 may include a spherical lens that can be positioned offset from the axis, the main optical axis 32 for comma correction. The visual optical elements 12 configured with a movable lens assembly 28 that includes one or more lenses for astigmatism correction can be used as a foroptor system. The configuration of the movable lens 28 with a lens or set of lenses for comma correction provides correction of an eye 18 that can not be obtained in a foroptor. The inverting prism 26 includes a plurality of mirror surfaces arranged to invert and flip an image (e.g., rotate the image around orthogonal and orthogonal axes in a plane perpendicular to optical axis 32 through the visual optical path 16). In some embodiments, the inverter prism 26 can be moved horizontally to accommodate several pupillary distances between the right and left eyes. The visual optical elements 12 include a path divider 34 positioned between the movable lens assembly 28 and a hole 33 in the visual optical elements 12 through which an appropriately positioned external objective 70 can be observed in the patient's field of view. . The trajectory divider 34 can optionally be placed to intercept the visible optical path 16, deflecting the field of view of the subject, such that the internal target 36 is included in the visible optical path 16. The path divider 34 shown in Figure IA it includes a mirror to divert the field of vision. In other embodiments, the path splitter may include other optical elements that change the visible optical path 16, for example a prism or beam splitter. The visual optical elements 12 may also include an internal target 36 and an objective lens 38 disposed between the path splitter 34 and the internal target 36. The objective lens 38 may be used to position an image of the internal target 36 at an image distance. perceived desired as would be seen by the eye 18. In some multiple objective modalities (not shown) can be included in the visual optical elements 12 and placed at different distances or different perceived distances, to present both objective images near and far to the eye 18. The configuration of the visual optical elements 12 may include a similar objective lens 38 in the optical elements defining the visible left and right optical paths 16. Alternatively, the configuration of the elements optical optics 12 may include two different lenses 38 or lens arrays of different focal lengths in the optical elements defining the visible left and right optical paths 16 to generate different perceived distances for each eye 18. In some embodiments, the internal objectives may be spheroscopic objectives, providing a three-dimensional effect and visually reinforcing the desired perceived image depth. ' The visual optical elements 12 may also include a target light source 40 which illuminates the internal target 36. This objective light source 40 provides illumination of the internal target 36 using a variety of different types of light sources, in accordance with various light sources. 'modalities. For example, the objective light source 40 may include a light emitting diode (LED), an incandescent light bulb, a fluorescent light bulb and / or any other type of light source that can provide appropriate illumination for the purpose. internal 36, such that the eye 18 can perceive the internal target 36. In various embodiments, the objective light source 40 is connected to conventional electronic light control elements 41 which control the intensity of the target light source 40. Furthermore, the light of the objective light source 40 can be changed by the control system to allow conditions of. Specific lighting representing real-world conditions such as driving at night, office or daylight. In an alternative embodiment, an adaptive optical mirror (not shown) can be used in place of one of the surfaces of the image inverting prism 26 of the visual optical elements 12. In addition to providing movable spherical correction and astigmatism optical elements, an adaptive optical mirror can be used in the visible optical path 26 to provide higher order error correction (focus and anterior astigmatism). The adaptive optical mirror can be controlled by means of programming elements based on measurements of the wavefront detector assembly 14 for example in an iterative process. The adaptive optical mirror corrects abrasions in the eye 18 or can be used in conjunction with focus correction lenses and astigmatism in the movable lens assembly to correct abrasions. By using spherical correction lenses, and astigmatism in conjunction with the adaptive optical mirror allows the use of a less expensive and shorter travel adaptive optical mirror, an appropriate adaptive optical mirror is available from Boston Micromachines Corporation, Watertown, MA, • and Flexible Optical BV, Delft, The Netherlands. Still referring to Figures IA and IB, the ophthalmic instrument 10 also includes a wavefront detector assembly 14, such as for example an optical self-imaged diffraction detector, a Shack-Hartmann system or ray tracking. In one embodiment, the wavefront detector assembly 14 includes optical illumination elements 66 that provide a light beam along a right injection path 68 to illuminate the eye 18. The illumination optical elements 66 include a source of light from eye 58, which can be a variety of appropriate light sources including a laser diode. In some embodiments, the light source 58 is a source of infrared light, for example an infrared laser diode or super-luminescent diode ("SLD"), according to one embodiment. The optical illumination elements 66 also include an optical sting element 62 disposed along the injection path 68 along which the light propagates from the light source of the eye 58 to the eye 18. The optical elements of illumination 66 may further include optical focussing elements 60 disposed along the injection path 66, between the sting 62 and the light source of the eye 58. The stinging optical element 62 and the focusing optical elements 60 are included in the optical illumination elements 66 for some embodiments wherein the light source of the eye 58 is an SLD. In other embodiments, the optical illumination elements 66 may include various types of lasers such as the light source of the eye 58. In various embodiments wherein the light source of the eye 58 is a laser, the laser may produce a beam of light substantial collimated strait. In some embodiments, therefore, optical collimation elements such as a collimator lens may not be necessary. Other types of light source for the eyes 58, in which other types of light-emitting diodes are included,. they can also be used in the optical illumination elements 66. In some embodiments, wherein the light source of the eye 58 is a laser diode or SLD, the light source of the eye 58 is focused on an optical fiber and collimated to an optical fiber. small beam using a focus lens (not shown) -. The output of the fiber, optics is coupled to a microlens that provides a small collimated beam to the eye. The wavefront detector assembly 14 also includes a beam splitter 64 arranged both in the optical path of the wavefront 56 and in the injection path 68 and aligned along the optical axis 22 and placed at an angle of 45 degrees with respect to the optical axis 22. In some embodiments, the beam splitter 64 is a 90% / 10% beam splitter (hereinafter referred to as the "90/10 64 wave splitter) which reflects the 90% and transmits the % of the light incident on it. The 90/10 beam splitter 64 is positioned in such a way that a light beam from the light source of the eye 58 propagating from the optical illumination elements along the injection path 68 al. 90/10 beam splitter 64 is reflected from the reflecting surface of the beam splitter 90/10 64 and propagates along the optical axis 22 of the wavefront detector assembly 14 through the prism 44 and the eye 18. Other combinations of pitch to pitch ratios may also be used in addition to 90/10 such as 80/20, 70/30, etc. Preferably, the light beam directed to the eye 18 is substantially narrow. In various embodiments, the divergence of the beam that propagates to the eye 18 is sufficiently small and the light beam is narrow enough, such that the cross-sectional dimensions (eg, diameter or width) of the light beam as shown in FIG. measured in a plane through the beam orthogonal to its direction of propagation toward the eye 18 are smaller than the size of the pupil of the eye 18. Preferably, the light beam entering the eye 18 has a cross-sectional dimensions, such as diameter or width that is substantially less than the average diameter of the pupil. For example, the pupil is commonly circular and has an average width of between about 4 to 8 mm, for example 6 mm. In various embodiments, the diameter of the light beam directed through the pupil is less than about 1 mm transversely and may be between about 200 to 600 microns for example about 400 microns. The light beam is preferably small to reduce the effect of an aberration of the eye 18 on the light beam. Also, the light beam is sufficiently small in such a way that an aberration in the cornea of the eye 18 does not alter the beam of light entering the eye 18 and does not increase the size or deform the shape of the point of light formed where the beam it is incident - on the retina. Preferably, the point of light formed on the retina is substantially small (e.g., in relation to the ocular and cornea lens) and approaches a point source. In various embodiments, the light beam of the optical illumination elements 66 does not propagate along the optical axis 22, but instead is displaced from the optical axis 22. For example, as shown in Figure 10. The center of a beam of light 270 that propagates to the eye 18 is parallel to but laterally offset from the optical axis 22 of the wavefront detector assembly 14. The center of the light beam 270 is incident on the cornea 272 a a travel distance 273 of the apex 274 of the cornea 272 (for example, where the optical axis 22 intersects the cornea 272). As illustrated in Figure 10, the lateral displacement of the incident light beam on the eye 218 causes the light reflected from the cornea 272 (represented by the reflected rays 276, 276 ') to be directed at angles with respect to the optical axis 22. This results in a reduction in the reflected portion of the light beam 270 from the surface of the cornea 272 back along the optical axis 22 and through the optical path of the wave front 56 to the wavefront detector 44. . Thus, the alteration of the wavefront measurement caused by the retroreflected light of the cornea 272 is also reduced. In some embodiments, the beam of the light source of the eye 58 is disposed directly by the optical axis 22 of the wavefront detector assembly 14 and the eye 18. An optical element 280 (Figures 11 and 12) having a central obstruction 282 may be inserted into beam path 284 to produce a beam with an annular or donut-shaped cross section 282 (Figure 13) having a central obscuration 