U.S. patent number 3,903,871 [Application Number 05/465,800] was granted by the patent office on 1975-09-09 for ophthalmodynamometer.
This patent grant is currently assigned to The United States of America as represented by the Secretary of the Navy. Invention is credited to Gloria T. Chisum, John Nichparenko.
United States Patent |
3,903,871 |
Chisum , et al. |
September 9, 1975 |
Ophthalmodynamometer
Abstract
A portable ophthalmodynamometer, which operates in the active
compression de, includes a transparent plastic eyecup or speculum
attached to a bellows-like bladder having glass endwalls. The
eyecup fits under the eyelids and is seated against the sclera by a
headstrap attached to the bladder structure and secured around the
head. An integral adjustment gauge facilitates correct positioning
of the ophthalmodynamometer on the eyeball. An air duct extends
from the interior of the bladder structure to a hand squeeze bulb
whereby manipulation of the bulb increases the internal pressure of
the bladder structure. Increasing bladder pressure is transmitted
to the eyeball via the eyecup to thereby raise intra-ocular
pressure. Bladder pressure is related to retinal artery blood
pressure. Means are provided to ascertain the bladder pressure so
that retinal artery blood pressure may be determined.
Inventors: |
Chisum; Gloria T.
(Philadelphia, PA), Nichparenko; John (Willow Grove,
PA) |
Assignee: |
The United States of America as
represented by the Secretary of the Navy (Washington,
DC)
|
Family
ID: |
23849201 |
Appl.
No.: |
05/465,800 |
Filed: |
May 1, 1974 |
Current U.S.
Class: |
600/489; 351/219;
351/205 |
Current CPC
Class: |
A61B
3/12 (20130101); A61B 5/022 (20130101); A61B
5/02216 (20130101) |
Current International
Class: |
A61B
3/12 (20060101); A61B 5/022 (20060101); A61B
003/00 (); A61B 005/02 () |
Field of
Search: |
;128/2T,2R,2.5N,2.5R,2.5P ;73/80 ;351/6,7 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Howell; Kyle L.
Attorney, Agent or Firm: Sciascia; R. S. Hansen; Henry
Mooney; R. J.
Government Interests
STATEMENT OF GOVERNMENT INTEREST
The invention described herein may be manufactured and used by or
for the Government of the United States of America for governmental
purposes without the payment of any royalties thereon or therefor.
Claims
We claim:
1. An ophthalmodynamometer comprsiing:
a speculum member having an opening formed by two oppositely
flaring surfaces of revolution, one of said surfaces being formed
to fit against the sclera of the eye beneath the upper and lower
eyelids;
a bladder member attached to the other of said surfaces for
transmitting a force to said speculum member, said bladder member
having a transparent portion concentric with said speculum
opening;
first means attached to said bladder member for securing said one
surface against the sclera;
second means operatively connected to said bladder member for
varying the internal pressure of said bladder member; and
third means operatively connected to said bladder member for
monitoring the internal pressure of said bladder member.
2. An ophthalmodynamometer according to claim 1 wherein said
bladder member includes:
a closed tube having a corrugated sidewall attached to first and
second transparent endwalls.
3. An ophthalmodynamometer according to claim 2 further
including:
at least one head strap;
means attached to said first endwall for securing said head strap
to said bladder member;
an adjustment gage;
retaining means attached to said second endwall for securing said
adjustment gage to said bladder member, said retaining means
including means integral therewith for securing said speculum
member to said bladder member.
4. An ophthalmodynamometer comprising:
a substantially cylindrical bladder having a pleated sidewall
attached to first and second transparent disc-shaped endwalls;
a keeper attached to said first endwall;
a mounting ring attached to said second endwall;
an eyecup member attached to said keeper, said eyecup member having
a viewing port concentric with said transparent disc-shaped
endwalls;
an adjustment gauge attached to said keeper; and
a tube having a first end portion extending through said mounting
ring and said second endwall, and a second end portion serially
connected to a normally closed exhaust valve, a squeeze bulb and a
pressure indicator means connected in parallel with respect to each
other.
5. An ophthalmodynamometer comprising:
first means for applying force over a predetermined area of an
eyeball;
a bladder member attached to said first means, said bladder member
having a transparent portion through which said eyeball may be
observed;
second means operatively connected to said bladder member for
varying the internal pressure of said bladder member;
third means operatively connected to said bladder member for
monitoring the internal pressure of said bladder member;
at least one head strap attached to said bladder member; and
an adjustment gage attached to said bladder member.
