Method and system for in situ measurement of intraocular lens tilt

Abstract

Certain aspects of the present disclosure provide intraocular lens (IOL) inclination in situ intraoperatively and provide information associated with an IOL inclination angle. An example method includes imaging an IOL within a patient's eye in situ via an ophthalmic imaging device after implanting the IOL within the patient's eye; processing the image of the IOL within the eye of the patient to determine a tilt angle of the IOL; and outputting information associated with the IOL tilt angle to the user interface.

Description

Technical Field

[0001] Aspects of the present disclosure relate to determining and correcting intraocular lens (IOL) tilt in situ. As defined herein, in situ may refer to a period of time during which a patient may lie supine during an IOL implantation procedure. Background Art

[0002] Presbyopia is caused by a gradual loss of accommodation in the visual system of the human eye. The loss of accommodation is due to an increase in the elastic modulus and growth of the lens of the eye, which is located directly behind the iris and pupil.

[0003] In the human eye, a circular ciliary muscle surrounds the lens. Tiny fibers in the eye called ciliary zonules connect the ciliary muscle to the lens capsule that encases the lens. The ciliary zonules pull or release the lens, causing the curvature of the lens to adjust. Adjustments to the curvature of the lens cause adjustments to the focusing power of the eye, bringing objects into focus. For example, when the eye is looking at a distant object, the ciliary muscle relaxes, causing the ciliary zonules to become taut, which pulls the lens to have a flatter curve. The flatter curve is better able to focus incoming light from distant objects onto the retina.

[0004] In young eyes, accommodation is nearly instantaneous and effortless. As the eye ages, the flexibility and elasticity of the lens decreases, and the strength of the ciliary muscle also declines. These changes lead to a decrease in the amplitude of accommodation (i.e., loss of accommodation), which can cause objects close to the eye to appear blurry. Loss of near vision is a hallmark sign of presbyopia in people over the age of forty, for example. People with symptoms of presbyopia often have difficulty reading small print, such as on computer monitors, restaurant menus, and newspaper ads, and may need to keep reading materials at arm's length.

[0005] Various surgical correction techniques and devices can be used to treat presbyopia, including, for example, implanting a multifocal intraocular lens (IOL) and accommodating IOLs in the eye and altering the corneal surface through corneal ablation techniques.

[0006] In cataract surgery, an implanted IOL may exhibit tilt (interchangeably referred to herein as IOL tilt), which can be defined as the angle between the IOL optical axis and a baseline axis. The baseline axis can be the pupil axis, which is defined as a line perpendicular to the corneal surface of the eye passing through the center of the pupil.

[0007] While implantation of an IOL for treating presbyopia is discussed herein, it should be understood that this is only one example of a use of an IOL and that IOLs may be implanted to treat other conditions and that aspects of IOL tilt described herein may apply to any such procedures.

[0008] IOL tilt may be caused by uneventful cataract surgery, zonular abnormalities, suture fixation, or asymmetric haptic-optic positioning. In scleral-sutured IOLs, multiple factors such as IOL haptic positioning, suture errors, lack of capsular support, scleral tunnel positioning, and haptic rupture may contribute to IOL tilt.

[0009] IOL tilt may cause astigmatism and higher-order aberrations. In one example, astigmatism A can be given by:

[0010] A=[P[1+(sin a) 2 / (3)]]×(tan a) 2

[0011] Parameter P is the focal power of the thin lens in air in the pupil plane (in diopters). Parameter a is the tilt angle of the implanted IOL relative to the pupil axis. The tilt angle a can include the IOL tilt in the horizontal direction and the vertical direction. The angle of IOL tilt in the vertical direction (the angle between the optical axis of the IOL or the IOL axis and the Y axis) can be expressed as γ. The angle of IOL tilt in the horizontal direction (the angle between the optical axis of the IOL and the X axis) can be expressed as β.

[0012] Conventionally, the IOL tilt is visually determined by the surgeon after the IOL is delivered to the patient's eye. This visual determination of the IOL tilt may be subjective and inaccurate. Further, using the naked eye, the discernible minimum tilt degree is estimated to be about 15 degrees, while an acceptable tilt degree may be less than 15 degrees (e.g., an acceptable IOL tilt degree may be about 5 degrees or less). Accordingly, visual assessment of tilt may not be sufficient to determine whether there is an acceptable low tilt degree. In addition, using the naked eye to visually estimate tilt can only estimate the tilt at one axis at a time.

[0013] Accordingly, there is a need for techniques to improve the field of vision correction, and in particular, a need to objectively determine IOL tilt. Summary of the invention

[0014] Certain embodiments provide techniques, devices, computer readable media, and systems for objectively determining IOL tilt. In addition, the determination of IOL tilt can be determined in situ. The embodiments described herein allow for contactless measurement of IOL tilt. IOL tilt can be objectively determined with improved resolution and repeatability. Image-based in situ measurement of tilt can find the tilt on any axis of the IOL, so a comprehensive tilt measurement can be provided. The embodiments described herein can, for example, be applied to any top-down surgical image of an IOL.

[0015] In some embodiments, image tracking and the arccosine of the major and minor axes are used to determine IOL tilt in situ. In some embodiments, Purkinje imaging tilt measurement techniques are used to determine IOL tilt in situ. In some embodiments, optical coherence tomography (OCT) imaging techniques are used to determine IOL tilt in situ. In some embodiments, techniques for measuring IOL tilt in situ are selected or switched based on the level of tilt.