288. For example, optical element 280. may be 'placed in the injection path 68 between the optical illumination elements 66' and the beam splitter 90/10 64 (FIG. 1A). The annular beam formed by the optical element 280 can intersect regions of the cornea 290 offset from the apex 274 of the eye 18 and results in light being reflected from the cornea in different directions back along the axis 22. This method can increase the amount of light that could be injected into the eye., when compared to the displacement of the incident beam as shown in Figure 10, and reducing the portion of the reflected light 292 by the cornea 290 along the optical axis 22 and directly to the wavefront detector assembly 14. to also reduce retroreflection disruptions of wavefront measurements In some embodiments, the beam can be 2-3 mm in diameter and has a blocking portion of 1.5 to 2.5 mm in diameter.The beam is preferably collimated as is presented to the eye In another embodiment, the beam can be made to diverge or converge using one or more fixed or movable optical elements to compensate for the spherical error of the subject eye, in order to minimize the diameter of the retina. Figure 1A, the wavefront detector assembly 14 can also include an optical relay lens system 48 that propagates the light emitted from the eye 18 to a modulation device 42 positioned perpendicular to the axis optical 35. The optical relay system 48 is placed as part of the wavefront optical path 56 such that the light that is emitted from the eye 18 and passing through the beam splitter 90/10 64 enters the optical system. optical relay lens 48 which then focuses this light on the modulation device 42. According to one embodiment, the lens relay system 48 includes two lenses 50, 52. One or more folding mirrors 54 disposed between the two lenses 50, 52 they make up the overall design of the most compact wavefront detector assembly 14. The wavefront detector assembly 14 employs one or more modulation devices 42 having a periodic pattern that is imaged in the Talbot self-image or plane panel. The principle of self-image formation of Talbot is dealt with in references that teach interference and optical wave elements, for example Joseph W. Goodman, Introduction to Fourier Optics. The McGraw-Hill Companies, Inc., which is incorporated herein by reference. The wavefront detector assembly 14 can take advantage of the pure Talbot effect in order to overcome the problems associated with Hartmann-Shack procedures and other procedures. The effect of Talbot is based on the fact that when certain modulation patterns of periodic intensity are placed in the optical pupil of the system, the modulation pattern will reappear in a predictable longitudinal position (Talbot plane) along the path of propagation. Thus, the pupil is "autoformed in image" and the modulation pattern can be registered by means of a detector placed in the position of the Talbot plane. If the optical system contains wavefront aberrations, the modulation pattern will be distorted relative to the periodic modulation element. The distortions in the periodic "carrier" intensity pattern can be extracted by means of computer algorithms applied to the image intensity values. The computer algorithms are incorporated into the Fourier transformation of the image and the subsequent extraction of the aberration information of the carrier signal. A detector 44 is placed in the Talbot image or plane plane of the modulation device 42. When the optical axis 22 of the wavefront detector assembly 14 is aligned with the eye 18 and the eye 18 is illuminated by the optical illumination elements 66, the light emitted from the eye 18 propagates along the optical axis 22, through the IR / visible beam splitter 20 and the beam splitter 90/10 64, along the path optical wave front 56, through relay lens systems 48 and modulation device 42 ai detector 44, which detects light as co-modulated by modulation device 42. A variety of appropriate detectors can be used for the wavefront detector 44 and the type of detector 44 selected may depend on the type of light source 58 that is used. In some modalities, the detector 44 is a digital camera of appropriate resolution and sensitivity. Detectors of various resolutions can be used and at least some oversampling of the modulation pattern is preferred. In some embodiments, the detector resolution is approximately 4 pixels per periodic element step. In some embodiments, a resolution of approximately 8 pixels per periodic element step is preferred to ensure that the pattern signal is oversampled to improve noise immunity. The modulation device 42 may include a two-dimensional pattern, for example, a checkerboard pattern or sinusoidal pattern, as discussed more fully below with reference to Figures 7 and 8, according to various modalities.

Preferred illustrations of one modality of the ophthalmic instrument 10 are shown in Figure 2 and 3, wherein Figure 2 shows a perspective view of the front and Figure 3 shows a perspective view of the back of the ophthalmic instrument 10. As shown in FIG. shows both in Figures 2 and 3, the visual optical elements 12, which are also referred to as the visible through module is disposed at the upper end of the ophthalmic instrument 10. As shown in Figure 2, the inverting prisms 26 are placed on rotating bearings 27 for accommodating different pupillary distances between the eyes 18. The wavefront detector assembly 14 is disposed on a slide 46 that can be moved on rails 47a, 47b, 47c to align with the right and left eye and its corresponding optical elements. Figure 3 further illustrates an embodiment of the ophthalmic instrument 10 shown and described in Figures IA and IB. Figure 3 shows, for example, the internal target 36, the flipped path diverter 34 and the movable lens assembly 28 that includes a movable lens movable support 72. Figures 4A and 4B schematically illustrate front and top views of devices in the visual optical elements 12. As shown in these figures, the visual optical elements 12 include eyepieces or optical elements of the eye 70, 70 'for the right and left eyes. The right and left image inverting prisms 26, 26 'can be connected by inverting prism link gears 78 to control their movement with each other. The stage of the wavefront detector 46 (Figure 2) can be moved in translation side. side to properly align with the wavefront detector assembly 14 (Figure 2) with the wavefront optical path 56 (Figure 1) through the desired eyepiece 70, 70 'and when aligned, the visible optical path 16 (Figure 1) and the wavefront optical path 56 (Figure 1) can pass through these eyepieces 7O, 70 '.- The inverter prism 2ß (Figure 4B) is preferably rotatable about the optical axis 32. of the movable lens assembly 28 to accommodate different pupillary distances (e.g., the distance between the pupils of the eyes 18) in different patients. In some embodiments, a motor can drive inverter prism 26 rotation. However, inverter prism 26 could alternatively be translated horizontally (for example parallel to the x axis) together with the movable lens to accommodate the pupil distance of the subject. The movable lens assembly 28 is preferably retained by moveable assembly that can be translated axially along the optical axis 32. Referring to Figure 4B, the distance between the eyepieces 70 can also be changed to accommodate different pupillary distances for different patients, according to some embodiments, a pupillary distance motor 74 can be used to move the eyepieces 70, 70 'horizontally to compensate for the patient's specific pupillary distance. Movable lens assembly 28 includes movable lens movable support 72 which can retain a lens or lens assembly. The movable lens movable support 72 can be moved axially along the optical example 32 (Figure IA). In some embodiments, the position of the moveable lens movable support 72 can be controlled by an optical element control module 53"on the computer 51 (Figure IA) In some embodiments, one or both of the movable lens assemblies 28 is they can move in translation side by side to accommodate different pupillary distances This translation can be controlled either manually or by means of a motor, which can be controlled by a control module of optical elements 53 in computer 51 (Figure IA). some embodiments, a motor can move the movable lens movable support 72. For example, a lens motor 76 can be used to move movable lens movable supports 72 along a lens rail 73. A motor or numerous motors can be used to move the eyepieces 70 and moving movable lens mounts 72. For example, in some embodiments, each of the eyepieces 70 is moved by a separate motor (not shown), wherein this direction is preferably side by side along a plane perpendicular to the optical axis 22 (Figure 1A) . In some embodiments, a single motor can cause separation - variable between, the eyepieces 70 and movable lens movable support 72. The angle between the optical paths 16 for the right and left eye can be changed either as one or both sets of lenses 28 are moved, according to some modalities. A low angle prism 49 (FIG. IA) can be arranged in each of the visible optical paths 16, 16 'between the IR / visible beam splitters 20, 20' and the. eyes of patient 18, 18 '. The adjustment of the position of the low angle prisms 49 modifies the angle of sight or convergence of the visible optical paths 16, 16 'to form - a convergence angle coinciding with a specific desired distance, for example a distance of 16 inch reading. Referring again to Figure IA, in some embodiments, the wavefront detector assembly 14 can be mounted on a movable stage XYZ 46 for three-dimensional placement of the wavefront detector assembly 14 either with the left eye or right of the patient. In some embodiments, the three-dimensional positioning of the wavefront assembly 14 is controlled by a stage control module 55 on the computer 51. In these embodiments, the stage control module 55 receives positioning data from either a user or a user. of other programming elements, for example a pupil tracking module or an image processing module and controls the XYZ stage 46 to place the wavefront detector assembly to measure the left or right eye as the patient observes an objective through the visual optical elements 12. For example, an image processing module 57 may be included in the computer 51 to determine the edge, center 'and size of the pupil of the eye.' Based on this actual location information of the pupil, the stage control module 55 can place the wavefront detector assembly 14 in such a manner that the pupil is in the desired XY location (eg, centered on the picture box). In some embodiments, the stage can be automatically placed in the Z direction to focus the image of the pupil, as described later for Figure 14. In other modalities, the. XYZ stage 46 can be manually adjusted to place the wave front detector assembly 14 in three dimensions (XYZ). The effect of different lighting conditions on dilation of the pupil can also be determined