Abstract:
An ocular fundus imager automatically aligns fundus illuminating rays to enter the pupil and to prevent corneal reflections from obscuring the fundus image produced. Focusing the produced fundus image is automatically performed using a pair of video sensors and is based upon the fundus image itself. A head restraint is used to reduce the gross alignment between the optical system and the patient&#39;s pupil.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
   The present application is a continuation-in-part application of an application entitled “Ocular Fundus Auto Imager”, filed Dec. 16, 2002, assigned Ser. No. 10/311,492, now U.S. Pat. Ser. No. 7,025,459 which is a national phase application based on a Patent Cooperation Treaty application entitled “Ocular Fundus Auto Imager”, filed Jul. 6, 2001, assigned Ser. No. PCT/US01/21410, which is a continuation of and claims priority to a United States application entitled “Ocular Fundus Auto Imager”, filed Aug. 25, 2000, assigned Ser. No. 09/649,462, now U.S. Pat. No. 6,296,358 and which application claims priority to the subject matter disclosed in a provisional application entitled “FUNDUS AUTO IMAGER”, filed Jul. 17, 2000 and assigned Ser. No. 60/218,757 all of which applications are directed to an invention made by the present inventors and assigned to the present assignee. 

   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   The present invention relates to the field of ocular imaging, and, more particularly, to devices for imaging the ocular fundus. 
   2. Description of Related Art 
   The term ocular fundus refers to the inside back surface of the eye containing the retina, blood vessels, nerve fibers, and other structures. The appearance of the fundus is affected by a wide variety of pathologies, both ocular and systemic, such as glaucoma, macular degeneration, diabetes, and many others. For these reasons, most routine physical examinations and virtually all ophthalmic examinations include careful examination of the ocular fundus. 
   Routine examination of the ocular fundus (hereinafter referred to as fundus) is performed using an ophthalmoscope, which is a small, hand-held device that shines light through the patient&#39;s pupil to illuminate the fundus. The light reflected from the patient&#39;s fundus enters the examiner&#39;s eye, properly focused, so that the examiner can see the fundus structures. 
   If a hard copy of the fundus view is desired, a device called a fundus camera can be used. However, to use existing fundus cameras successfully is a very difficult undertaking. The operator must (1) position the fundus camera at the correct distance from the eye, (2) position it precisely in the vertical and horizontal directions in such a way that the light properly enters the pupil of the patient&#39;s eye, (3) refine the horizontal and vertical adjustments so that the light reflected from the front surface of the eye, the cornea, does not enter the camera, (4) position a visual target for the patient to look at so that the desired region of the fundus will be imaged, and (5) focus the fundus image. All these operations must be performed on an eye that is often moving. Therefore, the use of existing fundus cameras requires a significant amount of training and skill; even the most skilled operators often collect a large number of images of a single eye in order to select one that is of good quality. 
   In existing fundus cameras, alignment and focusing are performed under visual control by the operator. This usually requires that the patient&#39;s eye be brightly illuminated. Such illumination would normally cause the pupils to constrict to a size too small to obtain good images. Therefore, most existing fundus cameras require that the patient&#39;s pupil be dilated by drugs. 
   U.S. Pat. No. 4,715,703 describes an invention made by one of the present inventors and discloses apparatus for analyzing the ocular fundus. The disclosure in this patent is incorporated herein by reference. 
   SUMMARY OF THE INVENTION 
   The present invention is in the nature of a fundus camera which automatically and quickly performs all the aligning and focusing functions. As a result, any unskilled person can learn to obtain high quality images after only a few minutes of training and the entire imaging procedure requires far less time than existing fundus cameras. Moreover, all of the automatic aligning and focusing procedures are performed using barely visible infrared illumination. With such illumination, the patient&#39;s pupils do not constrict and for all but patients with unusually small natural pupils, no artificial dilation is required. The fundus images can be obtained under infrared illumination and are acceptable for many purposes so that the patient need not be subjected to the extremely bright flashes required for existing fundus cameras. To obtain standard color images using the present invention, it is sometimes necessary to illuminate the eye with flashes of visible light. However, such images can be obtained in a time appreciably shorter than the reaction time of the pupil, so that the pupil constriction that results from the visible flash does not interfere with image collection. Unlike existing fundus cameras, the present invention provides for automatic selection of arbitrary wavelengths of the illuminating light. This facility has two significant advantages. First, it is possible to select illuminating wavelengths that enhance the visibility of certain fundus features. For example, certain near-infrared wavelengths render the early stages of macular degeneration more visible than under white illumination. Second, by careful selection of two or more wavelengths in the near infrared, it is possible to obtain a set of images which, when properly processed, generate a full color fundus image that reveals sub-retinal fundus features. Thus, it is possible to obtain acceptable color fundus images without subjecting the patient to bright flashes. 
   It is therefore a primary object of the present invention to provide a fundus imager which automatically positions fundus illuminating radiation to enter the pupil while preventing reflection from the cornea from obscuring the fundus image, irrespective of movement of the eye or the patient&#39;s head within the head restraint. 
   Another object of the present invention is to provide automatic focusing of the fundus image based upon the image itself. 
   Yet another object of the present invention is to provide automatic positioning of one or a sequence of fixation targets to select the sections(s) of the fundus to be imaged. 
   Still another object of the present invention is to provide a fundus imager for collecting a set of images that can be arranged in a montage to provide a very wide angle fluids image facilitated by the capability of the fundus imager to automatically align and focus the images. 
   A further object of the present invention is to provide automatic setting of video levels in a fundus imager to use the full range of levels available. 
   Yet another object of the present invention is to permit aligning and focusing a fundus imager under infrared illumination to permit imaging without drug induced dilation of the pupil. 
   A yet further object of the present invention is to provide for automatic selection of illumination wavelength. 
   A yet further object of the present invention is to provide a colored image from a fundus imager by sequential imaging and registration of images. 
   A yet further object of the present invention is to provide for automatic acquisition by a fundus imager of a stereo image pair having a known stereo base. 
   A yet further object of the present invention is to provide a head positioning frame for use with a fundus imager. 
   A yet further object of the present invention is to accommodate for astigmatism and/or extreme near and far sightedness by placing a lens of the patient&#39;s glasses in the path of illumination of the fundus imager. 
   A yet further object of the present invention is to provide a method for automatically positioning the illuminating radiation of a fundus imager to prevent corneal reflections from obscuring the fundus image obtained. 
   A yet further object of the present invention is to provide a method for automatic focusing in a fundus imager. 
   These and other objects of the present invention will become apparent to those skilled in the art as the description thereof proceeds. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The present invention will be described with greater specificity and clarity with reference to the following drawings, in which: 
       FIG. 1  is a schematic diagram illustrating the functional elements of the present invention and  FIG. 1  a representatively illustrates structure for moving the optical system; 
       FIGS. 2A and 2B  illustrate representations of the front and side views of apparatus for focusing the image; 
       FIGS. 2C and 2D  illustrate representations of the front and side views of a variant apparatus for focusing the image; 
       FIG. 3  is a block diagram illustrating a representative computer system for operating the present invention; 
       FIG. 4  illustrates the effect of corneal reflections to be avoided; 
       FIG. 5  is a schematic illustrating an alignment of the optical axis to avoid corneal reflections; 
       FIGS. 6  is a graph illustrating determination of an acceptable video level; 
       FIG. 7  illustrates determination of edge points; 
       FIGS. 8A ,  8 B and  8 C depict the light rays from a point to an image plane without an interposed aperture, and with an interposed aperture at two locations displaced from one another; 
       FIGS. 9A and 9B  illustrate the shift of an image upon an image plane located beyond the focal plane in response to displacement of an interposed aperture from one location to another; 
       FIGS. 10A and 10B  illustrate the shift of an image upon an image plane located short of the focal plane in response to displacement of an interposed aperture from one location to another; and 
       FIG. 11  illustrates a head restraint in the form of a pair of spectacles. 
   