[0016] Some embodiments provide that the IOL tilt measured in situ is output on the user interface. In some embodiments, the measured IOL tilt is displayed in situ on a remote display, on an umbilical display, on an imaging tool, on a surgical tool and / or on another display. In some embodiments, the measured IOL tilt is displayed in situ as an augmented reality (AR) superposition on an image (such as on an image of the patient's eye). In some embodiments, the measured IOL tilt is displayed in situ as a numerical value, an arrow, or is displayed in situ by other visual representation means. In some embodiments, the measured IOL tilt is provided as a tilt degree and a tilt orientation. In some embodiments, information indicating additional information is displayed. This additional information can guide the surgeon to assess the IOL tilt. In some embodiments, the additional information is associated with one or more thresholds related to the tilt degree. In some embodiments, the additional information can be provided as text information, audio prompts and / or visual prompts.

[0017] To accomplish the foregoing and related ends, one or more aspects include the features fully described below and specifically pointed out in the claims. The following description and the accompanying drawings set forth in detail certain illustrative features of one or more aspects. However, these features are only indicative of a few of the various ways in which the principles of the various aspects can be employed. BRIEF DESCRIPTION OF THE DRAWINGS

[0018] Certain aspects of one or more embodiments are depicted in the accompanying drawings, and therefore should not be considered to limit the scope of the disclosure.

[0019] Figure 1 The anatomy of a human model eye is shown.

[0020] Figure 2 is a flow chart of an example method for measuring IOL tilt in situ according to some embodiments.

[0021] Figure 3 yes Figure 1 Example sagittal vertical section of an eye showing a vertically tilted IOL.

[0022] Figure 4 A top view showing the vertically tilted Figure 3Example of the major and minor axes of an IOL.

[0023] Figure 5 yes Figure 1 Example sagittal horizontal cross section of an eye showing a horizontally tilted IOL.

[0024] Figure 6 A top view showing a horizontally tilted Figure 5 Example of the major and minor axes of an IOL.

[0025] Figure 7 is an example flow chart for tilt measurement using image tracking and arccosine in accordance with some embodiments.

[0026] Figure 8 Shown Figure 1 Example Purkinje reflex of an example eye.

[0027] Fig. 9 Example OCT images for IOL tilt measurement in accordance with certain embodiments are shown.

[0028] Fig.10 Example eye images are shown with IOL tilt superimposed in accordance with certain embodiments.

[0029] FIG. 11A to FIG. 11C Another example eye image is shown with IOL tilt superimposed in accordance with some embodiments.

[0030] Fig.12 An example system for in situ measurement and display of IOL tilt according to certain aspects described herein is presented.

[0031] To facilitate understanding, identical reference numerals have been used, where possible, to designate identical elements that are common to the figures. It is contemplated that elements and features of one embodiment may be beneficially incorporated in other embodiments without further recitation. DETAILED DESCRIPTION

[0032] Figure 1 The anatomical structure of a human eye 100 is shown. As used herein, the anterior side is the side through which light enters the eye, while the posterior side is opposite to the anterior side. As shown, the eye 100 includes a cornea 102, a retina 104, a lens 106, aqueous humor 108, and a vitreous body 110. The total axial length of the eye 100 is the distance between the anterior surface 102A of the cornea to the retina 104.

[0033] A thin transparent layer called the cornea 102 is connected to the sclera 105 by a ring called the limbus, which forms a generally spherical wall of the eye 100. The cornea 102 has a refractive index n 角膜The cornea 102 has an anterior corneal surface 102A and a posterior corneal surface 102P. The curvature radius of the anterior corneal surface is R A The radius of curvature of the posterior corneal surface is R P The central corneal thickness (CT) of the cornea 102 is the distance between the posterior corneal surface 102P and the anterior corneal surface 102A.

[0034] The iris (eye color) and the opening (pupil) defined by the iris are located behind the cornea and are visible due to the transparency of the cornea 102. The retina 104 is a layer of tissue in the back wall of the eye.

[0035] The lens 106 is a transparent, biconvex structure in the eye 100 that, along with the cornea 102, helps refract light so that it is focused on the retina 104. The lens 106 acts to change the focal length of the eye by changing its shape so that the eye can focus on objects at various distances, allowing a clear, true image of the object of interest to be formed on the retina 104. This adjustment of the lens 106 is called accommodation, and is similar to the focusing of a camera via the movement of its lens. The lens 106 is positioned in the capsular bag behind the iris. The capsular bag is attached at its equator to the suspended ciliary muscles 112 by zonular fibers. The ciliary muscles 112 are located under the front of the sclera 105 and can contract or relax in order to change the shape of the lens 106. The lens 106 has a refractive index n 晶状体 , lens diameter (LD) and lens thickness (LT), the lens thickness being the distance between the anterior lens surface 106A and the posterior lens surface 106P of the lens 106.

[0036] Aqueous humor 108 fills the space between cornea 102 and lens 106. Aqueous humor 108 has a refractive index n 房水 The aqueous humor 108 has an anterior chamber depth (AD), which is the distance between the apex of the posterior corneal surface 102P and the apex of the anterior lens surface 106A of the lens 106 .

