Operating environment with integrated diagnostic and therapeutic device

Abstract

A system includes an actuator, one or more diagnostic devices configured to make ophthalmic measurements, and one or more treatment devices configured to assist in performing an ophthalmic treatment on an eye of a patient. A controller is coupled with the actuator and configured to cause the actuator to move the one or more diagnostic devices and the one or more therapeutic devices into and out of a region in front of the eye of the patient. The ophthalmic treatment may be a LASIK or SMILE treatment with ametropia and / or eye geometry measured using a diagnostic device.

Description

Cross Reference to Related Applications

[0001] This application claims priority to U.S. Provisional Application No. 63 / 579,283, filed August 28, 2023, which is incorporated by reference herein in its entirety. BACKGROUND

[0002] The present disclosure relates generally to performing ophthalmic surgery.

[0003] Light received by an eye is focused by the cornea and lens of the eye onto the retina at the back of the eye, which includes photoreceptor cells. To correct refractive errors of the eye, ophthalmic treatments such as laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE) are performed on the cornea.

[0004] Assisting the performance of LASIK and SMILE treatments would be a progress in the art. SUMMARY

[0005] In certain embodiments, a system for performing ophthalmic surgery includes an actuator, one or more diagnostic devices configured to take ophthalmic measurements, and one or more treatment devices configured to assist in performing ophthalmic treatments on an eye of a patient. A controller is coupled with the actuator and configured to cause the actuator to move the one or more diagnostic devices and the one or more treatment devices into and out of a region in front of the eye of the patient. BRIEF DESCRIPTION OF DRAWINGS

[0006] For a more complete understanding of the above-described features of the present disclosure, reference is made to the following description taken in connection with the accompanying drawings in which certain embodiments are illustrated. However, it is to be noted that the appended drawings merely illustrate exemplary embodiments and therefore are not to be considered limiting of its scope, as the scope can allow for other equally effective embodiments.

[0007] Figure 1A is a schematic diagram of an operating environment including robotically-actuated diagnostic and treatment devices in accordance with certain embodiments.

[0008] Figure 1B is a diagram showing an operating environment including shared diagnostic and treatment devices in accordance with certain embodiments.

[0009] Figure 1C is a diagram showing an operating environment including diagnostic and treatment devices in accordance with certain embodiments. Figure 1B is a diagram showing an operating environment of in which diagnostic and treatment devices are located in different patient areas in accordance with certain embodiments.

[0010] Figure 1D is a diagram showing an operating environment including diagnostic and treatment devices and actuation instruments in accordance with certain embodiments. is a diagram showing an operating environment including diagnostic and treatment devices and actuation instruments in accordance with certain embodiments.

[0011] Figure 2A is a process flow diagram for a method for performing LASIK treatment according to certain embodiments.

[0012] Figure 2B is a process flow diagram for a method for making intraoperative diagnostic measurements according to certain embodiments.

[0013] Figure 3A is a cross-sectional view showing a SMILE treatment.

[0014] Figure 3B is a top view showing a SMILE treatment.

[0015] Figure 4A is a process flow diagram for a method for performing SMILE treatment according to certain embodiments.

[0016] Figure 4B is a process flow diagram for a method for performing SMILE treatment using additively manufactured micro-lenses according to certain embodiments.

[0017] For ease of understanding, the same reference numbers have been used in the drawings and the specification to identify same or similar elements. It is contemplated that elements and features of one embodiment can be beneficially incorporated into other embodiments without further recitation. DETAILED DESCRIPTION

[0018] Referring to Figure 1A , the operating environment 100a includes a patient support 102 on which a patient 104 will be placed while receiving ophthalmic treatment. The patient support 102 can support the patient 104 in a standing, leaning, sitting, or supine position. A clamp 106 or other type of restraining device is located on or near the patient support 102 and is configured to reduce movement of the patient's head 108 while receiving ophthalmic treatment.

