System and method for eye tracking during ocular treatment

Abstract

Systems and methods for ocular tracking during ocular treatment are disclosed. A corneal crosslinking system includes a light source configured to emit photoactive light. The system includes a spatial light modulator configured to receive the photoactive light from the light source and provide pixelated illumination. The spatial light modulator defines a maximum area of the pixelated illumination. The system includes a controller configured to cause the spatial light modulator to project a first pixelated illumination onto a cornea to photoactivate a crosslinking agent applied to a treatment area. An area of the first pixelated illumination is less than the maximum area defined by the spatial light modulator. The controller is configured to determine a movement of the cornea. In response to the movement, the controller controls the spatial light modulator to project a second pixelated illumination to the treatment area to continue photoactivating the crosslinking agent based on a translation and / or transformation of the first pixelated illumination.

Description

[0001] This case is a divisional application of the invention patent application filed on March 5, 2019, with application number 201980030236.0 and invention title "System and method for eye tracking during eye treatment".

[0002] Cross-reference to related applications

[0003] This application claims priority and benefit from U.S. Provisional Application No. 62 / 638621, filed March 5, 2018, the contents of which are incorporated herein by reference in their entirety. Technical Field

[0004] This disclosure relates to systems and methods for treating the eye, and more specifically, to systems and methods for tracking eye movements to deliver treatment to the desired area of ​​the eye. Background Technology

[0005] Cross-linking therapy can be used to treat eye conditions such as keratoconus. In particular, keratoconus is a degenerative eye disease where structural changes in the cornea cause it to weaken and become abnormally conical. Cross-linking therapy can strengthen and stabilize areas weakened by keratoconus, preventing unwanted shape changes.

[0006] Cross-linking therapy can also be used after surgical procedures such as laser-assisted in-situ phototropic keratology (LASIK). For example, corneal thinning and weakening caused by LASIK surgery can lead to a complication commonly known as LASIK postoperative hyperplasia. In LASIK postoperative hyperplasia, the cornea undergoes a gradual steepening (bulging). Therefore, cross-linking therapy can strengthen and stabilize the corneal structure after LASIK surgery, preventing LASIK postoperative hyperplasia.

[0007] Cross-linking therapy can also be used to induce changes in corneal refractive power to correct conditions such as myopia, hyperopia, astigmatism, irregular astigmatism, and presbyopia. Summary of the Invention

[0008] For example, to treat keratoconus or achieve refractive correction, an effective crosslinking process involves applying photoactivated light as precisely as possible to a designated area of ​​the cornea being treated with the crosslinking agent. Applying photoactivated light outside the designated area can produce undesirable structural changes on the cornea and negatively impact treatment outcomes. However, precise application of photoactivated light can be difficult to achieve due to eye movements that may occur during the procedure. Such eye movements may include translation along the plane (transverse to corneal depth), changes in gaze angle, and / or head movements. Because the crosslinking process may require exposing the cornea to photoactivated light for at least one minute, for example, one to twenty minutes, some eye movements are likely to occur during the procedure. To address the occurrence of eye movements, systems and methods can employ an active eye-tracking system to detect any changes in corneal position, and in response, the illumination system can be adjusted to precisely apply photoactivated light to the designated area of ​​the cornea.

[0009] According to an exemplary embodiment, a system for applying crosslinking treatment to the cornea of ​​an eye includes a light source configured to emit photoactivated light. The system includes a spatial light modulator configured to receive photoactivated light from the light source and utilize the photoactivated light to provide pixelated illumination. The spatial light modulator defines a maximum area of ​​pixelated illumination. The system includes a controller configured to cause the spatial light modulator to project a first pixelated illumination onto the cornea to generate crosslinking activity in the treatment area by photoactivating a crosslinking agent applied to the treatment area. The area of ​​the first pixelated illumination is smaller than the maximum area defined by the spatial light modulator. The controller is also configured to determine corneal movement. In response to corneal movement, the controller controls the spatial light modulator to project a second pixelated illumination onto the treatment area based on at least one of a translation or transformation of the first pixelated illumination to continue photoactivating the crosslinking agent applied to the treatment area.

[0010] In the above embodiments, using smaller pixelated illumination can provide a greater range of positional adjustment for the spatial light modulator. However, a smaller pixelated illumination pattern consists of fewer pixels. Reducing the size of the pixelated illumination may reduce the minimum resolvable spatial features projected onto the eye and may produce “pixelation” artifacts. To address this effect, a system for applying crosslinking treatment to the cornea of ​​the eye includes a light source configured to emit photoactivated light. The system includes a spatial light modulator configured to receive photoactivated light from the light source and utilize the photoactivated light to provide pixelated illumination. The system includes a controller configured to cause the spatial light modulator to project a first pixelated illumination and a second pixelated illumination onto the cornea to generate crosslinking activity in the desired treatment area by photoactivating a crosslinking agent applied to the desired treatment area. The desired treatment area includes at least one portion not illuminated by the first pixelated illumination. The second pixelated illumination includes one or more pixels that illuminate at least one portion of the desired treatment area not illuminated by the first pixelated illumination. The spatial light modulator projects the first pixelated illumination and the second pixelated illumination onto the cornea according to different time parameters. For example, the first pixelated illumination includes all the complete pixels that can be projected onto the desired treatment area, while one or more pixels of the second pixelated illumination include the remaining pixels, which combine with the pixels of the first pixelated illumination to illuminate the entire desired treatment area. Attached Figure Description

[0011] Figure 1 An example system is shown that, according to various aspects of this disclosure, a crosslinking agent and photoactivated light are delivered to the cornea of ​​the eye to generate corneal collagen crosslinks.

[0012] Figure 2A An example treatment system with an active eye-tracking system is shown according to various aspects of this disclosure.

[0013] Figure 2B exhibit Figure 2A Example lighting patterns for a therapeutic system.

[0014] Figure 3A Example treatment systems with alternative active eye-tracking systems are shown according to various aspects of this disclosure.

[0015] Figure 3B exhibit Figure 3A Example lighting patterns for a therapeutic system.

[0016] Figure 4A exhibit Figure 3A Example lighting pattern for example treatment systems.

[0017] Figure 4B Display based on Figure 4AAnother exemplary lighting pattern is a lighting pattern that responds to changes in the rotation of the subject's eye.