   DESCRIPTION OF THE PREFERRED EMBODIMENT 
   Referring to  FIG. 1 , there is illustrated a preferred embodiment of optical system  10  of the present invention. Lens L 1  focuses light from a light source S onto a small aperture A 1 . The light source may be a source of visible light, infrared radiation or of a wavelength in the near visible infrared region. Light passing through aperture A 1  passes through a filter F toward lens L 2 . Lens L 2  collimates (makes parallel) light from aperture A 1 . A beam splitter BS 1  reflects about ninety percent (90%) of the incident light from lens L 2  to lens L 3 . Half of the light passing through lens L 3  is transmitted through beam splitter BS 2  and is absorbed by light trap LT. The other half of the light passing through lens L 3  is reflected by beam splitter BS 2  and forms an image of aperture A 1  in the focal plane of lens L 3 , which focal plane lies in the plane of a patient&#39;s pupil P. The light passing through the pupil illuminates a section  12  of ocular fundus  14  (hereinafter only the term fundus will be used). 
   Light diffusely reflected from fundus  14  emerges from pupil P and half of it is transmitted through beam splitter BS 2  toward collimating lens L 4 , which lens is at its focal distance from the pupil. If the patient&#39;s eye is focused at infinity, the light reflected from each point on fundus  14  will be collimated as it is incident on lens L 4 . Therefore, the 50% of the light that passes through beam splitter BS 2  will form an aerial image of the fluids in the focal plane of lens L 4 , which focal plane is represented by a dashed line identified as FI (Fundus Image). The light passes through lens L 6 , which lens is at its focal distance from fundus image FI. Thus, lens L 6  will collimate light from each point on the fundus. Further, because the light considered as originating in the plane of pupil P is collimated by lens L 4 , lens L 6  will form an image of the pupil in its back focal plane, which is coincident with the location of second aperture A 2 . Light passing through second aperture A 2  is incident on lens L 7 , which lens will then form an image of the fundus in its back focal plane which is coincident with an image sensor or video sensor C 1 . The video image produced by video sensor C 1  represents an image of the fluids. 
   An infrared light emitting diode (LED), representatively shown and identified by reference numeral  21 , diffusely illuminates the region of the front of the eye. 
   If the eye is not focused at infinity, the aerial fundus image FI will be moved away from the back focal plane of lens L 4 . For example, if the eye is nearsighted, the aerial fundus image will move toward lens L 4 . Such movement would cause the fundus image to be defocused on video sensor C 1 . Focusing the image under these conditions is accomplished as follows. Lens L 6 , aperture A 2 , lens L 7 , and video sensor C 1  are mechanically connected to one another by a focusing assembly labeled FA; that is, these elements are fixedly positioned relative to one another and move as a unit upon movement of the focusing assembly. A unit identified by reference numeral  23  provides rectilinear movement of the focusing assembly on demand. 
   The entire optical system ( 10 ) discussed above and illustrated in  FIG. 1  is supported upon an assembly shown in  FIG. 1   a  and identified by reference numeral  20 . The assembly includes motive elements, such as rectilinear actuators and related servomechanisms responsive to commands for translating the entire optical system horizontally (laterally), vertically and toward and away from the eye, or movement in the x, y and z axis as representatively depicted by set of arrows  22 . By moving the assembly as necessary in the x, y and z axis the illumination light is positioned on the eye. 
   To operate optical system  10 , a computer control system  30  is required, which is representatively illustrated in  FIG. 3 . The computer control system includes a central processing unit (CPU)  32 , such as a microprocessor, and a number of units interconnected via a system bus  34 . A random access memory (RAM)  36 , a read only memory (ROM)  38  are incorporated. An input/output adapter  40  interconnects peripheral devices, such as a disk storage unit  42 . A user interface adapter  44  connects the keyboard  46 , a mouse (or trackball)  48 , a speaker  50 , a microphone  52 , and/or other user interface devices, such as a touch screen (not shown) with system bus  34 . A communication adapter  54  interconnects the above described optical system  10  through a communication network  56 . A display adapter  58  interconnects a display unit  60 , which maybe a video screen, monitor, or the like. The computer operating system employed maybe any one of presently commercially available operating systems. 
   In operation, an operator enters patient information data into the computer control system using the keyboard and also enters the location or set of locations on the fluids that is/are to be imaged. It may be noted that the field of view of the optical system is preferably 30° in diameter while the ocular fundus is about 200° in diameter. To image various regions of the 200° fundus, the eye can be rotated with respect to the optical system; such rotation is achieved by having the patient look from one reference point to another. After entry of the raw data, the patient&#39;s head is juxtaposed with a head positioning apparatus to locate the eye in approximate alignment with respect to the optical axis. An image of the front of the eye produced by a video sensor or camera CAM, ( FIG. 1 ) appears on computer-screen  60 . The operator may use a trackball or mouse  48  or similar control to move the image horizontally and vertically until the pupil is approximately centered on a set of cross-hairs displayed on the computer screen. Such horizontal and vertical movements, along with focusing of the image of the pupil, are achieved by moving entire optical system  10  through energization of assembly  20  (see  FIG. 1 ). That is, the horizontal and vertical movements of the image are achieved by moving the entire optical system horizontally and vertically and the focusing of the pupil image is accomplished by moving the entire optical system toward or away from the eye. When the operator is satisfied that the pupil is approximately centered, the operator de-energizes LED  21  (which illuminated the front of the eye) and then initiates the automatic alignment and image collection procedure. 