using the image processing module 57. For example, the size (eg diameter) of the pupil can be measured and analyzed as long as it is subjected to Various levels of illumination of the objective light source 40 and the size of the pupil can be determined for each of the various levels of illumination. Still referring to Figure IA, to determine a wavefront measurement of the eye 18, the optical illumination elements 66 of the wavefront detector assembly 14 provide a beam of light along the injection path 68 that is reflected from the beam splitter 90/10 and enters the eye 18. Some of the light entering the eye 18 is reflected or scattered from the retina and is emitted from the eye 18. A portion of the emitted light is propagated to the detector assembly. wavefront 14 along the direction of optical axis 22, propagates through the IR / visible beam splitter 20 and beam splitter 90/10 64, it propagates along the optical path of the wavefront 56, through the modulation pattern element 42 and falls incident on the detector 44. The detector 44 detects. The incident light and can provide data related to the incident light to the connected computer 51, which uses a wavefront analysis module 59 in the computer 51 to determine aberrations based on the wavefront measurement. While wavefront measurements of an eye 18 are taken, various adjustments can be made to the visual optical elements 12 to change the state of accommodation of the eye, so that specific wavefront measurements can be made in states of eye accommodation and selected pupil states. For example, objective illumination perceived by the patient's eyes may influence the size of the patient's pupil. The intensity of. the illumination for the objective light source 40 can be controlled to illuminate the internal target 36 at a predetermined illumination. In some embodiments, the light source 40 can be controlled to illuminate the internal target 36 with light that simulates a particular environment by changing the chromaticity and / or light intensity, for example, to simulate indoor lighting, outdoor natural lighting , office lighting, night lighting and / or night driving lighting conditions. To determine the reaction of the pupil to various lighting conditions, the wavefront detector assembly 14 can measure the pupil at desired illumination levels and image processing programming elements can determine the resulting size of the pupil. pupil. The size of the pupil can be correlated with the illumination used to observe the objective 36 while the pupil is measured to determine the reaction of the pupil to the various lighting conditions. Wave front measurements of the eye 18 can be made when the eye 18 perceives either the external objective 70 or the internal objective 36. One mode, for example, the "external objective" mode, of the ophthalmic instrument 10 directs the vision of a subject through the movable lens assembly 28 to the external objective 70 located at a distance away from the ophthalmic instrument 10, for example about 16 feet away. The movable lens assembly 28 can be configured with appropriate optical elements to correct the vision of the subject, such that the subject can reasonably observe the external objective 70. For example, the objective lens assembly 18 can include optical elements to correct aberrations spherical, astigmatism and coma. For this external target mode, the path deviator 34 rotates or moves out of the field of view of the visible optical path 16 allowing the eye 18 to observe the external objective 70 through the visual optic elements 12. The ophthalmic instrument 10 it may also provide another mode, for example the "internal target" mode, for the subject to observe the internal target 36. In the internal target mode, the trajectory deviator 32 is rotated or moved to the patient's field of view, in such a way that it intersects with the visible optical path 16, directing the vision of the 'Visible optical path 16 to internal target 36. Internal target mode is useful in small rooms, for example' where there is not enough space for a distance of 16 feet to an external objective. Thus, various embodiments of the visual optical elements 12 can be designed to include the use of the external objective 70 and / or the internal objective 36. Figure 1A shows the visible optical path 16 of the visual optical elements 12 and their corresponding optical elements . Figure 1A also shows that the path diverter 34 can be placed in the visual optical elements 12 between the movable lens assembly 28 and a hole 33 in the visual optical elements 12. The path diverter 34 can be moved in and out of the visible optical path 16, for example by pivoting, rotating or sliding the path diverter 34. In some embodiments, when moved to the visible optical path 16, the path diverter 34 redirects the patient's vision on the pair of targets internal fixation devices 36. Two sets of internal targets are preferably integrated into the visual optical elements 12, one which presents an image at a simulated reading distance and the other at a relatively more distant distance. In some embodiments, the trajectory deviator 34 - and objective 36 are driven by a three position lever 73 (Figure 3). In the first -position, the trajectory diverter 34 is upwardly allowing the object to observe the external objective 70 of the rear part of the ophthalmic element 10. In the second position, the trajectory diverter 34 is folded down and a target or an assembly of lenses 36 are shown at a specific distance to the objective position lens 38 for reading at 12 inches. In the third position, the trajectory derailleur 34 is still down and a second objective or set of lenses is shown at a predetermined perceived distance, e.g. at approximately 16 feet. When the path diverter 34 is rotated out of the visible optical path 16, the patient can observe through the visual optical elements 12 on a real objective 70 located at a relatively far distance. In some embodiments, a computer controlled actuator may place the path diverter 34 to display the desired objectives or desired sets of objectives to the patient. Such an actuator can be controlled by means of programming elements, for example a control module of the objective 65 that are executed in the computer 51. In some embodiments, the distance between the internal targets is adjustable either manually or by means of a mechanism of control to simulate uri accommodation of the eye when observing the first internal objective and the second internal objective through the binocular visual-optical system. For example, the objective control module 65 may be configured to control the distance between the first internal target and the second internal target to invoke a desired eye arrangement. In another embodiment, the trajectory deviator 34 can be used to provide a single objective in a field of vision that is shared between the two eyes. When a single objective is used, one or more prisms 49 can be placed in the visible optical path 16 of the visual optical elements 12 between the eye 18 and the beam splitter 20 to converge the images of each eye at a distance that simulates the angles of convergence for near and / or distant objectives. The flexibility of the trajectory of the visual optical elements 16 allows the patient to observe a target after the pre-correction for the measured focus. The ophthalmic instrument 10 may include flexibility in OD or MD protocol, near versus far, fog formation against internal focus, pre-corrected or uncorrected and other combinations that may be. desirable for use during. The measurement of the eye 18. Measurements of the left and right eyes of the patient can be made with the ophthalmic instrument 10 while the. patient is observing internal or external objectives using the visual optical elements' 12. The stage, of the XYZ detector 46 places the wavefront detector assembly 14 in such a manner that it can obtain a desired wavefront measurement of the eye. - In one position, for example, the stage of the XYZ detector 46 places the wavefront detector assembly 14 in such a manner that it aligns with the right eye and can obtain a wavefront measurement of the right eye. The detector stage XYZ 46 can move the wavefront detector assembly 14 to another site, such that the wavefront detector assembly 14 is aligned with and can obtain a wavefront measurement of the eye. left. The wavefront detector stage 46 can move the wavefront detector assembly 14 in three dimensions allowing it to align with the left or right eye with the wavefront optical path 56 on the optical axis 22. Additionally , the detector stage 46 causes the wavefront assembly 14 to move from one eye to the other. If a computer 51 is used to control the stage position of the wavefront detector 46, an eye positioning module 61 can be used to analyze the position of the eye 18 with respect to the wavefront detector set 14 and providing information for moving the wavefront detector board 46 to align the wavefront detector assembly 14 with the optical center of each eye 18. Referring to FIG. "A, when a patient is observing a target, a Through the optical optical elements 12, an optical element (e.g., a lens or lens assembly) in the movable lens assembly 28 can be moved to a position along the visible optical path 16 to provide spherical correction for the eye. The inverter prism 26 flips the lens image left to right and top to bottom in such a way that the patient can see the objective in its proper orientation. The movable lens assembly 28 may also include a plurality of lenses and other optical elements. For example, movable lens assembly 28 may include two cylindrical rotating movable lenses to provide both spherical and astigmatic correction. The movable lens assembly 28 may include a plurality of optical refractive elements or other optical elements that include correction for other higher order aberrations as well, such as a spherical lens (not shown) positioned off the axis of the main optical axis 32. to correct coma. For most patients, the spherical correction is enough to allow it. patient is sufficiently fixed on the internal objective 70 and / or the internal objective 36 in. so much so that a wavefront measurement is made. One modality of the ophthalmic instrument 10 includes six motors for positioning the optical elements and the stage 46 (Figure 2). In this example, a six-motor, a pair of motors (not shown) mode can move the moving lens supports 72, 72 ', of the movable lens assemblies 28, 28' (Figure 4B), the distance motor pupil (74) (Figure 4B), rotates the inverting prisms 26, 2-6 'to control the pupillary distance and three motors (not shown) control the movement of the stage XYZ 46 in three dimensions. In another modality, four additional engines can be used to correct astigmatism. A plurality of detectors can be employed in the ophthalmic instrument 10 to provide feedback of the optical elements of the movable lens assemblies 28, the stage XYZ 46 and / or the lenses 36.