[0018] Figure 5A exhibit Figure 3A Example lighting pattern for example treatment systems.

[0019] Figure 5B Display based on Figure 5A Another example of a lighting pattern that responds to changes in geometric deformation caused by changes in the subject’s eye gaze angle and / or head movement.

[0020] Figure 6A The display corresponds to Figure 3A Example pixel activation of the required lighting pattern for an example treatment system.

[0021] Figure 6B The demonstration is used to solve the problem caused by Figure 6A The example method shown is for pixelated artifacts obtained by pixel activation.

[0022] Figure 6C The demonstration is used to solve the problem caused by Figure 6A Another example method for pixelation artifacts resulting from pixel activation is shown.

[0023] Figure 7A The present invention demonstrates a substantially circular UV illumination pattern (diameter = 4 mm) defined by pixels with a size of 25 μm × 25 μm, according to various aspects of this disclosure.

[0024] Figure 7B The present invention demonstrates a substantially circular UV illumination pattern (diameter = 4 mm) defined by pixels with a size of 100 μm × 100 μm, according to various aspects of this disclosure.

[0025] Figure 7C The present invention demonstrates a substantially circular UV illumination pattern (diameter = 4 mm) defined by pixels with a size of 200 μm × 200 μm, according to various aspects of this disclosure.

[0026] Figure 7D The present invention demonstrates a substantially circular UV illumination pattern (diameter = 4 mm) defined by pixels with a size of 400 μm × 400 μm, according to various aspects of this disclosure.

[0027] Figure 7E The present invention demonstrates a substantially circular UV illumination pattern (diameter = 4 mm) defined by pixels with a size of 750 μm × 750 μm, according to various aspects of this disclosure.

[0028] Figure 7F The present invention demonstrates a substantially circular UV illumination pattern (diameter = 4 mm) defined by pixels with a size of 1000 μm × 1000 μm, according to various aspects of this disclosure.

[0029] Figure 8A Demonstration and use Figure 7A Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern (from before to after treatment).

[0030] Figure 8B Demonstration and use Figure 7B Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0031] Figure 8C Demonstration and use Figure 7C Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0032] Figure 8D Demonstration and use Figure 7D Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0033] Figure 8E Demonstration and use Figure 7E Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0034] Figure 8F Demonstration and use Figure 7F Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0035] Figure 9A The present disclosure illustrates, according to various aspects, the modeled difference in the elevation angle (in micrometers) of the anterior cornea between the results of two cross-linking treatments performed using larger pixels (750 μm × 750 μm) and smaller pixels (10 μm × 10 μm) for transmitting a substantially circular UV illumination pattern.

[0036] Figure 9B Shown Figure 9A The modeled difference in anterior corneal tangential curvature (D) between the two cross-linking treatment outcomes.

[0037] Figure 10A The present invention discloses a substantially annular UV illumination pattern (inner diameter = 4 mm, outer diameter = 8.5 mm) defined by pixels with a size of 25 μm × 25 μm, according to various aspects of this disclosure.

[0038] Figure 10B The present invention demonstrates a substantially annular UV illumination pattern (inner diameter = 4 mm, outer diameter = 8.5 mm) defined by pixels with a size of 100 μm × 100 μm, according to various aspects of this disclosure.

[0039] Figure 10CThe present invention demonstrates a substantially annular UV illumination pattern (inner diameter = 4 mm, outer diameter = 8.5 mm) defined by pixels with a size of 200 μm × 200 μm, according to various aspects of this disclosure.

[0040] Figure 10D The present invention demonstrates a substantially annular UV illumination pattern (inner diameter = 4 mm, outer diameter = 8.5 mm) defined by pixels with a size of 400 μm × 400 μm, according to various aspects of this disclosure.

[0041] Figure 10E The present invention illustrates a substantially annular UV illumination pattern (inner diameter = 4 mm, outer diameter = 8.5 mm) defined by pixels with a size of 750 μm × 750 μm, according to various aspects of this disclosure.

[0042] Figure 10F The present invention illustrates a substantially annular UV illumination pattern (inner diameter = 4 mm, outer diameter = 8.5 mm) defined by pixels with a size of 1000 μm × 1000 μm, according to various aspects of this disclosure.

[0043] Figure 11A Demonstration and use Figure 10A Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0044] Figure 11B Demonstration and use Figure 10B Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0045] Figure 11C Demonstration and use Figure 10C Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0046] Figure 11D Demonstration and use Figure 10D Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0047] Figure 11E Demonstration and use Figure 10E Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0048] Figure 11F Demonstration and use Figure 10F Modeled changes in anterior corneal tangential curvature after cross-linking treatment with a defined UV illumination pattern.

[0049] Figure 12AThe present disclosure illustrates, according to various aspects, the modeled difference in the elevation angle (in micrometers) of the anterior cornea between the results of two cross-linking treatments performed using larger pixels (750 μm × 750 μm) and smaller pixels (10 μm × 10 μm) for transmitting a substantially circular UV illumination pattern.

[0050] Figure 12B Shown Figure 12A The modeled difference in anterior corneal tangential curvature (D) between the two cross-linking treatment outcomes.

[0051] While this disclosure is susceptible to various modifications and alternatives, its specific implementation has been shown by way of example in the figures and will be described in detail herein. However, it should be understood that this disclosure is not intended to be limited to the specific forms disclosed, but rather is intended to cover all modifications, equivalents, and alternatives falling within the spirit of this disclosure. Detailed Implementation

[0052] Figure 1 An example of a treatment system 100 for generating collagen crosslinks in the cornea 2 of an eye 1 is shown. The treatment system 100 includes an applicator 132 for applying a crosslinking agent 130 to the cornea 2. In embodiments, the applicator 132 may be an eye dropper, syringe, or the like for applying a photosensitizer 130 as a drop to the cornea 2. An example system and method for applying a crosslinking agent is described in U.S. Patent Application Publication No. 2017 / 0296383, filed April 13, 2017, entitled “Systems and Methods for Delivering Drugs to an Eye,” the contents of which are incorporated herein by reference in their entirety.

[0053] The crosslinking agent 130 can be provided in a formulation that allows it to penetrate the corneal epithelium 2a and reach the basal region of the corneal stroma 2b. Alternatively, the corneal epithelium 2a can be removed or otherwise cut to allow the crosslinking agent 130 to be applied more directly to the basal tissue.