   To achieve proper alignment of the optical system with the eye requires that the light from light source S enter the pupil. Initially, the angular position of beam splitter BS 1  is set so that the image of aperture A 1  lies on the optical axis of the system. It is noted that the image of aperture A 1  contains the light used to illuminate the ftndus. If the operator has initially centered the pupil image even crudely, light from light source S will enter the pupil. About two percent (2%) of the light incident on the eye will be reflected from the corneal surface and if this light reaches video sensor C 1 , it would seriously obscure the image of the fundus. Therefore, the optical system includes the following elements for preventing corneal reflection from reaching video sensor C 1 . 
   If the light rays forming the image of aperture A 1  were aligned so that the central ray were perpendicular to the corneal surface, then many of the rays in the corneal reflection would pass backward along the incident light paths. As shown in  FIG. 4 , the central ray would pass back on itself; the ray labeled Ray- 1  would pass back along the path of the incident ray labeled Ray- 2 , etc. (The angle at which a ray is reflected from a shiny surface can be determined as follows. First, find the line that is perpendicular to the surface at the point that the ray hits. Then find the angle between the incident ray and the perpendicular ray; this is called the “angle of incidence”. Finally, the ray will be reflected at an angle equal to the angle of incidence but on the other side of the perpendicular line. This is called the angle of reflection.) It is therefore evident from the schematic shown in  FIG. 4  that many rays reflected from the corneal surface and impinging upon beam splitter BS 2  would enter lens L 4  and impinge upon video sensor C 1 . 
   However, the corneal surface is steeply curved and if the central ray of the incident light is moved far enough away from the perpendicular to the cornea, as shown in  FIG. 5 , the reflected light will be deflected far enough to miss beam splitter BS 2  and therefore miss passing through lens L 4  and therefore not impinge upon video sensor C 1 . The method for achieving this deflection will be described below. 
   Initially, the angle of beam splitter BS 1  ( FIG. 1 ) is set so that the image of A 1  lies on the optical axis. Thereby, the optical system is automatically aligned to be centered on the pupil and the image of A 1  is in the plane of the pupil, as set forth below. When this alignment is accomplished, the image A 1  will be centered on and in focus in the plane of the pupil. 
   If a fundus image were to be collected under these conditions, the reflection from the cornea would severely spoil the fundus image. To prevent this, after alignment is achieved, the angular position of beam splitter BS 1  is changed by motor  24  and linkage  26  to move the image of A 1  to the bottom of the pupil. If the pupil is about  4 mm or larger in diameter, this will deflect the corneal reflection sufficiently that it will not enter lens L 4 . To do this, the diameter of the pupil must be known. This diameter is determined by performing the method described below for automatic alignment in the vertical and horizontal directions. 
   If the pupil is relatively small, a further technique is employed to allow greater displacement of the illumination away from the center of the pupil. This is accomplished by automatically changing the aiming point of the vertical alignment servo so that the image of the pupil moves downward with respect to the optical axis by an amount that is a fixed proportion of the pupil diameter. Thus, the regions of the pupil through which the images are collected moves toward the top of the pupil and the image of A 1  has more room to move downward. This description refers to movement of the image of A 1  to the bottom of the pupil. The same effect can be achieved by moving the bar to the top of the pupil and moving the servo aiming point so that the pupil image moves upward. In general, if the patient is looking downward, moving the image of A 1  downward is more effective and if the patient is looking upward, it is more effective to move the image of A 1  to the top of the pupil. 
   A method for tracking the pupil and positioning the image of aperture A 1  on the pupil of the eye will be described hereafter with reference to  FIG. 1 . The images appearing on video sensors or cameras CAM 1  and CAM 2  are used for automatic tracking of the eye and the positioning of the image of aperture A 1 . This is done by using the computer system and its software for extracting the edges of the pupil from the video signal and computing the coordinates of its center and of its edges. 
   About half of the light reflected from fundus  14  is reflected from beam splitter BS 2  through lens L 3 , and about 10% of that light passes through beam splitter BS 1 . Some of that light passes through a lens L 8  and falls on a small camera CAM 1  on which an image of the pupil is formed. Others of those rays pass through another lens L 9  (shown in dashed lines) and to camera CAM 2  (shown in dashed lines) and forms another image of the pupil. These lenses and cameras are placed one above and the other below the plane of the paper in  FIG. 1 . Thereby, one camera receives the image of the pupil as seen at an angle to the left of the optical axis and the other camera receives the image of the pupil as seen at an angle to the right of the optical axis. 
