Abstract:
A stand-alone station such as a kiosk ( 10 ) includes automated equipment for performing eye examination procedures on a user positioned in the station ( 11 ). Information derived from the examination determines possible existence of a correctable medical condition. The station includes a user interface ( 22 ) and a fulfillment remedy section ( 30 ) that addresses the medical condition, as by fabrication of eyeglasses ( 32 ) for correction of refraction error, or by communicating treatments through the user interface to the user for treating such conditions as age-related macula degeneration, Alzheimer&#39;s disease, or visual field impairment. The station also includes a payment device ( 24 ) allowing the user to directly pay for the procedure and to indirectly pay using identified health insurance coverage.

Description:
FIELD OF THE INVENTION  
       [0001]     The present invention is directed to the field of user-operated medical diagnostic and remedy dispensing kiosks.  
       BACKGROUND OF THE INVENTION  
       [0002]     Currently, in the case of a health problem a patient goes to the medical specialist where the patient undergoes a series of tests in order to formulate a diagnosis, based on which a treatment can be prescribed. Often the patient has to go through several visits to different specialists and then to the place where the treatment could be delivered. Acquiring eyewear to correct the problem of vision loss is an example of the current standard health care practice. Although such practice provides a high quality solution for the common health care problems, it has several limitations and shortcomings. Among them are cost, duration of time before the problem is detected and corrected, and inapplicability for the counties where the health care systems are not well established and operated, and are lacking well-trained specialists. The latter is especially obvious in developing nations where the shortage of health care specialists, funding, and equipment results in serious problems for the population&#39;s health. To overcome those shortcomings systems are being developed that can perform several steps related to testing or diagnostics in an automatic fashion. In the area of optometry, for example, there exist several devices that perform automatic measurement of the refractive errors. These devices are known as Autorefractometers. For example, the Auto Refractometer Model KA-1000, manufactured by Kowa Optimed Inc., Torrance, Calif., which is an ophthalmic products division of Kowa Company, Japan, is used to automatically specify a corrective prescription of glasses or contact lenses for a user. Another device, Luneau L62-3D, manufactured by LUNEAU S.A., France, in addition to measuring refractive errors of the lens, provides an estimation of the optical properties and topography of cornea, which is particularly useful for a proper contact lens prescription. The systems, which perform higher order aberration measurements employing a wave front sensor, are currently being sold and further developed. Such a device is being developed by Ophthonix, Inc., San Diego, Calif. The Ophthonix device is described in U.S. Pat. No. 6,761,454 and it shines light into the eye and measures changes in the wave properties of the light reflected back by the retina. From these changes, the apparatus can calculate the measurements on any existing irregularities of the eye lens.  
         [0003]     Automatic measurement of refractive errors or higher order aberrations enables performance of necessary diagnostics of the person&#39;s vision in terms of the prescription lenses. Devices of this type can be operated by an assistant who requires only a limited training or by the user. However, such devices are not capable of automatically producing corrective eyewear, which is a highly desirable attribute for countries line China and India, where a large percentage of the population with the near- or far-sightedness lacks an access to the prescription eyewear.  
         [0004]     In order to provide prescription eye-ware, presently an optometrist or an eye professional performs a variety of measurements including bridge size, inter-pupillary distance, temple length, eye size and visual axis measurements, in addition to the measurements of refractive errors and/or higher order aberrations, which could be done automatically as described above. Usually, the optometrist performs a process of fitting the eyewear to the person&#39;s head, which may be time consuming. This operation is done to properly adjust the frame to the person&#39;s facial structure.  
         [0005]     U.S. Pat. No. 6,682,195 discloses a method of measuring parameters required for fitting of an eyeglasses frame using digital cameras. Examination of the eye is not only used for prescribing corrective eyewear, but can be also used for screening and diagnosing a variety of ophthalmologic diseases, such as cataract, uveitis, glaucoma, macula degeneration, visual field changes and others.  
