United States Patent No. US B2 Lee et al. Date of Patent:...

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lI2j United States PatentLee et al.

(Io) Patent No. : US 9,237,842 B2(45) Date of Patent: Jan. 19, 2016

(54) COMPUTERIZED REFRACTION ANDASTIGMATISM DETERMINATION

(56) References Cited

U.S. PATENT DOCUMENTS(71) Applicants: Steven P. Lee, Chicago, IL (US); Aaron

Dallek, Chicago, IL (US)

(72) Inventors: Steven P. Lee, Chicago, IL (US); AaronDallek, Chicago, IL (US)

3,807,839 A4,257,690 A4,529,280 A4,541,697 A

4/1974 Sugarman et al.3/1981 Howland7/1985 Nohda9/1985 Remijan

(Continued)

(73) Assignee: OPTERNATIVE, INC. , Chicago, IL(US)

( * ) Notice: Subject to any disclaimer, the term of thispatent is extended or adjusted under 35U.S.C. 154(b) by 0 days.

WOWO

2013126410 Al2013155002 Al

8/201310/2013

OTHER PUBLICATIONS

FOREIGN PATENT DOCUMENTS

(21) Appl. No. : 14/195,583

(22) Filed: Mar. 3, 2014

(65) Prior Publication Data

US 2014/0268060 Al Sep. 18, 2014

Related U.S.Application Data

(51) Int. Cl.A618 3/02A 618 3/036A618 3/00A618 3/103

(52) U.S. Cl.

(2006.01)(2006.01)(2006.01)(2006.01)

CPC ............... A618 3/036 (2013.01);A618 3/0041(2013.01);A618 3/103 (2013.01)

(58) Field of ClassiTication SearchUSPC ................. 351/211, 222, 237, 239, 241, 246;

600/558See application file for complete search history.

(60) Provisional application No. 61/777, 481, filed on Mar.12, 2013, provisional application No. 61/864, 328,filed on Aug. 9, 2013, provisional application No.61/881, 803, filed on Sep. 24, 2013, provisionalapplication No. 61/913,774, filed on Dec. 9, 2013,provisional application No. 61/923, 894, filed on Jan.6, 2014.

Prokerala, "Free Astigmatism Test~nline Test for Astigmatism",http;//www. prokerala. corn/health/eye-care/eye-test/astigmatism-

test. php, published 2012, accessed May 2015.*

(Continued)

Primary Examiner Mahidere Sable

(74) Attorney, Agent, or Firm K&L Gates LLP

(57) ABSTRACT

20 Claims, 23 Drawing Sheets

The present disclosure relates generally to a system andmethod for determining the refractive error of a patient, moreparticularly determining the patient's refractive error byusing a computerized screen, and providing the patient with aprescription for the patient's preferred type of correctivelenses. The system and method do not require the trip orexpense of a doctor visit, and are optimized for convenienceand cost effectiveness. In a general embodiment, the presentdisclosure provides a method for determining a correctivelenses prescription of a patient. The method includes, sepa-rately, for each eye of the patient, determining the astigma-

tismm

prescription of the patient via a computerized screen, anddetermining the power of the corrective lenses prescription ofthe patient via the computerized screen.

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US 9,237,842 B2Page 2

References Cited

U.S. PATENT DOCUMENTS

2013/002766g Al * I/2013 Pamplona et al.2013/0169929 Al * 7/2013 Fateh . ... ... ... ... ....2013/0201449 Al * g/2013 Walsh et al.

OTHER PUBLICATIONS

. .. 351/239

. .. 351/203

. .. 351/206

4,607,9234,611,8934,615,5945,436,6g15,675,3995,914,7725,929,9725,997,1426,386,7076,592,2236,742, 8957,232,2207,267,4397,350,9217,367,6757,384, 1467,396,12g7,429, 109g,083,353

2005/007364g2006/00231632006/0203195200g/0309ggo2010/00305702010/02654632011/0001924

AAAAAAAABlBlB2B2B2B2*B2*B2B2B2B2AlAlAlAlAl*Al*Al

g/19869/1986

10/19867/1995

10/19976/19997/1999

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12/20114/20052/20069/2006

12/200 g2/2010

10/2010I/2011

Task et al.SchrierTaskMichaelsKohayakawaDyerHutchinsonNakagawaPellicanoStern et al.RobinFranz et al.Toshima et al.RidingsMaddalena et al.Covannon et al.Fcher et al.Toshima et al.HytowitzToshima et al.FosterSquire et al.Fisher et al.Kratzer et al.Lai . ... ... .... ... ... ... .Giraudet et al.

.. .. 351/237

.. .. 351/237

. ... ... 705/2

. .. 351/237

International Search Report for International Patent Application No.PCT/US14/19944 mailed on Aug. 5, 2014.Ho, Connie K., "National Healthy Vision Month ZEISS OnlineVision Screening Check", [retrieved on Jul. 6, 2014] Published May7, 2012. Retrieved from the internet; &http: //ww. N, redorbit. corn/news/health/1112536966/national-healthy-vision-month-zeiss-online-vision-screening-checki¹VI tqHVHGOzKBJhvi .99&.The Eye Diseases Prevalence Research Group, "The Prevalence ofRefractive Errors Among Adults in the United States, WesternEurope, and Australia", pp. 495-505, p. 1314,Arch Ophthalmol/vol.122, Apr. 2004, www. Archophthalmo. corn, 2004 American MedicalAssociation.From Wikipedia, The Free Encyclopedia, "MIT NETRA", pp. 1-2,http: //en. wikipedia. org/wiki/MIT NETRA, first published Jan. 14,2012, and accessed from the internet on Apr. 11, 2014.Carl Zeiss Meditec AG, "Visuref 100 from Zeiss Autorefractor/Keratometer Premium Vision Starts With Premium Diagnostics", pp.1-4, www. meditec. zeiss. corn/visuref100, http: //applications/zeiss.corn, published 2013, and accessed from the internet on Apr. 11,2014.Reichert, Inc. , "RK600 AutoRefractor/Keratometer User's Guide,

"Reichert Opthalmic Instruments, pp. 1-2g, www. reichertoi. corn,Reichert, Inc. Depew, NY, USA, published 2005 and accessed fromthe internet on Apr. 11, 2014.

* cited by examiner

U.S. Patent Jan. 19, 2016 Sheet 1 of 23 US 9,237,842 B2

Display on a computerized screen a fillablc form for a patient to A1ake atleast Qne input of 8 priof' glasses Qf' contacts prBscnptlon, contacts braAcl

name, andior contacts manufacturer

Receive an input of a priorglasses or contacts

prescription, contacts brandname, Bnd! QI' coAtacts

manufacturer

Receive ari input that apatient does not have the

I'Bquestecl data

Display ori the computerized screen a query to the patient regarding .-108whether they are nearsighted or farsighted

Receive an input from ttie patient regarding whether they are nearsighted ~110or farsighted

For each eye of the patient, display on the computerized screen a firstdiagram

Receive an input from thepatient, wherein the input

correspollcls to BA axismeasurement for an

astigmatism

Display on the computerizedsrrcen a serond diagram

Receive an input from thepatient, wherein the inputindicates that they do not

have an astigmatism in thateye

Receive an input from thepatient, wherein the inputcorresponds to a cylinder

measurement

FIIG. 1A


For each eye of the patient, display on the computerized screen a first - l22figure, wherein the first figure is too small to be clearly seen by the patient

Receive at least one input from 8 patient to increase the sizeot the first figure until it can be clearly seen by the patient,

wherein the at least one input corresponds to a first spheremeasurelYient

Display on the computerized screen 8 second figure, whereinthe second figure is too large enough to be clearly seen by the

patient

Receive at least one input from a patient to increase the sizeof the first figure until it can be clearly seen by the patient,

wherein the at least one input corresponds to a first spheremeasurement

Average the first sphere measurement and the second sphere "l30measuI Bment to deterITline 8 fll Ial spheI'6 IneasuremGIIt

Display on the computerized screen a queIy to the patient regardingwhether they would like a glasses prescription, a contacts prescription, or

both

Receive an input from the patient regarding their desired prescription 134

Display pricing information to the patient, and enable them to select~-136

method of payment and to provide payment information

Receive at least one input from the patient regarding their desired method l 38

of payment arid their paymenit iniforrnation

Provide requested prescription ~140

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US 9,237,842 B21

COMPUTERIZED REFRACTION ANDASTIGMATISM DETERMINATION

PRIORITY CLAIM

This non-provisional patent application claims priority toand the benefit of U.S. Provisional Patent Application Ser.No. 61/777, 481, titled "COMPUTERIZED REFRACTION, "filed on Mar. 12, 2013; U.S. Provisional Patent ApplicationSer. No. 61/864, 328, titled "COMPUTERIZED REFRAC-TION AND ASTIGMATISM DETERMINATION, " filedAug. 9, 2013; U.S. Provisional Patent Application Ser. No.61/881, 803, titled "COMPUTERIZED REFRACTION ANDASTIGMATISM DETERMINATION, " filed Sep. 24, 2013;U.S. Provisional Patent Application Ser. No. 61/913,774,titled "COMPUTERIZED REFRACTIONANDASTIGMA-TISM DETERMINATION, " filed Dec. 9, 2013; U.S. Provi-sional Patent Application Ser. No. 61/923, 894, titled "COM-PUTERIZED REFRACTION AND ASTIGMATISMDETERMINATION, "filed Jan. 6, 2014, the entire contents ofeach ofwhich are expressly incorporated herein by reference.