[0037] The vitreous body 110 has a depth that is the distance between the lens 106 and the retina 104 and has a refractive index n 玻璃体 The anatomy of the human eye 100 also includes a white-to-white diameter (WD) (eg, the distance between the cornea or sclera borders on either side of the eye).

[0038] Various diseases and disorders of the lens 106 can be treated surgically, involving replacement of the lens 106 with an IOL. As examples, IOLs according to embodiments of the present disclosure can be used to treat cataracts, large optical errors in myopia (nearsightedness), hyperopia (hyperopia), and astigmatism, ectopia lentis, aphakia, pseudophakia, and nuclear sclerosis. However, for simplicity, IOL embodiments of the present disclosure are described with respect to cataracts, which often occur in the elderly population.

[0039] In cataract surgery, the lens 106 is replaced with an IOL. As discussed above, after the IOL is delivered and deployed, the IOL may exhibit IOL tilt, which may cause adverse optical results. Aspects of the present disclosure provide for in-situ determination of IOL tilt. By determining the IOL tilt in-situ, an objective measurement method can be used to measure the IOL tilt after the IOL is implanted, while the patient remains supine on the operating table. This aspect provides for displaying the IOL tilt and / or information associated with the IOL tilt on one or more user interfaces (UIs). The IOL tilt information can enable a surgeon or operator to easily assess the degree of IOL tilt, the direction of IOL tilt, and / or other information, thereby helping the surgeon or operator decide whether to take corrective action on the IOL, such as adjusting the IOL so as to reduce the degree of IOL tilt to an acceptable level.

[0040] Example Methods for Objectively Determining IOL Tilt in Situ

[0041] Figure 2 is a flow diagram of example operations 200 for measuring IOL tilt in situ according to certain aspects described herein. In some aspects, the operations 200 are performed by one system (eg, the system 1200). In some aspects, the operations 200 are performed by multiple systems.

[0042] As illustrated, operations 200 may optionally begin with operation 210 of selecting one or more tilt measurement methods.

[0043] As follows about Figures 3 to 9 Discussed in more detail, the tilt measurement method may include an image tracking tilt measurement method, a Purkinje imaging tilt measurement method, or an OCT imaging tilt measurement method. In some examples, multiple tilt measurement methods (e.g., all three tilt measurement methods) may be used simultaneously. Figure 2 In some examples, multiple tilt measurements can be obtained. In some cases, a measurement technique can be used to determine a final tilt measurement. In some examples, one or more machine learning models can be used to obtain a final tilt measurement based on tilt measurements derived from a combination of tilt measurement methods.

[0044] In some cases, different tilt measurement methods may have different effectiveness at different tilt levels. For example, at high tilt levels (e.g., at tilts of 15 to 90 degrees or greater), image tracking tilt measurement may be more effective than Purkin imaging tilt measurement methods and OCT imaging tilt measurement methods. In some cases, for smaller tilt levels (e.g., 0 to 10 degrees), Purkin imaging tilt measurement technology may provide the most accurate tilt measurement. Accordingly, a tilt measurement method may be selected based on an initial IOL tilt level, which may be measured by one of the techniques described herein, visually estimated by a surgeon, or expected based on empirical data. For example, an image tracking tilt measurement method may be used at a larger initial tilt level (which may be visually estimated by a surgeon or assumed after initial delivery of the IOL). After adjusting the IOL, or after measuring using image tracking tilt measurement, OCT and / or Purkin imaging tilt measurement (e.g., as an alternative or supplement to image tracking tilt measurement) may be performed. When it is determined, estimated, or assumed that the initial tilt is small, Purkinje imaging tilt measurement may be performed (eg, as an alternative to or in addition to OCT and / or image tracking tilt measurement).

[0045] At operation 220, operation 200 continues with imaging the patient's eye in situ after the IOL is implanted in the patient's eye. Imaging the patient's eye is performed by an ophthalmic imaging device, such as a digital surgical microscope, an intraoperative OCT system, an intraoperative aberrometer, or other ophthalmic imaging device. The image of the IOL can be captured in situ by the imaging device used throughout the surgical procedure, so any additional imaging device or repositioning of the patient's eye may not be required.

[0046] In some embodiments, the imaging device takes a top-down image of the IOL in the patient's eye when the patient is supine. In some embodiments, the imaging device performs continuous imaging to the IOL in the patient's eye (e.g., to provide real-time IOL tilt feedback during the delivery, positioning and / or adjustment of the IOL). In such an embodiment, a continuous image stream can be captured, processed and provided for visualization by the surgeon. In some embodiments, continuous (or nearly continuous) updates can be a real-time video stream of the image of the patient's eye and superimposed with IOL tilt information in real time. In some embodiments, continuous updates can be completed by periodically (e.g., every millisecond, every several milliseconds, every second, every several seconds, etc.) imaging the IOL in the patient's eye, determining the tilt angle of the IOL, and updating the IOL feedback.