[0054] The treatment system 100 includes an illumination system having a light source 110 and an optical element 112 for directing light to the cornea 2. The light causes photoactivation of a crosslinking agent 130 to generate crosslinking activity in the cornea 2. For example, the crosslinking agent may include riboflavin, and the photoactivating light may include ultraviolet A (UVA) light (e.g., about 365 nm). Alternatively, the photoactivating light may include another wavelength, such as a visible light wavelength (e.g., about 452 nm). As further described below, corneal crosslinking improves corneal strength by generating chemical bonds within the corneal tissue according to a system of photochemical kinetic reactions. For example, riboflavin and photoactivating light can be applied to stabilize and / or strengthen corneal tissue to address conditions such as keratoconus or post-LASIK atopy.

[0055] The treatment system 100 includes one or more controllers 120 for controlling aspects of the system 100, including a light source 110 and / or optical elements 112. In one embodiment, the cornea 2 can be treated more broadly using a crosslinking agent 130 (e.g., using an eye dropper, syringe, etc.), and photoactivated light from the light source 110 can be selectively directed to the treated area of ​​the cornea 2 according to a specific pattern.

[0056] Optical element 112 may include one or more mirrors or lenses for guiding and focusing photoactivating light emitted by light source 110 onto a specific pattern on cornea 2. Optical element 112 may also include filters for partially blocking wavelengths of light emitted by light source 110 and for selecting specific wavelengths of light to be guided to cornea 2 for photoactivating crosslinking agent 130. Furthermore, optical element 112 may include one or more beam splitters for splitting the beam emitted by light source 110, and may include one or more heat sinks for absorbing light emitted by light source 110. Optical element 112 can also accurately and precisely focus the photoactivating light onto a specific focal plane within cornea 2, for example, at a specific depth in the underlying sub-region 2b where crosslinking activity is required.

[0057] Furthermore, a specific regime of photoactivated light can be modulated to achieve the desired degree of crosslinking in selected areas of the cornea 2. One or more controllers 120 can be used to control the operation of the light source 110 and / or optical elements 112 to precisely deliver the photoactivated light according to any combination of: wavelength, bandwidth, intensity, power, position, penetration depth, and / or treatment duration (duration of exposure cycle, dark cycle, and ratio of exposure cycle to dark cycle duration).

[0058] The photoactivation parameters of crosslinking agent 130 can be adjusted, for example, to reduce the amount of time required to achieve the desired crosslinking. In one example embodiment, the time can be reduced from minutes to seconds. While some configurations can achieve 5 mW / cm²... 2Photoactivation light can be applied at a certain irradiance, but a higher irradiance, such as 5 mW / cm², can be applied. 2 The dose of energy absorbed in the cornea 2 can be described as the effective dose, which is the amount of energy absorbed by the region of the corneal epithelium 2a. For example, the effective dose of the region of the corneal surface 2A could be, for example, 5 J / cm². 2 Or as high as 20J / cm 2 Or 30J / cm 2 The effective dose described can be delivered from a single application of energy or from repeated applications of energy.

[0059] The optical element 112 of the treatment system 100 may include a microelectromechanical system (MEMS) device, such as a digital micromirror device (DMD), to modulate the application of photoactivated light spatially and temporally. Using DMD technology, photoactivated light from the light source 110 is projected in a precise spatial pattern created by an array of micromirrors arranged on a semiconductor chip. Each mirror represents one or more pixels in the pattern of the projected light. Topology-guided crosslinking can be performed using the DMD. Several different spatial and temporal irradiance and dose profiles can be employed based on the topology of the DMD. These spatial and temporal dose profiles can be created using continuous wave illumination, but can also be modulated via pulsed illumination by pulsed illumination of the illumination source at different frequencies and duty cycles. Alternatively, the DMD can be modulated with different frequencies and duty cycles on a pixel-by-pixel basis to provide ultimate flexibility using continuous wave illumination. Alternatively, a combination of pulsed illumination and modulated DMD frequencies and duty cycles can be combined. This allows for a specific number of spatially defined corneal crosslinks. This spatially defined crosslinking can be combined with dosimetry, interferometry, optical coherence tomography (OCT), corneal topography, etc., for pretreatment planning and / or real-time monitoring and modulation of corneal crosslinking during treatment. Various aspects of the dosimetry system will be described in further detail below. Furthermore, preclinical patient information can be combined with finite element biomechanical computer modeling to create patient-specific pretreatment plans.

[0060] To control various aspects of the delivery of photoactivated light, embodiments may also employ aspects of multiphoton excitation microscopy. In particular, the treatment system 100 may deliver multiple photons of longer wavelengths (i.e., lower energy) to the cornea 2 instead of a single photon of a specific wavelength, which combine to initiate crosslinking. Advantageously, longer wavelengths are scattered less within the cornea 2 than shorter wavelengths, allowing longer wavelength light to penetrate the cornea 2 more effectively than shorter wavelength light. The shielding effect of incident illumination at deeper depths within the cornea is also reduced compared to conventional short-wavelength illumination because the photosensitizer absorbs much less light at longer wavelengths. This allows for enhanced control over depth-specific crosslinking. For example, in some embodiments, two photons may be used, each carrying approximately half the energy required to excite molecules in the crosslinking agent 130 to produce the photochemical kinetics described further below. When the crosslinking agent molecule absorbs two photons simultaneously, it absorbs sufficient energy to release active free radicals in the corneal tissue. Embodiments may also utilize lower energy photons, such that the crosslinking agent molecule must absorb, for example, three, four, or five photons simultaneously to release active free radicals. The probability of multiple photons being absorbed almost simultaneously is very low, so a high-throughput excitation photon may be required, which can be achieved through a femtosecond laser.

[0061] Numerous conditions and parameters influence the crosslinking of corneal collagen with crosslinking agent 130. For example, illuminance and the dose of photoactivated light affect the amount and rate of crosslinking.

[0062] Especially when the crosslinking agent 130 is riboflavin, UVA light can be applied continuously (CW) or as pulsed light, and this choice affects the amount, rate, and extent of crosslinking. If UVA light is applied as pulsed light, the duration of the exposure cycle, the dark cycle, and the ratio of the exposure cycle duration to the dark cycle duration affect the resulting corneal rigidity. For the same amount or dose of energy delivered, pulsed light illumination can be used to create corneal tissue rigidity that may be larger or smaller than that achievable with continuous wave illumination. Further optimized chemical amplification can be achieved using light pulses of appropriate length and frequency. For pulsed light therapy, the on / off duty cycle can be between approximately 1 / 1000 to approximately 1 / 1000; the irradiance can be approximately 1 mW / cm². 2 Approximately 1000 mW / cm 2 Between the average irradiance, the pulse rate can be between about 0.01 Hz and about 1000 Hz or between about 1000 Hz and about 100000 Hz.