BACKGROUND

The present disclosure is generally related to determining aglasses and/or a contacts prescription for a patient with arefractive error in need of correction. Many people haverefractive errors of the eye which cause them to be eithermyopic (commonly known as nearsightedness) or hyperme-tropic (commonly known as farsightedness). One of ordinaryskill in the art will understand that myopia refers to a refrac-tive defect of the optical properties of an eye that causesimages to focus forward of the retina (i.e. a refractive error).Those optical defects are typically caused by, among otherthings, defects of the cornea, elongation of the eye structure,other conditions, or a combination of those conditions.Hyperopia, on the other hand, refers a refractive error of theoptical properties ofan eye that causes images to focus behindthe retina. Those optical defects are the result when the opticsofthe eye are not strong enough for the front to back length ofthe eye. Myopia and hyperopia have one component, a spheremeasurement, which indicates the strength or power neces-sary to correct for the optical defects.

Astigmatism refers to a refractive error that causes lightentering the eye to focus on two points rather than one. It iscaused by an uneven power ofthe cornea. An astigmatism hastwo components, an axis measurement, which indicates theangle along which any image viewed by the patient is dis-torted, and a cylinder measurement, which indicates thestrength or power of the distortion. Myopia, hyperopia, andastigmatism are the principle refractive errors that causepatients to seek treatment to correct their vision problems.

A manifest refraction analysis is a diagnostic tool used byophthalmologists and optometrists whereby a patient' srefractive error is tested to indicate whether the patient wouldbenefit from correction with glasses or contact lenses. As partof that technique, a patient looks through a phoropter whilethe ophthalmologist or optometrist evaluates each of thepatient's eyes. A retinal reflex diagnosis technique is oftenused to assess the magnitude of the refractive error present inthe patient's eyes. Subjective feedback from the patient isused to refine the manifest refraction, which involves thepatient making choices between image quality as differentlenses having different powers are slid into place in thephoropter. These refractive errors can be corrected withlenses, typically spectacle lenses, known as glasses, or con-tact lenses, which are applied directly to the eye. They can

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also be corrected with various types of surgery. At the end ofthe manifest refraction analysis, the ophthalmologist oroptometrist may produce a prescription for glasses, contactlenses, and/or refractive surgery.

Other methods for determining the refractive error of apatient include known diagnostic devices such wave front sen-sors, refractometers, and others that are well known in the art.Some of these diagnostic devices use computers to assist indetermining the refractive error of the patient. For example,one implementation of a wavefront-type refractor that is wellknown in the art uses a "Hartmann-Shack" sensor to measurethe wave front of a light beam generated from an illuminationspot projected on the retina and passed through the eye'soptics. In such a wavefront type refractor, a probe beam froma laser or a super-luminescent diode is projected onto theretina through the eye's optics. Light scattered by the retinapasses through the eye's optics, and emerges through theeye's pupil. The wavefront of the emerging beam carriesrefractive information relating to the eye's optics. Forexample, if the eye is emmetropic (i.e., the eye's optics arewithout refractive error), the wavefront of the emerging beamshould be flat. Relay optics relay the wavefront emergingfrom eye's pupil onto the Hartmann-Shack sensor. The Hart-mann-Shack sensor measures the distortion of the wavefrontand provides that information to a computer to compute therefractive errors of the eye due to aberrations of the eye'soptics.

Each of the above-described techniques for determining apatient's refractive error requires the patient to travel to aplace where such machines or doctors are present and avail-able to perform the determination. And, having traveled to adoctor's office, a patient then has to pay for the time andservices of the doctor, which may or may not be covered bytheir health insurance. This can be both expensive and incon-venient for a patient.

For a patient who desires contacts, a second charge gener-ally applies for a "fitting. "This charge is frequently unneces-sary because most contacts manufacturers only offer one or afew base curve and diameter combinations, meaning there isonly one or a few possible "fits" for that contact. When apatient has worn contacts before and is comfortable in theirprevious brand, there is no need to perform a "fitting. "Despitethis, it is commonly required by doctor's offices that a "fit-ting" be performed, and the accompanying fee charged.Health insurance seldom covers this fee. In some cases, thedoctor may require that the patient make another, separateoffice visit to have their "fitting. "Therefore, determining acontacts prescription can be even more expensive and incon-venient for a patient.

In addition, the cost of the above described machinery(phropter, wavefront refractor, etc.) is prohibitive to owner-ship by an individual not engaged in a medical practice, sopatients do not have the option of determining their ownglasses or contacts prescription outside of a medical practicesetting.

Furthermore, in-office subjective astigmatism tests gener-ally only determine a patient' s axis prescription within 10' ofaccuracy.

Thus, there exists a need for a more convenient, less costly,more accurate way for patients to determine and receiveglasses and contacts prescriptions.

SUMMARY

The present disclosure relates generally to a system andmethod for determining the refractive error of a patient, moreparticularly determining the patient's refractive error by

US 9,237,842 B2

using a computerized screen or other suitable visual tool, andproviding the patient with a corrective lenses prescription forthe patient's preferred type of corrective lenses. The systemand method do not require the trip or expense ofa doctor visit,and are optimized for convenience and cost effectiveness.

In a general embodiment, the present disclosure provides amethod for determining a corrective lenses prescription of apatient. The method includes, separately, for each eye of thepatient, determining the astigmatism prescription of thepatient via a computerized screen.

In an embodiment, determining the astigmatism prescrip-tion of the patient via the computerized screen includes pre-senting a first diagram to the patient via the computerizedscreen and enabling the patient to select at least one input. Theinput corresponds to an axis measurement. The method fur-ther includes presenting a second diagram to a patient via thecomputerized screen and enabling the patient to select at leastone input. The input corresponds to a cylinder measurement.

In a further embodiment, the first diagram and the seconddiagram are a same diagram. In an alternative further embodi-ment, the first diagram and the second diagram are differentdiagrams.

In another further embodiment, the first diagram is a rotat-able line. In a still further embodiment, the rotatable line ismade up of at least two alternating colors. In yet a furtherembodiment, the at least two alternating colors are selectedfrom the group consisting of the red family and the greenfamily, respectively.

In an embodiment, the method is provided via an internet.In an embodiment, the method includes sending the deter-

mined astigmatism prescription to at least one doctor forreview and approval.

In an alternative embodiment, the present disclosure pro-vides a method for determining a corrective lenses prescrip-tion of a patient. The method includes, separately, for eacheye of the patient, determining the astigmatism prescriptionof the patient via a computerized screen, and determining thepower of the corrective lenses prescription of the patient viathe computerized screen.

In a further embodiment, the method also includes, sepa-rately, for each eye of the patient, enabling the patient to makean input ofat least one data selected from the group consistingof a base curve from a prior contacts prescription, a diameterfrom a prior contacts prescription, a prior contacts brandname, and a prior contacts manufacturer. A base curve and adiameter are determined from the at least one data.

In a further embodiment, the method also includes, sepa-rately, for each uncorrected eye of the patient, determiningwhether the patient is nearsighted or farsighted by presentinga colorblocked diagram to the patient via the computerizedscreen and enabling the patient to select an input correspond-ing to part of the colorblocked diagram.

In another further embodiment, the method also includes,separately for each corrected eye of the patient, determiningwhether the patient is over corrected or undercorrected bypresenting a colorblocked diagram to the patient via the com-puterized screen and enabling the patient to select an inputcorresponding to part of the colorblocked diagram.

In an embodiment, determining the power of the correctivelenses prescription of the patient via the computerized screenincludes presenting a first figure to a patient via the comput-erized screen. The first figure is too small to be clearly seen bythe patient. The method further includes enabling the patientto make at least one input to increase the size of the first figureuntil it can just barely be made out by the patient. The at leastone input corresponds to a first sphere measurement. In afurther embodiment, the method includes presenting a second

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figure to a patient via the computerized screen. The secondfigure is large enough to be clearly seen by the patient. Themethod enables the patient to make at least one input todecrease the size ofthe second figure just until it can no longerbe made out by the patient. The at least one input correspondsto a second sphere measurement. In another further embodi-ment, the method includes determining a final sphere mea-surement based, at least in part, on the first sphere measure-ment and the second sphere measurement.

