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Description  |
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BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a measurement instrument in the field of
medical electronics. More particularly to a plethysmograph for determining
and registering variations in the size of an organ or limb and in the
amount of blood present or passing through it.
2. Description of the Prior Art
The use of plethysmograph instruments in the medical field has been known
for a considerable period of time. Generally, light rays are transmitted
into a finger or earlobe of the human body. An output signal is derived
from either the light rays transmitted through or reflected off the body.
The resulting plethysmogram is a plot showing a train of waves
representative of the amount of blood present in that region of the human
body.
Reference is made to the article, "Photoelectric Determination of Arterial
Oxygen Saturation in Man", by Wood et al in the Journal of Laboratory and
Clinical Medicine, Vol. 34, 1949. In that article, an oximeter is
described wherein a light source generates light in the infrared region
and in the red region. Light wave signals that are transmitted through the
pinna of the human ear are photoelectrically converted into a first and
second output signal to determine the oxygen saturation in the arterial
blood. The Herczfeld et al U.S. Pat. No. 3,704,706 discloses an apparatus
for the detection of pulse repetition rate and oxygenation of blood flow
by the direction of light through a patient's finger. Additional examples
of prior art can be found in the Liston U.S. Pat. No. 2,640,389 and the
Polanyi et al U.S. Pat. No. 3,628,525.
Common problems have existed in the subjective calibration of the
instruments to a particular patient and the sensitivity of the instruments
to various conditions of the skin. One of the more important regions of
the human body to monitor the normality of blood flow relates to the
brain, since serious damage is capable of happening in a relative short
period of time. Thus, the prior art is still seeking improvements in
plethysmograph devices.
SUMMARY OF THE INVENTION
The present invention is an advancement in the field of medical science, in
that it provides a novel plethysmograph assembly for obtaining a
plethysmograph from a region of the human body in which a plethysmograph
has not previously been obtained. The present invention provides an eye
fundus plethysmograph assembly which includes a source of at least a first
and second wavelength of light energy. Means are provided for directing a
beam of light energy from the source into a subject eye. Photoreceptive
means are provided for receiving a reflective portion of the beam of light
energy from the fundus of the subject eye. The photoreceptive means
provides a first output signal representative of the reflective first
wavelength and a second output signal representative of the reflected
second wavelength. These output signals are processed by a circuit means
which subtracts one of the first and second output signals from the other
to provide a representative measurement output of the amount of blood in
the blood vessels adjacent the eye fundus. The resultant plethysmogram
provides a unique monitoring characteristic of the eye that heretofore has
not been available to the medical profession. It is expected that a
diagnosis of various abnormalities of the body such a diabetes and
arteriosclerosis can be ascertained from this plethysmogram. Additionally
the eye fundus plethysmograph will permit a close monitoring of the blood
flow to the brain. Finally, the eye fundus plethysmograph assembly can be
integrated with eye fundus photography to permit a unique diagnosis of the
subject patient. The present invention provides not only a unique eye
fundus plethysmograph assembly, but also the recognition of the unique
problems associated with obtaining a plethysmogram from the fundus of an
eye.
The features of the present invention which are believed to be novel are
set forth with particularity in the appended claims. The present
invention, both as to its organization and manner of operation, together
with further objects and advantages thereof, may best be understood by
reference to the following description, taken in connection with the
accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic cross-sectional view of the optical design of a first
embodiment of the present invention;
FIG. 2 is a circuit diagram for the first embodiment;
FIG. 3 is a schematical cross-sectional view of the optical design of the
second embodiment of the present invention;
FIG. 4 is a circuit diagram of the second embodiment, and
FIG. 5 is graphical plots of the first output, second output and the final
plethysmogram obtained by the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
The following specification taken in conjunction with the drawings, sets
forth the preferred embodiments of the present invention in such a manner
that any person skilled in the optical and medical field can utilize the
invention. The embodiments of the invention disclosed herein, are the best
modes contemplated by the inventor in carrying out his invention in a
commercial environment, although it should be understood that various
modifications can be accomplished within the parameters of this invention.