   The output of one of these cameras is used to position optical system  10  in the x and y axis, as described in further detail below. To position the optics at the correct distance from the eye (the z direction), the images from cameras CAM 1  and CAM 2  are compared in software. When the pupil is at the correct distance from the optics, that is, when the pupil is in the focal plane of lens L 3  (and therefore, because of the mechanical arrangement, in the focal plane of lens L 4 ), then the two pupil images will lie in a particular relationship to each other. If the optical system were perfectly aligned and centered, the two images would each be perfectly centered in the fields of view of their respective cameras CAM 1  and CAM 2 . Then, considering the fields of view of the two cameras as superimposed, if the pupil image from the left camera is to the left of the image from the right camera, then the optics need to be moved closer to the patient and vice versa. 
   If the optical system is not perfectly aligned, there will be a particular relative positioning between the two images that occurs when the pupil is in the correct position, and the software drives optical system  10  in the z direction until that relative position is attained. (That relative position is determined during the procedure for optically aligning the entire system.) 
   A method for finding the center and the edges of the pupil image will now be described. It involves finding the edges of the pupil image on each video line that intersects the edges and then computing the most likely position of the center and of the edges of the actual pupil. The image from camera CAM 1  is read out, as is the standard video practice, by reading the values of the various points along a horizontal line and then the values along the next horizontal line, etc. (neglecting the detail of interlacing). If a given video horizontal line intercepts the image of the pupil, the video level will abruptly rise from the dark background level to the brighter level of the pupil. To locate this transition and find the position of each edge, it is necessary to define the values of the background and of the pupil. To do this, a histogram of pixel values is formed during the first few video frames. It will contain a large peak with values near zero, representing dark background pixels, and additional peaks at higher values that represent the pupil and various reflections to be discussed below. A typical histogram is illustrated in  FIG. 6 . Each point along the horizontal axis represents a different video signal level and each point on the vertical axis indicates the area of the image that displays the corresponding video level. 
   The “background level” is defined as the level just below the first minimum. Specifically, the histogram is first smoothed using a running block filter. That is, for a position on the horizontal axis the vertical value on the curve is replaced by the average of the vertical value and its adjoining values. This computation is performed in steps along the horizontal axis (video level) until there are ten consecutive values for which the vertical axis increases. The “background value” is then defined as the lowest of these ten values. An “edge point” on each horizontal line is defined as the horizontal location for which the video level changes from equal to or below the “background value” to above that value or changes from above that value to equal or below that value. As the video scan proceeds, the location of each point is saved. Thus, at the end of each video frame, a set of point locations is stored in the computer memory (see  FIG. 3 ). 
   If the pupil image consists solely of a bright disk on a dark background, the above described procedure would essentially always be successful in finding a close approximation to the actual pupil edges. However, for real pupil images the procedure is confounded by two sources of reflections. First, light reflected from the cornea; if this light reaches cameras CAM 1  and CAM 2 , it will form a bright spot superimposed on the pupil image. If that spot were entirely within the margins of the pupil, it would not interfere with the process described above. However, if it falls on the edge of the pupil image, as it may when a patient is looking at an angle to the optical axis of the optical system, then it will appear as a bulge on the edge of the pupil, as illustrated in  FIG. 7 . Therefore, some of the “edge points” located by the above computations will actually be edges of the corneal reflection instead of the edge of the pupil. Second, a similar problem arises if the image of aperture A 1  falls on the edge of the pupil, as it might during an eye movement too fast to be accurately tracked and compensated. In that event, finding the center and the edges of the pupil requires special procedures. 
   One such special procedure will described below. The edge points are collected as described above. There will typically be several hundred such points. An ellipse is then found (determined) that best fits the set of edge points. The pupil of the human eye is usually circular, but if it is viewed from an angle, as it will be if the patient is looking at a point other than on the optical axis, then the image of the pupil will approximate an ellipse. So long as the reflections from the cornea and iris do not overlap a major part of the pupil edge (and so long as the pupil is not of grossly abnormal shape), such a procedure yields a good estimate of the locations of the actual pupil center and the edge. 
   One method for finding the best fitting ellipse will be described. Assuming that two hundred points have been labeled edge points by the above procedure, each of such points has a horizontal (x) and a vertical (y) location. Assume that these two hundred points, that is pairs of values (x,y), are in a consecutive list. Five points are selected at random from the list, requiring only that each selected point be separated from the next selected point by at least ten positions on the list. This process will then yield the locations of five putative edge points that are some distances apart on the pupil. These five pairs of values are substituted into the equation for an ellipse and solved for the five ellipse parameters. One form of equation for an ellipse is:
 
