Wavefront by Method of Ray Tracing: Because the Eye is Not a Telescope Joe S. Wakil, M.D. Chairman,...
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Wavefront by Method of Ray Wavefront by Method of Ray Tracing: Because the Eye is Tracing: Because the Eye is
Not a TelescopeNot a Telescope
Joe S. Wakil, M.D.Joe S. Wakil, M.D.Chairman, Tracey Technologies, LLCChairman, Tracey Technologies, LLC
and EyeSys Vision, Inc.and EyeSys Vision, Inc.
Speaker has a Financial InterestSpeaker has a Financial Interest
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Founding Technology Founding Technology Developers:Developers:
Vasyl Molebny, DScVasyl Molebny, DSc
Kiev, UkraineKiev, Ukraine
Ioannis Pallikaris, MDIoannis Pallikaris, MD
Crete, GreeceCrete, Greece
Canadian & Swedish GovernmentsCanadian & Swedish Governments
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Why Dynamic Ray Tracing?Why Dynamic Ray Tracing?Because… the Eye is NOT a Telescope!Because… the Eye is NOT a Telescope!
Effects Refraction (ex. Night Myopia)Effects Refraction (ex. Night Myopia)Refraction is NOT a FIXED Number! Refraction is NOT a FIXED Number!
Effects Refraction (Instrument Myopia)Effects Refraction (Instrument Myopia)
Effects Quality of Vision (Aberrations) Effects Quality of Vision (Aberrations)
Where are the Sources of Where are the Sources of Aberrations? Aberrations?
How do they change with Surgery?How do they change with Surgery?Cornea:Cornea:
Lens:Lens:
Pupil Size:Pupil Size:
AccommodatioAccommodation:n:
Tear Film:Tear Film:
Astigmatism (Irreg.), Sph & other Astigmatism (Irreg.), Sph & other HOAHOA
Astigmatism, Coma & other HOAAstigmatism, Coma & other HOA
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The Eye is NOT a TelescopeThe Eye is NOT a Telescope
EYEEYE• Off-Axis designOff-Axis design• No magnification No magnification • Variable apertureVariable aperture• Variable detector res.Variable detector res.• AccommodationAccommodation• Changing fixationChanging fixation• Brain image Brain image
processingprocessing• Nature-madeNature-made
TELESCOPETELESCOPE• On-Axis designOn-Axis design• High magnificationHigh magnification• Fixed apertureFixed aperture• Constant detector res.Constant detector res.• No accommodationNo accommodation• Fixed alignmentFixed alignment• Digital image Digital image
processingprocessing• Man-madeMan-made
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Aberrometer/Wavefront Aberrometer/Wavefront TechnologiesTechnologies
• Hartmann-Shack Lenslet ArrayHartmann-Shack Lenslet Array• Tscherning AberrometerTscherning Aberrometer• Differential SkiascopyDifferential Skiascopy• Ray TracingRay Tracing
Features:Features:-Rapid, point by point, IR measurement - -Rapid, point by point, IR measurement -
no data confusion no data confusion-Pupillometry with auto-tracking/capture -Pupillometry with auto-tracking/capture -Programmable sampling (256 pts.) in -Programmable sampling (256 pts.) in
any pupil up to 8mmany pupil up to 8mm-Open Field Fixation – avoid instrument -Open Field Fixation – avoid instrument
myopia and measure Accommodationmyopia and measure Accommodation-Corneal Topography integration – -Corneal Topography integration –
able to measure Lens Aberrationsable to measure Lens Aberrations-VISX license for Custom LASIK-VISX license for Custom LASIK
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H/S Photo of patient with tight eye lid courtesy David WilliamsH/S Photo of patient with tight eye lid courtesy David Williams
Hartmann-Shack Hartmann-Shack Wavefront SensorWavefront Sensor
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Principles of TraceyPrinciples of Tracey
• Programmable thin beam ray tracing Programmable thin beam ray tracing measuring forward aberrations of the eyemeasuring forward aberrations of the eye
• Rapid sequential measurement of data Rapid sequential measurement of data points over entire entrance pupil (<50ms)points over entire entrance pupil (<50ms)
• Localization of each reflected retinal spotLocalization of each reflected retinal spot• Integration of individual retinal spots to Integration of individual retinal spots to
form Point Spread Function (PSF)form Point Spread Function (PSF)• Analysis of PSF for higher order Analysis of PSF for higher order
aberrations and other data formatsaberrations and other data formats
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Data Sample Points
Data Sample PointsData Sample Points
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Multiplying the Number of Sites
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Higher Local Density of Sites
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Overlay of Two Sets of Site Configuration