[0019] The patient support 102 and the clamp 106 can be fixed relative to each other by being mounted to a common support structure 110, for example. The support structure 110 can be mounted to the floor or a wall or can be large enough to effectively prevent movement during use.

[0020] A robotic arm 112 is mounted to a base 114 that is fixed relative to the clamp 106 (such as by being mounted to the same structure on the floor, wall, or ceiling or to the support structure 110). The robotic arm 112 can be embodied as any arrangement of actuators that provides five, six, or more degrees of freedom. The robotic arm 112 can be implemented as a serial robotic arm or other type of robotic arm.

[0021] The end effector 116 is driven by the robotic arm 112 and moves within the full range of degrees of freedom of the robotic arm 112. The end effector 116 is configured to grasp or otherwise selectively secure and release the diagnostic device 118 and the therapeutic device 120. The diagnostic device 118 includes one or more devices for observing or measuring a patient's eye. The diagnostic device 118 may include one or more of the following: an optical coherence tomography (OCT) imaging device, a wavefront analyzer, a surgical microscope (single-sided or stereoscopic), an automated refractometer, a scanning laser ophthalmoscopy (SLO), a multispectral imaging (MSI) or hyperspectral imaging (HSI) camera, a fundus autofluorescence (FAF) imaging device, or other types of imaging devices. The diagnostic device 118 may include sensors, such as an intraocular pressure (IOP) sensor or other types of sensors.

[0022] The end effector 116 is further configured to grasp or otherwise selectively fix and release the treatment device 120. The treatment device 120 is configured to perform or assist in performing ophthalmic treatments such as LASIK, SMILE, PRK, phacoemulsification, intraocular lens (IOL) placement, implantable contact lens (ICL) placement, glaucoma surgery (e.g., minimally invasive glaucoma surgery (MIGS)), vitrectomy, retinal reattachment, or other ophthalmic treatments. In the case of LASIK or SMILE, the treatment device 120 may include a laser and optics for guiding and focusing the laser to create a corneal flap and perform ablation in the case of LASIK or to create a microlens in the case of SMILE.

[0023] When not in use, the diagnostic device 118 can be placed on or in the diagnostic dock 122. When not in use, the treatment device can be placed on or in the treatment dock 124. The diagnostic dock 122 and treatment dock 124 may include structures for securing them to the diagnostic device 118 and treatment device 120, respectively. The diagnostic dock 122 and treatment dock 124 may include structures for sterilizing the diagnostic device 118 and treatment device 120 for use on the next patient or the next eye of the same patient 104. The diagnostic dock 122 and treatment dock 124 may include structures for replenishing consumable fluids (such as saline solution for rinsing the cornea) in the diagnostic dock 122 and treatment dock 124. The diagnostic dock 122 and treatment dock 124 may include structures for electrically connecting to and charging rechargeable batteries within the diagnostic dock 122 and treatment dock 124.

[0024] In some embodiments, the operating environment 100a may include one or more cameras 126. The one or more cameras 126 may position the patient's head 108 within their field of view. The one or more cameras 126 may be used to provide feedback related to the position of the diagnostic device 118 and the treatment device 120 relative to the patient's eyes 104.

[0025] Controller 128 may be wired or wirelessly connected to some or all of the following: gripper 106 (e.g., an actuator for engaging gripper 106 with the head 108 of patient 104), robotic arm 112, end effector 116, diagnostic device 118, treatment device 120, diagnostic dock 122, treatment dock 124, and camera 126. Controller 128 is a computing device or other electronic device programmed or otherwise configured to perform the methods described herein and initiate the functions of various components of operating environment 100a and / or other operating environments described below.

[0026] The functions of controller 128 can be controlled by the surgeon. For example, actions determined by controller 128 can only be invoked with the surgeon's approval, or can be aborted in response to the surgeon's instructions. Similarly, the surgeon can instruct controller 128 to invoke functions of operating environment 100a and / or other operating environments described below.