 c 1* x ^2 +c 2* xy+c 3* y ^2 +c 4* x+c 5* y =1
 
Substitute the five putative edge points as the pairs (x,y) of values in that equation. Invert the matrix to find the values for c 1  through c 5 . Then the angle that the ellipse makes with the xy axis is:
 
θ=½*arc cot(( c 1− c 3)/ c 2)
 
Then if u=x*cos θ+y*sin θ and v=−x*sin θ+y*cos θ, then d 1 *u^2+d 3 *v^2+d 4 *u+d 5 *v=1
 
Where d 1 =c 1 *cos^2+c 2 *cos θ*sin θ+c 3 *sin^2 θ
 
 d 3= c 1*sin ^2 θ−c 2*cos θ*sin θ+ c 3*cos ^2 θ
 
 d 4= c 4*cos θ+ c 5*sin θ
 
 d 5=− c 4*sin θ+ c 5*cos θ
 
The center of the ellipse has u coordinate u=−d 4 /(s*d 1 ) and v coordinate V=−d 5 /(2*d 3 ) so the center of the ellipse has the x coordinate
 
 x=u *cos θ− v *sin θ
 
and the y coordinate
 
 y=u *sin θ+ v *cos θ
 
If R=1+d 4 ^2/2d 1 +d 5 ^2/2d 3  then the semiaxes of the ellipse have lengths
 
   Square root (R/d 1 ) and square root (R/d 3 ) 
   This entire procedure is repeated, say, 100 times for 100 different sets of putative points yielding 100 different estimates of the x,y location of the center. The best fitting ellipse is the one for which the center is closest to the median x and y values of the set of 100. 
   The resulting deviations between the horizontal and the vertical locations of the center of the chosen ellipse and the optical axis of the optical system can be used directly as error signals to drive the positioning servos associated with assembly  20  ( FIG. 1   a ) and the image of aperture A 1  can be directly and finely positioned so that the image lies just inside the pupil. 
   An automatic method for focusing the ftndus image will be described with reference to  FIG. 2   a  and  2   b  showing an assembly  70 . Aperture A 3  and A 4  are holes significantly smaller then the image of the pupil and which is conjugate with the pupil; that is, they are in the same plane as the image of the pupil but offset laterally and vertically. In the preferred embodiment, apertures A 3 , A 4  are circular apertures two millimeter (2 mm) in diameter. Apertures A 3  and A 4  are mounted on subassembly  74  coupled to a linear actuator  72  that can move the subassembly rapidly in a vertical direction, as depicted by arrows  75 . Subassembly  75  lies in the plane of A 2  (see  FIG. 1 ) and representatively identified by a box labeled  77 . In the alignment method described above, the image of aperture A 1  is made to lie near the edge of the pupil and a fundus image is saved. To focus, two images are saved in rapid succession, one with aperture A 4  lying to the right of the center of the pupil image and the second with aperture A 3  lying to the left of the center of the pupil image, by enabling linear actuator  72  to rapidly translate plate  76 . If the focusing assembly FA is positioned so that the fundus image FI lies in the focal plane of lens L 6  (the fundus image is thus correctly focused on video sensor C 1 ) then the two images taken with apertures A 3  and A 4  in the two positions will be in registry and superimposable. However, if focusing assembly FA is not correctly positioned and the image is out of focus, then one of the images will be horizontally displaced with respect to the other. With the particular optical arrangement illustrated in  FIG. 1 , the direction of the displacement (unit  23 , arrow  25 ) indicates the direction that focusing assembly FA must move to achieve correct focus and the size of that displacement is directly proportional to the distance the focusing assembly must move to correct focus. 
   To explain more clearly the direction of displacement of the focusing assembly (FA) to achieve correct focus, joint reference will be made to  FIGS. 8A ,  8 B,  8 C,  9 A,  9 B,  10 A and  10 B. As shown in  FIG. 8A , lens Lx forms an image of a point P that is sharply focused on image plane IP. If the aperture of an apertured plate Ax is placed between point P and lens Lx off the optical axis, the image of point P will be in focus on image plane IP, as shown in  FIG. 8B . However, because certain of the-rays are excluded by the plate, the intensity of the image on the image plane will be reduced. As depicted in  FIG. 8C , displacement of the aperture in apertured plate Ax will have no effect upon the location of the image of point P on the image plane. If the image plane IP is displaced from the focal plane FP, as depicted in  FIG. 9A , a blurred image of point P will appear on the image plane at a location diametrically opposed relative to the optical axis from the aperture in apertured plate Ax. When the apertured plate is displaced (like the displacement shown in  FIG. 8C ), the blurred image on the image plane will be displaced in a direction opposite from the displacement of the apertured plate, as shown in  FIG. 9B . If image plane IP is short of the focal plane FP, as shown in  FIG. 10A , the rays passing through the aperture of apertured plate Ax will form a blurred image of point P on the image plane. This blurred image will be on the same side of the optical axis as is the aperture. If the apertured plate is displaced (like the displacement shown in  FIG. 8C ), the blurred image of point P on the image plane will be displaced in the same direction, as shown in  FIG. 10B . From this analysis, the following conclusions are evident. If the image is in focus on the image plane, any shift of an apertured plate will not affect the position of the image in the image plane. If the image plane is beyond the focal plane, the image on the image plane will shift in a direction opposite to the direction of displacement of the aperture. Congruously, if the focal plane is beyond the image plane, the image on the image plane will shift in the same direction as the aperture is displaced. From these relationships, it is a simple computational exercise performable by the computer system illustrated in  FIG. 3  to determine the direction and amount of displacement of focal assembly FA necessary to place the image of the fundus in focus on video screen C 1 . 