[0047] At operation 230, operation 200 continues with determining the tilt angle of the IOL based on the image of the patient's eye. The tilt angle of the IOL may be determined based on the selected IOL tilt method. For example, the tilt angle of the IOL may be determined using image tracking, Purkinje imaging, and / or OCT imaging tilt measurement methods, as described below with respect to Figures 3 to 9 In some embodiments, the tilt angle of the IOL is determined by an ophthalmic imaging device. For example, the ophthalmic imaging device has a processor that is configured to determine the tilt angle of the IOL (e.g., determined using image tracking, Purkinje imaging, and / or OCT imaging tilt measurement methods), as discussed in more detail below with respect to FIG. 13. In some other embodiments, the ophthalmic imaging device sends an image of the IOL to a local system or a remote system (e.g., a remote server or cloud) to determine the tilt angle (e.g., image tracking, Purkinje imaging, and / or OCT tilt measurement imaging methods), as discussed in more detail below with respect to FIG. 13.

[0048] At operation 240, operation 200 continues with outputting IOL tilt information to the UI in response to determining the tilt angle of the IOL. Outputting the IOL tilt information to the UI during the procedure. Figures 10 to 11C The IOL tilt information is discussed in more detail. The operator may be a surgeon performing an IOL implantation procedure. In some embodiments, the IOL tilt information is output to a display of an ophthalmic imaging device, an umbilical display coupled to the ophthalmic imaging device, or a remote display, as discussed in more detail below with respect to FIG. 13. The display may provide a user interface for the surgeon.

[0049] The surgeon can then use the IOL tilt information to determine whether and how to adjust the IOL in the patient's eye, as described below. Figures 10 to 11C As discussed above, with continuous IOL tilt feedback, the surgeon can adjust the IOL based on the IOL tilt feedback to correct the IOL tilt, and after adjusting the IOL, the IOL feedback is updated to provide the surgeon with information about the IOL tilt angle after adjustment, so that the surgeon can determine whether the angle of the IOL is acceptable or determine whether to further adjust the IOL (and / or determine the manner or degree of further adjustment) to correct the IOL tilt angle.

[0050] Example of IOL tilt determination in situ

[0051] In some embodiments, Figure 2 At operation 230, image tracking is used to determine IOL tilt in situ. Using the image of the patient's eye captured at operation 220, the edge of the IOL can be tracked.

[0052] As discussed above, the imaging device can take a top-down image of the IOL, which can be used for image tracking. From a top-down view, if the lens is completely flat, it will look like a circle. However, if the lens is tilted, it will look less round and more like an ellipse. Below, Figure 3 and Figure 4 The vertical tilt of IOL 306 is shown, and Figure 5 and Figure 6 Horizontal tilt of IOL 506 is shown. Figure 3 and Figure 5 is a cross-sectional view, and Figure 4 and Figure 6 It is a top view.

[0053] Figure 3 A sagittal vertical section of an example eye 100 is shown, showing an example IOL 306 with vertical tilt implanted in the example eye 100. The sagittal vertical section is defined by a sagittal plane along the longitudinal axis of the human body. Accordingly, as used herein, vertical tilt refers to tilt in the sagittal plane (i.e., tilt around the frontal axis of the human body). That is, in the case of vertical tilt, when viewed from top to bottom, the top and bottom of the IOL 306 are tilted in the front or rear direction of the eye 100. As shown, the tilt angle of the IOL 306 in the vertical direction (the angle between the optical axis of the IOL 306 or the IOL axis and the pupil axis of the eye) can be expressed as γ. Figure 4 An image 400 is presented showing the major and minor axes of an example IOL 306 tilted vertically in a top view.

[0054] Figure 5 A transverse horizontal cross section of an example eye 100 is shown, showing an example IOL 506 implanted in the example eye 100 with a horizontal tilt. The transverse horizontal cross section is defined by a transverse plane perpendicular to the sagittal plane. Accordingly, as used herein, horizontal tilt refers to a tilt in the transverse plane around the longitudinal axis of the body. That is, in the case of horizontal tilt, when viewed from top to bottom, the left and right sides of the IOL 506 are tilted in the posterior and anterior directions. As shown, the tilt angle of the IOL 506 in the horizontal direction (the angle between the optical axis of the IOL 506 and the X-axis) can be expressed as β. Figure 6 Image 600 is shown showing the major and minor axes of an example IOL 506 tilted horizontally in a top view. Figures 3 to 6 Vertical tilt and horizontal tilt are shown, but it should be understood that the IOL can be tilted in both the vertical and horizontal directions.

[0055] Figure 7is an example flow chart illustrating operations 700 for performing tilt measurement using image tracking. Operation 700 illustrates performing tilt measurement using image tracking. Figure 2 The tilt measurement operation 230 is performed.

[0056] For example, once an IOL is implanted and an image of it is captured, at operation 710, the edge of the IOL in the image is tracked. In some embodiments, an image recognition and / or analysis (hereinafter referred to as "image analysis") application may be used to track the edge of the IOL. Fig.12 In some embodiments, an application may also be referred to as a component. In some embodiments, an image analysis application is executed on a processor of an imaging device and / or another local or remote computing device. An image analysis application may refer to a set of software instructions that may take as input an image of an IOL and provide (e.g., automatically (e.g., without user input)) a tracked edge of the IOL in the form of pixel information associated with pixels representing an edge of the IOL. In some embodiments, the image analysis application includes a machine learning model trained based on a training data set that includes various historical IOL images labeled with information about the edge of the corresponding IOL.

[0057] In some embodiments, the image of the IOL is input into the image analysis application by an operator. In some embodiments, the image of the IOL is automatically input into the image analysis application by the imaging device.