         [0006]     High resolution longitudinal and depth imaging can be performed by optical coherence tomography (OCT) as described in articles “Optical Coherence Tomography” by D. Huang et al., Science 254, (1991), pp. 1178-1181; and “Optical Coherence Tomography” by A. F. Fercher, in Journal of Biomedical Optics Vol. 1, No. 2, April 1996, pp. 157-173. An OCT based instrument called StratusOCT is now commercially available from Carl Zeiss Meditec, Jena, Germany which produces OCT cross sectional images of the retina for objective measurement and clinical evaluation for the detection of glaucoma and retinal diseases. Examples of OCT apparatus for longitudinal and transverse imaging are described in U.S. Pat. Nos. 5,493,109; 5,537,162; 5,491,524; 5,469,261; 5,321,501; and 5,459,570. Another example, U.S. Pat. No. 6,293,674 discloses the use of optical coherence tomography (OCT) system for diagnosing glaucoma while examining the eye. This patent describes an apparatus that images the patient&#39;s retina to determine the parameters of the retinal nerve fiber layer, such as thickness, relevant to glaucoma.  
         [0007]     It is also known that eye exams may lead to detecting other illnesses. Alzheimer&#39;s disease, mental disorders, diabetes, cancer and drug usage were found to generate changes in the eye and eye behavior. For example, in the U.S. Patent Application Publication Ser. No. 2002/0182152 A1 described a method of diagnosing Alzheimer&#39;s disease by applying a dynamic light scattering probe to the eye lens of the mammals. In research studies it was found that the beta amyloid proteins that form plague in the brain in Alzheimer&#39;s patients tend to aggregate in the eye lens which increases the light scattering characteristics of the lens and can be therefore detected at the early stage of the illness.  
         [0008]     U.S. Pat. No. 6,704,588 discloses a method and an apparatus for non-invasive determination of blood glucose levels by performing measurements in the eye using light polarization effects.  
         [0009]     The above systems provide measurements related to the condition of the eye with respect to a number of illnesses and health status but do not provide any automated means of fulfillment.  
         [0010]     There is therefore a need for systems that will provide automated diagnosis of medical conditions, related to vision, ophthalmologic diseases as well as other types of health conditions, and that will automatically provide the necessary fulfillment of the patient&#39;s needs as dictated by the automated diagnosis. The present invention satisfies this need.  
         [0011]     The foregoing and other objects, features, and advantages of the invention will be apparent from the following more particular description of the preferred embodiments of the invention, as illustrated in the accompanying drawings.  
       SUMMARY OF THE INVENTION  
       [0012]     In accordance with the invention there is provided a health care kiosk, which is adapted to diagnose a medical condition of a user based on an examination of the user&#39;s eyes and to provide a remedy therefor. The health care kiosk comprises a user accommodation section adapted to locate a user in at least one position that enables an interaction between the station and the user, and a user interface that is adapted to permit a user to input data relevant to the user. The kiosk also includes an eye examination and information processing section adapted to examine at least one of a user&#39;s eyes while the user is in the at least one position, wherein the at least one position enables the user to align their eyes with an input to the eye examination section. The eye examination section is adapted to examine the eyes and to provide from the examination at least one of first information relevant to a state of the user&#39;s eyes and second, diagnostic, information based on the first information that is indicative of a medical condition of the user. Finally, the kiosk includes a fulfillment section adapted to respond to information from the examination section to provide a fulfillment remedy pertinent to the state of the eyes or other diagnosed medical condition. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0013]     In the detailed description of the preferred embodiments of the invention presented below, reference is made to the accompanying drawings, in which:  
         [0014]      FIG. 1  is a side schematic view of a health care kiosk in which eyeglasses with corrective lens are dispensed in accordance with the present invention;  
         [0015]      FIG. 2  is a front schematic view of the kiosk of  FIG. 1 ;  
         [0016]      FIGS. 3   a  and  3   b  are schematic illustrations of an eyeglass frame useful in the present invention;  
         [0017]      FIG. 4  is a schematic illustration of corrective lenses prior to insertion into the frame of  FIGS. 3   a  and  3   b;    
         [0018]      FIG. 5  is a schematic illustration of the eyeglass frame of  FIG. 4  with the corrective lenses inserted and the frame adjusted ready for use;  
         [0019]      FIG. 6  is a process flow chart of the diagnostic and eyeglass dispensing process employed in the health care kiosk of  FIG. 1 ;  