In a further embodiment, the first figure and the secondfigure are different figures. In an alternative further embodi-ment, the first figure and the second figure are a same figure.

In another further embodiment, the first figure and thesecond figure comprise at least one symbol selected from thegroup consisting of letters and numbers.

In still another further embodiment, at least one set of thepresentation of the first and second figures, enabling thepatient to make inputs, and receiving inputs from the patientis repeated at least once.

In a further embodiment, the method includes sending thedetermined astigmatism and power prescriptions to at leastone doctor for review and approval.

In another embodiment, the present disclosure provides anon-transitory computer readable medium. The non-transi-tory computer readable medium includes a plurality ofinstructions, which when executed by at least one processor,cause the at least one processor to operate with at least onedisplay device, at least one memory device, and at least oneinput device to determine a corrective lenses prescription ofthe patient. The corrective lenses prescription comprises anastigmatism prescription and a power. The non-transitorycomputer readable medium determines the glasses prescrip-tion of the patient by, for each eye of the patient, determiningthe astigmatism prescription of the patient. The non-transi-tory computer readable medium determines the astigmatismprescription of the patient by presenting a first diagram to thepatient via a computerized screen and enabling the patient toselect an input. The patient-selected input corresponds to anaxis measurement. The non-transitory computer readablemedium further determines the astigmatism prescription ofthe patient by presenting a second diagram to a patient via thecomputerized screen and enabling the patient to select at leastone input. The patient-selected input corresponds to a cylin-der measurement. The non-transitory computer readablemedium further determines the corrective lenses prescriptionof the patient by, for each eye of the patient, determining thepower of the corrective lenses prescription of the patient. Thenon-transitory computer readable medium determines thepower of the prescription by presenting a first figure to apatient via the computerized screen. The first figure is toosmall to be clearly seen by the patient. The non-transitorycomputer readable medium further determines the power ofthe prescription by enabling the patient to make at least oneinput to increase the size of the first figure until it can justbarely be made out by the patient. The at least one inputcorresponds to a first sphere measurement. The non-transi-tory computer readable medium further determines the powerof the prescription by presenting a second figure to a patientvia the computerized screen. The second figure is largeenough to be clearly seen by the patient. The non-transitorycomputer readable medium further determines the power ofthe prescription by enabling the patient to make at least oneinput to decrease the size of the second figure just until it canno longer be made out by the patient. The at least one inputcorresponds to a second sphere measurement. The non-tran-sitory computer readable medium determines a final sphere

US 9,237,842 B2

measurement based, at least in part, on the first sphere mea-surement and the second sphere measurement to determine.

An advantage of the present disclosure is to provide apatient more convenience in determining and receiving aglasses and/or contacts prescription.

An advantage of the present disclosure is to reduce the costand expense to the patient of determining and receiving aglasses and/or contacts prescription.

Another advantage of the present disclosure is to determinea glasses and/or contacts prescription without the need forexpensive equipment only feasible for use in a doctor office.

Another advantage of the present disclosure is to determinea glasses and/or contacts prescription without placing lensesbefore the eyes of the patient.

Still another advantage of the present disclosure is to morequickly determine a glasses and/or contacts prescription.

A further advantage of the present disclosure is to moreaccurately determine the axis and cylinder astigmatism pre-scriptions of a patient.

Additional features and advantages are described herein,and will be apparent from the following Detailed Descriptionand the figures.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A and 1B are a flowchart illustrating an examplemethod of operating an embodiment of the system of thepresent disclosure.

FIG. 2A illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays requests for information regarding a priorprescription of the patient, a fillable form for the patient toenter data regarding their prior prescription, and requests forinformation regarding what refractive errors the patient mayhave.

FIG. 2B illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays a request for information regarding aprior prescription of the patient and a request for informationregarding what refractive errors the patient may have.

FIG. 3 illustrates a screen shot of an example ofan embodi-ment of the system of the present disclosure, wherein thesystem displays a diagram and enables a patient to make aninput, wherein the input corresponds to an axis measurementof the patient.

FIG. 4A illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereina diagram is shown as it would look to a corrected eye withastigmatism, or to an eye without astigmatism.

FIGS. 4B, 4C, 4D, and 4E illustrate screen shots ofexamples of embodiments of the system of the present dis-closure, wherein each diagram is shown as it would look to anuncorrected eye with astigmatism along a given axis.

FIG. 5 illustrates a screen shot of an example ofan embodi-ment of the system of the present disclosure, wherein thediagram is shown as it would look to a corrected eye withastigmatism after the patient has made at least one input,wherein the input corresponds to a cylinder measurement ofthe patient.

FIG. 6 illustrates a screen shot of an example ofan embodi-ment of the system of the present disclosure, wherein thesystem calibrates the amount of distance between a cameramounted to the computerized screen and the patient.

FIGS. 7A and 7B illustrate screen shots of examples of anembodiment of the system of the present disclosure, whereinthe system displays a figure and enables a patient to make at

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least one input to change the size of the figure, wherein the atleast on input corresponds to a sphere measurement of thepatient.

FIGS. SA, SB, SC, and SD illustrate screen shots ofexamples of an embodiment of the system of the presentdisclosure, wherein the system displays a colorblocked dia-gram and enables a patient to make at least one input to selecta more defined-appearing part of the diagram, wherein theinput corresponds to a determination that the patient is near orfar sighted (if not wearing corrective lenses), over or undercorrected (if wearing corrective lenses), or otherwise.

FIG. 9A illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays a figure and enables a patient to make atleast one input to affect the rotation of the figure, wherein theat least one input corresponds to an axis measurement.

FIG. 9B illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays a figure and enables a patient to make atleast one input to affect the spacing or size ofvarious parts ofthe figure, wherein the at least one input corresponds to ancylinder measurement.

FIG. 10A illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays wherein the system displays a line dia-gram and enables a patient to make at least one input, whereinthe at least one input corresponds to a cylinder measurement.

FIG. 10B illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe figure of 10A is rotatable to align with the determined axisof a patient's astigmatism.

FIG. 11A illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays fine spoke diagram, which is a smallerangular portion of spoke diagram of FIG. 12B, and enables apatient to make at least one input, wherein the at least oneinput corresponds to a fine axis measurement.

FIG. 11B illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays a concentric semi-circle diagram 1105and enables a patient to make at least one input, wherein theat least one input corresponds to an axis and/or a cylindermeasurement.

FIG. 12A illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays line diagram, and enables a patient tomake at least two inputs, wherein the at least two inputscorrespond to a cylinder measurement.

FIG. 12B illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays a spoke diagram 1205 and enables apatient to make at least one input, wherein the at least oneinput corresponds to a gross axis measurement.

FIG. 13 illustrates a screen shot of an example of anembodiment of the system of the present disclosure, whereinthe system displays line diagram 1304, and enables a patientto make at least one input, wherein the at least one inputcorresponds to a cylinder measurement.

FIGS. 14A-D are screen shots of example embodiments ofthe system of the present disclosure which demonstrate thatthe alternating parts may be of different sizes or spacing, butstill test for the same determination in the astigmatism sever-ity determination.

FIG. 15 is a screen shot ofan example ofan embodiment ofthe system of the present disclosure, which demonstrates thatthe alternating parts may be of different sizes or spacing, butstill test for the same astigmatism axis determination.

US 9,237,842 B2

FIG. 16 is a screen shot ofan example ofan embodiment ofthe system of the present disclosure, which demonstrates thatan astigmatism axis gross determination figure may be modi-fied in size and shape, and stretched in minor fashion, and stillbe usable by the system for determining an axis of astigma-tism for a patient.

FIG. 17 is a screen shot ofan example ofan embodiment ofthe system of the present disclosure, which demonstrates apossible configuration for a macular degeneration test.

DETAILED DESCRIPTION

FIGS. 1A and 1B illustrate a flowchart of an example of aprocess or method 100 pursuant to an embodiment of thesystem of the present disclosure. In various embodiments,one or more processors execute a set of instructions to imple-ment the process 100.Although process 100 is described withreference to the flowchart shown in FIGS. 1A and 1B, thesystem may employ many other processes of performing theacts associated with this illustrated process. For example, thesystem may change the order of certain of the illustratedblocks. The system can also make certain of the illustratedblocks optional, the system may repeat certain of the illus-trated blocks, and/or the system may not employ certain of theillustrated blocks.