   Thereby, automatic focusing is achieved by finding the displacement of one image of a pair of images that is required to bring the two images into registry and then moving the focusing assembly in accordance with such result. The required displacement can be found by computing a cross-correlation function between the two images. This is a mathematical computation that, in effect, lays one image on top of the other, measures how well the two images correspond, then shifts one image horizontally a little with respect to the other, measures the correspondence again, shifts the one image a little more and measures the correspondence again and repeats these steps for a large number of relative positions of two images. Finally, the shift that produces the best correspondence is computed. 
   Even when a patient is trying to hold his/her eye steady, the eye is always moving and as a result the fundus image is continually shifting across the sensing surface of video sensor C 1 . Exposure durations for individual images are chosen to be short enough (about 15 milliseconds) so that this motion does not cause significant blur. Nevertheless, the time interval between members of pairs of images taken during the automatic focusing procedure may be long enough to allow movement between the images that would confound the focusing algorithm. Therefore, the actual procedure requires that a number of pairs of images be collected and, only when two members of a pair agree will they be used as the measure of focus error. 
   The focusing method described above requires that a number of image pairs must be collected in order to find a set that is relatively unspoiled by eye movements. It would be preferable to obtain the two images (one through the left and the other through the right side of the pupil) simultaneously, so that eye movements would not affect the result. A method for simultaneous image collection is described below. 
     FIG. 2A  illustrates of an assembly  70  that lies approximately in the plane of aperture A 2  shown in  FIG. 1  and mounted on the focus assembly FA (representatively identified as box  77 ).  FIG. 2A  shows a view of assembly  70  from the patient&#39;s side of the optical system and  FIG. 2B  is a representative top view of the assembly. A linear actuator  72  moves a subassembly  74 , as represented by arrow  75 , up or down. The subassembly consists of an opaque plate  76  with two round apertures, labeled A 3 , A 4  and a pair of mirrors  78 ,  80 . In one position of the subassembly, one (A 3 ) of the two apertures lies just to the left of the optical axis and in another position, the other aperture (A 4 ) lies just to the right of the optical axis. Those are the two positions described above for collecting images through the right and left sides of the pupil. 
   If subassembly  74  is moved farther upward by linear actuator  72 , the image of the patient&#39;s pupil will fall on double mirrors  78 , 80 . In a preferred embodiment, the double mirrors are formed by a right angle prism  82  with the two faces ( 78 ,  80 ) that form a right angle being silvered. When the mirrors are in place, light from the fundus that exits through the left side of the pupil is deflected through a lens L 8  and onto a video sensor or camera, CAM 3 , and light from the right side of the pupil is deflected through another lens L 9  and to another video sensor or camera, CAM 4 . When the fundus image is in proper focus, light from the fundus will be collimated when it arrives at each of lenses L 8 , L 9  and, because cameras CAM 3  and CAM 4  lie in the focal planes of those lenses, an image of the fundus will be formed on each camera, one of the images being formed with light passing through the left side of the pupil and the other is formed with light passing through the right side of the pupil. The two cameras are synchronized so that the two images are captured simultaneously. 
   If the fundus is in correct focus, and if the two lenses (L 8 , L 9 ) and two cameras (CAM 3 , CAM 4 ) are perfectly positioned on the optical axes, then the two images will occupy identical positions on the two cameras. If the image is out of focus, the two images will move in opposite directions with respect to their respective cameras. Thus, computing a cross-correlation function on the two images provides the information necessary to move the focus assembly FA to achieve correct focus, (by the same principle as explained with reference to  FIGS. 8 ,  9  and  10 ). Because the two images were collected simultaneously, eye movements cannot perturb the measurement. 
     FIGS. 2C and 2D  show another method for obtaining images from the two sides of the pupil simultaneously.  FIG. 2C  is a side view of an assembly  90  much like assembly  70  shown in  FIG. 2A  and is placed in the same position (box  77  in  FIG. 1 ) in the plane of the image of the pupil. The two upper holes A 5 , A 6  are, again, the holes for imaging the fundus through the right (A 6 ) and left (A 5 ) sides of the pupil for stereo imaging. When subassembly  92  is raised by linear actuator  94  (as represented by arrow  95 ) to cause the image of the pupil  84  to fall symmetrically on two lower holes A 7 , A 8 , one hole lets through light from the fundus that passes through the top of the pupil and the other through the bottom of the pupil. A wedge prism  96  is placed over top hole A 7  and right angle prism  98  or dove prism is placed over lower hole A 8 , as shown in  FIG. 2D . Light passing through the two holes (A 7 , A 8 ) and prisms  96 ,  98  falls on lens L 7  (shown in  FIG. 1 ) and forms fundus images on video sensor C 1 . 