As can be appreciated, the eye is enclosed by three membranes. The upper
most one consists of the transparent cornea, forming the bulge, and the
opaque sclera, enclosing the remainder of the eyeball. The choroid coat,
contains many nerves and blood vessels and is immediately under the
sclera. The innermost membrane of the eye is the retina which lines all of
the posterior wall or fundus. Behind the cornea is the iris in the lens.
Muscles in the eye change the size of the pupil for opening of the lens
and other muscles change the shape of the crystalline lens. Two chambers,
one interior to the lens and the other posterior are filled with
transparent material. The first with the aqueous humor and the second with
the vitreous humor. The aqueous humor has a water consistency similar to
blood plasma and the vitreous humor is jellylike. Although the retina
includes blood vessels, the major blood supply of the eye is the choroid
coat.
As can be appreciated, major refraction occurs at the cornea because this
is the largest refracted index change resulting from the index of air to
the index of the medium of the cornea. Generally, the cornea will absorb
light of all wavelengths shorter than about 320 nanometers and since the
ocular medium is essentially water, it will absorb most wavelengths longer
than 1400 nanometers. As can be appreciated, the surface of the cornea and
the transmission of the ocular medium will vary in a subjective manner
with each patient. For example, blue light will be attenuated heavily
particularly in older eyes because of the absorption and scattering in the
crystalline lenses.
Thus, the light rays that are reflected from the eye will include not only
the desired light rays reflected off of the fundus, but also light rays
which have not entered into the eyeball but have been reflected directly
by the surface of the cornea of the eye. In addition, the eye itself is
constantly seeking to accommodate the ambient light and the eyeball will
tremble in minute movements even if a patient is apparently steadily
looking at a point object. This minute trembling of the eyeball will
further result in irregular variations in the light rays which are
reflected directly from the cornea to produce a resultant disturbing noise
in the reflected light signal.
In accordance with the present invention, it has been discovered that a
pair of light rays of a predetermined wavelength both experience
substantially identical reflecting power characteristic from the cornea
while the relecting light rays from the fundus representative of the
presence of blood in the blood vessels will show a difference in
reflectance depending upon the wavelength of the light.
Basically the measurement of the plethysmogram from the fundus of an eye
involves the direction of light rays into the eyeball with a measurement
of the reflected light from the fundus providing the measurement signals.
The intensity of the reflected light from the fundus will vary due to a
pulsation of blood through the blood vessels distributed throughout the
fundus such as in the choroid coat. This variation or alternating current
component can be recorded as a plethysmogram.
The incident light can be assumed to have an intensity of I.sub.0. The
relative transmittance of light from the ambient air medium through the
aqueous humor and the vitreous humor to the fundus of the eyeball can be
assumed to be a constant transmittance of A. The light absorption
coefficient of the blood layer at the fundus is K, while the thickness of
the blood layer, which will vary with time, can be given as x(t). The
reflecting power of the visual rod and cone receptors and layers of the
fundus of the eyeball is R. Finally, the transmittance of the reflected
light rays from the fundus to the outside of the eyeball is B. If the same
optical path is traversed as the incident light, then theoretically the
transmittance B would equal A.
As can be appreciated, the thickness of the blood layer x(t) is a function
of time due to the resiliency of the blood vessel and the pulsation from
the heartbeat. Thus, the intensity, S.sub.1 of reflected light from the
fundus of the eyeball is given as follows;
S.sub.1 =I.sub.0 .multidot.A.multidot.e.sup.-K.multidot.x(t)
.multidot.R.multidot.B (1)
this measurable reflected light from a subject's eyeball will contain not
only the reflected light from the fundus of the eyeball, but also the
light which is directly reflected from the surface of the cornea. If we
assume a reflecting power, C, of the cornea, then the intensity, S.sub.2,
of reflected light from the surface of the cornea can be given as follows;
S.sub.2 =I.sub.0 .multidot.C (2)
accordingly, the equation for the total reflected light S, which can be
measured from the eyeball is given as follows;
S=S.sub.1 +S.sub.2 =I.sub.0 .multidot. A.multidot.e.sup.-K.multidot.x(t)
.multidot.R.multidot.B+I.sub.0 .multidot.C (3)
it has been discovered that the eyeball during a measurement period will
undergo minute movements in attempting to accommodate and perform its
physiological function even when the subject to told to keep a specific
target in sight. These minute movements of the eyeball are generally in
the order of 30 to 100 Hz and frequently peak at 50 Hz. In considering the
influence of the aforesaid minute movements in the resulting light
intensity measured, it is possible to regard the factors A, R, and B as
constants irrespective of the aforesaid minute movements of the eyeball.
