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The Glenn A. Fry Lecture Treating with Spectacle Lenses: A Novel Idea!? Eli Peli, MSc, OD, FAAO The Schepens Eye Research Institute Harvard Medical School "What has been is what will be, and what has been done is what will be done; there is nothing new under the sun.” Ecclesiastes 1:9 My First Refraction • At the Haifa Zoo (1975) – Helping Jake Sivak • The Mongoose refused to be fitted with any type of spectacles for day or night use My Second Refraction Customer • Helping Mogi Gur and Jake Sivak 1 2 3 Stimuli generation Water pump control spike timing, AP waveforms, eye position Eye position 6 5 spike timing, eye position 4 Water pipe and spoon • Determine refraction by listening to sounds of neural activity in the cortex, monitored with intracellular electrodes, while changing lenses 7 9 8 17 10 16 11 13 15 12 14 neuronal discharge lever and eye occluder signal There must be easier ways to refract! Are there more ways to use the spectacle lenses? Yes. Multiplexing. Multiplexing for Low Vision • Provide peripheral (wide field-of-view) together with central (high resolution) vision in ways that make them perceptually separable and useful – Many different forms of multiplexing • Spatial (superposition), Temporal (alternating), Biocular, or Spectral (colors) – Maintaining free head & eye movements Peripheral Prisms for Hemianopia • Expands upper and lower fields by about 20 deg High power prisms (40) • All positions of gaze affected • Biocular multiplexing • Prismatic color fringes mark eye of origin • Spectral Multiplexing Left Hemianopia Instantaneous View with Hemianopia Field expansion for homonymous hemianopia by optically induced peripheral exotropia. Opt. & Vis.Sci 77;453-464 View with the Peripheral Prisms Effect Demonstrated with Perimetry Without Prisms B Perimetry with Peripheral Prisms Without Prisms B With Prisms Peripheral Prisms Spectacles Cosmetically Acceptable MultiOptical, Sweden Dangerous? Peripheral Prisms Spectacles New more attractive, safer designs Chadwick Optical Solar Glare • Need to block peripheral field • Sunglasses and tinted visors-not dark enough • Opaque visor-fixed • Hand position is adjustable Headlight Glare at Night Coming from a limited section of peripheral field Multiplexing Glare Control Lenses Lens Tint • Block peripheral view • Top strip for solar glare • Left strip for headlight glare • Fine adjustments with head position are simple, accurate, and intuitive Clip-On Patent Search US 3,199,296 US 4,828,380 US 5,252,997 US 5,428,409 US 4,338,003 All for Night Glare All static - no movement Traffic Lights at Night Difficult for drivers with color deficiency with low vision or both Unilight® LED traffic lights As seen in Fort Hood, TX & Cheyenne, WY No shape clue No position clue As seen in Scottsdale AZ Multiplexing Spectacles for Red-Green Color Deficiency • When traffic-light is noted, slight head tilt brings it into the red-tined zone • Red light shines through • Green light is blocked Successful application of Temporal Multiplexing Bioptic Telescope • Wide field through the carrier lens • Occasional head tilt to gain high resolution • Limitations – Ring scotoma, Cosmesis, Social eye contact 45 degree field In-the-Lens Telescope Galilean Telescope View from above t Lens thickness, t, limits width of field Mirrors Only Design t Completely embedded in the lens Looking Through the Carrier Looking Through the Telescope In-the Lens Keplerian Telescope Wider Field-of-View Lens thickness, t, limits height of field t t Front View Side View SimulVision-Spatial Multiplexing Conclusion • Multiplexing offers a new way of thinking about low vision devices – Electronics or optics • Multiplexing is useful in other applications • Cosmetic considerations are critical to the success of any spectacle born device – We are all vain “…vanity of vanities; all is vanity” Ecclesiastes 1:2 Thank You! Supported generously by NIH grants