         [0020]      FIG. 7  is a process flow chart for another embodiment of the health care kiosk of the invention used in diagnosing and treating Alzheimer&#39;s disease;  
         [0021]      FIG. 8  is a process flow chart for another embodiment of the health care kiosk of the invention used in diagnosing and treating visual field impairment; and  
         [0022]      FIG. 9  is a process flow chart for another embodiment of the health care kiosk of the invention used in diagnosing and treating age-related macula degeneration disease (AMD). 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0023]     Turning now to  FIG. 1 , there is shown a health care kiosk  10  which comprises a stand-alone digital imaging device adapted to diagnose a medical condition of a user based on an examination of the user&#39;s eyes and to provide a remedy therefor, in accordance with one preferred embodiment of the invention. In particular, this kiosk is preferably an optometric kiosk, adapted to perform an eye-sight examination and to administer an issuance of corrective eye-ware specific to a person&#39;s needs. The illustrated kiosk includes a user accommodation section  1   1 , having a user&#39;s seat  14 , adapted to locate a user in at least one position that enables an interaction between the station and the user, a user interface device  22  through which a user can initiate the process of optometric service. This user interface section further includes a user identification and ID validation module  21 , and a mechanism for payment  24 , for example by means of a credit card. The user interface device  22  also permits the user to provide or insert relevant data about the user, such as for example medical history. The illustrated kiosk further includes an enclosure  12 , having an eye examination section  13  adapted to examine a user&#39;s eyes while the user is positioned on the seat. The eye examination and information processing section  13  includes an eye examination module  19 , an eyepiece  18 , an information processor  17 , and a detachable alignment fixture  28 . The seat  14  is preferably height adjustable and preferably includes a head rest  16 . In order to enable the user to align his or her eyes  15  with an input eyepiece  18  a detachable alignment fixture  28  is provided. This detachable alignment fixture  28  ensures the proper position of the user&#39;s eyes and allows the proper hygiene to be provided. It can either be cleaned between different users or it can be a single-use item. The eyepiece  18  can be adapted for use with one or two eyes. Eye examination module  19  includes a test device or suite of test devices adapted to perform eye examinations to determine the health condition of the user. In the illustrated embodiment, the eye examination module  19  preferably comprises a refractometer and/or wave front sensor, as described above, designed to measure refractive errors or higher order aberrations in the eye for producing corrective eyewear. The data from eye examination module  19  is collected and processed by information processor  17 .  
         [0024]     Although the aforementioned devices such as refractometers or wave front sensors imply a limited participation of an assistant or a device operator, other, fully automatic systems, have also been proposed and can be utilized in the invention. One such system is described by Ventura et al. in “Automatic diagnostic system for measuring ocular refractive errors,” SPIE, Vol. 2673, pp. 243-251. The information processor  17  is operative in response to the output of the eye examination module  19  to generate information relevant to the state of the user&#39;s eyes, in this case prescription data for eyeglasses to correct for refractive errors or higher order aberrations of the eyes uncovered in the examination.  
         [0025]     Alternatively, pre-existing prescription data can be entered into the system by means of manual typing by the user, reading from the encoded service card during the process of ID validation or obtaining it using Internet connection to a database where such data is stored.  
         [0026]     Several other important measurements needed to produce corrective eyewear can be obtained automatically by the eye examination module  19 , entered manually or acquired from the database via Internet connection. In addition, a digital camera  23  is co-mounted with the eye examination module  19  to image the person&#39;s face, from which the necessary physical measurements can be obtained. Such measurements include bridge size, inter-pupillary distance, temple length, eye size and visual axis. For example, the distance between the temple and the posterior part of the ear is entered as a part of the information for eyeglasses prescription either manually, acquired from the database or measured from the image of the user&#39; head captured by the digital camera  23 . In this case multiple images with different views are required and captured by the digital camera either sequentially or simultaneously. In the latter case a second digital camera not shown is provided, which is mounted approximately perpendicular the position of the first digital camera  23 . Alternatively, a method for producing measurements necessary to create a custom frame could be performed as described in the U.S. Pat. No. 6,682,195.  