[0058] At operation 720, a first length of a major axis of the IOL and a second length of a minor axis of the IOL are determined based on the tracked edge of the IOL. In some embodiments, the major axis and the minor axis are determined by an image analysis application (e.g., automatically (e.g., without user interaction)). The minor axis is the axis with the greatest degree of tilt. Thus, in the case of vertical tilt, the horizontal axis is the major axis and the vertical axis is the minor axis, such as Figure 4 As shown; and in the case of horizontal inclination, the major axis is the vertical axis and the horizontal axis is the minor axis, as shown Figure 6 In some embodiments, the major axis and the minor axis are determined in units of pixel length.

[0059] At operation 730, a tilt angle of the IOL is determined based on the first length of the major axis and the second length of the minor axis of the IOL. In some embodiments, the tilt angle can be determined as the arc cosine of the minor axis and the major axis. In some embodiments, the determination of the tilt angle is based on the measured tilt range. For example, when the front surface of the IOL faces upward, the tilt angle=cos -1 (minor axis / major axis) (i.e., tilt angle < 90°), whereas when the posterior surface of the IOL faces upward, tilt angle = 180-cos -1(minor axis / major axis) (i.e., tilt angle>90°). In some embodiments, the tilt direction is also determined (e.g., right / left, up / down, or a combination thereof). In some embodiments, the tilt angle of the IOL is determined by an image analysis application (e.g., automatically (e.g., without user interaction)).

[0060] In some embodiments, edge tracking, determination of the major and minor axes, and / or determination of IOL tilt are performed by an imaging device. In some embodiments, edge tracking, determination of the major and minor axes, and / or determination of IOL tilt are performed by a separate computing device. In some embodiments, edge tracking, determination of the major and minor axes, and / or determination of IOL tilt are performed at a remote server. For example, an image of the IOL may be sent to a remote server, and the remote server may perform edge tracking, determination of the major and minor axes, and / or determination of IOL tilt. The server may then send the results of the analysis (e.g., information about the major and minor axes and / or IOL tilt) back for display, as described below with respect to Figures 10 to 11C discussed.

[0061] In some embodiments, the IOL tilt is determined in situ using the Purkinje imaging tilt measurement method at operation 230. When using the Purkinje imaging tilt measurement method, an incident light source, such as a surgical microscope, may be used. Figure 8 Shown Figure 1 806A and 806B are examples of Purkinje reflections of an example eye 100. As shown, light 815 from a light source propagates through the pupil into the eye 100 and reflects off various components of the eye 100. For example, through Purkinje imaging, reflections from the anterior corneal surface 102A (referred to as a first Purkinje image or P1), reflections from the posterior corneal surface 102P (referred to as a second Purkinje image or P2), reflections from the anterior IOL surface 806A of an implanted IOL 806 (referred to as a third Purkinje image or P3), and reflections from the posterior IOL surface 806P (referred to as a fourth Purkinje image or P4) can be measured, as shown in FIG. Figure 8 As shown. When the light source is known and there is no tilt, the positions of reflections P1, P2, P3 and P4 are known. When the IOL is tilted, the positions of the reflections will change. Accordingly, the angle (e.g., magnitude and direction) of the IOL tilt can be determined based on the difference between the known positions when there is no tilt and the measured positions when there is tilt.

[0062] In some cases, Purkinje images P1 and P4 are formed relatively close to each other in approximately the same focal plane within a close distance of the pupil plane, while the P3 image may be formed in a different plane. Accordingly, an imaging device for use with the Purkinje imaging tilt measurement method may be focused at different planes, or a telecentric lens may be used to capture all Purkinje images in the same plane. In some embodiments, the determination of known Purkinje images is based on anatomical parameters of the eye, such as those described above with respect to Figure 1 One or more of the anatomical parameters of the eye 100 are discussed.

[0063] In some embodiments, Figure 2 At operation 230, IOL tilt is determined in situ using OCT imaging tilt measurement. Through OCT imaging, cross-sectional information can be obtained from the eye. By scanning at multiple orientations (e.g., by rotating the scanning angle, the eye, and / or the microscope), different cross-sections about a reference point such as the vertex of the cornea (e.g., the pupil plane) can be obtained. By comparing the angle of the reference plane and the angle of the IOL relative to the reference plane, the IOL tilt can be determined, such as Fig. 9 shown.

[0064] Example of IOL tilt displayed

[0065] exist Figure 2 At operation 240, outputting the IOL tilt information to a user interface may provide feedback to a user (eg, an operator or surgeon) regarding the IOL tilt angle.

[0066] In some embodiments, the IOL tilt information is an augmented reality (AR) overlay on the image of the patient's eye. Fig.10 An example eye image with an IOL tilt AR overlay is shown. In some embodiments, the IOL tilt information is a numerical value of the IOL tilt, such as 35°. Fig.10 In some embodiments, the IOL tilt information is presented in a visual manner, such as by lines or arrows, and also Fig.10 The line / arrow may have a length indicating the magnitude of the IOL tilt angle and a direction indicating the direction of the IOL tilt, such as FIG. 11A to FIG. 11C The arrow may indicate the artificial optical axis of the lens.