[0063] Treatment system 100 can generate pulsed light by employing a DMD, electronically turning light source 110 on and off, and / or using a mechanical or optoelectronic (e.g., Pockels battery) shutter or mechanical chopper or rotating aperture. Due to the pixel-specific modulation capability of the DMD and the subsequent stiffness imparting based on modulation frequency, duty cycle, irradiance, and dose delivered to the cornea, complex biomechanical stiffness patterns can be imparted to the cornea to allow for a variety of refractive corrections. These refractive corrections may, for example, involve combinations of myopia, hyperopia, astigmatism, irregular astigmatism, presbyopia, and complex corneal refractive surface corrections caused by ophthalmic conditions such as keratoconus, clear limbal disease, post-LASIK atopy, and other conditions of corneal biomechanical alteration / degeneration. A specific advantage of the DMD system and method is that it allows for random asynchronous pulse topological patterning, creating non-periodic and uniformly occurring illumination, which eliminates the possibility of photosensitive seizures or flicker vertigo induced by pulse frequencies between 2 Hz and 84 Hz.

[0064] While the example implementation may employ a step-by-step on / off pulsed light function, it is understood that other functions for applying light to the cornea can be used to achieve a similar effect. For example, light can be applied to the cornea according to a sine function, a sawtooth function, or other complex functions or curves, or any combination of functions or curves. Indeed, it is understood that the function can be substantially stepwise, with a more gradual transition between on / off values. Furthermore, it is understood that the irradiance does not need to decrease to zero during the off cycle and can remain above zero during the off cycle. The desired effect can be achieved by applying light to the cornea according to a curve that varies the irradiance between two or more values.

[0065] For example, embodiments of systems and methods for delivering photoactivated light are described in U.S. Patent Application Publication No. 2011 / 0237999, filed March 18, 2011, entitled "Systems and Methods for Applying and Monitoring Eye Therapy"; U.S. Patent Application Publication No. 2012 / 0215155, filed April 3, 2012, entitled "Systems and Methods for Applying and Monitoring Eye Therapy"; and U.S. Patent Application Publication No. 2013 / 0245536, filed March 15, 2013, entitled "Systems and Methods for Corneal Cross-Linking with Pulsed Light," the contents of which are incorporated herein by reference in their entirety.

[0066] The addition of oxygen also affects the amount of corneal stiffening. In human tissues, the O2 content is very low compared to the atmosphere. However, the rate of cross-linking in the cornea is related to the O2 concentration during photoactivated light irradiation. Therefore, it may be advantageous to actively increase or decrease the O2 concentration during irradiation to control the cross-linking rate until the desired amount of cross-linking is achieved. Oxygen can be applied in several different ways during cross-linking treatment. One method involves using O2 to supersaturate riboflavin. Thus, when riboflavin is applied to the eye, a higher concentration of O2 is directly delivered to the cornea along with the riboflavin and influences the O2-related responses when the riboflavin is exposed to photoactivated light. According to another method, a stable state of O2 (at a selected concentration) can be maintained at the surface of the cornea to expose the cornea to a selected amount of O2 and allow O2 to enter the cornea. For example, as... Figure 1 As shown, the treatment system 100 also includes an oxygen source 140 and an oxygen delivery device 142 that selectively delivers a selected concentration of oxygen to the cornea 2. For example, example systems and methods for applying oxygen during cross-linking treatment are described in U.S. Patent No. 8,574,277, filed October 21, 2010, entitled "Eye Therapy," and in U.S. Patent Application Publication No. 2013 / 0060187, filed October 31, 2012, entitled "Systems and Methods for Corneal Cross-Linking with Pulsed Light," the contents of which are incorporated herein by reference in their entirety. Furthermore, an exemplary mask device for delivering a given concentration of oxygen and photoactivated light during ocular treatment is described in U.S. Patent Application Publication No. 2017 / 0156926, filed December 3, 2016, entitled "Systems and Methods for Treating an Eye with a Mask Device," the contents of which are incorporated herein by reference in their entirety. For example, a mask can be placed over the eyes to create a consistent and known oxygen concentration above the surface.

[0067] When riboflavin absorbs radiant energy, particularly light energy, it undergoes photoactivation. Riboflavin photoactivation occurs via two photochemical kinetic pathways: type I and type II. The reactions involved in type I and type II mechanisms, as well as other aspects of the photochemical kinetic reactions that produce cross-linking activity, are described in U.S. Patent Application Publication No. 2016 / 0310319, filed April 27, 2016, entitled "Systems and Methods for Cross-Linking Treatments of an Eye," the contents of which are incorporated herein by reference in their entirety.

[0068] For example, to treat keratoconus or achieve refractive correction, an effective cross-linking process applies photoactivated light as precisely as possible to a designated area of ​​the cornea treated with the cross-linking agent. Applying photoactivated light outside the designated area can cause undesirable structural changes in the cornea, negatively impacting treatment outcomes. However, precise application of photoactivated light can be difficult to achieve due to eye movements that may occur during treatment. Such eye movements may include, for example,... Figure 1 The translation along the xy-plane, the change in the angle of constriction, and / or the big-head motion are shown. (In) Figure 1 In this study, the depth of cornea 2 is measured along the z-axis, and the pattern of photoactivated light can be projected onto the transverse xy-plane. Because the crosslinking process may require exposing the cornea to photoactivated light for at least one minute, for example, one to twenty minutes, some eye movements are likely to occur during the crosslinking process.

[0069] To address the occurrence of eye movements, various implementations may employ an active eye-tracking system to detect any changes in corneal position, and in response, an illumination system may be adjusted to precisely apply photoactivated light to a designated area of ​​the cornea. Figure 2A An embodiment of a treatment system 200 with an active eye-tracking system is shown. The treatment system 200 includes an illumination system for directing photoactivated light to the cornea 2 of the eye 1. The illumination system includes a light source 110 and an optical element 112 as described above. For example, the light source 110 may include one or more LEDs that emit UV light to photoactivate riboflavin applied to the cornea 2. The optical element 112, including a DMD 212, projects the photoactivated light onto the cornea 2 along the xy plane in a precise spatial pattern. Furthermore, the treatment system 200 includes one or more controllers 120 to control various aspects of the treatment system 200.