         [0027]     The prescription data and physical parameters described above are provided to a fulfillment section  30  for the purpose of fabricating a pair of eyeglasses to correct the vision of the user. In this embodiment, fulfillment section  30  comprises an eyeglass fabrication system  32 , which includes, in part, a system process controller  20 , a display and user interface device  22 , and a payment device  24 . A printer  26  is also provided for outputting printed information to the user and producing bill receipts. Further included in fulfillment section  30  are racks of lens supply rolls  34  for providing lenses of varying degrees of refractive correction, a lens cutter  36 , frame supply reels  38  and a lens injector  39  that places lenses  42  ( FIG. 4 ) in accordance to the refractive errors or higher order aberration correction information from information processor  17  into the eyeglass frame  50  ( FIGS. 3   a,    3   b ) selected from frame supply reels  38 . Preferably, the user is able to select a desired frame by means of a touch screen panel on the interactive display of the user interface device  22  as shown in  FIG. 2 . The parameters of the frame such as the bridge size, the temple length and the inter-pupillary distance are determined based on the measurements of the physical parameters of the user extracted from the user&#39;s head and face images or provided by the user. At this time the user is made aware of the cost for each frame option available to him or her and total cost of the eyeglasses. At this point the user may decide not to purchase the eyeglasses and is billed for just the exam and prescription generation. Otherwise the user authorizes a full payment and the eyeglass assembly process is initiated using an appropriately sized frame. The completed eyeglasses are then dispensed into output tray  40  for removal by the user or an attending clerk.  
         [0028]     Basic structure for an eyeglass frame  50  useful for the present purpose can be seen with reference to  FIGS. 3   a,    3   b,    4 , and  5 . As shown, the eyeglass frame  50  comprises a one-piece stamped or molded frame  51  having rims  52   a,    52   b  that are folded together along an integral rim hinge  54  to contain lenses  42  between the rims. An example lens  42  cut by cutter  36  in preparation for insertion into the frame  51  is provided with lens locator holes  62  which have been calculated from the eye examination module test information furnished by either information processor  17  or system process controller  20  for correct placement of the lens centerlines  44   a,    44   b  within the frame rims  52   a,    52   b.  For this purpose, the frame rims are provided with alignment pins  56  for registry with the lens locator holes  62  to assist in aligning the rims during the assembly process. The ear pieces  58  are cut to the appropriate lens and bended based on the measurement of the temple length of the user acquired from the digital camera image, and folded at integral earpiece hinges  60  by the user after removal from tray  40  to thereby complete the assembly as shown in  FIG. 5 . Alternatively, the earpieces  58  can be a separate piece that is pre-bent and inserted onto the frame  51  automatically, so that the appropriate temple length is obtained.  
         [0029]      FIG. 6 , shows a process flow chart for operation of the eyeglass kiosk of  FIG. 1 . The process begins by the user pressing the start button (not shown) on the front of the kiosk (step  100 ). The user, sitting on the seat  14  and facing the display interface device  22  is prompted to enter data such as name, social security number, medical insurance card number, or the like, uniquely identifying the user (step  102 ). The user is next prompted in step  104  to identify the manner of payment desired, such as for example credit card or insurance card, and, in step  106 , the appropriate card is inserted into payment device  24  to obtain the account data utilized later to charge for the services. Alternatively, a verified user ID can be used to access the payment data stored in the system or in a secure server in a different location, which can be accessed via wired or wireless connection. Once the account data is verified, the user is instructed to look into the eyepiece  18  (step  108 ). The tests are next performed (step  110 ). In the preferred embodiment the tests include the measurements of refractive errors or higher order aberrations obtained via an operation of the eye examination module  19  and required physical measurements including bridge size, inter-pupillary distance, temple length, eye size and visual axis using digital cameras  23 . Alternatively, other diagnostics measurements can be performed at step  110 . Once this is done, the prescription for the corrective lenses and necessary measurements for the eyeglasses frame are automatically created as a digital file. At the conclusion of the tests the test data results are communicated via information processor  17  to system process controller  20  for subsequent assembly of the eyeglasses (step  112 ). The user is next prompted by device to select a desired frame style to proceed (step  114 ). The user may decide to terminate the process at this time. Once the frame is selected according to the desired style and specified measurements, the proper lenses are cut (step  116 ) and inserted into the selected frame style of appropriate size (step  118 ). Subsequently, a data record consisting of the user identity, prescription, cost and payment data is created (step  120 ), which is then communicated to appropriate output such as printer  26  for a paper record for the user, and, if indicated, via telecommunication to an insurance of a claim for payment of the charges (step  122 ). At the same time, the completed eyeglasses are dispensed to output tray  40  (step  124 ), whereupon the process is ended at step  126 .  