   If the prisms were removed and the fundus were in good focus, the images through the top and bottom holes would be precisely superimposed, but if the image is out of focus, one image would move up and the other down, in proportion to the degree of defocus. If that displacement could be measured, it would serve as the error signal to perform automatic focusing of the fundus image. However, because the two images would strongly overlap, there is no simple way to distinguish one image from the other. The prisms serve the function of moving the two images so that they do not overlap, as follows. 
   Upper wedge prism  96  deflects all of the rays  100  passing through it upwards, 15 degrees in the preferred embodiment. Therefore, the fundus image formed through the top of the pupil will move upwards on the camera. This will cause the top half of the image to fall above the sensor surface and be lost. However, the bottom half of the image will fall on the top half of the sensor and can be captured since the field of view is 30 degrees. 
   Right angle prism  98  acting as a dove prism, performs two different functions. First, because hypotenuse side  102  of the prism is not horizontal but is tilted downward, the image (ray  104 ) passing through it will be deflected downward by 15 degrees. If this were its only action, it would cause the upper half of the fundus image to fall on the lower half of the sensor. Therefore the two images, being different parts of the fundus, could not be compared. However, its dove prism action causes the image passing through it to be rotated through 180 degrees (as depicted by ray  104 ), so that the bottom half of the fundus image falls on the bottom half of the sensor. That allows relative positions of the two images (and thus the focus error) to be computed. In this way, the focus error can be determined from (half) images collected simultaneously. 
   Of course, if the two lower holes (A 7 , A 8 ) were side by side instead of one above the other, and the prisms were rotated accordingly, the two half images would be positioned one on the left and the other on the right half of the sensor, and the computation for focus error could again be accomplished. 
   Selection of the fluids region to be imaged will now be described. Adjacent beam splitter BS 1  illustrated in  FIG. 1  lies a set of dots  15 ,  16 ,  17 ,  18  and  19 . Each dot represents a visible light emitting diode (LED). Beam splitter BS 1  transmits about 10% of the light from these LED&#39;s toward lens L 3  and the eye. The set of dots lies in the back focal plane of lens L 3  and these LED&#39;s appear to the eye as if they were a long distance away. Only one of the LED&#39;s is illuminated at any given time and the patient is asked to look at it. When the patient looks at the illuminated LED, the location of the LED with respect to the optical axis of the instrument determines the location on the fundus that will be illuminated and imaged. For example, if the LED that lies on the optical axis is turned on and the patient fixates it, then the image will be centered on the fovea or macula. If the illuminated LED is 17 degrees (17°) to the patient&#39;s left, then the region of the ftndus imaged has its center 17 degrees (17°) to the left of the macula (as observed from the front of the eye). 
   In addition to the LED&#39;s in the plane labeled FIX, other visible LED&#39;s, such as LED  28  shown in  FIG. 1 , are positioned at various angular displacements from the optical axis, lying, such as to the side of lens L 4 . When one of these LED&#39;s is turned on, it does not appear at optical infinity but nevertheless the patient can successfully fixate it to yield a view of more peripheral fundus features. 
   When the operator sets up the instrument prior to collecting images, he/she selects the region or set of regions of the fundus to be imaged. If just one region is to be imaged, the appropriate LED will be lighted. If a series of locations is to be imaged, the computer (see  FIG. 3 ) automatically selects the LED corresponding to the first location; after the image has been collected, the remaining selected LED&#39;s are lighted in sequence until the desired sequence of images has been obtained. If such a sequence involves locations that are widely separated so that the patient must make a significant eye movement to refixate, then the computer commands the horizontal and vertical positioning servo mechanisms of assembly  20  ( FIG. 1   a ) to move optical system  10  (and optical axis) to the position where the center of the pupil is expected to be after the fixation movement. 
   After the image of aperture A 1  has been located to exclude the corneal reflection and focusing has been achieved, another pair of images is collected with aperture A 2  in each of two positions. This pair of images constitutes a stereo pair of images with a known stereo base, which base is the distance through which aperture A 2  has moved. 
   During the alignment and focusing procedures previously described, filter F (see  FIG. 1 ) blocks visible light but transmits near infrared wavelength radiation. To obtain an image or set of images in infrared illumination, this filter need not be changed. For certain forms of colored images, it is necessary to collect an image, change the filter to one transmitting a different wavelength band, acquire another image and return the infrared filter. The result is two or more images, each taken in a different wavelength band. To display a single color image, the different images are used to drive different color guns in a display device. For example, if one image is collected in red illumination and a second is collected in green illumination then the red image is made to drive the red gun in the display device and the green image is made to drive the green gun in the display device. The combined images will appear as a normal (two color) image. 
   During the interval between images collected in different wavelengths, it is possible that the eye, and thus the fundus image, will move significantly. If such movement occurs, then the variously colored images would not be in registry when displayed. To prevent this occurrence the images are automatically registered before being displayed by performing a two-dimensional cross-correlation and then shifting the images in accordance with the result. 