As indicated by block 102, the system displays on a com-puterized screen a fillable form for a patient to make at leastone input of a prior glasses or contacts prescription, contactsbrand name, and/or contacts manufacturer.

A computerized screen in accordance with an embodimentof the present disclosure includes, without limitation: a moni-tor, a television display, a plasma display, a liquid crystaldisplay (LCD), a display based on light emitting diodes(LEDs), a display based on a plurality of organic light-emit-ting diodes (OLEDs), a display based on polymer light-emit-ting diodes (PLEDs), a display based on a plurality of surface-conduction electron-emitters (SEDs), or any other suitableelectronic device or display mechanism. In certain embodi-ments, as described above, the computerized screen includesa touch-screen. It should be appreciated that the computerizedscreen may be of any suitable size, shape, and configuration.

The computerized screen displays a fillable form, fillablefields, or other vehicle for the patient to input data, if thepatient has such data, including a prior glasses prescription, aprior contacts prescription, a prior contacts brand name, and/or a prior contacts manufacturer. The data related to the priorcontacts prescription can be information from a box of thepatient's contacts, which they may still have in their posses-sion. In one embodiment, the computerized screen is part of apatient terminal, which the patient may use to access thesystem and process.

In another example embodiment, the fillable form mayquery the patient regarding their satisfaction with their cur-rent glasses or contact lenses, as well as how often they wearthe glasses or contact lenses.

As indicated by block 104, the system receives at least oneinput ofa prior glasses prescription, a prior contacts prescrip-tion, a prior contacts brand name, and/or a prior contactsmanufacturer. It should be appreciated that the system mayautomatically fill in or populate the form, fields, or othervehicle based on other data input by the patient. As onenon-limiting example, the patient may input a prior contactsbrand name. The system may then use a look-up table or othermethod to retrieve from memory the corresponding basecurve and/or diameter aspects of the prior prescription. This is

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especially possible with respect to contacts brand names ormanufacturers who provide only one or a few possible basecurve and/or diameter sizes.

In one possible alternative to block 104, the system mayreceive an input that the patient either does not have or doesnot wish to enter the requested prior prescription information,as indicated by block 106.In one possible embodiment, block106 is not a part of the process 100, and the patient must enterprior prescription information before continuing to the nextblock. In another possible embodiment, block 106 is part ofprocess 100 and the patient is not required to enter any priorprescription information before continuing to the next block.

The system displays on the computerized screen a query tothe patient regarding whether they are nearsighted or far-sighted, as indicated by block 10S, and receives at least oneinput from the patient in response to the query regardingwhether they are nearsighted or farsighted, as indicated byblock 110.

At block 112, the system displays a first diagram to thepatient on the computerized screen intended for a first eye(either right or left) ofthe patient. It should be appreciated thatthe patient should view the first diagram with their uncor-rected first eye, i.e. if they wear glass or contacts, they shouldremove them and view the diagram without the correction oftheir glasses or contacts.

The system receives an input from the patient regardinghow they view the first diagram with their first eye, whereinthe input from the patient corresponds to an axis measure-ment for an astigmatism, as indicated by block 114.It shouldbe appreciated that the axis measurement can be used as atleast one part of a skew function which the system may applyto other diagrams and figures displayed for the first eye. In oneembodiment, the system receives an input from a patient,wherein the input indicates that they do not have an astigma-tism in the eye being tested, as indicated by block 120. In thisembodiment, the patient may either move on to blocks 122through 130with their first eye, or they may repeat block 112with their second eye.

If the patient makes an input which indicates an axis mea-surement in accordance with block 114,the system displays asecond diagram on the computerized screen, as indicated byblock 116.In one embodiment, the first diagram and seconddiagram are the same diagram. In another embodiment, thefirst diagram and the second diagram are different diagrams.In one embodiment, the second diagram is distorted based onthe partial skew from the axis measurement determined fromthe patient's input at block 114. For example, the seconddiagram may be stretched or elongated by some unit along thepatient-identified axis. In another embodiment, the seconddiagram is not initially distorted.

The system receives at least one input from the patient,wherein the at least one input corresponds to a cylinder mea-surement of the first eye, as indicated by block 11S.It shouldbe appreciated that the cylinder measurement can be used asat least one part of a skew function which the system mayapply to other diagrams and figures displayed for the first eye.The skew function is intended to correct for any astigmatismthat the patient may have in the eye being tested. As such, theskew function will make any diagram or figure it is appliedappear distorted to a corrected eye, while appearing clear to acorrected eye.

It should be appreciated that blocks 112 through 120should be repeated, separately, for the second eye of thepatient. After repeating blocks 112through 120 for the secondeye, it should further be appreciated that the axis measure-ment and cylinder measurement for the second eye can beused as parts of a skew function which the system may apply

US 9,237,842 B210

to other diagrams and figures displayed for the second eye inthe same way those measurements were described as beingused for the first eye. It should further be appreciated that, inone embodiment, immediately after completing blocks 112through 120 for a first eye, the patient may switch to theirsecond eye and again work through blocks 112 through 120.In an alternative embodiment, the patient may go on to otherblocks, for example, blocks 122 through 130, with their firsteye, before returning to blocks 112 through 120 for theirsecond eye.

At block 122, the system displays a first figure to the patienton the computerized screen intended for a first eye (eitherright or left) of the patient. The first figure is displayed suchthat it is too small to be clearly seen by the patient. It shouldbe appreciated that the patient should view the first figure withtheir uncorrected first eye, i.e. if they wear glass or contacts,they should remove them and view the figure without thecorrection of their glasses or contacts. In one exampleembodiment, the first figure is distorted by the skew functiondetermined with the patient inputs of blocks 114 and 11S forthe patient's first eye. In another example embodiment, thefirst figure is not distorted by the skew function.

The system receives an input from the patient regardinghow they view the first figure with their first eye, wherein theinput from the patient corresponds to a first sphere measure-ment, as indicated by block 124.

As indicated by block 126, the system displays a secondfigure on the computerized screen, wherein the second figureis displayed such that it is large enough to be clearly seen bythe patient. In one embodiment, the first figure and secondfigure are the same figure. In another embodiment, the firstfigure and the second figure are different figures. In oneembodiment, the second figure is distorted It should be appre-ciated that the patient should view the second figure with theiruncorrected first eye. i.e. if they wear glass or contacts, theyshould remove them and view the figure without the correc-tion of their glasses or contacts. In one example embodiment,the second figure is distorted by the skew function determinedwith the patient inputs ofblocks 114and 11Sfor the patient' sfirst eye. In another example embodiment, the second figure isnot distorted by the skew function.

The system receives an input from the patient regardinghow they view the second figure with their first eye, whereinthe input from the patient corresponds to a second spheremeasurement, as indicated by block 126. The system aver-ages the first and second sphere measurements to determine afinal sphere measurement, as indicated by block 130. Itshould be appreciated by one of skill in the art that the systemcan determine a final measurement in any suitable manner,and it final measurement need not be the product ofan straightaverage. For example, the system may use only the last-inputresult, only the first-input result, some weighted averagebased on statistical variance from other inputs, or the systemmay completely ignore inputs it considers to be of such a greatstatistical variance from other inputs that it is likely to be inerror.

It should be appreciated that blocks 122 through 130should be repeated, separately, for the second eye of thepatient. It should further be appreciated that, in one embodi-ment, immediately after completing blocks 122 through 130for their first eye, the patient may switch to their second eyeand again work through blocks 112 through 130 for theirsecond eye. In an alternative embodiment, the patient mayhave already completed blocks 112 through 120 with theirsecond eye.

It should further be appreciated that the system may repeatsets of blocks 122 and 124 any number oftimes, in any order,

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and may alternate sets of blocks 122 and 124 with sets ofblocks 126 and 12S any number of times. In one exampleembodiment, the system works through blocks 122 through12S for an eye of the patient, then repeats blocks 122 and 124again for the same eye before moving on to block 130.In thisexample embodiment, the three resultant sphere measure-ments are averaged to determine the final sphere measure-ment at block 130. In another example embodiment, the sys-tem works through blocks 122 and 124, then repeats blocks122 and 124, then also works through blocks 126 and 12S twotimes. In this example embodiment, the four resultant spheremeasurements are averaged to determine the final spheremeasurement at block 130.

As indicated by block 132, the system displays on thecomputerized screen a query to the patient regarding whetherthey would like a glasses prescription, a contacts prescription,or both. At block 134, the system receives an input from thepatient regarding their desired prescription or prescriptions.