         [0030]     In an alternative form of the test, the user looks through the eyepiece at the display screen where letters or objects of different sizes are successively displayed. The user then reads the letters aloud, and voice recognition software either identifies erroneous reading or confirms a correct reading. In the former case, bigger size letters or figures are displayed until the user correctly identifies the letters or objects. Once the user visual acuity is identified and corrective lens specifications are established, if required, the digital file is then communicated to the system process controller for preparation of the eyeglass fame assembly. Another way of entering the user input can be accomplished via a keyboard. In this case the user would be instructed to type a letter he or she sees on a keyboard.  
         [0031]     Another embodiment of the invention is described in the flow chart of  FIG. 7  as an example of diagnosing other health conditions including ophthalmologic diseases, such as cataract, uveitis, glaucoma, macula degeneration, diabetic retinopathy, etc., as well as other diseases such as Alzheimer&#39;s disease, mental disorders, diabetes, cancer and drug usage, brain injury, stroke, etc. As a specific example, the flowchart in  FIG. 7  will be described using a method of automatic diagnosing and fulfillment of a treatment appropriate for the medical condition found in Alzheimer&#39;s disease. In the case of Alzheimer&#39;s disease, a treatment may be in the form of memory training.  
         [0032]     It has been known that the onset of Alzheimer&#39;s disease is suspected when the patient starts experiencing the problems with memorizing new information and forgetting recent information. At present, the memory tests and questionnaires data obtained from the patient and often from family members are used to provide the patient with the diagnosis. However recent scientific studies have demonstrated that the Alzheimer&#39;s Disease (AD) can be detected by inspecting the eye lens using non-invasive optical technology, such as, for example, quasi-elastic light scattering (or dynamic light scattering), or Raman spectroscopy. One method of diagnosing a neuro-degenerative disease such as AD is described in U.S. Patent Application Publication Ser. No. 2002/0091321 A1, in which a dynamic light scattering probe is used to detect and monitor deposition of amyloid protein in the eye which is indicative of a neuro-degenerative disease such as AD. The probe is a portable apparatus consisting of the optical instrument for acquiring the optical information related to the amyloid protein aggregation in the eye lens, connected to the data acquisition and analysis system. Such a probe can be employed in this embodiment of the kiosk as one of the test devices of the eye examination module  19  of the kiosk of  FIG. 1 .  
         [0033]     In  FIG. 7 , steps  200 - 206  correspond in operation to steps  100 - 106  of  FIG. 6  described above. In step  208 , the user is instructed to position him or herself appropriately for the test. As an example the user is being prompted to look into the eyepiece  18 . With the user looking into the eyepiece, the light is generated into the user&#39;s eye(s) and the optical probe such as the dynamic light scattering test is performed in step  210  to detect the level of scattering, which is related to the beta amyloid deposition. The quantitative analysis of the amount of scattering is performed in step  212  by comparing the detected user data with a normal group data to indicate the possible presence of neuro-degenerative disease as a result (step  214 ). Additionally, the data can be compared with the previous data of the same person, which could then be used to monitor the change in the condition evoked by the progression of a disease or a therapeutic intervention  
         [0034]     In step  216 , the appropriate fulfillment for an identified health condition is formulated. One example of such a fulfillment for Alzheimer&#39;s disease could be a choice of memory training programs of varying complexity depending on the extent of the condition detected in the previous step. It has been demonstrated in the scientific studies that a memory training exercise such as a face/name association task when performed by Alzheimer&#39;s patients, improves their memory (L. Clare et al., “Relearning Face-Name Associations in Early Alzheimer&#39;s Disease,” Neuropsychology, Vol. 16, No. 4, 2002)  
         [0035]     Moreover, it has been shown that the memory enhancement can last for at least several months. Other examples of a fulfillment could be a prescription for the appropriate medication, a CD or a brochure describing the actions the user is instructed to take, or an appointment with the appropriate medical professional, or even dispensing treatment medication In the case where regulations require registered physician authorization for prescription dispensing, patient information and treatment options are automatically sent (via internet, telephone or wirelessly) to the users health care provider or designated physician for approval. The formulated fulfillment is then provided to the user in step  218 . As an example, a memory exercise for Alzheimer&#39;s disease is given to the user in the form of launching a computer program. Performance of the user during the fulfillment process is then measured, and a record is created, in step  220 , documenting the person ID, the optical probe results, and the fulfillment provided. Additionally, the actions of the user, such as for example, performance of the user in the series of memory exercises are recorded and stored for the user and medical professional&#39;s subsequent analysis, as well as a new set of baseline information. In the step  222  the payment is withdrawn from the account provide in step  206  and the user obtains a receipt. Additionally, the record created in step  220  can be communicated in step  224  to the medical professional, to the general user file for use as a permanent electronic health record, or other institutions and people upon the user agreement. At the conclusion, step  226  ends the process.  