Referring to Figure 1A, modalities of the ophthalmic instrument 10 may include a computer 51 that can be configured with programming elements to control the functionality of the ophthalmic element 10 and analyze the wavefront measurement data. The computer 51 is in data communication with the wavefront assembly 14 and the visual optical elements 12 for sending and receiving data, signals and information concerning, for example, wavefront images, optical elements, stage position, processing of 'image of internal and external objectives ,. eye placement, wavefront measurement, illumination, image verification and other data related to or controlling the process of obtaining wavefront measurements. The computer 51 may be any device controlled by an appropriate data processor, for example a pentium-based personal computer, and may include one or more electronic control circuit boards and element modules. programming that implements the movement control of lens and stage positioning motors, on / off and intensity control of the objective light source 40 and the light source of the eye 58, also as detectors located throughout the ophthalmic instrument 10. In one embodiment, the ophthalmic instrument 10 includes a computer 51 that includes an optical element placement module 53r a stage positioning module 55, an image processing module 57, a wavefront measurement module 59, a module of eye placement 61, a light control module 63, an objective module 65 and an image verification module 67. In other embodiments, computer 51 may have fewer additional modules or modules. Computer 51 may further include one or more input devices such as a keyboard, mouse, touch pad, game lever, bearing input pen, camera, camcorder and the like. The computer 51 may also include an output device such as a visual screen and an audio output. In some embodiments, the visual screen may be a computer screen or the screen 81 in the control system 500 (Figure 5). Additionally, the computer 51 may include an addressable storage medium or means that can be accessed by computer, such as random access memory (RAM), programmable read-only memory, electronically erasable (EEPROM), programmable read-only memory (PROM). ), erasable programmable read-only memory (EPROM), hard drives, floppy disks, laser disk players, digital video devices, compact devices, video tapes, audio tapes, magnetic recording tracks, electronic networks and other devices for transmit or store electronic content such as by way of example, programs and data. In one embodiment, the computer 51 is equipped with a network communication device such as a network interface card, a modem or other appropriate network connection device for connecting to a communication network and providing electronic information of the ophthalmic instrument. to another device. In addition, the computer 51 can execute an appropriate operating system such as Linux, Unix, Microsoft Windows, Apple MacOS, OS / 2 or other operating system. The appropriate operating system may include a communications protocol implementation that handles all incoming and outgoing message traffic that is passed in a network. In other modalities, while the operating system may differ depending on the type of computer, the operating system will continue to provide the appropriate communication protocols to establish communication links with a network. • The modules included in the computer 51 may include one or more subsystems or modules. As can be appreciated by those experienced in the art, each of the modules can be implemented in physical elements or programming elements and include several sub-routines, procedures, definition statements and macros that perform certain tasks. Accordingly, the description of each of the modules is used for convenience to describe the functionality of the computer 51 in the ophthalmic instrument 10. In. an implementation of programming elements, all modules are commonly compiled "and linked separately to a single executable program.The processes that are undertaken by each of the modules can be arbitrarily redistributed to one of the other modules, combined together in a single The modules can be configured to reside in the addressable storage medium and configured to run on one or more processors, so that a module can include other subsystems as an example. , components, • such as components of programming elements, components of object-oriented programming elements, class components and components of objectives, processes, functions, attributes, procedures, sub-routines, program code segments, controllers, elements permanent, micro.codes, circuits, - data, bases of data, data structures, tables, arrays and variables. The various components of computer 51 can communicate with each other and other components by means of mechanisms such as, for example, interprocess communication, remote procedure call, distributed object interfaces and various other program interfaces. In addition, the functionality provided in the components, modules, subsystems and databases can be combined into fewer components, modules, subsystems or databases or additionally separated into additional components, modules, subsystems or databases.

Additionally, the components, modules, sub-systems and databases can be implemented to run on one or more computers 51. Figure 5 illustrates one embodiment of the housing for a control system 500 for the ophthalmic instrument 10. The control system 500 is used to interact with the computer 51 (Figure 1A to place the wavefront detector assembly 14, where the positioning using the control system 500 is via a flywheel cable lever 80 similar to A video game The game lever 80 can control three motors, giving the three degrees of freedom required to move the wavefront detector 14 between the left and right eye and align the wavefront detector 14 with each eye 18. As shown in Figure 5, the ophthalmic instrument 10 can be designed with the ergonomics of the patient and operator in mind, which can help to relax the patient. 0 may also include a screen 81 which may be used for example to show the pupil and / or results of wavefront measurements. In other embodiments, the wavefront detector 14 (for example, Figure 2) can be placed using computer systems, microprocessor systems or electronically controlled systems, for example computer 51. As shown in Figure IA, the detector assembly Wavefront 14 may include one or more modulation devices 42, which may also be referred to as a modulation element. The demodulation device 42 can have periodic elements that produce one. self-image in Talbot's self-image or plane of light passing through the modulation element 42. Aberrations in the eye 18, in particular on the cornea and the lens, are encoded in the self-image formation of the modulation device 42 and recorded by the detector 44 (Figure 1A). The detector 44 can be for example a CMOS detector, the • Same as the one used in digital cameras. The aberration information in the recorded image can then be extracted by means of Fourier transform-based algorithms carried out by the computer 51. The various modalities, the modulation device 42. it may include one or more gratings or the modulation device 42 may be configured on an element through which light passes appropriately. In some embodiments, the modulation device 42 may include a two-dimensional repeating fine-step x-y pattern. An example of a pattern 42 is shown in Figures 6A-6C. Figure 6A shows the view of a modulation device 42 that can be placed perpendicular to and in the wavefront optical path 56, according to one embodiment. Figure 6B shows a side view of the modulation device 42. The modulation device 42 includes periodic elements that modulate a wavefront that was generated from the light emitted from the eye 18 and that propagates through the wavefront path 56 to the modulation device 42. Figure 6C shows a detailed view of the Details A of Figure 6A. In one embodiment, the dimensions (A and B of Figure 6A) of the modulation device are approximately 1 cm x 1 cm and represent the size of the area of - camera image plus a buffer area of approximately 2 mm on each side. The modulated wave front propagates a few millimeters along the wave front optical path 56 where an image of the element with periodic elements is self-formed in image and is detected by the detector 44 (FIG. IA). Modes of the detector 44 that detect images in the self-image formation or Talbot plane are disclosed in U.S. Patent Application 10 / 014,037 entitled "Systems and Methods for Wavefront Measurement" filed December 10, 2001, U.S. Patent Application. 10/314, 906 entitled "Systems and Methods for Wavefront Measurement" filed on December 9, 2002, each of which is incorporated herein by reference in its entirety. The wavefront detector assembly 14 can provide very high resolution wavefront information, for example with more than 300 x 300 measurement points a. through a 4 mm pupil. Information can be obtained that is well beyond the description of the usual Zernike mode and appropriate for relatively uniform errors. The wavefront detector 14 preferably offers sufficient resolution to measure relatively sharp phase errors within the pupil and can manipulate errors. High frequency wave front that could occur from previous surgical procedures. After the wavefront data is captured and analyzed, the. Wavefront analysis results can be displayed on a screen near the device, for example the screen 81 of the game control system 500 (Figure 5) or on a computer screen device. The results can also be encoded in d'e barcode format or transferred to another site via electronic means such as via the internet. Zernike data or wavefront data can be encoded in a bar code along with other information such as for example patient ID, left / right eye • and can be sent to a laboratory and used in the manufacture of a lens which may include wavefront correction elements. During an examination using the ophthalmic instrument 10, a sequence of short exposures is preferably taken at an adjustment, which involves only an initial alignment of the patient. The captured images are preferably re-screened for artifacts that may be the result of high frequency noise caused for example by undesirable eye reflections and processed. In this process, the patient is in the chair for only a few minutes and the results can be prepared to show the operator in less than 1 minute. Since the measurement is fast, there is no need to keep the patient restricted during the eye exam. The comfort level of the patient is improved by using the invisible near infrared laser as the light source of the eye 58. In one embodiment, the near infrared laser may have a wavelength of about 850 nm. Due to the efficiency of the optical measurement of the wavefront detector assembly 14, a beam of light of substantially less power can be used to illuminate the retina. The energy, for example, can be lower by a factor of about 4-7 compared to other conventional wavefront instruments. The use of infrared light in combination with the lower lighting power level increases patient comfort and safety. In various embodiments of the invention, an optical modulation element having a sinusoidal intensity modulation pattern can be used in order to introduce the ability to measure higher order aberrations very accurately. A sinusoidal intensity modulation produces a sinusoidal Talbot image, for example the carrier signal is sine-signal. This procedure results in that the property of the desired aberration information can be extracted exactly by means of Fourier transformation, with substantially no loss of information caused by higher order interference between the diffraction pattern of the optical element and the aberrations. of higher order. In common optical terminology, this procedure eliminates "chirping" caused by sharp edges in arbitrary non-sinusoidal intensity patterns; thus, higher order information is not "diffracted in the distance" in lobes