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US20140276674A1 - System and method for ophthalmic laser surgery employing eye tracking without eye docking - Google Patents

System and method for ophthalmic laser surgery employing eye tracking without eye docking Download PDF

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Publication number
US20140276674A1
US20140276674A1 US14/198,394 US201414198394A US2014276674A1 US 20140276674 A1 US20140276674 A1 US 20140276674A1 US 201414198394 A US201414198394 A US 201414198394A US 2014276674 A1 US2014276674 A1 US 2014276674A1
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US
United States
Prior art keywords
eye
patient
lens
undocked
ultra
Prior art date
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Abandoned
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US14/198,394
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English (en)
Inventor
Hon M. Lee
Peter Patrick De Guzman
Victor Kardos
Hong Fu
Robert G. Heitel
John M. Tamkin
Mikhail Levin
Bing Wang
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AMO Development LLC
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AMO Development LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
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Priority to US14/198,394 priority Critical patent/US20140276674A1/en
Publication of US20140276674A1 publication Critical patent/US20140276674A1/en
Assigned to AMO DEVELOPMENT, LLC. reassignment AMO DEVELOPMENT, LLC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: TAMKIN, JOHN M, HEITEL, ROBERT G, LEVIN, Mikhail, DEGUZMAN, PETER PATRICK, WANG, BING, FU, HONG, KARDOS, VICTOR, LEE, HON M
Priority to US15/847,897 priority patent/US11076990B2/en
Priority to US17/443,158 priority patent/US20210346195A1/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/009—Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A61F2009/00846—Eyetracking
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A61F2009/00851—Optical coherence topography [OCT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/0087—Lens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea

Definitions

  • a surgical laser beam is preferred over manual tools like microkeratomes as it can be focused accurately on extremely small amounts of ocular tissue, thereby enhancing precision and reliability.
  • LASIK Laser Assisted In Situ Keratomileusis
  • an ultra-short pulsed laser is used to cut a corneal flap to expose the corneal stroma for photoablation with an excimer laser.
  • Ultra-short pulsed lasers emit radiation with pulse durations as short as 10 femtoseconds and as long as 3 nanoseconds, and a wavelength between 300 nm and 3000 nm.
  • ultra-short pulsed lasers are used to perform cataract-related surgical procedures, including capsulorhexis, anterior and posterior capsulotomy, as well as softening and/or breaking of the cataractous lens.
  • Laser eye surgery is performed while the patient is in a reclined position but awake, meaning that the patient's eyes are moving during the procedure.
  • patient eye movement relative to the laser beam's focal point can undermine the laser's accuracy and precision, and may even result in permanent tissue damage.
  • a common complaint is that the mechanical pressure or vacuum suction used to attach the interfacing device to the eye causes discomfort and may contribute to post-operative pain and hemorrhaging. Another complaint is that patient discomfort and corneal wrinkling are exacerbated when the interfacing device uses a rigid contact lens to applanate or flatten the cornea as part of the surgical procedure.
  • Eye tracking systems and devices monitor the position of a selected feature of the eye and provide the laser system with real time signals about any displacement in the position as a result of movement during surgery. Then, as necessary, the surgical laser system uses the signals to adjust or re-position the focal point of the laser beam before making an incision.
  • Some examples of eye tracking systems and techniques are disclosed in U.S. Pat. No. 6,299,307, issued to Oltean et al., which is incorporated here by reference. In general, however, the delays inherent in eye trackers, coupled with the high speed and degree of precision required for incisions in procedures using ultra-short pulsed lasers, as well as the difficulty in accurately tracking the eye using an eye tracker can result in less than ideal cuts.
  • the surgical laser system includes a laser engine configured to provide an ultra-short pulsed laser beam; optics configured to direct the laser beam to an undocked eye of a patient; an eye tracker configured to measure five degrees of freedom of movement of the undocked eye; an optical coherence tomography module configured to measure depth of the undocked eye; and a controller configured to control laser beam position on the undocked eye toward a desired laser pattern based on depth and the five degrees of freedom of movement of the undocked eye.
  • Adaptive optics are also provided. Also disclosed are a scleral ring with fiducial markings and a compliant contact lens and fluid-fillable contact lens configured to facilitate ultra-short pulsed laser surgery while reducing or eliminating eye docking requirements.