         [0036]     The flowchart shown in  FIG. 7  can also be utilized to diagnose and manage a patient&#39;s glaucoma or retinal disease. In order to perform this function the eye examination module of  FIG. 1  would include an OCT scanning probe such as that described in U.S. Pat. No. 6,293,674. The result of such a probe would be an assessment of presence of glaucoma and retinal disorders. The fulfillment steps  216  and  218  may create a recommendation or an appointment with the ophthalmologist or other relevant medical professional. Alternatively, such a probe could provide a measure of progression of these disorders and assess the efficiency of undergoing treatment.  
         [0037]     The process flow chart of  FIG. 8  describes an embodiment of the invention where the eye examination module  19  performs a measurement of the visual field impairment caused by a stroke. An appropriate fulfillment in this case may include providing a therapy in the form of visual training. Recent studies in neuroscience have demonstrated that visual systems possess a remarkable flexibility in adapting to damage and compensating for lost functions. An example of such compensation is described in “Computer-based Training of Stimulus Detection Improves Color and Simple Pattern Recognition in the Defective Field of Hemianopic Subjects,” by Kasten et al.; Journal of Cognitive Neuroscience, 12, 2000, pp. 1001-1012. In a randomized placebo-controlled trial, they have demonstrated significant visual field enlargement induced by restitution therapy in patients with cerebral lesions.  
         [0038]      FIG. 8  shows a process flow chart illustrating operation of a kiosk for detection of visual field impairment and treatment thereof by visual training according to another embodiment of the present invention. Steps  300 - 306  are the same as described in the previous embodiments.  
         [0039]     In step  308 , a visual field test is launched in which the user is prompted to look at the kiosk display to begin a visual field test which is performed in the step  310 . An example of a visual test which can be used for this purpose is a computer-based campimetry described in “Computer-based Training of Stimulus Detection Improves Color and Simple Pattern Recognition in the Defective Field of Hemianopic Subjects,” by Kasten et al.; Journal of Cognitive Neuroscience, 12, 2000, pp. 1001-1012. Visual field impairment can be investigated by tests for detection of stimuli, shape recognition and color discrimination. The user is instructed to look at a fixation point at the center of the visual field generated by a display or light source throughout the examination and to respond to the visual stimulus by pressing a key on the computer keyboard. The stimuli are shown in different parts of the visual field.  
         [0040]     In step  312 , quantitative analysis of the reaction time to the presented stimuli is performed. High values of reaction time correspond to high degree of visual impairment. Obtained data are compared with the normal group data to indicate the state of visual impairment and to thereby determine diagnosis (step  314 ). Additionally, the data can be compared with previous data from the same person, which can then be used to monitor changes in condition over time.  
         [0041]     Based on information developed in step  314 , suggested fulfillment is formulated and appropriate visual training is selected in step  316 . Two examples of the visual training are the Visure and SeeTrain programs described in “Computer-based Training of Stimulus Detection Improves Color and Simple Pattern Recognition in the Defective Field of Hemianopic Subjects,” by Kasten et al. Journal of Cognitive Neuroscience, 12, 2000, pp. 1001-1012. Both programs are recommended for people with hemianopic scotoma (diminished vision in half of the visual field).  