6. An ophthalmodynamometer according to claim 5 wherein said
bladder member includes:
a hollow substantially cylindrical bladder having a corrugated
sidewall attached to first and second transparent disc shaped
endwalls;
a mounting ring attached to said first endwall and having at least
one head strap lug thereon for receiving said head strap; and
a keeper attached to said endwall for supporting said adjustment
gage, said keeper including attachment means integral therewith for
securing said first means to said keeper.
7. An ophthalmodynamometer according to clain 6 wherein said second
means comprsies:
a tube member extending from the interior of said hollow
cylindrical bladder through said first transparent endwall and said
mounting ring to a squeeze bulb shunted by a normally closed
exhaust valve.
8. An ophthalmodynamometer according to claim 7 wherein said third
means comprises:
a pressure indicator shunt connected to said tube member.
9. An ophthalmodynamometer according to claim 8 wherein said first
means comprises a transparent eyecup having:
a flared portion shaped to subatantially conform to the contour of
a sclera and operative to prevent eyelid closure as well as exert
force against the sclera; and
a frusto-conical portion terminating in a planar rim; wherein
said fursto-conical portion and said flared portion abut at their
respective smallest diameters to form a viewing port having a
diameter slightly larger than a cornea.
10. An ophthalmodynamometer according to claim 9 wherein said disc
shaped endwalls and said viewing port are concentric.
11. An ophthalmodynamometer according to claim 10 wherein said
bladder is substantially composed of a fluid impermeable,
distensible material.
12. An ophthalmodynamometer according to claim 11 wherein said
material is silicone rubber.
Description
BACKGROUND OF THE INVENTION
This invention relates to ophthalmodynamometers and in particular
to ophthalmodynamometers which employ the active compression
principle.
An ophthalmodynamometer is an instrument which measures retinal
artery pressures by applying a variable but calibrated force over a
known area of the eye to induce systole, i.e., pulsations at the
peak of the blood pressure cycle, and diastole, i.e., pulsations at
the minimum of the blood pressure cycle, of the central retinal
artery. With the ophthalmodynamometer the intra-ocular pressure is
artificially elevated by means of mechanically applied pressure or
suction. A separate apparatus, e.g., a hand held ophthalmoscope, is
then employed to observe or detect the pulsations. (The essential
function of the ophthalmoscope is to provide illumination through
the pupil of the eye so that the examiner may view the fundus of
the eye.) Measurement of retinal artery pressure can be used to
detect several important body conditions, e.g., increased
intracranial pressure, partial or complete carotid artery blockage,
and carotid vascular blockage.
Present day ophthalmodynamometers increase intra-ocular pressure by
using either a suction device or a compression device. The
compression device employs a small flat disc which is pressed
against the sclera of the eye with a calibrated force applicator.
The suction device employs a small cup and a calibrated vacuum
device to apply suction to a portion of the sclera. The compression
and suction ophthalmodynamometer devices both distort the globe of
the eye. This distortion tends to raise the pressure of the
relatively incompressible vitreous fluid within the eye. The
increased pressure of the vitreous fluid is then exerted against
the central retinal area of the eye.
Conventional ophthalmodynamometers have several drawbacks. In both
the compression type and the suction type, the actual increase in
intra-ocular pressure is nonlinearly related to the external force
applied to sclera. Hence it is difficult to establish an exact
relationship between the force applied to the sclera and the actual
retinal artery pressure. In the compression type, the axis of
pressure application is sometimes non-normal to the sclera giving
rise to lateral forces which can cause slippage of the disc on the
sclera. In the suction type, measurement errors are sometimes
introduced when there is a partial loss of vacuum around the
periphery of the suction cup or the pneumatic tube providing the
vacuum partially collapses. Both types of conventional
ophthalmodynamometers are uncomfortable for the patient, difficult
to properly and conveniently employ and generally give uncertain
results. In addition, conventional ophthalmodynamometers cannot be
used under field or combat conditions since they employ cumbersome
equipment and normally require the patient to be in a upright
position.
SUMMARY OF THE INVENTION
Accordingly, it is an object of this invention to provide a
compression ophthalmodynamometer which is convenient to employ and
which reliably determines retinal artery pressure without unduly
discomfiting the patient. It is a further object of this invention
to provide an ophthalmodynamometer which is portable, atraumatic to
the eye, and which can be used under field or combat conditions
even where the patient is in a prone position. These and other
objects of the invention are achieved as follows:
A portable ophthalmodynamometer, which operates in an active
compression mode, is provided with a transparent plastic eyecup and
a fluid impermeable bladder structure. The bladder structure is
substantially cylindrical with glass endwalls and a sidewall
fabricated from a pleated but distensible material. The eyecup is
removably secured to the bladder structure by means of a grooved
retaining clip. A fixed length attachment gauge secured to the
retaining clip ensures correct seating of the eyecup on the sclera.