The reflecting power, C, of the cornea, however will vary because the
angle of the reflecting surface varies in correlation with the minute
movements of the eyeball. Accordingly, the light intensity which is
measured will also vary with a resulting noise factor and the measured
signal must be compensated. It has been discovered in the present
invention that incident light having two different wave lengths
.lambda..sub.1 and .lambda..sub.2 can be used to solve this noise factor
problem. Accordingly it is possible to redraft equation 3 as follows;
##EQU1##
In the above equations, the factors R.lambda..sub.1, R.lambda..sub.2 and
K.lambda..sub.1, K.lambda..sub.2 relate to the characteristics of the
fundus and will vary with the wavelengths, while the transmittance
A.lambda..sub.1, A.lambda..sub.2, B.lambda..sub.1, B.lambda..sub.2, and
the reflecting power C.lambda..sub.1, and C.lambda..sub.2 are primarily
depended on the index of refraction of the fluid mediums and within the
wavelength range which is transmitted, they may be regarded as constant
for each preselected wavelength. Thus, in accordance with the above
equations, the following relationships may be given;
A.lambda..sub.1 =A.lambda..sub.2 =A, B.lambda..sub.1 =B.lambda..sup.2 =B,
C.lambda..sub.1 =C.lambda..sub.2 =C (5)
accordingly, when the base lines or reference levels for the measurements
of S.lambda..sub.1 and S.lambda..sub.2 are brought into coincidence to
obtain a difference (that is a relationship corresponding to I.sub.0
.lambda.1=I.sub.0 .lambda.2=I.sub.0) then;
S.lambda..sub.1 -S.lambda..sub.2 =I.sub.0
.multidot.A.multidot.B(R.lambda..sub.1 .multidot.
e.sup.-K.lambda..sbsp.1.sup. .multidot.x(t) -R.lambda..sub.2
.multidot.e.sup.-K.lambda..sbsp.2.sup..multidot. x(t)) (6)
As is apparent, from the above equation 6, the resulting influence or
effect of the reflecting power, C, of the cornea is eliminated. In
addition, the following relationships are found that are relevant to
equation 6;
##EQU2##
Accordingly, taking these relationships (equations 7) into account,
equation 6 can be modified as follows;
##EQU3##
As can be appreciated in the equation (8), I.sub.0, A, B, R.lambda..sub.1,
R.lambda..sub.2, K.lambda..sub.1, and K.lambda..sub.2 are constants.
Accordingly as can be seen from equation 8 the only variable factor will
be the thickness of the blood layer which will vary with time and
accordingly a linear function equation has been derived. Thus, it is
discovered that by a simple subtraction process, that is S.lambda..sub.1
-S.lambda..sub.2, it is possible to provide an output signal, S, which
represents a plethysmogram. With this subtraction process, the influence
of any light reflected off of the cornea that would produce resultant
noise due to the minute movements in the eyeball is effectively
eliminated.
Referring specifically to FIG. 1, the optical apparatus or design of the
first embodiment of the present invention is disclosed. A patient's
eyeball, 1, is disclosed schematically receiving light rays from a light
source 2 emitting the light across a wide range of wavelengths. A
synchronized light chopper 5, interposes filters 3 and 4 into the light
path. The color filters 3 and 4 provide wavelengths .lambda..sub.1 and
.lambda..sub.2 respectively. A reflective surface or mirror 6 directs the
light rays into the eyeball 1. The rotational rate of the light chopper 5
is sufficiently high as compared with the cycle of minute movements of an
eyeball so that the eyeball may be regarded as being in a fixed position
with respect to successive light rays having the alternate wavelengths
.lambda..sub.1 and .lambda..sub.2. Additionally, noise introduced by
eyeball movement is reduced. The light reflected from the eyeball 1 is
passed through the half-mirror 6 to be received by a light receptive
element or a photodetector 7.