[0067] like Fig.11A As shown, when the tilt of the IOL 1106 in the eye 1100 is large, the image 1150A of the eye 1100 is superimposed with a long axis whose relative magnitude is associated with the magnitude of the tilt angle of the IOL 1106 and whose direction indicates the tilt direction of the IOL 1106. Fig. 11BAs shown, when the tilt of the IOL 1106 in the eye 1100 is moderate, the image 1150B of the eye 1100 is superimposed with a moderate length arrow that is longer than Fig.11A The arrows in are short. Fig. 11C As shown, when the IOL 1106 in the eye 1100 has no tilt, the image 1150C of the eye 1100 has no arrow superimposed or is superimposed with a dot representing zero tilt of the IOL 1106.

[0068] In some embodiments, color can be used to indicate IOL tilt information. For example, different IOL tilt ranges can be associated with different colors. For example, IOL tilt of zero to five degrees (0° to 5°) can be associated with green (e.g., indicating a good / acceptable level of IOL tilt); IOL tilt between five and fifteen degrees (5° to 15°) can be associated with yellow (e.g., indicating an intermediate level of IOL tilt); and, IOL tilt of fifteen degrees (15°) and above can be associated with red (e.g., indicating a high / unacceptable level of IOL tilt). Colors can be used for numerical values ​​(e.g., Fig.10 35° in ) and / or for visual representation (e.g. Fig.10 and FIG. 11A to FIG. 11C ). Although three colors associated with three IOL tilt ranges are described, it should be understood that fewer or more colors and associated ranges may be used to provide additional IOL tilt information.

[0069] In some embodiments, IOL tilt information is provided in real time. For example, the AR overlay can be output to a user interface, such as a display showing an image of the eye, and as the IOL is adjusted, the AR overlay can be continuously updated to provide real-time feedback about the IOL tilt. Accordingly, a user (e.g., a surgeon) can use the IOL tilt information as a guide to position the IOL in the patient's eye.

[0070] In some embodiments, IOL tilt information is provided via audio means (eg, audio output of a numerical value of IOL tilt).

[0071] In some embodiments, the IOL tilt information provides additional information to guide the surgeon to correct the IOL tilt. For example, the IOL tilt information can indicate how to correct the IOL tilt visually or via audio. For example, the superposition of the image of the eye can provide a visual prompt (such as an arrow) indicating how to adjust the IOL to correct the IOL tilt. For example, as a supplement or alternative to indicating the IOL tilt angle and / or the IOL tilt direction, an arrow or other visual prompt can be used to point to the direction required to correct the IOL tilt.

[0072] In some embodiments, the patient's preoperative measurements can be used to define a patient-specific tilt threshold. Figure 1 Any anatomical parameter of the eye 100 discussed or other anatomical parameters of the patient's eye can be used to determine the acceptable IOL tilt range for the patient. In some embodiments, the tilt threshold and / or range can be based on the type of IOL. For example, for multifocal IOLs and extended focus IOLs, it may be desirable to achieve near-zero tilt, while a monofocal IOL may have a higher acceptable tilt threshold. Accordingly, the IOL implantation surgery can make the postoperative refractive outcome of the IOL more certain and reduce the risk.

[0073] Accordingly, the surgeon can use the IOL tilt information to adjust the IOL so as to correct the IOL tilt angle during the operation. For example, after or at the same time as the IOL is implanted in the patient's eye, the surgeon can adjust the position of the IOL to correct the IOL tilt. For example, when the superimposed IOL tilt information shows that the IOL tilt angle is large (for example, such as a numerical value above a threshold, a major axis or an arrow, and / or a red color indicating an unacceptable level of IOL tilt), the surgeon continues to adjust the IOL until the superimposed IOL tilt information shows an acceptable IOL tilt angle (for example, such as a numerical value below a threshold, a minor axis or an arrow, and / or a green color indicating an acceptable level of IOL tilt). In addition, in the case where the superimposed information shows the IOL tilt direction and / or provides correction guidance information, the surgeon knows how to adjust the IOL to correct the IOL tilt.

[0074] Example system for designing, configuring and / or forming a contact lens having a smooth surface diffractive design

[0075] Fig.12 An example system 1200 for IOL tilt determination and IOL tilt information display according to certain aspects described herein is shown.

[0076] As shown, system 1200 may include, but is not limited to, an imaging device 1205 , an umbilical display 1250 , a remote display 1255 , and a remote server 1260 .

[0077] The imaging device 1205 may be any suitable ophthalmic imaging device, such as an OCT device (e.g., an intraoperative OCT device), a Purkinje imaging tilt measurement system, a digital microscope, a scanning laser polarimeter (SLP), a Scheimpflug camera, or other ophthalmic imaging devices. The imaging device 1205 may include an imaging component 1210, an image analysis component 1215, an IOL tilt information output component 1235, a user interface 1240, and an input / output (I / O) interface 1245.

[0078] The imaging component 1210 can be configured to capture images of the IOL within the patient's eye 100. In some examples, the imaging component 1210 is configured to capture images of the top of the patient's eye in situ while the patient is supine. In some embodiments, the imaging component 1210 can be configured to capture images of the IOL continuously. In some embodiments, the imaging component 1210 can be configured to image the IOL from different angles, for example by rotating the eye 100 or the imaging component 1210.