  • FIG. 2 is a general diagram of the components employed in the ultra-short pulsed ocular laser surgical system that does not require eye docking.
  • FIG. 4 is a typical zoom beam expander employed with the present design.
  • FIG. 5 shows a typical setup of an eye tracker in accordance with the present design.
  • FIG. 6 illustrates adaptive optics that may be employed in the present design.
  • FIG. 7A is a side view of an eye with a scleral ring provided.
  • FIG. 7B is a front view of an eye with a scleral ring provided in accordance with one embodiment of the present design.
  • FIG. 8 illustrates a variety of potential scleral ring designs.
  • FIG. 9 is a side view of an eye employing a compliant contact lens for use in ultra-short pulsed laser ocular surgery including fiducial markings.
  • FIG. 10 is a side view of an eye employing compliant contact lens for use in ultra-short pulsed laser ocular surgery with a low force docking construction.
  • FIG. 12 shows a fluid-fillable contact lens for use in femtosecond laser ocular surgery with a low force docking construction.
  • FIG. 1 illustrates a general overview of an ultra-short pulsed laser arrangement configured to employ the present design.
  • laser engine 100 includes laser source 101 provides laser light to variable attenuator 102 configured to attenuate the beam, then to energy monitors 103 to monitor beam energy level, and first safety shutter 104 serving as a shutoff device if the beam is unacceptable.
  • Beam steering mirror 105 redirects the resultant laser beam to the beam delivery device 110 , through articulated arm 106 to range finding camera 111 .
  • the range finding camera 111 determines the range needed for the desired focus at the eye 120 .
  • Beam delivery device 110 includes second safety shutter 112 and beam monitor 113 , beam pre-expander 114 , X-Y (position) scanner 115 , and zoom beam expander 116 .
  • Zoom beam expander 116 expands the beam toward IR mirror 117 which reflects and transmits the received beam.
  • Mirror 118 reflects the received beam to video camera 119 , which records the surgical procedure on the eye 120 .
  • IR mirror 117 also reflects the laser light energy to objective lens 121 , which focuses laser light energy to eye 120
  • the system may be used to photoalter a variety of materials (e.g., organic, inorganic, or a combination thereof), the system is suitable for ophthalmic applications in one embodiment.
  • the focusing optics such as beam pre-expander 114 , zoom beam expander 116 , IR mirror 117 and objective lens 121 , direct the pulsed laser beam toward an eye 120 (e.g., onto or into a cornea) for plasma mediated (e.g., non-UV) photoablation of superficial tissue, or into the stroma of the cornea for intrastromal photodisruption of tissue.
  • the system may also include a lens to change the shape (e.g., flatten or curve) of the cornea prior to scanning the pulsed laser beam toward the eye.
  • the system is capable of generating the pulsed laser beam with physical characteristics similar to those of the laser beams generated by a laser system disclosed in U.S. Pat. Nos. 4,764,930 and 5,993,438, which are incorporated here by reference.
  • the ophthalmic laser system can produce an ultra-short pulsed laser beam for use as an incising laser beam.
  • This pulsed laser beam preferably has laser pulses with durations as long as a few nanoseconds or as short as a few femtoseconds.
  • the pulsed laser beam has a wavelength that permits the pulsed laser beam to pass through the cornea without absorption by the corneal tissue.
  • the wavelength of the pulsed laser beam is generally in the range of about 400 nm to about 3000 nm, and the irradiance of the pulsed laser beam for accomplishing photodisruption of stromal tissues at the focal point is typically greater than the threshold for optical breakdown of the tissue.
  • the pulsed laser beam may have other pulse durations and different wavelengths in other embodiments.
  • Further examples of devices employed in performing ophthalmic laser surgery are disclosed in, for example, U.S. Pat. Nos. 5,549,632, 5,984,916, and 6,325,792, which are incorporated here by reference.
  • the fast-z scan optics operate rapidly due to the changes that can result in depth and are generally fast enough to compensate for the z (depth) change due to saccadic movements resulting from by X-roll ( ⁇ x ) and Y-roll ( ⁇ y ).
  • Illumination fixation element 210 provides adjustable fixation direction. Such fixation facilitates alignment of a high grade cataractous eye with desired surgical direction and may reduce gross eye movements.