Generally, one of the wavelengths of light is selected to be somewhat
longer than the red zone that is about 600 nanometer while another of the
light waves is selected to be somewhat shorter than the red zone. By this
predetermined selection of the wavelengths, the blood present in the blood
vessels of the fundus will show a lesser light absorption for the light
.lambda..sub.1 of a relatively longer wavelength than for the light
.lambda..sub.2 of a relatively shorter wavelength. The measured difference
in absorption between the two wavelengths can provide the information for
determining the amount of blood in the fundus. As can be appreciated, the
position of the light chopper 5 and filters 3 and 4 can be varied without
affecting the design parameters of the present invention. For example, the
light chopper 5 and filters can be positioned immediately upstream of the
light receiving element 7.
Connected to the photodetector or light receiving element 7, is a timing
and signal processing circuit means shown in detail in FIG. 2. The light
receiving element 7 consists of a photodiode of a conventional
construction, which generates a signal proportional to the magnitude of
the incident light energy. A differential amplifier A.sub.1 provides a
measurement output signal voltage. The respective field effect transistor
(FET) G.sub.1 and G.sub.2 are adapted to be alternately opened in response
to the position of the filters 3 and 4 and synchronous with the motor (not
shown) of the light chopper 5. As the filter holder or light chopper 5
rotates, a sampling pulse is generated as the light rays intersects
substantially the center of each filter. Such a sampling pulse train can
be established from the rotation of the driving synchronous motor in a
well-known manner; for example employing phased locked loop techniques.
These sampling pulses can be applied to the gates in a well-known manner
such as shown in U.S. Pat. No. 3,892,490.
Accordingly, the FET gate G.sub.1, is conductive when the light of a
wavelength .lambda..sub.1 is incident on the light receiving photoelectric
diode 7. At that time, the condensor C.sub.1 will be charged through the
gate G.sub.1 commensurate with the output of the differential amplifier
A.sub.1. When the FET gate G.sub.1 is rendered noncoductive in response to
the rotation of the light chopper 5, the output voltage produced by the
amplifier A.sub.1 during the .lambda..sub.1 interval will be stored on the
condensor C1. The buffer amplifier A.sub.3 maintains the value of the
condensor C.sub.1 constant, until the gate G.sub.1 is again opened.
Because the gate transistor G.sub.2 is rendered conductive while the gate
G.sub.1 is closed, the output of the photoelectric diode 7 representing
the light energy of wavelength .lambda..sub.2 will charge the condensor
C.sub.2. When the gate G.sub.2 is nonconductive, the voltage value
representative of the wavelength .lambda..sub.2 energy is stored on the
condensor C.sub.2. An appropriate buffer amplifier A.sub.2 maintains the
value of the voltage on the capacitor C.sub.2.
With the condensor C.sub.1 and C.sub.2 now charged, the apparatus is ready
to perform a subtraction operation during the next sampling interval. The
next sample of light energy of wavelength .lambda..sub.1 incident on the
light receiving element 7 is sampled and applied to the differential
amplifier A.sub.1 together with voltage across the capacitor C.sub.2.
Subtraction is thereby performed between the voltage output of the
photoelectric diode 7 representing the light energy of wavelength
.lambda..sub.1, and the stored voltage of the condensor C.sub.2
representative of the light energy of wavelength .lambda..sub.2.
The difference, E.lambda..sub.1 -E.lambda..sub.2 represents the amount of
energy absorbed, and accordingly the amount of blood in the fundus. The
differential voltage developed by the differential amplifier and
representing E.lambda..sub.1 -E.lambda..sub.2 is stored on the capacitor
C.sub.1, when the gate G.sub.1 is activated by a sample signal during the
.lambda..sub.1 filter interval. When the gate G.sub.2 is again activated
by a sample signal, condensor C.sub.2 will be recharged with an output
voltage associated with a new input of the light energy of wavelength
.lambda..sub.2. Thus, a difference in output voltages obtained due to
light signals representative of the energy of respective wavelengths
.lambda..sub.1 and .lambda..sub.2 continually fed to the condensor C.sub.1
through the differential amplifier A.sub.1 and the gate G.sub.1 in the
manner described above. The output voltage of the condensor C.sub.1 is
amplified by way of the buffer amplifier A.sub.3 to improve the signal
quality of the output signal for additional amplification by the buffer
A.sub.4. A low pass filter circuit (LPF) can be utilized to remove noise.