An air duct extends from the interior of the bladder structure to a
squeeze bulb and pressure indicator means. After the
ophthalmodynamometer has been properly placed on the eyeball with
the aid of head straps the bladder structure is pressurized by
means of the squeeze bulb. As the bladder pressure increases a
force is transmitted to the sclera via the eyecup and the
intra-ocular pressure is thereby increased. With an ophthalmoscope,
systole and diastole are observed and the corresponding bladder
pressure is ascertained from the pressure indicator means. Since
internal bladder pressure is related to intra-ocular pressure, a
measurement of retinal artery pressure is obtained.
Other objects, advantages, and novel features of the invention will
become apparent from the following detailed description of the
invention when considered in conjunction with the accompanying
drawings wherein:
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1a shows an ophthalmodynamometer according to the invention
partially in section;
FIG. 1b shows an end view of the ophthalmodynamometer of FIG. 1;
and
FIG. 2 shows a modification of a portion of the
ophthalmodynamometer shown in FIG. 1; and
FIG. 3 shows the ophthalmodynamometer of the present invention
positioned on the eye and held in place with a head strap.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to FIG. 1a the ophthalmodynamometer 10 of the present
invention includes a transparent plastic eyecup or speculum 12
attached to a bladder 14 having a bellows-like structure. The
eyecup 12 has a flared or virtually semi-spherical portion 12a
which fits under the eyelids (not shown) and rests against the
sclera 31 just outside the periphery of the cornea 33. The flared
portion 12a tapers to a viewing port or orifice 12b having a
circumference slightly larger than a cornea. (The flared portion
12a prevents the eyelids from closing when the ophthalmodynamometer
is used and also exerts pressure on the sclera as will be described
more fully hereinbelow). Thereafter the eyecup 12 extends as a
substantially frusto-conical portion 12c having a planar rim 12d
which is removably retained within a circular groove 13a provided
on a plastic retaining clip or keeper 13. (A suitable eyecup 12
that may be used in the present invention may be the eyecup
employed to hold the Burian Allen ERG Electrode manufactured by the
Hansen Ophthalmodynamometer Development Laboratory of Iowa City,
Iowa). The sidewall 14c of the bladder structure 14 is fabricated
from any suitable material which is both distensible and fluid
impermeable such as silicone rubber. The bladder 14 is generally
cylindrical in form and has a sidewall 14c constructed in a pleated
or corrugated fashion much like a bellows. Both endwalls 14a, 14b
of the bladder 14 are fabricated from anti-reflection coated glass
or scratch resistant plastic formed in the shape of a disc.
One endwall 14b of the bladder structure 14 is provided with a
plastic circular mounting ring 16 having head strap lugs 32, 32' as
can be seen best in FIG. 1b. The circular ring 16 occupies the
outer periphery of the glass endwall 14b and is attached thereto by
an adhesive such as permaband 101 contact cement or any other
suitable means. The circular ring 16 has a thickness sufficient to
provide a secure base or support for head strap lugs 32, 32'. A
head strap 38 is attached to each head strap lug 32, 32' and
brought behind the patient's head where it can be incrementally
tightened.
A second endwall 14a of the bladder structure 14 is provided with a
grooved circular retaining clip or keeper 13 which is securely
attached to the glass endwall 14a by an adhesive such a permaband
101 contact cement or any other suitable means. The plastic
retaining clip or keeper 13 occupies the outer periphery of glass
14a and is used to removably secure the speculum or eye cup 12 to
the bladder structure 14 by means of a groove 13a.