of higher order. In principle, the sinusoidal optical element allows the measurement of extremely high order abrasion information, which may be necessary to restore 20/20 vision by means of correction devices. In order to implement this procedure, a good approximation to a pure sinusoidal transmission element can be used, a properly constructed phase modulation element could be used to produce the desired intensity modulation. For intensity modulation, the preferred transmission function comprises a continuous two-dimensional sinusoidal function (gray scale) as shown in Figure 7. The transmission of this two-dimensional pattern can be described by the following equation: where x and y are coordinates that define the position through the pattern and P corresponds to the period of the sinusoidal modulation. Current technologies for manufacturing transmission grids may have limited capabilities to create grayscale transmission functions "and functions of The realizable transmissions can be limited to binary patterns in which the transmission in a given discrete area is either zero or one. For this reason, a binary transmission function can be used which preferably optimally approximates the ideal continuous sinusoidal function. According to one embodiment, a preferred approximately binary can be obtained by the threshold of the continuous sinusoidal function (rounding up / down to binary values 0 and '1) to form a pattern that resembles the chessboard pattern. such as a rotated chessboard pattern (that is, a lattice of diamond shapes) as shown in Figure 8. The transmission tt (x, y) of this two-dimensional pattern can be for example described by the following equation: Computer modeling was carried out, in which continuous and binary periodic patterns were modulated by an aberration-free wavefront, propagated numerically to the plane of the detector and analyzed in terms of 'residual phase error. The residual phase error for the periodic binary patterns coincided substantially such that the continuous sinusoidal periodic element and examination of the Fourier transforms of both periodic elements showed reduced or minimal error in the vicinity of the fundamental frequency of the periodic pattern. The periodic element is advantageous because the spatial frequency spectrum is preserved in the vicinity of the fundamental spatial frequency of the ideal periodic pattern. The spectrum in the vicinity of the fundamental is not corrupted by harmonic components of the periodic binary element. The rotated checkerboard pattern is an achievable and accurate approximation to a continuous sinusoidal element and can be manufactured using non-expensive manufacturing techniques. Other types of lattices, patterns or periodic elements may also be used, according to various modalities. Other methods of manufacturing sinusoidal or non-sinusoidal patterns that may or may not be a continuous two-dimensional sinusoidal pattern may also be employed. Figures 9A-9D illustrate "model eye" 100 which can be used to test the ophthalmic instrument 10. The model eye 10 includes a set 110 having a chamber 112 which may contain liquid or solution, such as for example mineral oil. Preferably, this liquid or solution or other content in the chamber has a well-defined refractive index. The chamber 112 has an opening 114 and a lens 116, for example a hard contact lens, can be placed in front of the opening 114 enclosing one end of the chamber. A rotary image forming disk 118 with an image forming surface is placed in the chamber 112. The image forming disk 118 can be manufactured from a variety of suitable materials, for example aluminum. The image formation disk can be flat or spherical. An optical path of the eye model 100 extends from the lens 116 'to the rotating surface on the image forming disk 118 and it is along this optical path that the light is provided to the eye model 100. The forming disk Rotary image 118 is disposed on a rotary shaft 120 which can be retained in place by rolling .122 in a bearing block 124. The model eye 100 can also incorporate a seal 117 to enclose the portion of the chamber 112 surrounding the rotating shaft 120 and preventing fluid from leaking from chamber 112. Rotating shaft 120 can be connected to a motor 126 which drives shaft 120 rotatably about a longitudinal axis through the shaft. The shaft 120 in the bearing block 124 can be mounted to a micrometer plate 128 for moving the shaft 120 - and the rotating surface on the image forming disc 118 on the shaft to place the image forming disk 118 with respect to to the lens 116. • In the model eye, the lens 116 corresponds to the cornea. The rotating surface of the image forming disc 118 corresponds to the retina. The model eye 100 can be placed in a similar location as that where a human eye 18 would be located when the ophthalmic instrument 100 is used to perform measurements in a human eye. In particular, the light of the ophthalmic instrument 10 is directed to the model eye 100 through the lens 116 and the aperture 114 and reflected within the model eye 100 back to the ophthalmic diagnostic instrument 10. More specifically, light is propagated a, through the lens 116 of the eye model 100 is preferably incident on the rotating surface of the image forming disk 118. This light is preferably reflected back from the camera 112 through the lens 116 and reaches the detector 44 in the Optical wave front set 14 (Figure 1A). The rotation of the image forming surface on the. image forming disk 118 eliminates the appearance of elements such as scratches on the surface of the image forming disk 118 and other 'laser spots, which would otherwise be imaged on the detector 44 - (Figure IA) and alter the calculations used to characterize the wavefront. The rotation introduces .borrosity and washes the detail of such distracting elements. The fluid within the chamber 112 preferably has a known re-fraction index to assist in calculations of the optical characteristics of the model eye 100. This fluid can also reduce reflections. The micrometer 128 can be adjusted to position the lens 116 and the image forming surface on the image forming disk 118 at a desired distance apart. Preferably, the micrometer 128 establishes one. distance between the lens 116 and the rotating reflective surface, such that a beam of light propagating through the lens 116 is focused substantially at a point formed on the rotating reflective surface on the image forming disk 118. The model eye 100 advantageously has a posterior focal length of movable and rotating simulated retina. The motor 126 rotates the image forming disk 118 which acts as the averaging surface for the scattering of the illumination beam. Depending on the speed of the motor and the integration time of the detector of the chamber 44, the surface may appear as a substantially Lambertian source. In various embodiments, the fluid chamber 112 can be filled with a solution that closely matches that of the eye 18. Also, the lens 116 can be removed and replaced with another lens for further testing. Other model eye modalities and methods for simulating the light that is propagated through the eye 18 are also possible. In another embodiment of the invention, a process uses real-time or near-real-time analysis of images -created with a wavefront measurement system to identify problems in the images, provide narrow-circuit feedback of position information to the XYZ stage to center the pupil in the picture frame, adjust the focus Z, and analyze pictures or sets of images captured to determine false before averaging. The flow chart of Figure 14 illustrates methods for verifying images created with a wavefront measurement system such as the ophthalmic instrument 10. The methods can be implemented and used as a single method for verifying images or as one or more methods separated. In one embodiment, the methods for determining which images should be used to calculate a wavefront are implemented in an image verification module 67 in the computer, 51 (Figure IA).

Referring to Figure 14, at state 1405, the process receives images as input for processing. For example, the images may be provided to the computer 51 (Figure 1A) from the wavefront detector assembly 14 (Figure IA) or from another source, for example images stored in a computer storage medium (e.g. , tape, CD, DVD, other optical disc, magnetic disk or RAM). In step 1410, the process carries out statistical verification in real time or almost in real time of the images to determine the location of the pupil in the image, in pupil diameter and the quality of the image. The statistical verification process incorporates various image processing techniques to detect erroneous results that occur from incorrect XYZ placement of the detector, eye movement, torn film, eye blinks, eyelashes, glares, artifacts and spurious or uncontrolled accommodation. In one embodiment, during the statistical verification, the process segments a wavefront image using a histogram-based procedure to identify the pupil of the background of the image. The process stores values that represent attributes of the image, for example the diameter of the pupil, the location of the pupil within the frame of the image and if the image contains a saturated point, for example a bright point or glare (image characteristics) undesirable that can be harmful to wavefront analysis). In step 1415, the process evaluates the results of step 1410 to determine whether the image is a valid or invalid image. For example, the image may be an invalid image if it contains a saturated point, a bright return or brightness or if the image is otherwise of sufficient quality. If the image is not valid, the process moves to step 1420 and discards the analysis image. From step 1420, the process moves to step 1410 and proceeds as described above. After the process evaluates whether an image is valid in step 1415, the process moves to a step 1430 and verifies the location of the pupil and the focus of the image. In one embodiment, the process determines the location of the pupil by comparing a predetermined desired pupil location in an image (usually near or in the center of the image) with the pupil location rea-l (for example, the XY coordinates). of the pupil determined in step 1410) of the image being evaluated.