The system displays pricing information to the patient, andconventionally enables the patient to select a method of pay-ment and to provide payment information, as indicated byblock 136. Enabling the patient to select their method ofpayment and to provide payment information may be accom-plished via a fillable form, fillable fields, or some other way,as is well-known in the art. The system receives at least oneinput from the patient regarding their desired method of pay-ment and their payment information, as indicated by block13S, and provides the patient their requested and paid-forprescription or prescriptions, as indicated by block 140.

In one embodiment, before the patient receives their pre-scription, it is sent to one or more doctors to sign off on thevarious determined refractive error measurements. Forexample, the system may send the axis measurement to besigned offupon by one doctor, the cylinder measurement to besigned off upon by another doctor, and the sphere measure-ment to be signed off upon by a third doctor. In an alternativeexample, the system may send all three measurements to thesame doctor for sign off. It should be appreciated that anycombination ofdoctors signing offon any part of the prescrip-tion may be employed for any combination of cost and timeeffectiveness considerations.

It should be appreciated that the system may enable thepatient to make an input regarding how or where to send theirselected prescription after they have received it. In oneembodiment, the system may send the prescription data to anoptometrist's or ophthalmologist's offices, a central glassesand/or contacts fulfillment company, a glasses and/or con-tacts retail location (physical or virtual), or the like. In afurther embodiment, the patient may select where to send theprescription by choosing from a list, a map, entering a name,or some other method.

In another embodiment, the system may enable a patient tobrowse eyeglass frames. In such an embodiment, the systemmay display an image of the patient with mock eyeglassframes displayed over the top of the patient's face, and mayenable the patient to modify the appearance of the frames, forexample, by changing the size, shape, color, material, texture,etc. of the mock frames. In another further embodiment, thesystem may determine a location for the mock lenses on theface of the patient in any suitable manner, such as via knownfacial or pupil recognition systems, or via a system-recogniz-able physical frame provided to and worn by a user. In anotherfurther embodiment, the system may display instructions fora patient to purchase their desired frames online, at a physicalstorefront location, or to have them shipped to a desiredlocation.

US 9,237,842 B212

It should be appreciated by one of skill in the art that theapplicant has surprisingly discovered, and disclosed herein, anovel inversion of the conventional method of determiningthe refractive error for a patient. In the conventional tech-nique, the patient is located far from a figure or diagram, andlenses of various strengths and configurations are placedbefore the patient's eyes. The patient provides subjectivefeedback on which of the lenses provides better vision qual-ity. The doctor or technician refines the prescription bychanging the lenses placed in front of the patient's eyes, untilthe subjective feedback from the patient indicates that the bestvision quality has been accomplished by one of the providedlenses. In contrast, the embodiments of the present disclosuredo not require any lenses. It should be appreciated that thediagrams and figures themselves are adjusted by the inputs ofthe patient, and thus the necessary prescription may be deter-mined, in whole or in part, from factors such as: the distancebetween the patient and the computerized screen, the originalsize of the diagram or figure on the computerized screen, thepatient-adjusted size of the diagram or figure on the comput-erized screen, the number of inputs received from the patient,the amount of incremental effect of each input, and otherrelevant factors.

It should further be appreciated that, in some embodimentsof the present disclosure, the patient may indicate to a secondperson which input should be made. In those embodiments,the second person would perform the input to the computer-ized screen, based on the instructions of the patient. Thesecond person may be any suitable person, including a friendof the patient, family member of the patient, doctor, officeassistant, office technician, or any other person.

It also be appreciated that the present disclosure is notlimited to a single computerized screen. In some embodi-ments, the patient may use more than one computerizedscreen, on one or more patient terminals, to interact with thesystem. In another embodiment, the patient and the secondperson may interact with the system on the same patientterminal and/or computerized screen. In still another embodi-ment, the patient and the second person may interact with thesystem on different patient terminals and/or computerizedscreens.

In another embodiment the system may allow a patient tobegin the process and method in one location, such as a brickand mortar location, and continue or complete the process andmethod in at least one other location, such as in their home. Itshould be appreciated that in such an embodiment some kindofunique patient identification would be used to authenticatethat the same patient is interacting with the system in the firstlocation and the additional location(s). Such authenticationsystems are known in the art and described below.

In another embodiment, a patient may use one computer-ized screen to control another computerized screen. Forexample, the system may enable a patient with a smartphoneto use the smartphone as a remote to control another patientterminal with a computerized screen, such as a kiosk, per-sonal computer, or tablet computer in order to interact withthe system. In one example of such an embodiment, thesystem would send a patient a link to their remote device, suchas via email or SMS text message. The patient is enabled toaccess the link to launch an interface, such as via a browser,which can then be used to interact with the system in a uniquehand held manner. In another example embodiment, theremote device interacts with the system through an applica-tion stored on the remote device, commonly known as an"app."The remote device may be any suitable device, such asa cell phone, smart phone, tablet, notebook, or other remotedevice, that is capable of interacting nearly-instantaneously

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with the system to receive instructions and enable the patientto make at least one input to the system over at least onecommunication interface, such as the internet, text messag-ing, email, voice, or data, to control the computerized screenfrom a distance. It should be appreciated by one of skill in theart that such a system is unique in that it allows a patient totake a medical examination with their own smartphone orother remote device, and fully be able to control the exami-nation.

In another embodiment, the system uses a voice recogni-tion system to enable a patient to make at least one input. In afurther embodiment, the system includes a voice recognitionsystem for conducting an eye examination, or a sub-exami-nation of an eye examination. In a such an embodiment, thesystem would enable a user to make an input by speaking tothe system, equipped with a microphone and conventionalvoice recognition software. As is known in the art, micro-phones and voice recognition software are readily commer-cially available and use standard voice recognition formulaswhich embed a conventional automatic learning system, sothat the system would be able to adapt to more difficultlanguages over time. The system would receive voice inputsfrom the patient to record and analyze them using the con-ventional voice recognition software. It should be appreciatedby one of skill in the art that enabling a patient to provideinputs via their voice would provide several benefits. First, thepatient that is taking constituent tests of an examination, suchas an eye examination, would not need to see the details of thescreen perfectly clearly, and could utilize their hearing (com-municated through spoken instructions) and speaking (to pro-vide inputs back to the system) instead, which is more user-friendly since it is easier to use and provides additionaloptions for inputting responses. This is especially relevant forportions of the system in which the patient is using an uncor-rected eye, is somewhat distant from the computerizedscreen, or both. Another benefit of such a system is that itenables a patient to use their hands for purposes other thanproviding inputs to the system. For example, the patient maythen be free to hold up test object, or to cover their eyes.Further, the use of a system which speaks to the patient andallows the patient to respond by speaking back simulates amore typical doctor's office-based subjective eye examina-tion, and may help patient's assimilate to the system of thepresent disclosure.

Referring now to FIGS. 2A and 2B, an embodiment of thepresent disclosure is illustrated. The example system of FIG.2A includes a display 200 which the system shows on theabove-described computerized screen. The display 200includes progress bar 202, 204, 206, and 20S. It should beappreciated that the progress bar may be any suitable progressmeter. In the embodiment of FIG. 2A, the progress bar 202,204, 206 and 20S is a secti oned progress bar where the sectioncurrently being worked on 202 is indicated by being a darkercolor than the other sections. It should be appreciated that fora sectioned-type progress bar, or other types of progressmeters, the indication of the section being worked on can beany variation in color, size, font, text, or otherwise. In anotherembodiment, the sections of the progress bar are selectable bythe patient, such that the patient can move through the process100 by selecting the section of the process to which they wishto go. In a different embodiment, the sections are not select-able by the patient to move the patient through the varioussections.

In the embodiment illustrated by FIGS. 2A and 2B, thesystem provides instructions for the patient regarding how towork through the section 202, and further provides verbal

13US 9,237,842 B2

14instructions which the patient can control, turn off, turn on,and/or adjust by articulating the verbal direction control ele-ments 210.

As illustrated by the embodiment shown in FIGS. 2A and2B, the system queries the patient regarding whether theyhave their prior glasses or contacts prescription 212. Thepatient is enabled to respond to the query by selecting one ofthe radio buttons 214 or 216. It should be appreciated that anyother method for accepting a response to a query from thepatient may be employed by the system, such as a drop downlist, a fillable field, and/or a check box.