  • One example of operation may be the eye tracker 209 operating at a frame rate of 1000 Hz, with a latency time of less than 1.0 milliseconds.
  • a high degree of accuracy is preferable, such as in the single digit micrometer range and angular accuracy in the hundredths of degree range.
  • Such values tend to be a function of the distance range of the tissue affected zone affected by the laser pulse, and more particularly the distance between the eye 215 , objective 211 , and the video camera illumination fixation element 210 and eye tracker 209 . A smaller distance between these elements may enable a looser tolerance range.
  • FIG. 3 provides a representation of a control module 300 employed in the present device, which may take the form of a program provided in the system controller. From the left side of FIG. 3 , the desired laser pattern or current position of the laser beam relative to the eye is input and represents the reference value of the present design. The output is the actual position of the laser beam on the eye, and the eye position is measured by both eye tracker 209 (X, Y, ⁇ x , ⁇ y , and ⁇ C ) and OCT module 206 (Z), shown as eye position module 302 . Laser beam position is determined by a beam delivery confirmation module 303 .
  • Beam delivery confirmation module 303 represents any device or arrangement that determines position of the beam on the eye, and may include simple monitoring at the input or output of objective 211 , out of zoom beam expander 208 , and/or observation by eye tracker or other external devices. Output of the beam delivery confirmation module 303 is the position of the beam. Both this beam position and the eye position are fed back to summation element 304 , where output of summing element 304 is the error between the desired position of the beam on the eye (reference) versus the actual position of the beam on the eye.
  • Control algorithm 305 receives the error and other pertinent information (historic eye position, eye movement profiles, expected future laser pattern, and so forth) and provides control values to beam delivery components 306 to direct the beam to the appropriate position on the eye.
  • Beam delivery components 306 include X-Y Scan Galvanometer 207 , Fast-z scan module 205 , adaptive optics 204 , laser blanking module 203 , and fixation light 210 . These components are configured to have alterable parameters (position, focus, timing, and so forth) controllable by the controller 305 to effectuate the desired position of the beam on the eye 301 .
  • FIG. 4 illustrates a zoom beam expander that may be employed with the present design as zoom beam expander 208 .
  • the zoom beam expander 208 includes a number of lens elements that can be repositioned to effectuate expansion of the incoming beam.
  • View 401 shows various lens elements with middle elements 451 , 452 , and 453 positioned to provide a beam for use in a capsulotomy at a 6.0 millimeter depth.
  • View 402 provides various lens elements with middle elements 451 , 452 , and 453 positioned for a flap creation procedure.
  • FIGS. 1-6 there is provided a system that performs eye tracking and ultra-short pulsed laser surgery without the use of a docking mechanism, wherein eye tracking provides sensing of five degrees of freedom for the subject eye and an OCT system provides the sixth degree of freedom, namely depth.
  • the present design also employs adaptive optics, such as a deformable mirror, during ocular surgery wherein the adaptive optics are employed to measure the wavefront, adjust at least one reflective surface and compensate for patient movement during the surgical procedure.
  • a control system employs measurements from the eye tracker and the OCT system for position of the eye as well as position of the laser beam and compensates for errors in these positions by adjusting components of the system, such as XY Scan Galvanometer, a Fast-z scan module, adaptive optics, a laser blanking module, and/or a fixation light.
  • the resultant device enables robust ultra-short pulsed laser surgery without the need for docking the eye of the patient.
  • one issue with eye tracking is the difficulty in discerning different attributes and/or positions of an eye. Different eyes exhibit different visual characteristics, and issues may arise such as a gradual change in color between the iris, cornea, and/or sclera, and different refractive qualities to different eyes that can be difficult to discern using an eye tracker.
  • the present design may employ a device that places known and readily discernible markers in connection with the eye for the express purpose of tracking the position of the eye.
  • FIG. 7A illustrates a first embodiment of the present aspect of the design.
  • scleral ring 701 is a hollow ring that fits over the eye 702 and contacts the sclera 703 .
  • No material is provided in the center region, and thus the pupil, iris, and cornea in a typical patient is unobscured and open for purposes of eye surgery.
  • the eye, lid, and ocular fluid keep the scleral ring 701 in a fixed position relative to the eye, i.e. the scleral ring 701 does not slide when the eye moves.