- If the values representing the current location of the pupil in the image and the desired location of the pupil in the image are deflected by a predetermined amount, the process moves to a step 1425 and orders the stage 46 (Figure 1A) to move to a new position X and / or Y in such a way that in subsequent images the pupil will be closer to the center or in the center of the "frame" of image. The process creates the next image in the new location of the stage and processes the image as described here. If the location of the pupil in the image deviates from the center of the image excessively, 'in such a way that the pupil is unusable to determine a wavefront measurement (for example, the pupil is not completely in the image), the stage is repositioned in step 1425, the image is discarded and the process it moves to stage 1410, where it continues the verification of the incoming images. If the location of the pupil in the. If the image is not deflected by an amount such that the image is unusable, the process may reposition the stage at step 1425 if necessary, the image is not discarded and the process is moved to stage 1435. In a mode, the process controls the focus of the image via an algorithm implemented in the image verification module 63 (Figure 1A). The process controls the focus by verifying whether a first image is in focus by determining the sharpness of the image formed pupil using various image processing techniques, for example when analyzing high frequency spatial components in the image. If the first image is out of focus, the process causes the Z axis of the wavefront detector 46 to move (Figure 2) a small amount in one direction to a new Z position. A second image is generated in the new position Z and the process analyzes this image to determine if the second image is more or less clear. If the second image is sharper, the stage 46 continues to move in the same direction as before and subsequent images are analyzed in terms of sharpness until the sharpness of an image passes a predetermined sharpness threshold. If the second image becomes less sharp or unfocused after the movement of the stage, the process changes the direction of the stage and the stage moves in this new direction as subsequent images are generated. The stage continues to move until it. Subsequent images are in focus, for example they pass a sharpness threshold. Alternatively, two images can be generated at two locations on the Z axis of the wavefront detector stage '46 and then those images can be compared to determine which one is sharpest. Following this comparison, the process generates other images in that it moves the plate 46 in the direction of the sharpest image, until the process determines that the images pass the focus or threshold of sharpness. If after the initial movement of the stage, the image becomes more out of focus, the stage changes direction and continues moving until the subsequent images are "in focus." If the image is out of focus by a predetermined amount making the image unusable for the calculation of an exact wave front measurement, the image is discarded and the process moves to state 1410 and proceeds as described above.If the focus of a valid image is acceptable in state 1430, the process is moves to state 1435, where one or more of the images of a pupil, for example a series of -images, are stored in a buffer or temporary storage of image as in "image stack." The stack of images it can be a sequential series of images or it can be a series of images of an eye that are not sequential due for example to intermittent invalid images. The process compensates for the patient's flicker by eliminating images that were generated during a certain period of time after the patient blinked. This compensation can improve the quality of the images used for wavefront measurements. The detection when a patient flashes and the determination of an appropriate image acquisition synchronization to compensate for the blinks can be made based on the result of the previous process. In state 1440, the process performs blink detection synchronization to capture images of the same point in time after blinking. When the patient blinks, the image is of poor quality because the battery is either partially or completely obscured by the eyelids and thus the image is considered not to be. It is valid, for example, through the process described above. Images from the wavefront of the pupil taken too early or too late after 'a flicker can also be wrong, a contributor to erroneous wavefront measurements is the torn film of the eye, which is commonly degraded and dried with the the passage of time after a blink. If the images are taken immediately after an appropriate delay period after blinking, the eye has a chance to stabilize. The delay period should not be so long that the tear film - has begun to dry or break. During flicker compensation, the process • verifies the time elapsed between when the eye blinks and selects images generated after the eye has stabilized but before it dries. In one embodiment, a series of wavefront images are analyzed to identify an image that illustrates a pupil at least partially obscured by an eyelid during eye blinking. This analysis can be part of the analysis carried out to determine valid images or it can be carried out by another appropriate image analysis process. The series of wavefront images is then further analyzed to identify another image that is generated after the eye has completed the blinking, so that this image generated later illustrates an unobscured pupil. In some embodiments, the image identified is the first image in the series of images illustrating a pupil not obscured subsequent to the image illustrating a pupil at least partially obscured. This image illustrating a non-obscured pupil (for example a valid image) and / or valid images generated subsequent to this first image, can be stored and used for subsequent processing (for example, determination - of excessive movement between images, post-rating). -analysis of images, averaging of images and determination of a wavefront measurement). In some embodiments, the process determines which images to store for further processing based on a predetermined time interval after blinking. For example, a timer or stopwatch may start after the process identifies a valid image that illustrates an unobscured pupil in a series of wavefront images that were taken during the eye blink and one or more of the images generated subsequently to The identified image is stored to a buffer or temporary memory at a specific interval after the blinking occurs. For example, the time interval may be for example less than 0.10 seconds or equal to or between (in seconds) 0.10-0. 20.0. 20-0.30, 0.30-0. 40.0. 40-0.50, 0.50-0. 60.0. 60-0.70, 0.70-0. 80.0. 80- 0.90, 0.90-1. 00.1. 00-1.10, 1.10-1. 20.1. 20-1.30, 1.30-1. 40.1. 40-1.50, 1.50-1. 60.1. 60- 1.70, 1.70-1. 80.1. 80-1.90, 1.90-2. 00.2. 00-2.10, 2.10-2. 20, 30.2. 30-2.40, 2.40- 2.50, 2.50-2. 60.2. 60-2.70, 2.70-2. 80.2. 80- 2.90, 2.90-3. 00.3. 00-3.10, 3.10-3. 20.3. 20- 3.30, 3.30-3, 40.3. 04-3.50, 3.50-3. 60.3. 60-3.70, 3.70-3. 80.3. 80-3.90, 3.90-4. 00 or greater than 4.00 seconds. In a preferred embodiment, the time interval is approximately 1.00 seconds. While this process is in operation, the patient can look at the wavefront measurement instrument and blink normally, eliminating the possibility of capturing images during or directly after a blink, which could contaminate the data. The images identified for the analysis are therefore always of approximately the same point in time after a blink. Images that do not meet the timing or synchronization criteria can be discarded from the analysis. In an alternative modality, the process determines which images to store for the additional processing based on the number of images generated after the determination that an image illustrates a non-obscured pupil. When moving to a state 1445, the process analyzes images to determine if the movement of the pupil in successive images exceeds predetermined criteria. The pupil can move due to swelling or other eye movement. Excessive movement of the pupil can compromise the wavefront measurement. In one embodiment, the process determines the amount of movement of the pupil by analyzing the stored XY location of the pupil in each image of a stored stack of related images and determines whether the movement exceeds the criteria. If in the state 1445 the process determines that there is excessive movement of the pupil, the process moves to a state 1450 where the image is discarded from the analysis and the next image in the stack of related images is analyzed. In state 1445, if the process determines that the movement of the pupil is not excessive, the image can be used for further processing, in which the determination of a wavefront measurement of the aberrations of the eye and the eye is included. process moves to a state 1455. In state 1455, the process stores the images that are to be used for further processing in a temporary memory or buffer as a set or stack of images and the images are further evaluated to determine if they must be combined to form an "average" image. The process will subsequently determine a wavefront measurement of the averaged image. The images are averaged to help eliminate image noise, for example camera noise. In state 1455, the process performs further analysis of the images to determine whether the images in the image set are "like" images before they are averaged in the 1470 state. For example, the process may perform bubble analyzes to determine if the pupil is round or if there is a greater inclusion in a pupil formed in image, such as a fallen eyelash or eyelid. Opaque abnormalities in an image such as cataracts, floats, etc. They can also be identified using image processing techniques and. these anomalies can subsequently be masked in such a way that they do not affect the formation of the averaged image. Also, the abnormalities identified can be "provided to the operator to alert the operator and the patient to certain conditions that are present in the patient's eye." For example, the ophthalmic instrument 10 can be used to • early detection of cataracts, where a cataract appears as a dark spot in the image shown to an operator and / or the cataract is identified by means of programming elements of image processing as an anomaly that requires further investigation. Following the image qualification, the process moves to a state 1460 where the process determines whether the images stored in a set are acceptable for averaging. If they are acceptable, the process moves to state 1470 in -where the images are averaged and the process provides the resulting image to the wavefront measurement module 59 (Figure 1). In one embodiment, the images are averaged by jointly adding the values of similar pixels (for example, pixels corresponding to the same eye position) of each image in the set of images by dividing by the number of images. If the process determines in state 1460 that the image set is not acceptable for averaging, the process moves to state 1465 where the image stack is discarded from further processing and then the process returns to state 1440 to process another series of pictures. At state 1475, the process sends the resulting image of the averaging process to the wavefront measurement module 59. At state 1480, the wavefront measurement module 59 determines a wavefront measurement using processes that are known in the art for processing Talbot images, for example US Patent No. 6,781,681 issued to Horwitz, entitled "System and Method for Wavefront Measurement". At state 1475, the process performs a sequence correlation of wavefront processing images. Here, the process compares the wave fronts of two or more average images (for example, of two or more sets of images) to determine how similar the wave fronts "are to each other and identify abnormalities that were not identified in the processes For example, problems concerning the spurious arrangement, torn film and angle of view can be determined by image sequence correlation In one embodiment, the sequence correlation of wavefront processing images can be performed by analyzing each one of the image stacks completely by means of wavefront processing and comparing the wave fronts' or Zernike polynomial representation In an alternative mode, one can perform waveform processing image correlation on a wavefront. sequence of images partially processed at any intermediate stage, such as on a Fourie stage r of processing the images. For example, wavefront data can be processed-quickly to determine FFT and FFT can be compared to determine the similarity of wavefronts. After the correlation of two or more wave fronts, in the 1490 state, the process provides the wavefront data for use for example to create a lens or for eye surgery to correct aberrations identified by the front data. cool. The foregoing description details certain embodiments of the invention. However, it will be appreciated that no matter how detailed the above appears in the text, the invention can be practiced in many ways. As also stated above, it should be noted that the use of particular terminology when describing certain elements or aspects of the invention should not be taken to imply that the terminology is re-defined in the present to be restricted-to include some specific characteristics of the elements or aspects of the invention with which that terminology is associated. Accordingly, the scope of the invention should be interpreted in accordance with the appended claims and any equivalents thereof.

