1. The Glenn A. Fry Lecture Treating with Spectacle Lenses: A Novel Idea!? "What has been is what will be, and what has been done is what will be done; there is nothing new under the sun.” Ecclesiastes 1:9 Eli Peli, MSc, OD, FAAO The Schepens Eye Research Institute Harvard Medical School

2. My First Refraction At the Haifa Zoo (1975) –Helping Jake Sivak The Mongoose refused to be fitted with any type of spectacles for day or night use

3. My Second Refraction Customer Helping Mogi Gur and Jake Sivak Determine refraction by listening to sounds of neural activity in the cortex, monitored with intracellular electrodes, while changing lenses

4. There must be easier ways to refract! Are there more ways to use the spectacle lenses? Yes. Multiplexing.

5. Multiplexing for Low Vision Provide peripheral (wide field-of-view) together with central (high resolution) vision in ways that make them perceptually separable and useful –Many different forms of multiplexing - Spatial (superposition), Temporal (alternating), Biocular, or Spectral (colors) –Maintaining free head & eye movements

6. Peripheral Prisms for Hemianopia Expands upper and lower fields by about 20 deg High power prisms (40  ) All positions of gaze affected Biocular multiplexing Prismatic color fringes mark eye of origin Spectral Multiplexing Left Hemianopia

7. Instantaneous View with Hemianopia Field expansion for homonymous hemianopia by optically induced peripheral exotropia. Opt. & Vis.Sci 77;453-464

8. View with the Peripheral Prisms

9. Effect Demonstrated with Perimetry Without Prisms

10. Perimetry with Peripheral Prisms Without Prisms With Prisms

11. Cosmetically Acceptable Dangerous? MultiOptical, Sweden Peripheral Prisms Spectacles

12. Peripheral Prisms Spectacles New more attractive, safer designs Chadwick Optical

13. Solar Glare Need to block peripheral field Sunglasses and tinted visors-not dark enough Opaque visor-fixed Hand position is adjustable

14. Headlight Glare at Night Coming from a limited section of peripheral field

15. Multiplexing Glare Control Lenses Block peripheral view Top strip for solar glare Left strip for headlight glare Fine adjustments with head position are simple, accurate, and intuitive Lens Tint Clip-On

16. Patent Search US 5,428,409 US 4,338,003 US 5,252,997 US 4,828,380 US 3,199,296 All for Night GlareAll static - no movement

18. Traffic Lights at Night Difficult for drivers with color deficiency with low vision or both

19. Unilight ® LED traffic lights As seen in Fort Hood, TX & Cheyenne, WY As seen in Scottsdale AZ No position clue No shape clue

20. Multiplexing Spectacles for Red-Green Color Deficiency When traffic-light is noted, slight head tilt brings it into the red-tined zone Red light shines through Green light is blocked

26. Successful application of Temporal Multiplexing Bioptic Telescope Wide field through the carrier lens Occasional head tilt to gain high resolution Limitations –Ring scotoma, Cosmesis, Social eye contact

27. 45 degree field

29. In-the-Lens Telescope

30. View from above t Lens thickness, t, limits width of field Galilean Telescope

31. Completely embedded in the lens t Mirrors Only Design

32. Looking Through the Carrier

33. Looking Through the Telescope

34. Wider Field-of-View In-the Lens Keplerian Telescope

35. t t Front View Side View Lens thickness, t, limits height of field

36. SimulVision-Spatial Multiplexing

38. Conclusion Multiplexing offers a new way of thinking about low vision devices –Electronics or optics Multiplexing is useful in other applications Cosmetic considerations are critical to the success of any spectacle born device –We are all vain “…vanity of vanities; all is vanity” Ecclesiastes 1:2

39. Thank You! Supported generously by NIH grants