  • the scleral ring 701 is similar to a traditional contact lens in form and construction, but may be made of a slightly more rigid material to hold the scleral ring 701 in place. Further, the construction of the scleral ring 701 may be flared slightly, with a base 704 that is slightly larger than an average eye while the upper edge 705 is sized to tightly contact the sclera of the patient in order to facilitate holding the entire scleral ring 701 on the sclera 703 .
  • the base 704 or posterior surface material may be compliant to allow the scleral ring to conform to the natural curvature of the eye, and the scleral ring 701 may self-center in a manner similar to a contact lens.
  • markers 706 and 707 are provided. These markers may be dark markings in or on the scleral ring 701 that may be discerned from a distance and may be resolved by an eye tracker, while the remainder of the scleral ring is either a contrasting color, such as white in contrast to black, or clear/transparent similar to a contact lens.
  • a single marker or multiple markers may be provided, sometimes called fiducial marks or fiducials, and the marker or markers may take any form usable and discernible by an eye tracking system.
  • FIG. 7B illustrates a front view of an eye 751 including scleral ring 753 positioned in association with cornea 752 .
  • No covering exists over cornea 752 i.e. the center of scleral ring 753 is a void or open space enabling ultra-short pulsed laser surgery on the cornea.
  • Fiducial markings 754 and 755 are provided, in this arrangement squares having a dark coloring.
  • the scleral ring 701 can provide enhanced certainty of patient eye position and may be less likely to result in positioning errors of the laser beam clue to patient movement or eye feature issues.
  • Use of a scleral ring including fiducials tends to significantly reduce time required for processing the image of the eye and enables robust resolution of the position and orientation of the eye at any given time.
  • the scleral material comprises material similar to contact lenses, including but not limited to polymers, RGP materials, hydrogels, and the like.
  • the scleral ring is formed to allow a contoured fit to the sclera for a general set of the population.
  • One alternative is to provide a pre-made set of scleral rings that match a specific set of patients. Using contact lens type materials to form the scleral ring, external forces on the cornea are removed, intraocular pressure is reduced, and corneal wrinkle risk can be decreased as compared to docking arrangements previously employed.
  • a conical patient interface including a suction ring and a flat applanating lens.
  • a curved patient interface or a liquid patient interface may be used for docking to ease some of the discomfort.
  • conventional docking and applanation procedures can cause patient discomfort at the very least, and may in some instances, increase intraocular pressure and/or cause corneal wrinkles.
  • a further issue, particularly in the case of an eye tracker being used with an eye subjected to ultra-short pulsed laser surgery is a difference in the index of refraction encountered between the air and the eye material. The drastic difference in refractive index can in certain instances provide less than ideal laser cuts and the laser beam can reflect or scatter when contacting ocular tissue.
  • the present design may employ a compliant contact lens as shown in FIG. 9 .
  • the design of FIG. 9 requires no docking or physical patient interface.
  • the device of FIG. 9 may be employed with or without a scleral ring, and in the particular arrangement shown in FIG. 9 , markers or fiducials are illustrated.
  • the compliant contact lens 901 includes a posterior surface or inner edge 902 curved to conform either to the particular patient's eye, or to an average or expected patient profile, such as the mean radius of curvature of the general population.
  • Compliant contact lens 901 fits over the cornea 903 and comprises a flat or relatively flat exterior surface 904 .
  • the compliant contact lens 901 may be formed of a uniform single material construction or a multi-part construction to facilitate patient comfort, tracking of the position of the eye, and ability of the laser to successfully perform the desired cutting pattern.
  • the compliant contact lens 901 may be formed of or include a transparent or translucent material having an index of refraction that matches or is very close to that of the cornea, in humans approximately 1.37, where the compliant contact lens 901 is penetrable by an ultra-short pulsed laser.
  • the posterior surface or inner edge 902 may be made from a material identical to or different from the rest of compliant contact lens 901 to enable the lens to conform to the natural curvature of the patient's eye and may self center in a manner similar to a conventional contact lens.
  • the inner edge 902 may be provided with additional material or a fluid may be applied between the cornea 903 and the inner edge 902 , or between the cornea 903 and material placed between the inner edge 902 and the cornea 903 .
