U.S. patent number 3,929,124 [Application Number 05/465,978] was granted by the patent office on 1975-12-30 for opthalmodynamometer.
This patent grant is currently assigned to The United States of America as represented by the Secretary of the Navy. Invention is credited to John Nichparenko, Michael E. Yablonski.
United States Patent |
3,929,124 |
Yablonski , et al. |
December 30, 1975 |
Opthalmodynamometer
Abstract
An opthalmodynamometer includes an inflated toroid member
attached to an speculum having a viewing port. The eye of the
toroid and the viewing port are axially aligned to permit the
fundus of the eye to be illuminated and viewed. Pressure applied to
the toroid member is transmitted to the eyeball to thereby raise
intra-ocular pressure. Internal toroid member pressure is related
to retinal artery blood pressure. Means are provided to ascertain
the toroid member pressure so that retinal artery blood pressure
may be determined.
Inventors: |
Yablonski; Michael E. (Golden
Valley, MN), Nichparenko; John (Willow Grove, PA) |
Assignee: |
The United States of America as
represented by the Secretary of the Navy (Washington,
DC)
|
Family
ID: |
23849948 |
Appl.
No.: |
05/465,978 |
Filed: |
May 1, 1974 |
Current U.S.
Class: |
600/489; 351/205;
351/219; 600/558 |
Current CPC
Class: |
A61B
5/02216 (20130101); A61B 5/398 (20210101) |
Current International
Class: |
A61B
5/0496 (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
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 comprising:
a speculum member provided with a viewing port;
a pressurized toroidal bladder attached to said speculum member
with the eye of the toroidal bladder coaxial with said speculum
viewing port; and
means operatively connected to said bladder for determining the
internal pressure of said bladder.
2. An ophthalmodynamometer according to claim 1 wherein:
said bladder is substantially composed of an impermeable
distensible material; and
the diameter of the eye of said bladder is equal to or greater than
the diameter of the speculum viewing port.
3. An ophthalmodynamometer according to claim 1 wherein said
pressure determining means includes:
a pneumatic tube member operatively connected to the bladder;
and
a pressure indicator means connected to said pneumatic tube member
for indicating the internal pressure of said bladder.
4. An ophthalmodynamometer according to claim 1 further including:
force applicator means attached to said bladder for applying an
external force to said bladder.
5. An ophthalmodynamometer according to claim 4 wherein said force
applicator means comprises:
a ring attached to said bladder and having a curved stem depending
therefrom.
6. An ophthalmodynamometer comprising:
a speculum having an opening formed by two oppositely flaring
annular surfaces, one of said surfaces being formed to fit against
the sclera of the eye beneath the upper and lower eyelids; and
a pressurized bladder attached to the outer periphery of the other
of said surfaces, said bladder defining an opening therethrough
that is coaxial with said speculum opening; and
means operatively connected to said bladder for determining the
internal pressure of said bladder.
Description
BACKGROUND OF THE INVENTION
This invention relates to ophthalmodynamometers and in particular
to ophthalmodynamometers which employ the compression
principle.
An ophthalmodynamometer is an instrument which measures retinal
artery pressure 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
intra-cranial 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 the 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 an 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
discomforting the patient. It is a further object of this invention
to provide an ophthalmodynamometer which is 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 pressurized fluid impermeable bladder shaped in the form of a
toroid or life preserver is attached to one end of an eye speculum.
The second end of the speculum is inserted under the eyelids and
presses against the eyeball. An external force is applied to the
bladder. The external force increases the pressure within the
bladder. The increased pressure within the bladder is transmitted
through the speculum to the eyeball to thereby increase
intra-ocular pressure. Means for measuring the internal pressure of
the bladder is provided so that bladder pressure can be determined.
Bladder pressure is related to intra-ocular pressure, hence retinal
artery pressure can be determined.
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.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows a perspective view of a compression
ophthalmodynamometer according to the invention;
FIG. 2 shows the ophthalmodynamometer of FIG. 1 applied to the
eyeball and partially in section; and
FIG. 3 shows an alternate embodiment of an ophthalmodynamometer
according to the invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to FIG. 1 the ophthalmodynamometer of the present
invention includes a transparent plastic eyecup or speculum 10
having a flared or virtually semi-spherical portion 10a which fits
under the eyelids and rests against the sclera. The flared portion
10a prevents the eyelids from closing when the ophthalmodynamometer
is being used and also exerts pressure on the sclera as will be
more fully described hereinbelow. The flared portion 10a tapers to
an orifice or viewing port 10b having a diameter slightly larger
than a cornea. Thereafter the eyecup 10 extends from the viewing
port 10b as a frusto-conical portion 10c terminating in a planar
circular rim 10d which abuts a pressurized bladder 14. (An eyecup
10 suitable for use with the present invention may be that used to
hold a Burian Allen ERG Electrode manufactured by the Hansen
Ophthalmic Development Laboratory of Iowa City, Iowa.) The bladder
14 may be fixedly secured to the rim 10d of the eyecup 10 by an
adhesive such as Permabond 101 contact cement or any other suitable
means. Alternatively, the bladder 14 may be removably attached to
the eyecup 10 by means of a grooved circular retaining clip (not
shown) affixed to the periphery of the bladder 14.