[0027] During operation, the robotic arm 112 positions the end effector 116 adjacent to the diagnostic device 118 located on the diagnostic dock 122. The end effector 116 is then secured to the diagnostic device 120 by gripping or other selective fixation methods. The robotic arm 112 then positions the diagnostic device 118 adjacent to the patient's head 108 to perform the functions of the diagnostic device 120, such as imaging the patient's eye 104, measuring refractive errors, measuring the eye's IOP, or performing other measurements. The robotic arm 112 then returns the diagnostic device 118 to the diagnostic dock 122, and the end effector 116 disengages from the diagnostic device 118.

[0028] Then, the robotic arm 112 positions the end effector 116 against the treatment device 120 located on the treatment dock 124. The end effector 116 is then secured to the treatment device 120 by gripping or other selective fixation methods. The robotic arm 112 then positions the treatment device 120 adjacent to the patient's head 108 to suit the performance of the functions of the treatment device 120, such as performing laser corneal flap cutting, laser ablation, microlentiolum fabrication, or other aspects of ophthalmic treatment such as LASIK or SMILE treatment.

[0029] Operating environment 100a and other operating environments described herein enable eye measurements and treatments to be performed almost simultaneously (e.g., within 30 minutes, 10 minutes, or less). In this way, changes in eye geometry due to positional changes (sitting versus supine), eye dryness, temperature changes, changes caused by contact lenses, or other time-varying parameters have less impact on the treatment.

[0030] refer to Figure 1B and Figure 1C In some embodiments, the illustrated operating environment 100b can be used to improve equipment utilization. The operating environment 100b includes two or more treatment areas 130a, 130b separated from each other by partitions 132 (e.g., curtains, walls defining one or more openings, or other types of partitions 132). Each area 130a, 130b may be a room or simply defined as an area located on one side of the partition 132. Each area 130a, 130b includes a patient support 102 and a clamp 106. Each area 130a, 130b may include one or more cameras 126, with the patient's head 108, held by the clamp 106, within the camera's field of view as described above. Each area 130a, 130b includes robotic arms 112a, 112b, which have the properties of robotic arm 112 as described above and include corresponding end effectors 116a, 116b. Each robotic arm 112a, 112b is fixed to a corresponding base 114a, 114b, which is fixed relative to the patient support 102 of the corresponding region 130a, 130b. The bases 114a, 114b can be positioned within regions 130a, 130b, i.e., the bases 114a, 114b are positioned on either side of the separator 132 corresponding to regions 130a, 130b. In the operating environment 100b, the end effector 116a is permanently or selectively fixed to the diagnostic device 118, and the end effector 116b is permanently or selectively fixed to the treatment device 120.

[0031] In the first usage mode, robotic arm 112a positions the diagnostic device 118 adjacent to the head 108 of the patient 104 located in area 130a, with the distance and relative position suitable for realizing the function of the diagnostic device 118. In the first usage mode, robotic arm 112b positions the treatment device 120 adjacent to the head 108 of the patient 104 located in area 130b, with the distance and relative position suitable for realizing the function of the treatment device 120.

[0032] like Figure 1CAs shown, in the second mode of use, robotic arm 112a allows diagnostic device 118 to pass through partition 132 and reach a position, distance, and relative position adjacent to the head 108 of patient 104 located in area 130b suitable for realizing the function of diagnostic device 118. In the second mode of use, robotic arm 112b extends treatment device 120 through partition 132 and positions treatment device 120 adjacent to the head 108 of patient 104 located in area 130a, with the distance and relative position suitable for realizing the function of treatment device 120. Partition 132 may be a curtain defining one or more slits or other openings, or a wall defining one or more openings, to allow robotic arms 112a, 112b to pass through while still protecting patient privacy.