[0070] For an active eye-tracking system, treatment system 200 includes a camera (image capture device) 252 that dynamically captures images of eye 1 during the procedure. One or more controllers 120 can process the images to detect the position of eye 1 relative to a reference point (such as the pupil) of treatment system 200. Using the position of the reference point as a reference, one or more controllers 120 can determine the position of a designated area of ​​cornea 2. Therefore, one or more controllers 120 can adjust treatment system 200 to deliver photoactivated light to the designated area. In some cases, camera 252 and software for processing images and adjusting treatment system 200 (e.g., computer-readable instructions stored on a non-transitory medium) can be collectively referred to as a vision system.

[0071] Reference Figure 2BThe entire mirror array of DMD 212 defines a maximum region 202 for transmitting activation light. The maximum region 202 includes boundaries 202a-d. Any portion of the DMD 212 array can be activated to transmit activation light from any portion of the maximum region 202. For example, as... Figure 2B As shown, a portion of the DMD 212 array can be activated to generate an illumination pattern 204, which is substantially circular and positioned at (x... c y c Centered on the boundary 202, the illumination pattern 204 has a diameter D1. The diameter D1 of the illumination pattern 204 can be slightly smaller than the distance along the y-axis between the relative boundaries 202a and b and the distance along the x-axis between the relative boundaries 202c and d. Therefore, a space can exist between the illumination pattern 204 and the boundaries 202a-d. This space allows the center of the illumination pattern 204 to be translated a small distance within the region 202 while maintaining the same shape as the diameter D1. For example, another part of the array of DMD 212 can be activated to produce illumination patterns at different positions (x, y, d). c +δ x1 y c +δ y1 The lighting pattern 204 is centered on δ. x1 δ represents the possible translation along the x-axis. y1 This represents a possible translation along the y-axis. The translation of the illumination pattern 204 within region 202 alters the position of the corresponding photoactivated light delivered to the cornea 2. Therefore, in response to eye movements detected via camera 252, one or more controllers 120 can control the DMD 212 to modulate the delivery of the photoactivated light, directing it to a designated area of ​​the cornea 2 to achieve the desired effect.

[0072] However, the adjustments that one or more controllers 120 can make using the DMD 212 are limited by the small space between the illumination pattern 204 and the boundaries 202a-d. Using only the DMD 212, one or more controllers 120 may not be able to make sufficiently large adjustments to the position of the illumination pattern 204 within region 202 in response to larger eye movements. In other words, the illumination pattern 204 may reach one of the boundaries 202a-d before it can move the required distance. To make larger adjustments that cannot be made using the DMD 212, the treatment system 200 includes an electromechanical XY motion system 254 coupled to one or more optical elements 112. One or more controllers 120 can control the XY motion system 254 to move one or more optical elements 112 to better mechanical alignment with the cornea 2 in response to larger eye movements. For example, the XY motion system 254 may include electromechanical stages operable to move one or more optical elements 112 and corresponding photoactivated light along the x-axis and / or y-axis. Therefore, the treatment system 200 employs a DMD 212 for smaller adjustments and an XY motion system 254 for larger adjustments in response to different amounts of eye movement.

[0073] Figure 3A An embodiment of a treatment system 300 with another active eye movement tracking system is shown. (Compared to...) Figure 2A Unlike the treatment system 200 shown, treatment system 300 does not employ the XY motion system 254. Instead, treatment system 300 uses a DMD 312 to digitally perform virtually all necessary adjustments. Similar to the DMD 212 described above, as... Figure 3B As shown, the entire mirror array in the DMD 312 defines the same maximum region 202 for transmitting activation light. The maximum region 202 includes identical boundaries 202a-d. Any portion of the DMD 312 array can be activated to transmit light from any portion of this maximum region 202. To eliminate interference... Figure 2A To meet the needs of the XY motion system 254 used in the lighting pattern 204 shown, the DMD 312 provides a lighting pattern 304 that is much smaller than the lighting pattern 204.

[0074] Figure 2B , 3B The comparison shows the differences between the respective illumination patterns 204 and 304 within the same maximum area 202. The illumination pattern 304 in the smaller area is produced by activating even fewer DMD arrays. Illumination pattern 304 is substantially circular and is located at position (x... c y cCentered on the boundary 202a-d, but with a diameter D2 smaller than the diameter D1 of the illumination pattern 204. Therefore, the space between the illumination pattern 304 and the boundary 202a-d is larger than the space between the illumination pattern 204 and the boundary 202a-d. This larger space allows the center of the illumination pattern 304 to be translated along the x-axis and / or y-axis within the region 202 to a greater extent than the center of the illumination pattern 204. In other words, another part of the array of DMD 312 can be activated to produce illumination patterns at different positions (x... c +δ x2 y c +δ y2 The lighting pattern 304 is centered on δ. x2 Greater than δ x1 δ y2 Greater than δ y1 , and δ x1 and δ y1 The possible translation of the representative and treatment system 200 along their respective axes.

[0075] Translation of the illumination pattern 304 within region 202 alters the position of the corresponding photoactivated light applied to the cornea 2. The greater possible translation of the illumination pattern 304 using the DMD 312 allows for a wider range of adjustment in the delivery of the photoactivated light along the X and / or Y axes. Therefore, in response to eye movements detected via camera 252, one or more controllers 120 can employ the DMD 312 to perform substantially all necessary adjustments, thereby ensuring that the photoactivated light reaches a designated area of ​​the cornea 2 to achieve the desired result.

[0076] The treatment system 200 relies on an electromechanical XY motion system 254 that may employ a slower motor. In contrast, the DMD 312 can respond digitally to commands at a rate of approximately 60 Hz, thus allowing the treatment system 300 to position the delivery of photoactivated light more quickly.