  • the material used for the exterior surface or relatively flat exterior surface 904 may differ from the other components, layers, or parts of compliant contact lens 901 to facilitate laser delivery.
  • fiducials or markings provided may vary but in general may take any for as discussed, i.e. providing one or multiple markings, rings, or other eye tracker discernible characteristics.
  • the flat exterior surface is a large surface rather than a ring, other discernible markings or fiducials may be provided, including but not limited to lines, arrows, different color markings, curves, and virtually any marking imaginable.
  • either a support arrangement or a complete scleral ring 907 may be provided at the base of compliant contact lens 901 , separate from or adjoined to compliant contact lens 901 . Such a support arrangement or scleral ring 907 is not required but can provide support and stability when deployed in the eye.
  • compliant contact lens employing near zero force docking may be provided as shown in FIG. 10 .
  • compliant contact lens 1001 does not include markings or fiducials, but rather includes a cavity 1002 formed by exterior raised edge or edges 1003 , 1004 that may be docked with a lesser force than a traditional patient interface docking arrangement, such as one employing a suction ring and flat applanating lens.
  • the device of FIG. 10 may be employed with or without a scleral ring.
  • the compliant contact lens 1001 includes a posterior surface or inner edge 1005 curved to conform either to the eye of the particular patient, or to an average or expected patient profile, such as the mean radius of curvature of the general population.
  • Compliant contact lens 1001 fits over the cornea 1006 typically includes a flat or relatively flat exterior surface 1007 .
  • Compliant contact lens 1001 may be formed of a uniform construction or a multi-part construction.
  • the compliant contact lens 1001 may include a transparent or translucent material having an index of refraction that matches or is very close to that of the cornea, where the compliant contact lens 1001 is penetrable by an ultra-short pulsed laser.
  • the posterior surface or inner edge 1005 may be made from a material identical to or different from the rest of compliant contact lens 1001 to enable the lens to conform to the natural curvature of the patient's eye and may self center in a manner similar to a conventional contact lens.
  • the inner edge 1005 may be provided with additional material or a fluid may be applied between the cornea 1006 and the inner edge, or between the cornea and material placed between the inner edge 1005 and the cornea 1005 .
  • FIG. 11 illustrates an alternate embodiment of the present design including a fluid filled contact lens 1101 having an open area configured to receive fluid from, for example, entry point 1102 and exit from exit point 1103 .
  • the fluid filled contact lens 1101 includes sides 1104 sufficient to receive and maintain fluid, such as using a hard plastic or polymer, and rests primarily above cornea 1105 .
  • a certain distance is provided between an upper surface 1106 and cornea 1105 sufficient for fluid to collect.
  • a vacuum may be formed by filling or partially filling the cavity 1107 formed by the fluid filled contact lens 1101 . Fiducials or markings may be provided, and in FIG.
  • fiducials are shown by darkened elements 1108 and 1109 , but again, any form of marking discernible by an eye tracker may be employed.
  • a support arrangement or scleral ring 1110 may be provided.
  • the exterior side or sides 1104 may include at the base thereof a ring or element or elements 1110 used to hold the fluid filled contact lens 1101 in juxtaposition with the sclera, and this ring, element, or elements may comprise a scleral ring as described, or other appropriate device.
  • the design of FIG. 11 does not have a posterior surface or inner edge, but instead provides fluid to gradually change index of refraction from air to fluid to cornea. Additionally, once fluid is introduced into cavity 1107 , suction may be applied by reversing fluid flow, enabling the device to be physically fixed to the eye. The resultant suction force is applied over a larger area, reducing intraocular pressure.
  • FIG. 12 illustrates an alternate embodiment of a fluid filled contact lens 1201 that employs a low or near zero force docking function.
  • fluid filled contact lens 1201 has an open area configured to receive fluid from, for example, entry point 1202 and exit from exit point 1203 .
  • the fluid filled contact lens 1201 includes side(s) 1204 sufficient to receive and maintain fluid, such as a generally circular side constructed of a hard plastic or polymer, and rests primarily above cornea 1205 . A certain distance is provided between an upper surface 1206 and cornea 1205 sufficient for fluid to collect.
  • a vacuum may be formed by filling or partially filling the cavity 1207 formed by the fluid filled contact lens 1201 . In this arrangement, fiducials or markings are typically not provided, but are not expressly prohibited.