[0033] refer to Figure 1D In the third operating environment 100c, the diagnostic device 118 and the treatment device 120 are mounted on an actuator 134, such as a turntable, rail, or channel, and a corresponding actuator that facilitates linear translation, a frame that enables movement of two or more degrees of freedom, or other types of actuators. Therefore, the actuator 134 can selectively position the diagnostic device 118 or the treatment device 120 to perform device functions on the patient 104's eyes 136. The range of motion of the actuator 134 is sufficient to bring the diagnostic device 118 and the treatment device 120 close to and aligned with the patient's eyes 136 in order to perform the functions of the diagnostic device 118 or the treatment device 120 on the patient's eyes 136.

[0034] In some embodiments, the diagnostic device 118 and the treatment device 120 each include multiple devices. For example, the diagnostic device 118 may include a refractometer 118a for measuring refractive errors of the eye and an OCT 118b for measuring the geometry of the eye (particularly the cornea). In LASIK surgery, the treatment device 120 may include a laser 120a for cutting a corneal flap and a laser 120b for performing ablation. An actuator 134 or a separate actuator may bring specific devices 118a, 118b, 120a, 120b close to and aligned with the patient's eye 136 according to the functional requirements of the devices 118a, 118b, 120a, 120b. Alignment can be performed in conjunction with one or more cameras (whose images are used for eye tracking) to align specific devices 118a, 118b, 120a, 120b with the optical axis of eye 136 and to dock specific devices 118a, 118b, 120a, 120b with eye 136 (which may include magnetic contact with eye 136).

[0035] A robotic arm 138 may be provided, having a base 140 fixed relative to an actuator 134, and the robotic arm may cooperate with one or both of the diagnostic device 118 and the treatment device 120 to perform one or more functions. For example, the robotic arm 138 may include an end effector 142, specifically implemented as surgical forceps, for grasping and removing microlenses or inserting artificial microlenses. The end effector 142 may be specifically implemented as other instruments, such as a phaco-vit instrument, an instrument for inserting shunts or making incisions to treat glaucoma, an instrument for providing infusion fluid, an instrument for providing illumination, an instrument for providing laser for retinal repositioning, or other types of ophthalmic instruments.

[0036] In operating environments 100a and 100b, the diagnostic device 118 may further include a refractometer 118a and an OCT 118b. Similarly, the treatment device 120 in operating environments 100a and 100b may also include multiple lasers 120a and 120b. The selective placement of the refractometer 118a and OCT 118b and alignment with the eye 136 can be achieved using robotic arms 112 and 112a or independent actuators 134. The selective placement of each laser 120a and 120b and alignment with the eye 136 can also be achieved using robotic arms 112 and 112b or independent actuators 134. Alternatively, combined optics can be used to select between the refractometer 118a and OCT 118b, and among multiple lasers 120a and 120b.

[0037] The operating environments 100a, 100b, and 100c shown are merely exemplary. For example, in other embodiments, the patient 104 may move between positions while the diagnostic device 118 and treatment device 120 remain stationary, for example, except for minor adjustments (e.g., less than 4 cm) to align with the patient 104's eyes 136. For example, the patient support 102 may be implemented as a bed 102 actuated between two or more positions. For example, a surgeon may actuate foot pedals, joysticks, or other interfaces to cause actuation of the bed between two or more positions.

[0038] Figure 2A and Figure 2BMethods 200a and 200b are demonstrated that can be performed using any of the aforementioned operating environments 100a, 100b, and 100c. Methods 200a and 200b specifically relate to performing LASIK surgery. Methods 200a and 200b can be performed on patient 104 while performing the complete method 200a or method 200b, or while performing methods 200a and 200b, with the patient's head 108 continuously restrained using clamp 106.