Claims

CLAIMS 1. A binocular wave front measurement system for performing wavefront analysis on a patient's eyes, the system is characterized in that it comprises: a system of optical elements for providing an image to a first eye along a a first optical path and an image to a second eye along a second optical path and a detector system, the detector system is configurable in a first mode, for effecting the wavefront measurement of a first eye through a portion of the first optical path and configurable in a second mode for performing the wavefront measurement of a second eye through a portion of the second optical path. The system according to claim 1, characterized in that it further comprises a platen system for positioning the detector system to receive light from the first eye in the first mode and to receive light from the second eye in the second mode. 3. The system according to claim 1, characterized in that the detector system is a Hart an-Shack wavefront detector. 4. The system according to claim 1, characterized in that the detector system is a beam-tracking wavefront detector. 5. The system according to claim 1, characterized in that the image comprises a first image presented to the first eye and a second image presented to the second eye. 6. The system according to claim 1, characterized in that the system of optical elements comprises: a first internal target; a second internal target and a path deviator with a first mode for placing the first internal target on the first optical path and the second internp objective on the second optical path and with a second way for positioning the first internal target of the first optical path and the second internal target outside the second optical path, wherein the first and second optical paths extend to an location external to the binocular wave front system, when the optical path diverter is placed in the first mode. The system according to claim 6, characterized in that the first and second internal targets are a pair of stereoscopic images. 8. The system according to claim 6, characterized in that the placement of the first internal objective and the second internal objective is adjustable to simulate the accommodation of the eye when observing the first internal objective and the second internal objective through the element system binocular optics. 9. The system according to claim 1, characterized in that the system of optical elements comprises a convergence device located to provide an image of at least one of the first and second optical paths to at least one of the first and second optical paths. second eyes to invoke a state of convergence of the eyes. 10. The system, in accordance with the claim .9, characterized in that the convergence device comprises at least one low angle prism. 11. The system in accordance with the claim I, characterized in that the system of optical elements comprises: a first set of configurable optical elements for controlling aberrations in a first eye 'and a second set of optical elements configurable to control aberrations in a second eye. 12. The system in accordance with the claim II, characterized in that the 'aberrations comprise spherical aberrations. The system according to claim 11, characterized in that the aberrations comprise astigmatism. 14. The system according to claim 11, characterized in that the aberrations comprise comma. The system according to claim 11, characterized in that the system of optical elements comprises at least one adaptive optical mirror having a movable mirror surface., the at least one adaptive optical mirror placed in one of the first and second optical paths and the at least one adaptive optical mirror configurable to correct an aberration when adjusting "the movable mirror surface. claim 1, characterized in that the system of optical elements also comprises an objective light system for illuminating internal objectives .. The system in accordance with the claim 16, characterized in that the illumination intensity of the target light system is controlled in a variable manner. 18. The system according to claim 16, characterized in that the objective light system provides illumination that simulates different lighting conditions. 19. The system according to claim 18, characterized in that the different lighting conditions are selected from the group consisting of daylight, tungsten, fluorescent, moonlight and night driving. 20. The system according to claim 17, characterized in that it also comprises a computer connected to the detector system and the objective light system, the computer is configured to determine the diameter of the pupil of an eye and to control the intensity of illumination of the source of light based on the diameter of the pupil. The system according to claim 1, characterized in that the detector system comprises: a light source for emitting a light beam along a source optical path; an obstruction element having a blocking portion, the obstruction element is arranged to place the blocking portion in the source optical path to obstruct a central portion of the light beam and produce an annular beam of light to illuminate the retina of a eye; a modulation pattern element placed in a path of a reflected beam of the eye and a detector positioned to receive at least a portion of the light passing through the modulation pattern element to detect an eye wavefront aberration . 22. The system according to claim 21, characterized in that the light source provides light having a beam diameter of about 2-3 mm. diameter. 23. The system according to claim 21, characterized in that the blocking portion of the obstruction element is approximately 1.5 to 2.5 mm in diameter. 24. The system according to claim 21, characterized in that the beam of light emitted is a beam of collimated light. The system according to claim 1, characterized in that the detector system comprises: a light source that provides light along an optical path source to an eye, the light source placed in relation to the eye of such so that the light from the reflected light source of the retina of the eye travels in a first direction and the reflected light from the cornea of the eye travels in a second direction, where the angle of the first direction relative to the optical path source is different from the angle of the second direction in relation to the source optical path, such that the light traveling in the second direction does not enter the optical path to receive light in the detector system; a modulation pattern element positioned to receive light reflected in the first direction and a detector for detecting a wavefront aberration of the eye, the detector positioned to receive at least a portion of the light passing through the pattern element of modulation. 26. The system in accordance with the claim 25, characterized in that the wavefront detector system further comprises one or more optical elements, placed along the source optical path to decrease the diameter of the spot in the retina of the eye. 27. The system in accordance with the claim 26, characterized in that the spot diameter of the light in the retina is less than about 1 mm. 28. The system according to claim 26, characterized in that the point diameter of the light in the 'Retina is less than about 6D0 microns. 29. The system according to claim 26, characterized in that the spot diameter of the light in the retina is less than about 400 microns. 30. A method for detecting aberrations in the eyes of a patient, characterized in that it comprises: placing a binocular optical element system in relation to the eyes of a patient to provide an image to a first eye of the patient and an image to a second patient's eye; placing a wavefront detector to receive light reflected from the retina of the first eye; illuminate the retina of the first eye with a light source; receiving the light reflected from the retina of the first eye in a detector, while the patient observes the image with the first eye and detects an aberration of the wave front of the first eye with the detector. 31. The method of compliance with the claim 30, characterized in that it further comprises controlling the binocular optical element system to affect the accommodation of the first eye and the second eye. 32. The method according to claim 30, characterized in that it further comprises providing one or more images with aberration to the first eye of the patient and to the second eye of the patient. 33. The method of compliance with the claim 32, characterized in that the provision of one or more images with aberration invokes a state of accommodation of the eye. 34. The method of compliance "with the claim 33, characterized in that the provision of one or more images with aberration comprises providing images that invoke a state of accommodation of the distance of the eyes. 35. The method of compliance with the claim 34, characterized in that the provision of one or more images with aberration comprises providing images that invoke a state of accommodation in the reading of the eyes. 36. The method according to claim 33, characterized in that it further comprises: placing the wavefront detector to receive light reflected from the retina of the second eye; illuminate the retina of the second eye with the light source; receiving the light reflected from the second retina in the detector while the patient is observing the image with the second eye and detecting a wavefront aberration of the second eye with the detector. 37. A method for identifying an aberration in the eye of a patient, characterized in that it comprises: placing a light source to emit a beam of light along an optical path of the source; placing an obstruction element having a blocking element positioned in the source optical path to obstruct a central portion of the light beam and producing an annular light beam to illuminate the retina of an eye; illuminate the eye with the light source; receive light reflected from the retina in a detector; detect a wavefront of the eye with the detector e - identify an aberration in the eye based on the wavefront detected. 38. A method for measuring aberrations in at least one of a patient's eyes, by using a wavefront detector system, the method is characterized by comprising: placing a binocular optical system in relation to the eyes, in such a way that a first eye is placed in a first optical path of the binocular optical system and a second eye is placed in a second optical path of the binocular optical system; place a light source in relation to the first eye, in such a way that the light from the light source that is - Reflected from the retina of the first eye travels in a first direction and light from the reflected light source of the cornea of the first eye travels in a second direction, where the angle of the first direction, relative to the optical path source is different from the angle of the second direction in relation to the optical path source, in such a way that the light traveling in the second. address does not enter an optical path to receive light in the detector system; illuminate the retina of the first eye with the light source; receiving light reflected from the retina in a first direction - through a portion of the first optical path, the light includes a wavefront representing an aberration in the first eye and identifying aberrations in the first eye based on the wavefront - received. 39. In a wavefront system, a method for placing a wavefront detector to receive light from an illuminated eye of a patient, based on 'the location of the pupil of the eye, the method is characterized' because includes: illuminating the eye with a light source; placing a wavefront detector system at a first location in relation to the pupil of the eye, such that the light reflected by the eye propagates along an optical path of the wavefront detector to receive light; detect the light reflected by the eye in the wavefront detector; - determine the position of the pupil of the eye based on the detected light and place the wavefront detector in a second location in relation to the pupil of the eye, based on the determined position of the pupil, where the second Location is a desired location to perform a wavefront measurement of the eye. 40. A wavefront detector system, characterized in that it comprises: a modulation element having a two-dimensional sinusoidal pattern placed in a light path to be analyzed and - a detector system having a detector positioned to receive at least a portion of light passing through the modulation element, the detector is located substantially in a plane of self-formation of diffraction image, in relation to the modulation element and wherein the detector system is capable of emitting a signal based on - the light received by the detector. 41. A wavefront detector system, characterized in that it comprises: a modulation element having a two-dimensional chessboard pattern placed in a light path to be analyzed and a detector system having a detector placed to receive at least a portion of light passing through - of the modulation element, the detector is substantially located at. a plane of self-formation of diffraction image in relation to the modulation element and wherein the detector system is capable of emitting a signal based on the light received by the detector. 42. A method for determining aberrations in a reflective or internally reflective object system, characterized in that it comprises: passing reflected light from an object system through a modulation element having a two-dimensional sinusoidal pattern to produce a diffraction pattern of campó nearby in a plane of Talbot; detect diffraction pattern signals -from near field in * the Talbot plane and use the detected signals to emit a measure of an aberration in the object system. 