  • Compliant contact lens 1201 includes a cavity 1208 formed by exterior raised edge or edges 1209 , 1210 that may be docked with a lesser force than a traditional patient interface docking arrangement, such as one employing a suction ring and a flat applanating lens.
  • the device of FIG. 12 may be employed with or without a support arrangement or scleral ring 1211 .
  • FIGS. 11 and 12 While shown in FIGS. 11 and 12 with entry point 1102 above exit point 1203 and on opposite sides of fluid filled contact lens 1101 , for example, such positioning is not required and the entry and exit points may be placed elsewhere on or in fluid filled contact lens 1201 and 1202 , and fluid may be provided and/or expelled or drawn through a slit or larger opening than is illustrated.
  • the intent is to provide and draw fluid in an efficient manner while effectuating the functionality, including ultra-short pulsed laser surgical functionality, disclosed herein.
  • the device shown comprises a contact lens having a relatively flat exterior surface configured to provide a buffer region between air and the eye to decrease index of refraction issues.
  • the device includes a piece configured to fit over a cornea of a patient with a curved posterior surface and a flat or relatively flat anterior surface, the piece dimensioned to cover the cornea of the patient's eye.
  • markings or fiducial markings are provided, while in another embodiment a cavity is provided using the anterior surface that facilitates a low force docking to the eye.
  • a second embodiment comprises a generally hollow contact lens comprising an anterior surface adjoining at least one exterior wall with fluid entry and exit openings provided, the anterior surface sized to cover a cornea of a patient.
  • the generally hollow contact lens may include markings or fiducials, and the generally hollow contact lens is configured to be filled with fluid that contacts the cornea of the patient and facilitates index of refraction transition from air to fluid to cornea.
  • a cavity is provided using the anterior surface that facilitates a low force docking to the eye.
  • an apparatus for performing eye docking free laser surgery comprises an ultra-short pulsed femtosecond laser engine configured to provide a laser beam, optics configured to direct the laser beam to an undocked eye of a patient, an eye tracker configured to measure five degrees of freedom of movement of the undocked eye of the patient, an optical coherence tomography module configured to measure depth of the undocked eye of the patient, and a controller configured to control laser beam position on the undocked eye of the patient toward a desired laser pattern based on depth of the undocked eye of the patient measured by the optical coherence tomography module and the five degrees of freedom of movement of the undocked eye of the patient measured by the eye tracker.
  • the apparatus may include an adaptive optics device configured to compensate for wavefront error based on topography of the undocked eye measured by the optical coherence tomography module.
  • a method for performing eye docking free laser surgery comprises providing an ultra-short pulsed laser beam, directing the laser beam to an undocked eye of a patient, measuring five degrees of freedom of movement of the undocked eye of the patient using an eye tracker, measuring depth of the undocked eye of the patient using an optical coherence tomography module, and controlling laser beam position on the undocked eye of the patient toward a desired laser pattern based on depth of the undocked eye of the patient measured by the optical coherence tomography module and the five degrees of freedom of movement of the undocked eye of the patient measured by the eye tracker.
  • the method may include compensating for wavefront error based on topography of the undocked eye measured by the optical coherence tomography module.
  • a further embodiment includes a scleral ring configured to fit over a cornea of a patient, the scleral ring comprising an exterior circular ring formed with a circular opening therein.
  • the scleral ring comprises at least one fiducial marking discernible from a distance by an eye tracking device.
  • An apparatus implementing the techniques or circuits described herein may be a stand-alone device or may be part of a larger device.
  • the functions described may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored on or transmitted over as one or more instructions or code on a computer-readable medium.
  • Computer-readable media includes both computer storage media and communication media including any medium that facilitates transfer of a computer program from one place to another.
  • a storage media may be any available media that can be accessed by a computer.