[0039] For details, please refer to the following: Figure 2A Method 200a may include measuring the refractive error and eye geometry of a patient's eyes using diagnostic device 118 in step 202. Step 202 may include measuring the refractive error and eye geometry of both eyes of the patient using diagnostic device 118. Step 202 may include translating diagnostic device 118 to bring refractive meters 118a and OCT 118b close to and aligned with each eye 136 as required to perform the functions of refractive meters 118a and OCT 118b. Alternatively, a beam splitter or other optics may be used to direct light toward or away from refractive meters 118a and OCT 118b without translation. The geometry of the eye may include the radius of curvature of the cornea 300, the thickness of the cornea, or other geometries.

[0040] In step 204, method 200a includes calculating parameters for performing LASIK surgery based on the refractive errors and eye geometry measured in step 202 for each eye. Parameters may include parameters for cutting the corneal flap, such as the position of the cutting plane along the optical axis of the eye. Parameters may include parameters defining the corneal ablation to be performed after the corneal flap is cut. The parameter calculation in step 204 can be performed in any manner appropriate for performing LASIK surgery.

[0041] Step 204 may include taking into account previous measurements of refractive error and / or eye geometry, such as measurements calculated under different conditions over the past day or days. For example, step 202 may include modifying parameters calculated based on previous measurements based on changes in refractive error and / or eye geometry from step 202. Step 204 may also take into account the time elapsed between performing step 202 and performing ablation and incision (see description of step 210 below) to account for dry eye or other time-varying properties of eye 136.

[0042] In step 206, the diagnostic device 118 is removed, and in step 208, the treatment device 120 is moved in. Specifically, as used herein, moving the device in should be understood as transferring it to an area in front of the eye 136, within which the device can perform its function (whether the function of the diagnostic device 118 or the function of the treatment device 120). Moving in can be image-guided, i.e., eye tracking can be performed using images from camera 126 or the device, aligning the device with the eye and placing it at the correct distance or in contact with the eye. For example, some types of therapeutic lasers can establish an adhesive contact with the eye receiving treatment.

[0043] Removing a device involves moving it out of the area so that another different device can be positioned in the area and perform the functions of that other different device (whether it is the diagnostic device 118 or the therapeutic device 120). Removal and insertion can be performed as described above for any operating environment 100a, 100b, 100c. Between removing one device and inserting another, one or more other steps, such as inserting an eyelid speculum, can be performed.

[0044] Then, method 200 may include performing incision and ablation in step 210 using treatment device 120 according to parameters calculated in step 204. Performing incision and ablation may include performing eye tracking (e.g., tracking iris movement) or fixing the eye 136. During eye tracking, the treatment laser of treatment device 120 may be actuated to compensate for the movement of the eye 136.

[0045] In some embodiments, after the incision is made, method 200a may include removing the treatment device 120 and moving the diagnostic device 118 in to measure the geometry of the eye after the incision. The ablation parameters can then be updated or recalculated based on the actual geometry of the eye 136 after the incision, taking into account any errors between the actual incision and the incision parameters calculated in step 204. The diagnostic device 118 can then be removed and the treatment device 120 moved in to perform ablation according to the ablation parameters. The ablation parameters can be modified based on the amount of time elapsed since the incision was made.

[0046] For details, please refer to the following: Figure 2B Method 200b can be performed after method 200a. In step 220, the treatment device 120 is removed, and in step 222, the diagnostic device 118 is moved in.

[0047] Method 200b may include measuring refractive error in one or both eyes of the patient in step 224. Prior to step 224, the corneal flap obtained in method 200a may be folded back over the ablation area of ​​the cornea. Method 200b may include evaluating the refractive error of each eye measured in step 224 against a threshold in step 226. Step 226 may include adjusting the refractive error and comparing the adjusted refractive error to the threshold. This adjustment may take into account changes in refractive error that occur after the corneal flap heals. Therefore, adjustment can be obtained by analyzing measurements of intraoperative and postoperative refractive error from previous LASIK treatments. For example, a machine learning model may be trained to correlate preoperative values ​​with postoperative refractive error measurements, including some or all of the preoperative refractive error, preoperative eye geometry, incision and ablation parameters (describing the actual incision and ablation and / or calculated parameters), and intraoperative refractive error (e.g., measured after ablation but before healing).