[0077] By using the DMD 312, the treatment system 300 can also perform other positional corrections that the XY motion system 254 cannot achieve. For example, the treatment system 300 can respond more effectively to rotational changes in eye position by applying a corresponding rotational transformation to the illumination pattern applied to the eye via the DMD 312. Figure 4A The initial illumination pattern 404a generated by activating a portion of the array of DMD 312 is shown. Illumination pattern 404a has an initial rotational state. When the treatment system 300 detects a change in eye position rotation via camera 252, another portion of the array of DMD 312 can be activated to generate... Figure 4B The illumination pattern 404b is shown. Illumination pattern 404b provides a geometric transformation of the initial illumination pattern 404a, having different rotational states in response to changes in eye position.

[0078] Furthermore, the treatment system 300 can more effectively respond to geometric deformations caused by changes in eye gaze angle and / or head position. For example, Figure 5A An initial illumination pattern 504a generated by activating a portion of the array of DMD 312 is shown. As shown, illumination pattern 504a is substantially circular. Preferably, photoactivated light from treatment system 300 is projected in a substantially circular shape onto the desired plane (e.g., the xy plane) in cornea 2 as predicted. However, changes in eye gaze angle and / or head position may alter the angle of the desired plane in cornea 2 and geometrically distort the projection of photoactivated light into a shape different from the initial illumination pattern 504a. For example, changes in eye gaze angle and / or head position may cause illumination pattern 504a to be elongated, thereby projecting an elliptical shape onto the desired plane. When treatment system 300 detects a change in eye gaze angle and / or head position via camera 252, as shown in FIG. 5b, another portion of the array of DMD 312 can be activated to generate illumination pattern 504b. Illumination pattern 504b provides a different shape for the geometric transformation of the initial illumination pattern 504a, compensating for the geometric distortion caused by changes in eye gaze angle and / or head position. When the illumination pattern 504b is projected onto the desired plane of the cornea, the projection precisely achieves the desired shape. Specifically, in Figure 5A In the embodiment of -B, the projection has a substantially circular shape. However, in other applications, the projection may have other desired shapes (e.g., elliptical, etc.).

[0079] A smaller illumination pattern provides a wider range of positional adjustment for the DMD 312. As mentioned above, the DMD provides an illumination pattern that is pixelated based on an array of mirrors. Because the illumination pattern from the DMD consists of a discrete number of pixels, a smaller illumination pattern consists of fewer pixels. Therefore, reducing the size of the illumination pattern reduces the minimum resolvable spatial feature projected onto the eye and produces "pixelated" artifacts. Figure 6A As shown, the DMD 312 provides a maximum illumination area 602 defined by a plurality of pixels 602a. The treatment system 300 can activate a subset of these pixels to produce a smaller illumination pattern, thereby allowing for a greater range of positional adjustments. For example, Figure 602a shows the boundary (outline) of the desired illumination pattern 606. However, due to the size of the desired illumination pattern 606, only pixels 604a substantially fit within the desired illumination pattern 606. If only pixels 604a are activated, portions of the desired illumination pattern 606 remain unfilled. However, if pixels 604b are activated to fill the remaining portions of the desired illumination pattern 606, the resulting illumination pattern does not have the desired shape. In both cases, the resulting illumination pattern does not have smooth edges corresponding to the desired illumination pattern 606. Generally speaking, Figure 6A The embodiments illustrate the trade-off between the possible range of adjustments for active eye tracking using a DMD array of a given size and the resolution required to achieve the desired lighting pattern.

[0080] Figure 6B The demonstration is used to solve the problem caused by Figure 6A The method demonstrates pixelation artifacts and generates an illumination pattern with smoother edges corresponding to the desired illumination pattern 606. Specifically, one or more controllers 120 can operate the DMD 312 during the process to dither the pixels 604b at a fast rate. For example, the pixels 604b can be alternately activated every other update cycle of the DMD 312. When dithered during the process, the total dose of photoactivating light delivered by the pixels 604b is less than the dose of light activated throughout the entire process. Therefore, dithering can be applied to provide a smoother illumination pattern that more closely approximates the desired illumination pattern 606 and the corresponding dose of photoactivating light.

[0081] Figure 6C Display for smoothing by Figure 6A Another method for demonstrating pixelated artifacts. Specifically, it can be achieved by... Figure 6A The basic shape defined by pixel 604a shown applies dithering by alternatingly moving + / - 1 pixel along the x-axis or y-axis at staggered time points. For example, at one update cycle, DMD 312 is operated to move in the positive y-direction (from...) Figure 6A The basic shape is translated one pixel (as shown in the image) to include the boundary partially defined by pixel 608a. At the next update cycle, DMD 312 is operated to shift in the positive x-direction (from...) Figure 6A The base shape is translated by one pixel (as shown in the image) to include the boundary partially defined by pixel 608b. At the next update cycle, DMD 312 is operated in the negative y direction (from...). Figure 6A The base shape is translated one pixel (as shown in the image) to include the boundary partially defined by pixel 608c. At the next update cycle, DMD 312 is operated to shift in the negative x direction (from...). Figure 6A (As shown in the image) the base shape is translated by one pixel to include the boundary partially defined by pixel 608d. This series of steps is repeated to provide a smoother illumination pattern that more closely approximates the desired illumination pattern 606 and the corresponding photoactivated light dose.

[0082] The maximum acceptable pixel size of the DMD and the optimal parameters for each of the above embodiments can be determined by biomechanical modeling of the cornea's response to the crosslinking process.

[0083] Figure 7A-F demonstrates the use of increased pixel size to transmit a substantially circular UV illumination pattern 706 with a diameter of approximately 4 mm. For example, the illumination pattern 706 can be used to create corresponding cross-linking activity areas in the cornea to treat myopia. Figure 7A In this context, the lighting pattern 706 is defined by pixels 708a with dimensions of 25 micrometers × 25 micrometers. Figure 7B In this context, the lighting pattern 706 is defined by pixels 708b with dimensions of 100 micrometers × 100 micrometers. Figure 7C In this context, the lighting pattern 706 is defined by pixels 708c with a size of 200 micrometers × 200 micrometers. Figure 7D In this context, the lighting pattern 706 is defined by pixels 708d with dimensions of 400 micrometers × 400 micrometers. Figure 7E In this context, the lighting pattern 706 is defined by pixels 708e with dimensions of 750 μm × 750 μm. Figure 7F In this context, the lighting pattern 706 is defined by pixels 708f with dimensions of 1000 μm × 1000 μm. Figure 7A In -F, the effect of eye movement on lighting pattern 706 is... Figure 7A -F uses a 100-micron blur function along the edge of the lighting pattern 706 for modeling.