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Optics & Photonics (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Laser Surgery Devices (AREA)
  • Eye Examination Apparatus (AREA)
US14/198,394 2013-03-15 2014-03-05 System and method for ophthalmic laser surgery employing eye tracking without eye docking Abandoned US20140276674A1 (en)

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US14/198,394 US20140276674A1 (en) 2013-03-15 2014-03-05 System and method for ophthalmic laser surgery employing eye tracking without eye docking
US15/847,897 US11076990B2 (en) 2013-03-15 2017-12-19 System and method for ophthalmic laser surgery employing eye tracking without eye docking
US17/443,158 US20210346195A1 (en) 2013-03-15 2021-07-21 System and method for ophthalmic laser surgery employing eye tracking without eye docking

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US14/198,394 US20140276674A1 (en) 2013-03-15 2014-03-05 System and method for ophthalmic laser surgery employing eye tracking without eye docking

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US12377622B2 (en) 2019-04-05 2025-08-05 Amo Groningen B.V. Systems and methods for vergence matching with an optical profile and using refractive index writing
US11583389B2 (en) 2019-04-05 2023-02-21 Amo Groningen B.V. Systems and methods for correcting photic phenomenon from an intraocular lens and using refractive index writing
US11583388B2 (en) 2019-04-05 2023-02-21 Amo Groningen B.V. Systems and methods for spectacle independence using refractive index writing with an intraocular lens
US12409028B2 (en) 2019-04-05 2025-09-09 Amo Groningen B.V. Systems and methods for correcting photic phenomenon from an intraocular lens and using refractive index writing
US11678975B2 (en) 2019-04-05 2023-06-20 Amo Groningen B.V. Systems and methods for treating ocular disease with an intraocular lens and refractive index writing
US11931296B2 (en) 2019-04-05 2024-03-19 Amo Groningen B.V. Systems and methods for vergence matching of an intraocular lens with refractive index writing
US11944574B2 (en) 2019-04-05 2024-04-02 Amo Groningen B.V. Systems and methods for multiple layer intraocular lens and using refractive index writing
US11529230B2 (en) 2019-04-05 2022-12-20 Amo Groningen B.V. Systems and methods for correcting power of an intraocular lens using refractive index writing
US12357449B2 (en) 2019-04-05 2025-07-15 Amo Groningen B.V. Systems and methods for treating ocular disease with an intraocular lens and refractive index writing
US11564839B2 (en) 2019-04-05 2023-01-31 Amo Groningen B.V. Systems and methods for vergence matching of an intraocular lens with refractive index writing
US20210186753A1 (en) * 2019-12-19 2021-06-24 Alcon Inc. Laser treatment of media opacities
US12478505B2 (en) 2020-07-31 2025-11-25 Alcon Inc. Visualization and treatment of media opacity in eye
CN116018115A (zh) * 2020-08-28 2023-04-25 爱尔康公司 用于将眼睛与眼科激光装置的患者接口对准的系统
DE102020212084A1 (de) 2020-09-25 2022-03-31 Carl Zeiss Meditec Ag Anordnung zur Laserbearbeitung von Augentrübungen
US12390102B2 (en) 2021-11-19 2025-08-19 Alcon Inc. Generating and evaluating two- and three-dimensional images of the interior of an eye
US12390369B2 (en) 2021-11-19 2025-08-19 Alcon Inc. Ophthalmic procedure contact lens with enhanced vitreous visualization
US12390105B2 (en) 2021-11-19 2025-08-19 Alcon Inc. Evaluating and treating eye floaters
US12467745B2 (en) 2021-11-19 2025-11-11 Alcon Inc. Anamorphic depth gauge for ophthalmic systems
US12465210B2 (en) 2021-11-19 2025-11-11 Alcon Inc. Optical coherence tomography system with an extended depth range
US12478250B2 (en) 2021-11-19 2025-11-25 Alcon Inc. Imaging a target within an eye and calibrating imaging devices

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WO2014149774A3 (fr) 2015-01-15
AU2019280095B2 (en) 2021-05-27
EP2968005B1 (fr) 2021-06-23
US20210346195A1 (en) 2021-11-11
AU2019280095A1 (en) 2020-01-16
AU2014237843B2 (en) 2018-03-08
EP3900684A1 (fr) 2021-10-27
AU2014237843A1 (en) 2015-10-08
CA2906408A1 (fr) 2014-09-25
CA2906408C (fr) 2021-05-18
AU2018203435A1 (en) 2018-06-07
US11076990B2 (en) 2021-08-03
US20180110647A1 (en) 2018-04-26
WO2014149774A2 (fr) 2014-09-25
EP2968005A2 (fr) 2016-01-20

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