The bladder 14 is fabricated from any suitable fluid impermeable,
distensible material, such as silicone rubber, which is capable of
being inflated or pressurized i.e., capable of holding a fluid
under pressure. The bladder 14 is formed substantially in the shape
of a toroid or doughnut with the eye 15 of the toroid concentric
with the viewing port 10b of the speculum 10. A pressure indicator
18 is connected to the bladder 14 by a pneumatic tube 16 which
extends through the wall of the bladder 14 to its interior. The
pressure indicator 18 is of conventional construction and serves to
transduce the internal pressure of the bladder 14 to a numerical
value which can be read by the examiner.
Referring to FIG. 2, the flared portion 10a of the speculum 10 is
shown inserted under the eyelids 30, 30' and resting against the
sclera 32 of the eye just beyond the periphery of the cornea 31.
The speculum 10 and attached bladder 14 are positioned on the
sclera 32 so that the lens 34 of the eye, the speculum viewing port
10b and the eye of the toroid 15 are concentric. With the
ophthalmodynamometer positioned in this manner, light from an
ophthalmoscope 40 can be directed into the lens 34 of the eye so
that an examiner may view the fundus 36 of the eye while an
external force is applied to the bladder 14 by means of a suitable
force applicator 42. The force applicator 42 may, for example, be
formed as a thin plastic ring 42a having a curved depending plastic
stem 42b. The ring 42a is placed against the outer periphery of the
bladder so as not to interfere with the light emanating from the
ophthalmoscope 40. The stem 42b of the force applicator 42 may be
connected to a conventional source of calibrated forces such as a
modification of the well-known Goldman applanation tonometer or any
other suitable device which will cause force applicator 42 to bear
against the bladder 14 with controlled force. (Alternatively the
force applicator 42 may be hand held by the stem 42b and manually
pressed against the bladder. In another embodiment the force
applicator may be affixed to the bladder 14 by any suitable means
and serve not only to increase bladder pressure but also to
facilitate positioning of the ophthalmodynamometer on the eye.
Other suitable means for increasing the pressure within the bladder
14 will occur to those skilled in the art. For example, the force
applicator 42 may be entirely dispensed with and the ophthalmoscope
40 may be pressed against the bladder 14 as the examiner views the
fundus 36 of the eye.)
Operation of the ophthalmodynamometer is as follows. The
ophthalmodynamometer eyecup 10 is inserted under the eyelids 30,
30' and held in place by hand, by the force applicator, or by any
other suitable means. Thereafter an external force is applied to
the bladder 14. The internal pressure of the bladder 14 increases
under the influence of the external force and this pressure
increment is transmitted to the sclera 30 via the speculum 10 to
thereby increase the intra-ocular pressure. As the pressure within
the bladder 14 and the eyeball increases, the examiner notes the
characteristic collapse of the retinal artery at the low point of
the blood pressure cycle, i.e., diastole. As the pressure within
the bladder 14 is further increased, the examiner notes the
characteristic rapid pulsation of the retinal artery yielding to a
sustained collapse even at the peak of the blood pressure cycle,
i.e., systole. To obtain the retinal artery pressure, the readings
of the pressure indicator 18 at diastole and systole are converted
to blood pressure readings according to a previously determined
calibration. (For example, the exact relationship between the
pressure within the bladder 14 and the intra-ocular pressure can be
determined experimentally by raising the pressure within the
bladder to several distinct but known levels and measuring the
intra-ocular tension with a Schiotz tonometer at each distinct
level. This kind of experiment would result in a chart of
corresponding bladder pressures and intra-ocular pressures. The
chart would then serve as the previously determined calibration set
forth above. Alternatively, the relationship may be established by
inserting a hollow needle into the eyeball of a cadaver after the
ophthalmodynamometer has been positioned over the sclera. The
internal bladder pressure is then raised to several distinct but
known levels and the corresponding intra-ocular pressures are
determined with a second pressure indicator attached to the hollow
needle.)
Many modifications of the invention will occur to those skilled in
the art without departing from the spirit of the invention. One
such modification is shown in FIG. 3 which shows a bladder formed
as a single walled bellows 50 which can be used in lieu of the
toroid shaped bladder 14 shown in FIGS. 1 and 2. The bellows 50 is
substantially cylindrical in shape and is attached to the speculum
10 by an adhesive such as Permabond 101 contact cement or any other
suitable means. The sidewall 50a of the bellows 50 is fabricated
from distensible rubber such as silicone rubber (or any other
material which is distensible and fluid impermeable) and is
pleated. The endwalls 50b, 50c of the bellows 50 are fabricated
from disc-shaped reflection coated glass to provide an unobstructed
view through the bellows structure. The pneumatic tube 16 extends
through the endwall 50c and opens into the interior of the bellows
50. Operation of the device shown in FIG. 3 is the same as that set
forth for the device shown in FIGS. 1 and 2.
In addition to measuring the retinal artery pressure, the
ophthalmodynamometer of the present invention can also be used to
measure the effect of increased intra-ocular pressure on the
electroretinogram (ERG). This can be accomplished by mounting a
conventional Burian Allen ERG electrode within the viewing port of
the eyecup 12. The electrode is a ring type corneal electrode which
picks up the electrical response of the eye to a flash of light. As
the intra-ocular pressure is varied to any desired level in the
manner set forth above, the eye is stimulated with light flashes
and the output of the electrode is observed on a recorder or other
suitable device.
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.
* * * * *