         [0042]     In step  318 , the selected visual training program is performed. For example, the Visure program stimulates systematically the border between intact and deficient zones of the visual field. A large white square that rhythmically changes its size moves from the intact visual field towards the border area. The user is instructed to press a key as long as she/he is able to perceive the stimulus. The square then moves further into the direction of the blind area. If the user is not able to see the stimulus at this position, the stimulus automatically changes the direction of its movement and retracts back into the intact area. The SeeTrain program is based on static stimuli that can be presented stationary. In this case users have to detect the stimulus as quickly as possible and press a response key while the stimulus increased in size or in brightness. By performing this procedure the user exercises his or her visual field and stimulates healing. In step  320 , the training results are measured and the performance record is created, documenting the person ID, the diagnosis, and the training performed. Additionally, the performance of the user in the series of training exercises is recorded as well as establishing a new set of baseline information. In step  322 , the diagnosis and training results can be communicated to the doctor, to the general user file to used as a permanent electronic health record, or for other institutions and people upon the user agreement. The process then ends in step  324 .  
         [0043]     The process flow chart of  FIG. 9  describes the operation of yet another embodiment of the invention for diagnosing Age-related Macula Degeneration (AMD) based on fundus photography and providing a fulfillment in the form of photodynamic therapy. Photodynamic therapy is a recently developed intervention that uses photosensitive drugs (e.g., verteporfin) and a specially developed low-powered laser to treat AMD patients who still retain some visual acuity. Results of photodynamic therapy using verteporfin have shown it to be safe and effective in randomized clinical trials which have been reported, for example, in “Photodynamic Therapy of Subfoveal Choroidal Neovascularization in Age-related Macular Degeneration With Verteporfin: One-Year Results of 2 Randomized Clinical Trials—TAP Report 1,” Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study Group., Arch Ophthalmol, Vol. 117, October 1999, pp. 1329-1345.  
         [0044]     Referring to  FIG. 9 , steps  400 - 406  are the same as described in the previous embodiments. In step  408 , the user is prompted to look at a fundus camera, which is a test device for the eye examination module of the kiosk. Fundus camera is a specialized low power microscope with an attached camera, which allows the photographing of the retina (fundus) of the viewer. While the user looks at the camera, flashes of light are generated into the user&#39;s eye and retinal images are taken in step  410 . The automatic analysis of the retinal images is performed in step  412  and appropriate image parameters are determined (e.g., contrast, lightness homogeneity, etc.). In step  414 , the determined images parameters are compared with corresponding parameters for normal group data to indicate the possible presence and type of AMD disease. AMD is classified as either wet (neovascular) or dry (non-neovascular) types. Additionally, the data can be compared with previous data taken from the same person, which can then be used to monitor changes in the condition of the user&#39;s retina.  
         [0045]     Assuming a diagnosis of AMD, a fulfillment procedure is selected in step  416 . In the case of AMD a fulfillment can utilize for example a photodynamic therapy procedure.  
         [0046]     Photodynamic therapy is a novel form of treatment for the “wet” or exudative form of age-related macular degeneration. The wet form of macular degeneration involves the growth of abnormal blood vessels called choroidal neovascularization (CNV), beneath the retina resulting in leakage and bleeding. Without treatment, a majority of patients eventually develop scar tissue beneath the macula (the central part of the retina), which results in loss of central vision. In some cases, the blood vessels causing the leakage and bleeding are located outside the central part of vision.  
         [0047]     The concept of photodynamic therapy is to selectively close the abnormal blood vessels, eliminating the leakage and bleeding, and stabilizing or improving the vision. This is done without the damaging effect of conventional laser on the normal structures of the retina and back of the eye.  
         [0048]     During photodynamic therapy a patient receives an injection of a special dye, for example, Visudyne (liposomal BPD-MA verteporfin) through a vein in the hand or arm. This dye has unique properties which allow it to be used for this treatment. Specifically, this chemical circulates through the body and sticks to the walls of the abnormal blood vessels beneath the macula. At this point in the procedure, a laser is used to shine a light into the back of the eye. The energy produced by this laser is of a very low power and is not damaging like regular laser treatment. Instead, the light simply activates the chemical which is bound to the abnormal blood vessel wall. When the chemical is activated by this light beam, there is closure of the blood vessel. The result is that the fluid and blood which had been leaking beneath the retina is stopped. Over time, the body is able to absorb the blood and fluid, which results in stabilization or improvement in visual function. The blood vessel itself has not been completely destroyed, but rather is no longer leaking nor actively growing.  