In the embodiment ofFIG. 2A, when the patient selects theradio button corresponding to "YES"214, the system pro-vides the fillable form 218 through 264. The system enablesthe patient to upload a picture of a prior glasses prescription218 and/or a prior contacts prescription 236. The system alsoenables the patient to enter their prior prescription data intothe conventional fillable fields 220 through 234 and 238through 264. Specifically, the fillable form has fields for theglasses prescription of the patient's right eye, or "OD" 220,222, 224, and 226. "OD" is the common acronym for the latin"oculus dextrus, "which means "right eye."The fillable formalso has fields for the glasses prescription of the patient's lefteye, or "OS" 228, 230, 232, and 234. "OS" is the commonacronym for the latin "oculus sinister. " which means "lefteye."More specifically, fillable fields 220 and 228 are for thesphere, or "SPH,"orpowermeasurement ofthepatient's rightand left eyes, respectively. The sphere measurement repre-sents the degree of nearsightedness or farsightedness of thepatient. The unit of the sphere measurement is the diopter. Aplus sign "+"in front of the sphere measurement indicates theamount of farsighedness of the patient, while a negative sign"—"in front of the sphere measurement indicates the amountof nearsightedness of the patient. The more positive (forfarsighted people) or negative (for nearsighted people) thesphere measurement is, the more severe the refractive error,and thus, the more powerful the corrective lenses must be tocorrect for the error.

The cylinder, or "CYL"fields 222 and 230 for the right andleft eye, respectively, and the axis fields 224 and 232, for theirright and left eye, respectively, indicate that the patient has anastigmatism in the corresponding eye. If no astigmatism ispresent, the cylinder and axis fields are conventionally leftblank. The cylinder measurement indicates the severity, indiopters, of the astigmatism in the patient's eye. The biggerthe cylinder measurement, the more severe the astigmatism ofthe patient. The axis measurement is a number between 0'and 180'. The unit of the axis measurement is degrees. Theaxis measurement indicates the axis along which the patient' svision is distorted due to the imperfections in the curvature ofthe cornea.

The combination of sphere, cylinder and axis measure-ments make up the distance vision portion ofthe conventionaleyeglasses or contacts prescription. The remainder of theglasses prescription is directed to the near vision portion ofthe prescription, and is generally for reading glasses or thereading portion of bifocal corrective lenses. The ADD fields226 and 234, respectively for the right and left eyes of thepatient, represent the additional refractive power, in diopters,to be added to the spherical power in order to allow the patientto read up-close if they are presbyopic. Ifthe patient needs nocorrection for distance vision, the ADD power alone would bethe patient's prescription for conventional reading glasses,available at most drugstores and/or convenience stores.

In an example embodiment, the system enables a patient todetermine the ADD power for those patients who require it.Those patients are referred to as presbyopic emmetropes

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(those that do not require spectacle correction for distance),and their presbyopia is generally a result of aging, typicallyoccurring around approximately 40 years old. This is the ageperiod when a patient generally begins to need readingglasses. However, in the past, in order to determine a correctreading glasses ADD number, or to create a proper no-linedprogressive bifocal spectacle or contact lens, patients neededto go to an eye doctor's office to obtain the proper measure-ment. Applicants have surprisingly found, however, a systemfor determining the power for both top and bottom portions ofbifocal lenses which avoids the need to visit a doctor's officeor endure a full and lengthy examination at the office. Thesystem queries the patient regarding their age, the size offigures they are able to see with their uncorrected eyes (viaany of the methods or processes disclosed herein), and thedistance they desired to be corrected for (ke. a patient maydesire a single pair of glasses to see both books at 16 inchesand to see other objects at 21 inches (or any other combinationof top segment and bottom segment)). It should be appreci-ated that the desired distances can be determined by anysuitable method, such as via a computerized screen as dis-closed herein (such as a smartphone), a simple printable papermeasurement aid, via estimation with a length of paper. Thesystem may also enable a patient to estimate the distancerange they most desire to be corrected for, such as the distancerange they use most often, in easily estimable terms, such asarms length, further than arms length, or closer than armslength. The system utilizes such inputs from the patient todetermine a custom prescription for no-line bifocals or singlereading glasses without guessing or requiring a trip to a doc-tor's oflice and its associated expenses.

As shown in FIG. 2A, the contacts prescription includesmany of the same measurement fields as the glasses prescrip-tion. Specifically, the sphere measurement fields, 238 and252; the cylinder measurement fields, 240 and 254; the axismeasurement fields, 242 and 256; and the add measurementfields, 244 and 258, for the right and left eyes, respectively,are also present in the contacts prescription. Although thefields have the same names and abbreviations, contacts pre-scriptions and glasses prescriptions can be different, partlybecause the lenses of glasses are further from the surface ofthe eye than contacts.

In addition, the system provides the additional measure-ment fields for the base curve, or "BC," 246 and 260, thediameter, or "DIAM," 248 and 262, and the name of thecontacts brand and/or manufacturer, 250 and 264. During thetime when only hard, gas permeable contact lenses wereavailable, the base curve and diameter measurements werenecessary to ensure the comfort of the rigid lenses. With therise of soft, flexible contact lenses, many contact lens manu-facturers only provide one, two, or a few different base curveor diameter options for their lenses. If the base curve anddiameter measurements are known from a prior prescription,and the patient was comfortable in those lenses, then otherlenses with those same measurements are highly likely to alsobe comfortable for the patient, even if the manufacturer isdifferent. If the manufacturer is the same, it is even morelikely that the patient will be comfortable in lenses with thesame measurement. In this way, it should be appreciated thata contacts "fitting" is generally unnecessary for those whohave previously worn contacts, so long as the patient wascomfortable in their prior lenses. In one embodiment, forpatient-identified prior contacts manufacturers or brandnames, the base curve and diameter measurements can belooked up by the system in a lookup table or other memorydatabase. In another embodiment, the system can automati-

15US 9,237,842 B2

16cally fill in, or populate, any possible fields 246, 24S, 260,and/or 262 with the looked-up base curve and diameter mea-surements.

In an embodiment, the system can use the prior prescrip-tion information as a check on the determined current pre-scription. In a further embodiment, the system can requiremore tests from a patient to confirm the current prescription ifthere is a statistically significant difference between a value ofthe prior prescription and the corresponding value of thedetermined prescription.

In one embodiment, the system is capable of reading theuploaded picture or scan of the prior glasses prescription 21Sand/or the prior contacts prescription 236. In a furtherembodiment, the system may automatically fill in, or popu-late, any possible fillable fields with information read fromthe uploaded prior glasses prescription 21S and/or the priorcontacts prescription 236. In another embodiment, the patientmay upload a photograph or scan of a prior contacts box orcontainer and the system may automatically fill in, or popu-late, any possible fillable fields with information read fromthe uploaded photograph or scan of the prior contacts box orcontainer. In another embodiment, the system is capable ofrecognizing conventionally encoded information, such asinformation from a barcode. QR code, matrix code, Azteccode, or other known types of encoded information. In afurther embodiment, the system is capable of scanning theencoded information from a prior glasses or contacts pre-scription, and/or a prior glasses or contacts box or container.In a still further embodiment, the system may automaticallyfill in, or populate, any possible fillable fields with informa-tion read from the scanned prior glasses or contacts prescrip-tion, and/or a prior glasses or contacts box or container.

After the patient fills in whatever data the patient has avail-able from prior prescriptions, the system queries the patientregarding what appears more blurry or out of focus for themwhen they are not using corrective lenses 26S. Again, in theexample embodiment of FIG. 2A, the system provides radiobuttons 270, 272, and 274 for the patient to select an answer,but any suitable method for enabling an input to the querywould be acceptable. If the patient selects distance 270 asbeing more blurry, this may suggest that they are nearsighted,and they may have some astigmatism. If the patient selectsnear 272 as being more blurry, this may suggest that they arefarsighted, and they may have some astigmatism. If thepatient selects both as being equally blurry 274, they may benearsighted or farsighted, and they likely have an astigma-tism.

As illustrated in the embodiment of FIG. 2B, when thepatient responds to the query regarding whether they have aprior prescription with "NO."the system does not display thefillable form and fields 21S through 264, as in FIG. 2A.Instead, in the embodiment of FIG. 2B, the system movesdirectly to a presentation of query 26S and enables the patientto respond via radio buttons 270, 272 and 274, just as in FIG.2A.

Referring now to FIG. 3, another embodiment of thepresent disclosure is illustrated. At this stage of the process,the system presents display 200, and the progress bar indi-cates that the patient is currently in the Astigmatism Anglesection 204. The eye tracker 302, 304 indicates which eye isbeing tested. It should be appreciated that the eye tracker maybe any suitable progress meter. In the embodiment of FIG. 3,the eye tracker 302, 304 is a sectioned eye tracker where thesection corresponding to the eye being tested 302 is indicatedby being a darker color than the other section correspondingto the other eye. It should be appreciated that for a sectioned-type eye tracker, or other types of progress meters, the indi-

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cation of the eye being tested can be any variation in color,size, font, text, or otherwise. In another example embodi-ment, the sections of the eye tracker 302, 304 are selectable bythe patient, such that the patient can change the eye beingtested by selecting the section corresponding to the other eye.In a different embodiment, the sections are not selectable bythe patient to change the eye being tested.