[0079] In some embodiments, the image analysis component 1215 includes a control module, which includes one or more central processing units (CPUs), memory, and storage devices. The CPU can retrieve and execute programming instructions stored in the memory. Similarly, the CPU can retrieve and store application data present in the memory. The CPU can have multiple processing cores. The memory can represent a random access memory. In addition, in some aspects, the storage device can be a disk drive. The storage device can be a combination of a fixed storage device or a removable storage device, such as a fixed disk drive, a removable memory card or an optical storage device, a network attached storage (NAS) or a storage area network (SAN).

[0080] The image analysis component 1215 may include an edge tracking component 1220, an IOL axis determination component 1225, a Purkinje reflection determination component 1228, and an IOL tilt determination component 1230. Fig.12 1205, but in some embodiments, the image analysis component 1215 can be located on a different device, such as on a remote server 1260 (e.g., a cloud server). The image analysis component 1215 can be configured to obtain an image of an IOL (e.g., IOL 306, 506, 806, etc.) from the imaging component 1210 and determine the IOL tilt.

[0081] In some embodiments, the edge tracking component 1220 can be configured to track the edge of the IOL based on the image of the IOL obtained from the imaging component 1210, as described above. The IOL axis determination component 1225 can be configured to determine the major axis and minor axis of the IOL based on the tracking and provide the major axis and minor axis to the IOL tilt determination component 1230. The IOL tilt determination component 1230 can be configured to determine the IOL tilt based on the major axis and minor axis of the IOL, as discussed herein. For example, the IOL tilt determination component 1230 can determine the IOL tilt based on the arc cosine of the major axis and the minor axis.

[0082] In some embodiments, the Purchin reflection determination component 1228 can be configured to determine one or more Purchin reflections based on the image of the IOL obtained from the imaging component 1210 and provide information about the Purchin reflections to the IOL tilt determination component 1230. The IOL tilt determination component 1230 can be configured to determine the IOL tilt based on the Purchin reflections, as discussed herein. For example, the IOL tilt determination component 1230 can be configured to compare the Purchin reflections from the IOL with known or expected Purchin reflection positions and determine the IOL tilt angle based on the difference between the Purchin reflections from the IOL and the known or expected Purchin reflection positions.

[0083] In some embodiments, IOL tilt determination component 1230 is configured to determine the IOL tilt angle based on one or more OCT cross-sectional images of the IOL, as described herein.

[0084] The IOL tilt information output component 1235 can be configured to output information associated with the IOL tilt determined by the IOL tilt determination component 1230. For example, the IOL tilt information component can output any information discussed herein, such as a numerical value of the IOL tilt angle, a visual representation of the IOL tilt, audio information associated with the IOL tilt, an AR overlay, a color associated with a range of IOL tilt angles, and / or guidance information for correcting the IOL tilt. In some embodiments, the IOL tilt information output component 1235 outputs the information to a user interface 1240 on the imaging device 1205, to an umbilical display 1250, and / or to a remote display 1255.

[0085] The I / O interface 1245 allows one or more I / O devices (eg, keyboard, display, mouse device, pen input, etc.) to be connected to the imaging device 1205 .

[0086] Additional considerations

[0087] The foregoing description is provided to enable any person skilled in the art to practice the various embodiments described herein. Various modifications to these embodiments are clear to those skilled in the art, and the general principles defined herein may be applied to other embodiments. For example, without departing from the scope of the present disclosure, the functions and arrangements of the elements discussed may be changed. Various examples may appropriately omit, replace or add various programs or components. In addition, the features described with respect to some examples may be combined in some other examples. For example, any number of aspects set forth herein may be used to implement a device or practice method. In addition, the scope of the present disclosure is intended to cover such devices or methods practiced using other structures, functions, or structures and functions in addition to or different from the various aspects of the present disclosure set forth herein. It should be understood that any aspect of the present disclosure disclosed herein may be embodied by one or more elements of a claim.

[0088] As used herein, a phrase referring to "at least one of" a list of items refers to any combination of those items, including single members. For example, "at least one of a, b, or c" is intended to cover any combination of a, b, c, ab, ac, bc, and abc, as well as multiples of the same element (e.g., aa, aaa, aab, aac, abb, acc, bb, bbb, bbc, cc, and ccc or any other order of a, b, and c).

[0089] As used herein, the term "determining" encompasses a wide variety of actions. For example, "determining" may include calculating, computing, processing, deriving, investigating, searching (e.g., searching in a table, database, or other data structure), ascertaining, etc. In addition, "determining" may include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory), etc. In addition, "determining" may include parsing, selecting, choosing, establishing, etc.

[0090] The method disclosed herein includes one or more steps or actions for implementing the method. Without departing from the scope of the claims, the method steps and / or actions can be interchangeable with each other. In other words, unless a specific step or action sequence is specified, the order and / or use of specific steps and / or actions can be modified without departing from the scope of the claims. Further, the various operations of the above-mentioned method can be performed by any suitable device that can perform the corresponding function. These devices may include various hardware and / or software components and / or modules, including but not limited to circuits, application specific integrated circuits (ASICs) or processors. Generally, in the case of operations shown in the figure, those operations can have corresponding corresponding devices with similar numbers plus functional components.