         [0049]     In spite of the fact that the blood vessel may lie directly beneath the center of vision, photodynamic therapy does not result in damage to the normal retinal tissue or to the wall of the eye. As a result, unlike in traditional laser treatment, vessels directly beneath the center of vision can be effectively treated and closed without causing permanent damage to vision.  
         [0050]     After selection of the therapy in step  416 , the fulfillment is performed (step  418 ). For the photodynamic therapy a photosensitive dye (e.g., Visudyne) is administered into user&#39;s body and allowed to perfuse the choroidal neovascular membranes (CNVM), which are the leaky vascular structures under the retina in the “wet” form of AMD. Next, a red laser of a specific wavelength (689 nm) is directed into user&#39;s eye for few seconds (e.g., 90 seconds). The non-thermal laser light activates the Visudyne producing an active form of oxygen that both coagulates and reduces the growth of abnormal blood vessels. This, in turn, inhibits the leakage of fluid from the CNVM.  
         [0051]     In step  420 , the record is created, documenting the person ID, the diagnosis, and the procedure performed. In step  422 , the diagnosis and treatment descriptions as well as further instructions are communicated to the patient, to the doctor, to the general user file to used as a permanent electronic health record, or for other institutions and people upon the user agreement. In the case of photodynamic therapy the instruction to the patient would be to avoid exposure to the sunlight and intense halogen lights for a period of 24 hours until the drug has completely cleared out of the body. This is required since the dye remains within the body for approximately 24 hours. The process then ends in step  424 .  
         [0052]     The invention has been described in detail with particular reference to certain preferred embodiments thereof, but it will be understood that variations and modifications can be effected within the scope of the invention. For example, rather than a totally enclosed arrangement as described above, the invention encompasses a station comprising separate components interconnected and arranged so as to operate as described without necessarily being contained inside of an enclosure and the term “kiosk” as used herein shall be understood to include such an unenclosed arrangement of individual components.  
       PARTS LIST  
       [0000]    
       
           10  kiosk  
           11  user accommodation section  
           12  enclosure  
           13  eye examination and information processing section  
           14  seat  
           15  eyes  
           16  head rest  
           17  information processor  
           18  eyepiece  
           19  eye examination module  
           20  system process controller  
           21  ID validation module  
           22  user interface device  
           23  camera  
           24  payment device  
           26  printer  
           28  detachable alignment fixture  
           30  fulfillment section  
           32  eyeglass fabrication system  
           34  lens supply rolls  
           36  lens cutter  
           38  eyeglass frame supply reels  
           39  lens injector  
           40  output tray  
           42  lens  
           44   a  lens centerline  
           44   b  lens centerline  
           50  eyeglass frame  
           51  basic frame  
           52   a  frame rim  
           52   b  frame rim  
           54  integral rim hinge  
           56  alignment pins  
           58  ear pieces  
           60  integral earpiece hinges  
           62  locator holes  
           100  process starts  
           102  input patient data  
           104  identify payment  
           106  verify account information  
           108  position user  
           110  perform test  
           112  communicate test results to system process controller  
           114  select eye glass frame  
           116  cut lens  
           118  insert lens into selected frame  
           120  create record  
           122  communicate record  
           124  dispense frame assembly  
           126  process ends  
           200  process starts  
           202  input patient data  
           204  identify payment  
           206  verify account information  
           208  position user  
           210  perform test  
           212  analyze test  
           214  obtain results  
           216  select fulfillment  
           218  perform fulfillment  
           220  create record  
           222  print receipt  
           224  communicate record  
           226  process ends  
           300  process starts  
           302  input patient data  
           304  identify payment  
           306  verify account information  
           308  launch visual field test  
           310  perform visual test  
           312  analyze visual test  
           314  establish diagnosis  
           316  select visual training  
           318  perform visual training  
           320  create record  
           322  communicate record  
           324  process ends  
           400  process starts  
           402  input patient data  
           404  identify payment  
           406  verify account information  
           408  launch fundus images  
           410  take fundus images  
           412  analyze fundus images  
           414  determine diagnosis  
           416  select fulfillment  
           418  perform fulfillment  
           420  create record  
           422  communicate record  
           424  process ends