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Position sensitive detector
Objective lens
Eye optics
Retina
Ray TracingRay Tracing
Input BeamInput Beam
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Position sensitive detector
Objective lens
Retina
Ray TracingRay Tracing
Eye optics
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Position sensitive detector
Objective lens
Eye optics
Retina
Ray TracingRay Tracing
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Position sensitive detector
Objective lens
Eye optics
Retina
Ray TracingRay Tracing
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Position sensitive detector
Objective lens
Eye optics
Retina
Ray TracingRay Tracing
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Position sensitive detector
Objective lens
Eye optics
Retina
Ray TracingRay Tracing
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Refractive Error MeasurementsRefractive Error Measurements
MyopiaMyopia HyperopiaHyperopia
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Retinal Spot Diagram/Point Retinal Spot Diagram/Point Spread FunctionSpread Function
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X, µm20100-10-20
Y,
µm
40
30
20
10
0
-10
-20
Refraction MapRefraction MapRetinal Spot DiagramRetinal Spot Diagram
Wavefront MapWavefront MapAblation MapAblation Map
Data DisplaysData Displays
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Tracey AnalysisTracey Analysis
• Conoid of Sturm EvaluationConoid of Sturm Evaluation• Contrast Sensitivity DataContrast Sensitivity Data• Depth of Field AnalysisDepth of Field Analysis• Individual Data Point PSF’sIndividual Data Point PSF’s• Zernike CalculationsZernike Calculations
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Diagnostic CapabilitiesDiagnostic Capabilities
• Determine Higher Order AberrationsDetermine Higher Order Aberrations• True Point Spread Function True Point Spread Function
PresentationPresentation• Optical Media Opacity MappingOptical Media Opacity Mapping• Integrated Corneal TopographyIntegrated Corneal Topography
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Validation StudiesValidation Studies
Three independent studies of Three independent studies of Tracey vs. Manifest RefractionTracey vs. Manifest Refraction• Koch et al - 58 eyesKoch et al - 58 eyes• Slade et al - 42 eyesSlade et al - 42 eyes• Schalhorn et al - 106 eyesSchalhorn et al - 106 eyes
ResultsResults• Accuracy to manifestAccuracy to manifest <0.12 D<0.12 D• ReproducibilityReproducibility <0.12 D<0.12 D
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Post Post LASIKLASIK
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Post Post LASIKLASIK
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Post LASIKPost LASIK
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KeratoconuKeratoconuss
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NormalNormal
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NormalNormal
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Accommodating IOL
Change due to Accommodation
Far Fixation
Near Fixation
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Advantages of Ray Tracing Advantages of Ray Tracing Aberrometry Combined with Corneal Aberrometry Combined with Corneal
Topography - iTraceTopography - iTrace• Robust dynamic range to measure highly Robust dynamic range to measure highly
irregular eyes including immediately post-opirregular eyes including immediately post-op• Multi-Zone Refraction in seconds to Multi-Zone Refraction in seconds to
measure variations in refraction from normal measure variations in refraction from normal night myopes to post-op results saving chair night myopes to post-op results saving chair timetime
• Able to separate Corneal from Lenticular Able to separate Corneal from Lenticular (internal ocular) sources of aberrations with (internal ocular) sources of aberrations with EyeSys Corneal TopographyEyeSys Corneal Topography
• Improved Diagnostic Wavefront to help in Improved Diagnostic Wavefront to help in patient selection including Custom LASIK patient selection including Custom LASIK and IOL proceduresand IOL procedures
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ConclusionConclusion
The Tracey iTrace brings a new The Tracey iTrace brings a new standard of care in completely standard of care in completely
assessing vision in terms of quality assessing vision in terms of quality of vision (aberrometry) and corneal of vision (aberrometry) and corneal
topography to progress visual topography to progress visual correction diagnosis and treatments correction diagnosis and treatments
to its ultimate goals.to its ultimate goals.