A fixed length plastic adjustment gauge 30 is attached to the
retaining clip 13 and extends above and along the upper portion of
the bladder structure 14. The gauge 30 is slightly smaller than the
undistended length of the bladder structure 14; within this
constraint the exact length of the adjustment gauge is not critical
but its optimum length will depend on the actual dimensions of a
finally and fully fabricated ophthalmodynamometer 10. The gauge 30
is used by the examiner to properly position the
ophthalmodynamometer 10 on the patient's eye as will be explained
more fully hereinbelow. A duct 18, of any suitable material,
extends through the lower portion of ring 16 to at least the
interior surface of the glass endwall 14b. The duct 18 is suitably
connected to a pneumatic tube 20 which extends to a normally closed
exhaust valve 24 and a squeeze-bulb 26 such as those used with a
conventional cuff-type sphygmomanometer. (To those skilled in the
art the exhaust valve 14 is also known as sphygmomanometer
inflation bulb). The exhaust valve 24 and squeeze-bulb 26 are
shunted by a conventional pressure indicator 22 which transduces
applied pressures to a readable numerical value.
Referring to FIGS. 1 and 3, the operation of the
ophthalmodynamometer 10 is as follows. The ophthalmodynamometer 10
is placed on the eyeball so that the eyecup 12 fits under the
eyelids and rests against the sclera 31 just outside the periphery
of the cornea 33. The Headstraps 38 (FIG. 3) attached to the lugs
32 and 32' on the mounting ring 16 are brought behind the patient's
head and thereafter incrementally tightened. The head straps 38 are
tightened only until the outer surface of the ring 16 is aligned
with the distal end 30a of the adjustment gauge 30 as shown in FIG.
3. When such alignment occurs the eyecup 12 is correctly seated on
the sclera 30 and presses against the sclera with enough force to
minimize slippage but not enough force to introduce a significant
pressure increment to the eyeball prior to pressurization of the
bladder structure.
After the ophthalmodynamometer has been positioned on the eyeball,
the pressure within the bladder structure 14 is increased by
squeezing bulb 26. As the pressure increases, the bladder structure
tends to distend and exerts a pressure against the eyeball via the
eyecup 12. With an opthalmoscope 40 the examiner views the fundus
34 of the eye and continues to increase the pressure until he
observes the characteristic collapse of the retinal artery.
Thereafter the exhaust valve 24 is opened and the pressure
decreases. As the pressure decreases the examiner observes the
characteristic first blood pulse at the high point of the blood
pressure cycle, i.e., systole. As the pressure continues to
decrease, the examiner notes the last blood pulse at the low point
of the blood pressure cycle, i.e., diastole. The corresponding
readings from pressure indicator 22 represent the retinal artery
blood pressure at systole and diastole respectively.
It is apparent from the description of the ophthalmodynamometer's
operation set forth above, that it operates in an active
compression mode as opposed to a passive compression mode. In the
active mode, the bladder sructure 14 is in a semi-flaccid or
substantially undistended state when the ophthalmodynamometer is
initially positioned on the eyeball. Thereafter, the bladder
structure 14 is pressurized by squeeze-bulb 26 and caused to expand
or distend to thereby transmit an increased pressure to the eyeball
via the eyecup 12. If the ophthalmodynamometer 10 were operated in
a passive mode, there would be no need for the squeeze-bulb 26 and
the exhaust valve 24. That is, the bladder structure 14 is
pressurized before it is placed on the eyeball and the internal
pressure of the bladder structure 14 is increased by exerting an
internal force against an endwall of the bladder structure 14 after
the ophthalmodynamometer is positioned on the eyeball. The
increased internal pressure within the bladder structure 14 under
the influence of the external force is registered on the pressure
indicator 22.
Referring to FIG. 2, wherein like numerals refer to parts already
illustrated, a modification of the bladder structure shown in FIG.
1a is portrayed. The single walled bladder structure 14 of FIG. 1
is replaced by a double walled bladder structure 14' shaped
substantially in the form of a toroid having pleated or corrugated
sidewalls 14a' and 14b' much like a bellows. The entire double
walled bladder 14' maybe fabricated from a fluid impermeable but
distensible material such as silicone rubber. The double walled
bladder 14' is secured to the eyecup 12 by an adhesive such as
permabond 101 contact cement or by any other suitable means at
endwall 14c'. And air duct 18' extends from the interior of the
double walled bladder to the parallel connected pressure indicator
22, exhaust valve 24 and squeeze bulb 26 as before. An advantage of
the double walled bladder structure 14' over the single walled
structure is that glass endwalls are made unnecessary since the
fundus 34 may be observed through the toroid hole 14d'. Operation
of an ophthalmodynamometer equipped with the double walled bladder
14' is the same as that set forth hereinabove for the single walled
bladder structure 14.
Obviously, many modifications and variations of the present
invention are possible in the light of the above teachings. It is
therefore to be understood that within the scope of the appended
claims the invention may be practiced otherwise than as
specifically described.
* * * * *