   Essentially all standard ophthalmic instruments position a patient&#39;s head using a combination of a chin rest and a forehead rest. Other devices, such as a combination of chin rest and support for the bridge of the nose would be suitable. Typically, only a bridge of the nose rest is used in the present device. These types of devices are representatively shown in  FIG. 1  by box  13 . The variations in the location of the eyes with respect to the bridge of the nose is such that virtually all eyes will fall within a cube that is fixed with respect to the instrument and is about 20 millimeters on a side. This is a much smaller variation then is encountered by using the usual chin and forehead rest apparatus. Thus, the commonality and uniformity of the location of the eyes with respect to the spectacles or nose bridge requires a very small range of accommodating movement of optical system  10 . Furthermore, a properly chosen device constrains head movement appreciably better than a chin and forehead rest apparatus; thus, the requirement for an automatic tracking system is reduced. 
   The motion of focusing assembly FA (see  FIG. 1 ) compensates for a patient&#39;s spherical refractive error (near or farsightedness) but does not correct for astigmatism. Because the fundus images are collected through a small aperture A 2 , moderate amounts of astigmatism will not significantly spoil the image quality. If a patient has a strong astigmatism, correction is desirable. In principle, this correction could be achieved by allowing the patient to wear his/her glasses in the instrument. However, the reflections from such eyeglasses may seriously impair the image quality. An equivalent result which does not create serious reflections is that of mounting the patient&#39;s eyeglasses in the optical system in a plane close to the plane of aperture A 2  with the same orientation as when worn. A representative mounting  29  for receiving and retaining a lens of a pair of glasses is shown in dashed lines in  FIG. 1 . 
   Color images are always composed of what can be considered as separate images taken in each of a number of wavelength bands. In the present invention, the bands are. chosen by selecting filters (such as filters F, F 1  shown in  FIG. 1 ). When the fundus is illuminated with green light, the resulting images show the superficial features of the retina clearly because green light is either reflected from the superficial features or if it is not reflected, it is completely absorbed. When the fundus is illuminated with red or near infrared light, the light passes through most of the superficial features and is reflected from deeper ones. Thus, images in green light reveal some of the nerve tissue of the retina and the blood vessels that nourish those tissues, while images in red illumination reveal the subretinal (choroidal) vessels that nourish the deeper layers. 
   It is standard procedure in fimdus imaging to display black and white images taken in green and in red light to reveal these different features and also to combine those images to form a single color image. Through software and manipulation of a mouse a technique has been implemented that presents these images in an interesting and useful way as set forth below. 
   The computer screen  60  ( FIG. 3 ) that displays the fundus image includes a mouse ( 48 ) controlled computer generated (CPU 32 ) slider. When the slider is at one end of its travel, the red light image is displayed as a black and white image. At the other end, the green light image is displayed as a black and white image. Between those two positions, the two images are superimposed by having the red image drive the red gun of the display and the green image drive the green gun. As the slider moves from the red light end toward green light end, the intensity of the red image diminishes and the intensity of the green one increases. In this way, as the slider moves, the image changes as if the depth of the view of the fluids were changing. The selective change in image can be accomplished when viewing the images in stereo as well. 
   When a fundus image is displayed, a small image of the pupil that was taken at the same time as the fundus image is also displayed. The pupil image has drawn upon it indications of which parts of the pupil were used to collect the images (that is, which parts of the pupil were imaged on the two positions of holes A 3 , A 4  or A 5 , A 6  in  FIG. 2A and 2C , respectively). In this way, the operator can judge whether or not, for example, the patient&#39;s eye lids partially obscured the optical paths, whether or not eye lashes might have interfered, etc. This is particularly useful when the fundus image appears poor, because it often informs the operator about what needs correction. 
   If the eye being imaged has a cataract that lies in the relevant optical path, the fundus image can be spoiled. The way in which the pupil image is formed in the cameras, ( FIG. 1 , CAM 1  and CAM 2 ) by retro-reflection from the fundus, results in cataracts being visible to the operator. If the operator observes a cataract that will spoil the image, he or she can choose a control option and use mouse  48  to move the aiming point of the alignment servos and thus move the optics with the respect to the eye to try to avoid the cataractous region. 
   While the invention has been described with reference to several particular embodiments thereof, those skilled in the art will be able to make the various modifications to the described embodiments of the invention without departing from the true spirit and scope of the invention. It is intended that all combinations of elements and steps which preform substantially the same function in substantially the same way to achieve the same result are within the scope of the invention.