43. A system for determining an aberration in a reflective or internally reflective object system, characterized in that it comprises: passing the reflected light of an object system through a modulation element having a two-dimensional chessboard pattern for produce a near-field diffraction pattern in a Talbot plane; detect signals from the near-field diffraction pattern in Talbot's plane and use the detected signals to emit a measure of an aberration in the object system. 44. A method for simulating the propagation of light through an eye, the method is characterized in that it comprises: passing light through a lens disposed in front of a camera; focusing the light on an image forming surface in the camera by adjusting the distance between the lens and the image formation system; rotate the image forming surface and reflect the light from the image forming surface of the camera and through the lens. 45. An eye simulation system for testing wavefront detector systems, characterized in that it comprises: a housing having a chamber with an opening to allow light to enter the chamber; a fluid located in the chamber, the fluid has a known refractive index; a lens disposed in relation to the housing, such that the light entering the chamber opening passes through the lens and a rotating image forming surface placed in the chamber, such that the passing light , through the lens it propagates through the fluid and is incident on the rotating image forming surface. 46. A method for measuring pupillary distance with a binocular wavefront measurement system, characterized in that it comprises: aligning an optical path of a wavefront detector system with a first pupil in a first position; analyzing the light received from the first pupil by the wavefront detector to determine position information of the first pupil in relation to the first position; aligning the optical path of the wavefront detector with a second pupil in a second position, analyzing the light received from the second pupil by the wavefront detector to determine position information of the second pupil in relation to the second position determine the pupil distance based on the first and second position and based on the position information of the first pupil in relation to the first position and the "Position information of the second pupil in relation to the second position 47. A method for identifying aberrations of a patient's eye, characterized in that it comprises: illuminating a first objective with a light source configured to produce a first illumination condition; "performing a first wavefront measurement of the pupil of a first eye of the patient, while the first eye is observing the first lens illuminated with the light source configured to produce a first illumination condition; illuminating the first objective with a light source configured to produce a second lighting condition; performing a second wavefront measurement of the pupil of the first eye while the first eye is observing the first illuminated objective with the light source configured to produce a second illumination condition. and determining the response of the pupil of the first eye to the second illumination condition based on the first and second wavefront measurements of the pupil of the second eye. 48. The method according to claim 47, characterized in that it further comprises: illuminating a second objective with a light source configured to produce a first lighting condition; performing a first wavefront measurement of the pupil of the patient's second eye while the second eye is observing the second objective illuminated with the light source configured to produce a first illumination condition; • "illuminate the second objective with a light source configured to produce a second illumination condition; - make a second wavefront measurement of the second eye pupil while the second eye is observing the illuminated objective with the source of the second eye; light set to produce a second lighting condition and - determining the response of the pupil to the second illumination condition based on the first and second wavefront measurements of the pupil of the second eye. 49_. A wavefront measurement system - to determine the response of the pupil of a patient's eye to a specific lighting condition, characterized in that it comprises: means for illuminating a first objective with a light source configured to produce a first condition of illumination; means for effecting a first wavefront measurement of the pupil of the patient's first eye, while the eye is observing the first objective illuminated with the light source configured to produce a first illumination condition; means for illuminating the first objective with a light source configured to produce a second lighting condition; means for performing a second wavefront measurement of the pupil of the first eye, while the first eye is observing the first illuminated objective with the light source configured to produce a second illumination condition and means for determining the response from the pupil of - first eye to the second lighting condition based on the first and safe measurements of the wavefront of the pupil. 50. The method according to claim 49, characterized in that it further comprises: means for illuminating a second target "with a light source configured to produce a first lighting condition; means for effecting a first wavefront measurement of the pupil of the second eye of the patient, while the second eye is observing the second objective illuminated with the light source configured to produce a first lighting condition; means for illuminating the second objective with a light source configured to produce a second condition of illumination means for making a second wavefront measurement of the pupil of the second eye, while the second eye is observing the illuminated objective with the light source configured to produce a second illumination condition and means for determining the response from the pupil of the second eye to the second condition of illumination based on the first and second measurements of the wavefront of the pupil. 51. A method for generating information to correct optical aberrations for a patient's eye, characterized in that it comprises: placing the patient's eyes in relation to a binocular visual optical system having a first optical path and a second optical path, in such a way that the line of sight of the first eye is aligned with the first optical path and the line of sight of the second eye is aligned with the second optical path; providing an image via the first optical path to the first eye and an image via the second optical path for the second eye; enabling a wavefront detector to receive reflected light from the retina of the first eye; illuminate the retina of the first eye with a light source; receiving the light reflected from the retina of the first eye in the wavefront detector; measuring a wavefront aberration of the first eye of the light received from the first eye; . identifying at least one optical aberration in the first eye based on the measured wavefront aberration and generating information concerning the at least one optical aberration for use in a process to correct the at least one optical aberration of the first eye of the patient. 52. The method according to claim 51, characterized in that it comprises generating a lens for correction of the identified optical aberration. 53. The method according to claim 51, characterized in that it comprises changing an optical characteristic of the first eye or second eye by means of a surgical process to correct the identified optical aberration. 54. A method for determining the range of accommodation of the eyes of a patient, characterized in that it comprises: providing a plurality of images to the eyes by means of a binocular optical system invoking a plurality of states of accommodation in the eyes; receive wavefront signals representing at least one aspect of the eyes in the states of accommodation invoked and from the wavefront signals, determine the range of accommodation of the eyes, based on at least one aspect of the eyes in a plurality of states of accommodation invoked. 55. A method for providing optimally controlled aberration images in the eyes of the patient, characterized in that it comprises: providing images through a binocular optical system to the first eye and the second eye; receiving wavefront signals representing at least one aberration in the first and second eyes; identify an aberration of the first eye and an aberration of the second eye, based on wavefront signals; determine a correction for the identified aberration of the first eye and a correction for the identified aberration of the second eye and adjust the binocular optical system based on the corrections determined, in such a way that the images provided to the eyes through the adjusted binocular optical system are optimally compensated for the aberrations. 56. The method according to claim 55, characterized in that the aberrations comprise spherical aberrations. 57. The method according to claim 55, characterized in that the aberrations comprise astigmatism. 58. The method according to claim 55, characterized in that the aberrations comprise comma. 59. A system for providing a patient with optically controlled aberrations to the eyes of the patient, characterized in that it comprises: means for providing images through a binocular optical system to a first eye and a second eye; means for receiving wavefront signals representing at least one aberration in the first and second eyes; means for identifying an aberration of the first eye and an aberration of the second eye based on wavefront signals; means for determining a correction for the identified aberration "of the first eye and a correction for the identified aberration of the second eye and means for adjusting the binocular optical system based on the determined corrections, in such a way that the 5 images provided to the eyes through the adjusted binocular optical system are optically compensated for by the aberrations. 60. A method for identifying aberrations in the eye of a patient, characterized in that it comprises: placing a binocular optic system in relation to The eyes of a patient, such that a first eye is placed along a first optical path of the binocular optical system and a second eye is placed along a second optical path of the optical system '15 binocular; receiving a first wavefront representing an aberration in the first eye through a portion of the first optical path; identifying an aberration in the first eye in base 20 at the first wavefront received. 61. The method according to claim 60, characterized in that it further comprises: placing a wavefront detector at a first location to receive a first wavefront of the first eye 25 through-a portion of the first optical path; Place the wavefront detector in a second location to receive a second front of. wave of the second eye through the second optical path; receiving a second wavefront representing an aberration in the second eye through a portion of the second optical path and identifying an aberration in the second eye based on the second wavefront received; 62. A method for analyzing a series of wavefront images, characterized in that it comprises: providing a first group of wavefront images of an object, wherein at least one wavefront image in the first group of wavefront images illustrate a pupil at least partially obscured during a first blink of the eye; analyzing the first group of wavefront images to identify a first wavefront image illustrating a pupil at least partially obscured during a first eye blink; analyze a second group of subsequent generated wavefront images. to the first wavefront image to identify a second wavefront image that illustrates an unobscured pupil and determine from the second set of wavefront images at least one wavefront image generated after the second wavefront image was generated, which illustrates a non-obscured pupil and wherein the act of determining the at least one wavefront image is based on selecting an image that was generated at a predetermined time interval in relation to when the blinking came. 63. The method according to the claim 62, characterized in that it further comprises: analyzing an image in the first group of wavefront images to determine a first location of the pupil in the image, wherein the image was generated using a wavefront detector located in a first position in relation to the pupil; compare the first location of the pupil with a predetermined location and if the first location of the pupil is different from the predetermined location by a predetermined amount, move the wavefront detector to a second position relative to the pupil, of Such a way that a subsequent image illustrates the pupil in a second location, where the second location of the pupil is closer to the predetermined location than the first location of the pupil. 64. The method of compliance with the claim 63, characterized in that it further comprises: storing a plurality of wavefront images generated after the second wavefront image was generated; combine the stored images to form an averaged image and determine a wavefront measurement from the averaged image. 65. The method according to claim 64, characterized in that it further comprises: forming a set of wavefront measurements, each wavefront measurement is determined from an averaged image; compare the set of wavefront measurements to identify anomalies in the plurality of wavefront measurements and identify one or more wavefront measurements in the set of wavefront measurements to provide correction errors in the body based on the anomalies - identified.