We have invented a means to evaluate the refractive state of the eye and visual process, as well as binocularity in the nine cardinal positions of gaze while in real space, by using holographic projection for each eye. The refractive state assessment has been ingeniously designed to enable the eye of the patient to focus on a three dimensional target, in the manner that the refractive imbalance will focus to maintain clear vision. For example, a target is presented with three dimensions. The myopic eye will focus on the near side of the target and see it with clarity. The dimensions and position of the target is then moved to refocus the far or distance side of the target and calibration is determined as to the power of the eye and the power of the lens required to re-focus the eye to best visual acuity at infinity.

The same would occur for the hyperopic eye, only the far portion of the three-dimensional target will be in initial focus. The patient using hand movements and/or voice command to yield the subjective measurement of the dioptric power to correct the vision to best visual acuity can accomplish manipulation of the target in real space.

The eye with astigmatism would be presented a three dimensional object where perpendicular lines would enable the patient to observe that one of the lines is clear and the other blurred. The target will be rotated to determine the axis of the astigmatism and then the opposite or blurred side of the target would be shifted in space virtually to bring it into focus. This will provide the amount of astigmatism measured in this eye and therefore the predicted amount of cylindrical correction needed to bring clarity. If the patient has both myopia or hyperopia and astigmatism, the target would simultaneously be manipulated to determine myopia or hyperopia while also evaluating the dioptric power of the astigmatism.

Once this is determined for each eye, a binocular balance refraction for both eyes will be performed by increasing the plus dioptric value and comparing the two disassociated images seen by each eye for equality of blue.

Adjustment will be made with the holographic images, to determine the binocular balance of the dioptric value for spherical correction for both eyes. Once the balance is achieved, the holographic image would then be manipulated in real space to bring the image to the best subjective clarity. The manipulation of the holographic image is calibrated for spherical power, cylindrical power to correct for astigmatism and for the axis of the astigmatism.

The holographic refraction can be repositioned in any of the nine primary gaze positions as needed. Binocularity can incorporate the 21 Point Examination. This includes the monocular and binocular refraction as well as eye muscle balance (phoria testing) for both distance, intermediate and near ranges. Before the holographic refraction, the intermediate range of testing would be estimated – because there was no means of positioning a target at a range between 20” and 10 feet. The phoria test for distance will be performed by disassociating the images vertically. This produces a state of vision, without fusion or integration, by the brain to integrate the images. When this occurs the eyes will turn inward (esophoria0 or outward (exophoria0 to a position of rest. By manipulating the images for each eye, the images will be moved toward the point where the holographic image for each eye appears to be vertically aligned (one directly above the other). This measurement is the state of phoria measured in real space, rather than the limitation through the voropter to only a central area that can skew the measurement. The vertical phoria is also measured by dissociating the holographic images horizontally to determine if one eye moves up or down in the position of rest. This will determine a hyper or hypo phoria, and a similar means of moving the holographic images will be conducted to align the images – thereby measuring a vertical balance in prism diopters. The prism diopters are calibrated by determining how much vertical deviation is present relative to the distance from the patient. A diopter is a measured by the deviation of the image at a specific distance (1 prism diopter = 1 cm deviation of the image at a 1 meter distance). The phobia measurements will be taken as distance optical infinity, near and intermediate ranges or any testing distance pertinent to the needs of the patient.

Fusional ranges for distance and near can be evaluated. Fusion is the brain’s ability to integrate the image from each eye. If the person has a large or high phoria, it can influence the ability for the patient to maintain ocular alignment. For example, if at a near range there is a large exophoria (eg. 15 prism diopters), during tests of ductions and vergences to evaluate maximum muscle reserve to maintain fusion as the images are diverged to produce diplopia (double vision) and then to reduce the demand to determine at what point is there a recovery it my be determined that the divergence range for “break’ or loss of fusion is high as will be the “grasp” or recovery. However, for convergence there may be a low ‘break’ point or loss of fusion and a low “recovery”. These ductions and vergense testing will be repeated for the vertical dimension of oculomotor balance. These same tests performed for distance are repeated for near vision analysis of binocularity.

Additional accommodative tests will be performed to assess the range of focus or accommodation, for raising accommodation to its maximum amount that produces blur and ridiculing the demand to the point of recovery. This accounts for the Negative Relative Accommodation (NRA). The Positive Relative Accommodation (PRA) will then be analyzed by reducing demand on accommodation to determine the maximum amount of accommodation that can be released, and at what point there is recovery. The accommodation tests will be performed with the distance prescription in place. A holographic target will be used that will be three dimensional and analyze the point of focus for the eye (0 at a near range of 16 inches). The target will be moved and manipulated and the calibration of the shift will determine the prescription for near glasses.

The holographic Refractive Sequence will provide the means to evaluate the patient in real space without restriction of peripheral vision. The ability to test for any working distance rather than the standard optical infinity and then for a working distance of 16 inches is a benefit of this instrument as well as the full and free space incorporated.