[0091] The following claims are not intended to be limited to the embodiments shown herein, but are given the full scope consistent with the language of the claims. In the claims, unless otherwise specified, reference to a singular element is not intended to mean "one and only one", but "one or more". Unless otherwise specifically stated, the term "some" refers to one or more. According to 35 U.S.C. § 112 (f), the elements of any claim will not be interpreted unless the phrase "device for..." is used to expressly describe these elements, or in the case of a method claim, the phrase "step for..." is used to describe these elements. All structural and functional equivalents of the elements of the various aspects described throughout this disclosure that are known or will be known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be covered by the claims. In addition, whether or not such disclosure is explicitly described in the claims, the content disclosed herein is not intended to be contributed to the public.

Claims

1. A method for providing intraoperative intraocular lens (IOL) tilt measurement, the method comprising: After the IOL is implanted in the patient's eye, imaging the IOL in the patient's eye in situ via an ophthalmic imaging device to generate an image of the IOL; The processor processes the image of the IOL to determine the tilt angle of the IOL, wherein the processing includes: automatically tracking an edge of the IOL in the image; automatically determining a length of a major axis and a length of a minor axis of the IOL based on the tracked edge of the IOL; and automatically calculating a tilt angle of the IOL based on the length of the major axis of the IOL and the length of the minor axis of the IOL; and Information associated with the tilt angle of the IOL is output to a user interface.

2. The method of claim 1, wherein: Imaging the IOL within the patient's eye, processing the image of the IOL within the patient's eye, and outputting the information associated with the tilt angle of the IOL are performed while the patient is lying supine.

3. The method of claim 1, further comprising selecting an IOL tilt measurement technique based on the initial tilt degree, wherein: Imaging the IOL within the patient's eye and / or processing an image of the IOL within the patient's eye is performed based on the selected IOL tilt measurement technique.

4. The method of claim 1, wherein: Outputting the information associated with the tilt angle of the IOL to the user interface includes superimposing the information associated with the tilt angle of the IOL over an image of the IOL within the patient's eye.

5. The method of claim 1, wherein: Imaging the IOL within the patient's eye and outputting the information associated with the tilt angle of the IOL are performed continuously.

6. The method of claim 1, wherein: The information associated with the tilt angle of the IOL includes one or more of the following: a numerical value of the tilt angle of the IOL, a color associated with a range of tilt angles of the IOL, an artificial optical axis of the IOL, tilt correction guide information, an audio prompt associated with the tilt angle of the IOL, or a combination of the above.

7. The method of claim 1, wherein: Processing the image of the IOL within the patient's eye to determine the IOL tilt angle further comprises: determining a second tilt angle of the IOL based on one or more optical coherence tomography (OCT) images; and determining a third tilt angle of the IOL based on a difference between the first set of measured Purkinje reflexes and the second set of expected Purkinje reflexes; or A combination of the above; and The information associated with the tilt angle is based on the tilt angle, the second tilt angle, and the third tilt angle.

8. A device for intraoperative intraocular lens (IOL) tilt measurement, the device comprising: An imaging component configured to image the IOL in situ in the patient's eye via an ophthalmic imaging device after the IOL is implanted in the patient's eye to generate an image of the IOL; at least one memory, the at least one memory comprising executable instructions; as well as at least one processor in data communication with the at least one memory and configured to execute the instructions to perform the following operations: automatically tracking an edge of the IOL in the image; automatically determining a length of a major axis and a length of a minor axis of the IOL based on the tracked edge of the IOL; as well as Calculating a tilt angle of the IOL based on the length of the major axis of the IOL and the length of the minor axis of the IOL; as well as Information associated with the tilt angle of the IOL is output to a user interface.

9. The device of claim 8, wherein: The imaging component is configured to image the IOL in the patient's eye when the patient is lying supine, and wherein the at least one processor is configured to calculate the tilt angle of the IOL and output the information associated with the tilt angle of the IOL when the patient is lying supine.

10. The device of claim 8, wherein: The at least one processor is further configured to select an IOL tilt measurement technique based on the initial tilt degree, and wherein the at least one processor is configured to calculate the tilt angle of the IOL based on the length of the major axis of the IOL and the length of the minor axis of the IOL in response to the selection of the IOL tilt measurement technique.

11. The device of claim 8, wherein: The at least one processor is configured to output the information associated with the tilt angle of the IOL to the user interface by superimposing the information associated with the tilt angle of the IOL over an image of the IOL within the patient's eye.

12. The apparatus of claim 8, wherein: The imaging component is configured to continuously image the IOL within the patient's eye, and wherein the at least one processor is configured to continuously output the information associated with the tilt angle of the IOL.

13. The apparatus of claim 8, wherein: The information associated with the tilt angle of the IOL includes one or more of the following: a numerical value of the tilt angle of the IOL, a color associated with a range of tilt angles of the IOL, an artificial optical axis of the IOL, tilt correction guide information, an audio prompt associated with the tilt angle of the IOL, or a combination of the above.

14. The apparatus of claim 8, wherein: The imaging component is further configured to image the IOL within the patient's eye via an optical coherence tomography (OCT) imaging device; The at least one processor is further configured to determine a second tilt angle of the IOL based on the one or more OCT images; as well as The information associated with the tilt angle is further based on the second tilt angle.

15. The apparatus of claim 8, wherein: The at least one processor is further configured to measure a set of Purkinje reflections and determine a third tilt angle of the IOL based on a difference between the set of measured Purkinje reflections and a set of expected Purkinje reflections, and wherein the information associated with the tilt angle is further based on the third tilt angle.

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