As can be seen by reference to FIG. 3, the eye tracker 302,304 indicates that the eye being tested is the left eye, indicatedby the darker shading of the left eye section 302. Writteninstructions 306 are provided to the patient, along with verbalinstructions, which the patient can control with verbal direc-tion control elements 210. In the example embodiment shownin FIG. 3, the written directions read "Cover your right eye.Select the line that is darker, thicker or more prominent. Ifthree lines are darker, thicker or more prominent then selectthe middle. If two lines are darker, thicker or more prominentthen select the middle button between those lines. "The direc-tions 306 refer the patient to the diagram 310.Diagram 310 isa known diagram for diagnosing the axis of an astigmatism.Patients with an astigmatism will see the lines around the axisof their astigmatism as more bold, or in better focus, then theother lines of the diagram. The lines correspond to anglemeasurements. In this example embodiment, the lines areevenly spaced at intervals of 15'. It should be appreciated thatany suitable angular interval may be employed by the dia-gram 310.The system enables the patient to make an input ofa line, or the centermost part of a group of lines, which aremore prominent when the patient views the diagram. It shouldbe appreciated that the patient is viewing the diagram withtheir uncorrected eye.

In the embodiment shown in FIG. 3, the letters A through S30S, as well as the smaller letter combination buttons 310 areselectable to indicate the axis angle of the patient. It should beappreciated that the axis line selectable icons 30S. 310 neednot be letters, but could be numbers, the angle measurement,pictures, symbols, or any other suitable icon. As shown inFIG. 3, the letter "A" 30Sa corresponds to an axis of 0', theletter "G"30Sb corresponds to an axis of 75', the letter "I"30Sc corresponds to an axis of 90', the letter "0"30Sd cor-responds to an axis of 165', and the letter S 30Se correspondsto an axis of 180'. In another example embodiment, thesystem provides a button for the patient to indicate that noneof the lines in the diagram appears as darker, thicker or moreprominent, indicating that the patient does not have an astig-matism in that eye. In a further example embodiment, whenthe patient makes at least one input which indicates that theydo not have an astigmatism in the eye being tested, the systemmoves on to test the other eye for an astigmatism. In anotherembodiment, when the patient makes at least one input whichindicates that they do not have an astigmatism in the eye beingtested, the system moves on to the eye test for that same eye,skipping the section testing the astigmatism severity for thateye. In an alternative embodiment, when the patient makes atleast one input which indicates that they do not have anastigmatism in the eye being tested, the system still tests theseverity of any astigmatism in that eye as a double-check thatthe patient does not have an astigmatism in that eye.

It should be appreciated that, after selecting the line or linesofthe patient' s axis measurement for the patient' s left eye, asshown in FIG. 3, the system may repeat the same test withdiagram 310 for the right eye by moving the eye tracker 302,304 to indicate that the right eye 304 is being tested, and byadjusting the written instructions 306 to reflect that the righteye is now being tested. In another embodiment, the patientcontinues to work through the sections of the progress barwith the left eye, and, after completing the astigmatism sever-

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18ity test 206 for the left eye, will repeat the two astigmatismsections 204 and 206 for the right eye before moving on to theeye test 20S for either eye. In another embodiment, the patientworks through all sections 204, 206, and 20S with one eye, theleft eye, for example, before going back to work through eachsection 204, 206, and 20S with the other eye, in this example,the right eye. It should further be appreciated that any order oftesting, with any order of eyes being tested is suitable. Itshould further be appreciated that by providing patient-se-lectable progress bar sections 204, 206 and 20S, and eyetracker sections 302 and 304, the patient may select which-ever order they prefer.

Referring now to the embodiment illustrated in FIG. 4A,another example embodiment of the present disclosure isillustrated. At this stage of the process, the system presentsdisplay 200, and the progress bar indicates that the patient iscurrently in the Astigmatism Severity section 206. The eyetracker 302, 304 indicates that the left eye 302 is being tested.The written directions 406 read: "Cover your right eye. l.Keep Right Eye covered. 2. Click the (+) until the grid is allperfect squares. " The written instructions refer to diagram40Sa, which shows a large square divided into several smallersquares. The system provides patient-selectable icons 410and 412 to adjust the diagram until the patient views all of thegrid of diagram 40Sa as perfectly square. When the patientviews all of the grid of diagram 40Sa as perfectly square, thepatient selects the patient-selectab le icon 414. If the system ismalfunctioning in some way, the system provides a button41S to request assistance with the malfunction. It should beappreciated that button 41S is optional, but useful in the casethat the animation of the diagram changing is not visible to thepatient. It should further be appreciated that diagram 408a inFIG. 4A is illustrated as it would appear to a patient withoutan astigmatism, or to a patient with an astigmatism who iswearing their corrective lens on the eye being tested. In otherwords, the boxes of diagram 40Sa are square in FIG. 4A, butwould appear distorted to an uncorrected eye with an astig-matism.

The applicant has surprisingly found that use of the gridshown as diagram 40Sa can be used to determine the cylinderprescription of a patient by measuring the amount of distor-tion is necessary, along the patient's axis of astigmatism, inorder for the patient to view the figure as square to theiruncorrected eye.

Referring now to the embodiments illustrated in FIGS. 4B,4C, 4D and 4E, other embodiments of the present disclosureare illustrated. In the embodiments of these figures, thepatient has selected icons 30Sa, 308b, 308c, 30Sd, and 30Seof FIG. 3, respectively. Thus, the corresponding diagrams ofthose FIGS. 408b, 408c, 40Sd, and 40Se, respectively, areillustrated as being stretched along the patient-selected axisfor that figure. Specifically, FIG. 4B shows the diagram 408bdistorted along the 75' axis, FIG. 4C shows the diagram 408cdistorted along the 90' axis. FIG. 4D shows the diagram 40Sddistorted along the 165' axis, and FIG. 4E shows diagram40Se distorted along the 180' axis. If the patient selects the"+"412, the diagram elongates along the axis. If the patientselects the "—"410, the diagram contracts along the axis. Inthis way, the patient can manipulate the diagram until theboxes appear square to their uncorrected eye. As the patientmanipulates the diagram, scale 416 provides a visual repre-sentation to the patient of how much they have changed thediagram 408b, 408c, 40Sd, or 40Se.

It should be appreciated that the system may distort thediagram in any suitable way, at any suitable speed, and at anysuitable increment. In one embodiment, the system automati-cally distorts the diagram prior to enabling the patient to make

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an input. In another embodiment, the system automaticallybegins distorting the diagram, and continues to distort thediagram until the patient makes an input to stop the distortion.In a further embodiment, the patient may further adjust thedistortion of the diagram by making at least one input. Inanother further embodiment, the patient may not furtheradjust the distortion of the diagram by making any inputs. Inanother embodiment, the system does not distort the diagramprior to receiving at least one input from the patient.

Referring now to the embodiment illustrated in FIG. 5,another embodiment of the present disclosure is illustrated.As shown in FIG. 5, the patient has manipulated diagram 40Sfsuch that, to the patient's uncorrected eye, the boxes appearsquare. Scale 416 demonstrates that the diagram 40Sf hasbeen manipulated. At this point, the patient can press the icon414 indicating that they view the boxes of the diagram 40Sfassquare. The system determines, from the amount of manipu-lation ofdiagram 40Sf a cylinder measurement for that eye ofthe patient.

It should be appreciated that the combination of the axismeasurement and the cylinder measurement for a given eye ofthe patient can be used by the system to determine a skewfunction to apply to further diagrams and figures intended forthe given eye. In this way, the astigmatism will not affect theresults ofthe eye test, for example, because the figures used inthe eye test will have been modified to counter the effect oftheastigmatism.

Referring now to the embodiment illustrated in FIG. 6,another example embodiment of the present disclosure isillustrated. At this stage of the process, the system presentsdisplay 200, and the progress bar indicates that the patient iscurrently in the Eye Test section 206. Specifically, the display200 in FIG. 6 is directed to calibrating a camera which may beattached to the computerized screen to determine the distanceof the patient from the computerized screen. The system mustknow the distance of the patient in order to accurately calcu-late the sphere measurements from the eye tests. If thepatient's computerized screen does not have a camera, thesystem will provide the patient a specified distance to remainaway from the screen. This distance may be the same ordifferent for each instance of the "small-to-large"eye test(described at blocks 122 and 124 of FIG. 1A) and/or eachinstance of the "large-to-small" eye test (described at blocks126 and 12S of FIG. 1A).