[0048] If the refractive error is found to meet the threshold in step 226, method 200b may terminate. If the refractive error is found not to meet the threshold in step 226, method 200b may include calculating ablation parameters in step 228 to reduce the refractive error. The ablation parameters may be calculated according to any method known in the art for performing LASIK treatment.

[0049] Method 200b may include removing the diagnostic device 118 in step 230 and inserting the treatment device 120 in step 232. In step 234, ablation is performed again based on the parameters calculated in step 228. Prior to step 234, the corneal flap created by incision may be lifted. Steps 224 to 234 may be repeated an arbitrary number of times until the threshold of step 226 is found to be met.

[0050] Figure 3A and Figure 3B SMILE treatment is demonstrated. In SMILE treatment, a set of cuts is made within the cornea 300 using one or more lasers. These cuts are described below with reference to the optical axis 302 of the cornea 300. The cuts described below may be made in the order described or some other order. These cuts may be made according to any method known in the art for performing SMILE treatment.

[0051] The microlens section 304 is the deepest section and can be a circular region perpendicular to the optical axis 302 and centered on the optical axis. For example, in... Figure 3AAs clearly shown, a portion of the cornea 300 extends around the microlens section 304 in a plane parallel to the microlens section 304. The microlens side section 306 extends parallel to the optical axis 302 around the periphery of the microlens section 304. As shown in Figure 3, the microlens side section 306 does not extend completely to the outer surface of the cornea 300.

[0052] The corneal cap section 308 is above and offset from the microlenticule section 304. For example... Figure 3A As shown, the corneal cap section 308 can be located at a uniform depth below the surface of the cornea 300. The corneal cap section 308 extends outward from the lenticule section 304, and the lenticule side section 306 terminates at the corneal cap section 308. The region between the lenticule section 304, the lenticule side section 306, and the corneal cap section 308 is the microlens 310, which is separated from the rest of the cornea 300. The microlens 310 is removed through an incision 312 extending from the outer surface of the cornea 300 to the corneal cap section 308.

[0053] Figure 4A and Figure 4B Methods 400a and 400b are demonstrated to be executable in any operating environment 100a, 100b, or 100c. Methods 400a and 400b can be executed during the execution of the complete method 400a or method 400b, or while the patient's head 108 is continuously restrained by clamp 106 during the execution of methods 400a and 400b.

[0054] Method 400a includes measuring the refractive error and the geometry of the eye 136 using a diagnostic device 118 in step 402. For example, the refractive error can be measured using an optometer 118a, and the geometry of the eye can be measured using an OCT 118b. Method 400a includes calculating SMILE parameters in step 404. SMILE parameters may include the depth and diameter of the microlental section 304, the depth of the corneal cap section 308, the location of the incision 312, or other parameters. SMILE parameters may be calculated in any manner known in the art.

[0055] Method 400a includes removing the diagnostic device 118 in step 406 and inserting the treatment device 120 in step 408. Then, method 400a includes creating a SMILE section in step 410 based on the SMILE parameters calculated in step 404. Step 410 may include creating a microlens section 304, a microlens side section 306, a corneal cap section 308, and an incision 312 according to the SMILE parameters. Then, method 400a may include removing the treatment device 120 in step 412 and inserting the diagnostic device 118 in step 414. Then, the geometry of the eye 136 is measured in step 416 (e.g., using OCT). The measurement in step 416 can image the layers formed by the section obtained in step 410. The layers represented by the measurements in step 416 can then be identified in step 418. Then, the microlens 310 is removed in step 420 (e.g., using a robotic arm 138). For example, steps 416 and 418 can be repeated during step 420 to provide feedback to guide the robotic arm 138.