These circuits are presented only as an example, other circuits equivalent
in function are seen as well within the purview of a person of ordinary
skill in the art. The elements of these circuits, such as the operational
amplifiers, diodes, capacitors and switching transistors are well-known
and understood in the prior art. The particular revolutions per minute of
the light chopper 5 are determined in accordance with a well-known
sampling theorem.
As will be appreciated by those skilled in the art, the voltage on the
capacitor C.sub.2 should be of the same order of magnitude as that
produced by the photodiode in response to a .lambda..sub.1 energy signal
in order to establish a meaningful difference signal. While not shown
specifically, but fully known in the prior art, an attenuation or
automatic gain control circuit may be inserted into the circuit at point
`a` to adjust the magnitude of the voltage on capacitor C.sub.2 to within
the desired reference range. Alternately a band pass filter may be
inserted upstream of the light receiving photoelectric diode 7 to limit
the light energy transmission band to the desired wavelength range.
Referring to the schematic of FIG. 3, a second embodiment of the optical
design features of the present invention is disclosed. In this embodiment,
the light rays from the light source 2 of a relative wide bandwidth are
reflected on a half-mirror 6 into the eyeball 1. The light reflected from
the eyeball 1, including both the light reflected from the fundus and the
light reflected from the cornea is transmitted through the half-mirror 6
and then separated by a dichroic mirror 8 into a pair of light rays having
respective wavelengths .lambda..sub.1 and .lambda..sub.2. The
photoelectric diodes or light receiving elements 9 and 10 receive the
respective light wavelengths .lambda..sub.1 and .lambda..sub.2 and convert
these into electrical signals. As known in the prior art, filter elements
can be interposed in front of the light receiving elements 9 and 10 if
spectral sensitivity is to be maximized. Mounted within the light path of
.lambda..sub.2 is an ND (neutral density) filter 11 adapted to adjust the
intensity of the incident light on the light receiving photoelectric diode
10 to thereby bring the reference levels or base line of the
.lambda..sub.1 and .lambda..sub.2 signals into coincidence with each other
for subtractive processing of their output signals. The ND filter 11 is
preferably a variable density filter such as a shiftable wedge-shaped
filter. The density of the ND filter is recommended to be adjusted with
respect to each individual patient by consulting with an oscillograph
displaying the .lambda..sub.1 and .lambda..sub.2 signals.
An appropriate signal processing circuit for the second embodiment is
disclosed in FIG. 4. Light receiving and amplifying circuits are disclosed
in the boxes 12 and 13. The respective outputs of these light receiving
circuits can be detected and compared in a differential amplifying circuit
14. Again the elements of these circuits such as the operational
amplifiers, and switching transistors are well-known and understood. As
can be appreciated from the illustration, a straight forward signal
processing can be utilized as a result of an initial balancing of the
reference level between the two representative wavelength signals prior to
their application to the photoelectric diodes.
FIG. 5 discloses a graph plotting the results of measurements given in
accordance with the present invention. The respective intensity versus
time plots designated (a) and (b) are representative of the output signal
of the wavelength .lambda..sub.2 and the output signal of the wavelength
.lambda..sub.1. These respective outputs disclose the noise arising from
the minute movements of the eyeball so that the determination of any
usable waveform is difficult. As noted the abscissa represents time
plotted versus intensity. However, since the instantaneous noise is
constant, the output (c) resulting from the subtraction process between
the outputs (a) and (b), effectively removes the noise to provide a useful
plethysmogram.
As can be appreciated by a person skilled in the art, variations of the
circuits disclosed are possible by a person skilled in the art.
* * * * *
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