[0084] Accordingly, Figure 8A -F respectively display as follows Figure 7A As shown in -F, the increased pixel size is used to convey the modeled change in anterior corneal tangential curvature (from pre-treatment to post-treatment) after cross-linking treatment with UV illumination pattern 706. Figure 8A The result is shown when the lighting pattern 706 is defined by pixel 708a (25 μm × 25 μm). Figure 8B The result is shown when the lighting pattern 706 is defined by pixels 708b (100 μm × 100 μm). Figure 8C The result is shown when the lighting pattern 706 is defined by pixel 708c (200 μm × 200 μm). Figure 8D The result is shown when the lighting pattern 706 is defined by pixel 708d (400 μm × 400 μm). Figure 8E The result is shown when the lighting pattern 706 is defined by pixel 708e (750 μm × 750 μm). Figure 8F The results are shown when the illumination pattern 706 is defined by pixel 708f (1000 μm × 1000 μm). Table 1 shows the changes (D) in corneal measurements over the central 3 mm region for various pixel sizes.

[0085]

[0086]

[0087] Table 1

[0088] Figure 9A -B illustrates the modeled differences between the results of two crosslinking treatments performed using larger and smaller pixels, respectively, to provide a substantially circular UV illumination pattern. Specifically, the larger pixel has a size of 750 μm × 750 μm, and the smaller pixel has a size of 10 μm × 10 μm. Figure 9A The display shows the elevation angle (in micrometers) of the anterior cornea obtained using larger pixels minus the elevation angle (in micrometers) obtained using the anterior cornea obtained using smaller pixels. Figure 9B The result shows the tangential curvature (D) of the anterior cornea obtained by using larger pixels minus the tangential curvature (D) of the anterior cornea obtained by using smaller pixels.

[0089] However, as the results in 8A-F and Table 1 demonstrate, for substantially circular illumination patterns, the changes in tangential curvature and corneal measurements are virtually similar for treatments using pixels with sizes as high as 250 μm × 250 μm, or even 400 μm × 400 μm. Similar results with larger pixel sizes (e.g., compared to smaller 10 μm × 10 μm pixels) allow for the efficient implementation of the eye-tracking method of the example system 300 described above.

[0090] Figure 10A -F demonstrates the use of increased pixel size to deliver a substantially circular UV illumination pattern 1006. The illumination pattern 1006 has an inner diameter of approximately 4 mm and an outer diameter of approximately 8.5 mm. For example, the illumination pattern 1006 can be used to create corresponding cross-linking activity areas in the cornea to treat farsightedness or presbyopia. Figure 10A In this context, the lighting pattern 1006 is defined by pixels 1008a with dimensions of 25 micrometers × 25 micrometers. Figure 10B In this context, the lighting pattern 1006 is defined by pixels 1008b with dimensions of 100 micrometers × 100 micrometers. Figure 10C In this context, the lighting pattern 1006 is defined by pixels 1008c with a size of 200 micrometers × 200 micrometers. Figure 10D In this context, the lighting pattern 1006 is defined by pixels 1008d with dimensions of 400 micrometers × 400 micrometers. Figure 10E In this context, the lighting pattern 1006 is defined by pixels 1008e with dimensions of 750 μm × 750 μm. Figure 10F In this context, the lighting pattern 1006 is defined by pixels 1008f with dimensions of 1000 micrometers × 1000 micrometers. Figure 10A In -F, the effect of eye movement on the illumination pattern 1006 is modeled using a 100-micron blur function along the edge of the illumination pattern 1006.

[0091] Accordingly, Figure 11A -F respectively display as follows Figure 10AAs shown in -F, the modeled change in anterior corneal tangential curvature (from before to after treatment) after crosslinking treatment using increased pixel size to transmit UV illumination pattern 1006. Figure 11A The result is shown when the lighting pattern 1006 is defined by pixel 1008a (25 μm × 25 μm). Figure 11B The result is shown when the lighting pattern 1006 is defined by pixels 1008b (100 μm × 100 μm). Figure 11C The result is shown when the lighting pattern 1006 is defined by pixels 1008c (200 μm × 200 μm). Figure 11D The result is shown when the lighting pattern 1006 is defined by pixels 1008d (400 μm × 400 μm). Figure 11E The result is shown when the lighting pattern 1006 is defined by pixel 1008e (750 μm × 750 μm). Figure 11F The results are illustrated when the illumination pattern 1006 is defined by pixel 1008f (1000 μm × 1000 μm). Table 2 shows the changes in corneal measurements (D) for various pixel sizes within the central 3 mm region.

[0092] Pixel size, micrometers Changes in corneal measurements, D 10 1.09 200 1.09 400 1.07 750 1.03 1000 1.01 1500 0.87

[0093] Table 2

[0094] Figure 12A -B illustrates the modeled differences between the results of two crosslinking treatments performed using larger and smaller pixels, respectively, to provide a substantially circular UV illumination pattern. Specifically, the larger pixel has a size of 750 μm × 750 μm, and the smaller pixel has a size of 10 μm × 10 μm. Figure 12A The display shows the elevation angle (in micrometers) of the anterior cornea obtained using larger pixels minus the elevation angle (in micrometers) obtained using the anterior cornea obtained using smaller pixels. Figure 12B The result shows the tangential curvature (D) of the anterior cornea obtained by using larger pixels minus the tangential curvature (D) of the anterior cornea obtained by using smaller pixels.

[0095] However, as the results in 11A-F and Table 2 demonstrate, the changes in tangential curvature and corneal measurements are effectively similar for treatments using pixels with sizes up to 200 μm × 200 μm, or even 400 μm × 400 μm, for illumination patterns that are essentially circular. Similarly, similar results for larger pixel sizes (e.g., compared to smaller 10 μm × 10 μm pixels) allow for the efficient implementation of the eye-tracking method of the example system 300 described above.

[0096] While the above embodiments may involve the use of DMD devices, other embodiments can achieve similar results using any type of programmable spatial light modulator. For example, embodiments may employ transmissive or reflective liquid crystal microdisplays. Spatial light modulators that impart polarization changes can be used in conjunction with fixed polarizers to achieve similar results. Transmissive implementations may also offer additional advantages in terms of overall system size.