The written instructions 606 of the example embodimentillustrated by FIG. 6 read: "1.Hold a credit card with themagnetic strip facing the camera. 2. Place the card 11"fromthe camera. 3. Use a piece of paper to measure 11".Roll thepaper the long way. Place one end touching the screen near thecamera and the other touching the credit card. Remove thepaper and keep the card in place. Click the Calibrate button. 4.Click on the magnetic strip in the picture. 5. When magneticstrip is highlighted click the Done button. " Camera viewer610 shows the patient what the camera is viewing. The patientcan follow the instructions to click the Calibrate button 612and the Done button 614 in accordance with the writteninstructions. It should be appreciated that any other suitableor conventional method of calibrating the distance betweenthe patient and the computerized screen may be employed.

It should be appreciated that any suitable distance betweenthe patient and the screen may be used. In one embodiment,the distance between the patient and the screen is determinedbased on whether the patient is nearsighted or farsighted. In afurther embodiment, the system determines that the distancebetween the patient and the screen is the same for a near-sighted patient and a farsighted patient. In another embodi-ment, the system determines that the distances between the

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20patient and the screen are different for a nearsighted patientand a farsighted patient. In one embodiment, the system maydetermine the distance between the patient and the screendepending on the kind, type, dimensions, or other character-istics of the screen. In another embodiment, the patient maybe enabled to make an input regarding whether the deter-mined input is difficult for the patient to use. In a furtherembodiment, the system may determine a new distancebetween the patient and the screen after the patient makes aninput regarding whether the determined input is difficult forthe patient to use.

In another example embodiment, they system or patientterminal may utilize mirrors to simulate the a greater or lesserdistance between the patient and the computerized screen,such as is conventional in projection technology, or in, forexample, a optometrist' s office. In a further example embodi-ment, the mirrors are adjustable based on the location of thepatient, such that the patient may move and the mirrors mayadjust to account for the movement to maintain the samesimulated distance.

In an additional example embodiment, the system mayquery the patient for their shoe size and gender and, using thatinformation, have the patient estimate their distance from thecomputerized screen via heel-to-toe measurement and enterthat distance into the system. In an alternative exampleembodiment, the system may instruct the patient to take adetermined number of heel-to-toe steps from the computer-ized screen, placing the patient at a fairly accurate distancefrom the computerized screen.

Referring now to the embodiment illustrated in FIG. 7A,another embodiment of the present disclosure is illustrated.At this stage of the process, the system presents display 200,and the progress bar indicates that the patient is currently inthe Eye Test section 206. The eye tracker 302, 304 indicatesthat the left eye 302 is being tested. For systems with cameras,the system provides a calibration box 70S with an estimate ofthe distance of the patient from the camera/computerizedscreen. In one embodiment, the system uses the camera-measured distance of the patient from the screen to determinea font size or an icon size to display to the patient as part offigure 710.

The written instructions 706 read: "Cover your right eye.Move your face 28 inches from the screen. Click "I can see"when you can just barely recognize the letters from thatdistance. DON'T WAIT UNTIL IT IS CLEAR! Use the+ and—to make sure the letters are just barely recognizable. "Thewritten instructions refer to figure 710, which in this embodi-ment is a series of letters. It should be appreciated that anysuitable kind or number of visual cues, symbols, shapes, oricons can make up the figure 710, such as letters, numbers,pictures, or the like. As shown in FIG. 7A, the system pro-vides patient-selectable icons 712 and 716 to adjust the figureuntil the patient views the figure as just barely being able tomake out the letters of the figure. When the patient views thefigure and can just barely make out the letters, the patientselects the patient-selectable icon 414. In one embodiment,the figure 710 starts small enough that the figures cannot beclearly seen by the patient, and the patient must make at leastone input to increase the size of the figure until it can justbarely be made out. In another embodiment, shown in FIG.7B, the figure starts large enough to be clearly seen by thepatient, and the patient must make at least one input todecrease the size of the figure just until the figure can nolonger be made out.

The system determines a sphere measurement from at leastone input from a "small-to-large" eye test. The system deter-mines another sphere measurement from at least one input of

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a "large-to-small" eye test. As discussed previously, the"small-to-large" eye test and the "large-to-small" eye testmay be performed any number of times, in any order, for eacheye, with each eye test resulting in a sphere measurementdetermined from the at least one input of the patient. In oneembodiment, the system may perform only the "small-tolarge" eye test, and not the "large-to small" eye test. Inanother embodiment, the system may perform only the"large-to small" eye test, and not the "small-to large" eye test.Either or both eye tests may be performed one or more timesper eye of the patient. When the system has provided allinstances of the eye test to both eyes, the system averages thesphere measurements from the eye test instances to determinea final sphere measurement. It should be appreciated that thesystem may determine not to use a given sphere measurementin the final sphere measurement if it is a statistically signifi-cant unit of measurement away from the average of theremaining resultant sphere measurements.

In one embodiment, the system takes the mean of theresultant sphere measurements as the final sphere measure-ment. It should be appreciated that the system may adjust thesize of the figure in any suitable way, at any suitable speed,and at any suitable increment. In one embodiment, the systemautomatically increases (for the "small-to-large" test) ordecreases (for the "large-to-small" test) the figure prior toenabling the patient to make an input. In another embodiment,the system automatically begins increasing or decreasing thefigure, and continues to increase or decrease the figure untilthe patient makes an input to stop the increasing or decreas-ing. In a further embodiment, the patient may further adjustthe size of the figure by making at least one input. In anotherfurther embodiment, the patient may not further adjust thesize of the figure by making any inputs. In another embodi-ment, the system does not increase or decrease the figure priorto receiving at least one input from the patient.

It should be appreciated that the above-described embodi-ments ofthe present disclosure may be implemented in accor-dance with or in conjunction with one or more of a variety ofdifferent types of systems, such as, but not limited to, thosedescribed below.

Referring now to FIGS. SA, SB, SC and SD, anotherembodiment of the present disclosure is illustrated, whereinthe system displays at least one colorblocked diagram S00and enables a patient to make at least one input to select amore defined-appearing pan ofthe diagram, wherein the inputcorresponds to a determination that the patient is near or farsighted (if not wearing corrective lenses), over or under cor-rected (if wearing corrective lenses), or otherwise. The col-orblocked diagram S00 may be presented once, twice, ormore in a series, for each eye. The colorblocked diagram S00may be the same or slightly different for each presentation tothe patient. In the examples shown in FIGS. SA, SB, SC, andSD, the colorblocked diagrams S00 are slightly different.

The colorblocked diagram S00 has at least two parts,shown as part S02 and part S04. In the embodiment shown inFIGS. SA-D, parts S02 and S04 are semicircles having abackground color. In the examples shown in FIGS. SA-D, partS02 has a brighter background color, while part S04 has aduller background color. It should be appreciated by one ofskill in the art that any suitable brighter and duller colors, maybe used as the background color ofparts S02 and S04, respec-tively. In one embodiment, part S02 has a background fromthe green family of colors (including the various colors ofgreen from dark to light, bright to dark, and mixed with othercolors, i.e. yellow-green or blue-green), while part S04 has abackground from the red family ofcolors (including the vari-ous colors of red from dark to light, bright to dark, and mixed

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22with other colors, i.e. purple-red or red-orange). In anotherembodiment, part S02 has a background from the yellowfamily, while part S04 has a background from the purplefamily.

Parts S02 and S04 further include a plurality of lines ofvarious lengths S06 that, when placed closed together andviewed from a short distance, appear as an arrowhead shape.In each of FIGS. SA-D, the arrow directions face away fromeach other, and are comprised of horizontal or vertical linesS06. It should be appreciated by one of skill in the art that anysuitable number of lines (straight or curved, in any suitabledensity), arranged into any suitable direction, making up anysuitable aggregate shape may be used. In another furtherembodiment, the lengths S06 may be replaced by solid orsemi-solid shapes, such as circles, squares, triangles, letters,numbers etc. It should further be appreciated that parts S02and S04 may be shapes other than semicircles, such as halfsquares, half triangles, etc.

As discussed above, the colorblocked diagram S00, in oneor more of its configurations, may be used to determinewhether a patient is near or far sighted if not wearing correc-tive lenses. The system may instruct the patient to remove anycorrective lenses, such as glasses or contacts, before using thesystem. The system presents a colorblocked diagram to oneeye of the patient, and enables the patient to make an inputregarding which of the arrow parts appears more distinct totheir uncorrected eye. In one embodiment, the patient mayselect that part S02 with the brighter background looks moredistinct (ke. sharper or more defined), that part S04 with theduller background looks more distinct, or that the arrows onparts S02 and S04 are about equally distinct. In general, aselection that part S02 with the brighter background is moredistinct than part S04 with the duller background suggeststhat the patient is farsighted. In general, a selection that partS04 with the duller background is more distinct than part S02with the brighter background suggests

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