[0097] In view of the above, the embodiments employ a purely digital means for eye tracking, which can be used in conjunction with an illumination system to perform corneal cross-linking. In particular, the embodiments do not require an electromechanical motion system (e.g., for adjustment along the xy-plane) to align the photoactivated beam with the desired area of ​​the subject's eye. Advantageously, this significantly reduces the cost and complexity of the treatment system. Furthermore, among other advantages, the system allows for increased response time relative to other systems, adjustment of eye rotational movements, and compensation for geometric distortions caused by changes in eye gaze angle and / or head movement.

[0098] As described above, according to some aspects of this disclosure, some or all of the steps of the processes described and illustrated can be automated or guided under the control of a controller (e.g., controller 120). Generally, the controller can be implemented as a combination of hardware and software elements. The hardware aspects can include a combination of operatively coupled hardware elements, including microprocessors, logic circuits, communication / network ports, digital filters, memory, or other logic circuits. The controller can be configured to perform operations specified by computer-executable code, which can be stored on a computer-readable medium.

[0099] As described above, the controller can be a programmable processing device, such as an external conventional computer or an onboard field-programmable gate array (FPGA) or digital signal processor (DSP), which executes software or stored instructions. Generally, the physical processor and / or machine employed in the various embodiments of this disclosure for any processing or evaluation may include one or more networked or non-networked general-purpose computer systems, microprocessors, field-programmable gate arrays (FPGAs), digital signal processors (DSPs), microcontrollers, etc., programmed according to the teachings of the embodiments of this disclosure, as understood by those skilled in the art of computers and software. The physical processor and / or machine may be externally networked to an image acquisition device (e.g., camera 252) or may be integrated to reside within the image acquisition device. Suitable software can be readily prepared by a programmer of ordinary skill based on the teachings of the exemplary embodiments, as understood by those skilled in the art of software. Furthermore, as understood by those skilled in the art of electrical engineering, the devices and subsystems of the exemplary embodiments may be implemented by fabricating application-specific integrated circuits or by interconnecting suitable conventional component circuit networks. Therefore, the exemplary embodiments are not limited to any particular combination of hardware circuitry and / or software.

[0100] Embodiments of this disclosure, stored on any combination of computer-readable media, may include devices and subsystems for controlling the embodiments, devices and subsystems for driving the embodiments, and software for enabling the devices and subsystems of the embodiments to interact with human users. Such software may include, but is not limited to, device drivers, firmware, operating systems, development tools, application software, etc. Such computer-readable media may also include computer program products of embodiments of this disclosure for performing all or part of the processing executed in the embodiments (if the processing is distributed). Computer code means of embodiments of this disclosure may include any suitable interpretable or executable code mechanism, including but not limited to scripts, interpretable programs, dynamic link libraries (DLLs), Java classes and applets, complete executable programs, etc. Furthermore, some processing in exemplary embodiments of this disclosure may be distributed to achieve better performance, reliability, cost, etc.

[0101] Common forms of computer-readable media may include, for example, floppy disks, hard disks, magnetic tapes, any other suitable magnetic media, CD-ROMs, CDRWs, DVDs, any other suitable optical media, punched cards, paper tapes, optical marking sheets, any other suitable physical media with perforated patterns or other optically identifiable markings, RAM, PROMs, EPROMs, FLASH-EPROMs, any other suitable memory chips or cartridges, carrier waves, or any other suitable computer-readable media.

[0102] While this disclosure has been described with reference to one or more specific embodiments, those skilled in the art will recognize that many changes can be made thereto without departing from the spirit and scope of this disclosure. Each of these embodiments, and its obvious variations, is considered to be within the spirit and scope of this disclosure. It is also contemplated that additional embodiments according to various aspects of this disclosure may combine any number of features of any of the embodiments described herein.

Claims

1. A system for applying cross-linking treatment to the cornea of ​​the eye, comprising: A light source configured to emit and activate light; An oxygen delivery device connected to an oxygen source, configured to deliver a selected concentration of oxygen to the cornea; A spatial light modulator configured to receive photoactivated light from a light source and to provide pixelated illumination using the photoactivated light; as well as A controller configured to cause a spatial light modulator to project first pixelated illumination onto the cornea to generate crosslinking activity in the treatment area by photoactivating a crosslinking agent applied to the treatment area. The system is further configured to detect changes in eye gaze angle and / or head position, and in response to changes in eye gaze angle and / or head position, the controller is configured to control the spatial light modulator to generate a second pixelated illumination that is a geometric transformation of the pattern of the first pixelated illumination to compensate for the geometric deformation caused by the change in eye gaze angle and / or head position, and to project the second pixelated illumination onto the treatment area to continue photoactivating the crosslinking agent applied to the treatment area.

2. The system of claim 1, wherein the spatial light modulator is a digital micromirror device, the digital micromirror device comprising a plurality of mirrors arranged in an array, the plurality of mirrors being configured to selectively reflect photoactivated light from a light source to provide pixelated illumination, the plurality of mirrors defining a maximum area of ​​pixelated illumination, and a controller determining a first subset of mirrors to provide a first pixelated illumination and a second subset of mirrors to provide a second pixelated illumination.

3. The system of claim 1 further includes an image acquisition device configured to capture an image of the cornea, wherein the controller is configured to: (i) receive information relating to the image of the cornea from the image acquisition device, and (ii) determine geometric deformation based on the information from the image acquisition device.

4. The system of claim 1, wherein the spatial light modulator includes a boundary defining a maximum region of pixelated illumination, the first pixelated illumination being centered at a first position within the boundary, and the second pixelated illumination being centered at a second position within the boundary, the second position being different from the first position.

5. The system of claim 4, wherein the first pixelated illumination and the second pixelated illumination have the same shape and size.

6. The system of claim 1, wherein the first pixelated illumination and the second pixelated illumination have different shapes.

7. The system of claim 1, wherein the geometric transformation rotates the first pixelated illumination to produce the second pixelated illumination.

8. The system of claim 1, wherein the controller controls the spatial light modulator to project a first pixelated illumination onto the plane of the cornea according to a desired shape and size, the movement of the cornea involves the movement of the plane of the cornea, and the controller controls the spatial light modulator to project a second pixelated illumination onto the plane of the cornea to produce the desired shape and size.

9. The system of claim 1, wherein the oxygen delivery device is a mask configured to be placed above the eyes.

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