[0056] In step 420, the controller 128 can use the identified positions of the microlens 310 and the incision 312, as well as the possible end effector 142 of the robotic arm 138 itself, to control the robotic arm 138 to insert into the incision 312, grasp the microlens 310, and remove the microlens from the incision 312. For example, steps 416 and 418 can be used to provide feedback to ensure that the end effector 142 is aligned with the incision in both directions parallel and perpendicular to the optical axis, to align the end effector with the corneal cap section 308, the microlens section 304, or the microlens 310 itself, or to perform other types of alignment.

[0057] The end effector 142 may include a torque sensor that measures the torque applied through the end effector to provide feedback to the controller 128, for example, to determine whether excessive torque is needed to separate the layers (e.g., the layers between the corneal cap section 308 and the microlens section 304), thereby aborting microlens retrieval. For example, the end effector 142 may include probes with corresponding torque sensors for separating the layers, and separate surgical forceps for grasping the microlens 310.

[0058] refer to Figure 4BMethod 400b can be performed after method 400a. Method 400b may include removing the treatment device 120 in step 430 and inserting the diagnostic device in step 432. Method 400b may include measuring the refractive error of the eye 136 in step 434. The refractive error of the eye 136 may then be evaluated against a threshold in step 436. If the refractive error is below the threshold, method 400b may terminate. Step 436 may include adjusting the refractive error to account for changes in refractive error due to corneal healing 300 and comparing the adjusted refractive error to the threshold. Therefore, adjustment can be obtained by analyzing measurements of refractive error during and after previous SMILE treatment. For example, a machine learning model can be trained to correlate pre-healing values ​​with post-healing refractive error measurements, including preoperative refractive error, preoperative eye geometry, SMILE parameters, and some or all of intraoperative refractive error (e.g., measured after microlens removal but before healing).

[0059] If the refractive error is found to be below a threshold, method 400b can terminate. If the refractive error is found to be above a threshold, method 400b may include fabricating a replacement microlens based on the refractive error. For example, an artificial microlens may be fabricated in step 438. The artificial microlens may be fabricated using 3D printing of a biocompatible transparent material. The size of the artificial microlens may be selected based on the refractive error measured in step 434 and one or more other values ​​(such as preoperative refractive error, preoperative eye geometry, post-operative eye geometry (e.g., after microlens removal in step 420), and the refractive error obtained in step 434).

[0060] Then, in step 440, the artificial microlens can be inserted through the incision 312 into the cavity previously occupied by the microlens 310. Step 440 can be performed using a robotic arm 138. For example, an end effector 142 can grasp the artificial microlens and insert it through the incision 312. After the artificial microlens is inserted, method 400b can end or be repeated from step 434. If repeated, method 400b can include removing the previously inserted artificial microlens before inserting a new one.

[0061] Methods 200a, 200b, and 400a, 400b are merely exemplary. Operating environments 100a, 100b, and 100c can be used to perform other refractive correction surgeries such as PRK. In some embodiments, measurements of refractive error and eye geometry obtained using diagnostic equipment can be used to select from a variety of refractive correction surgeries such as LASIK, SMILE, PRK, and ICL implantation. Additional considerations

[0062] 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 will be apparent to those skilled in the art, and the general principles defined herein can be applied to other embodiments. For example, changes can be made to the function and arrangement of the elements discussed without departing from the scope of this disclosure. Various examples may be appropriately omitted, substituted, or added to various procedures or components. Furthermore, features described with respect to some examples may be combined in some other examples. For example, any number of aspects set forth herein can be used to implement an apparatus or practice. Additionally, the scope of this disclosure is intended to cover such apparatus or methods practiced using other structures, functions, or structures and functions other than or different from the aspects of this disclosure set forth herein. It should be understood that any aspect of this disclosure may be embodied by one or more elements of the claims.

[0063] As used herein, the phrase “at least one of a series of items” refers to any combination of those items, including a single member. For example, “at least one of a, b, or c” is intended to cover a, b, c, ab, ac, bc, and abc, as well as any combination of multiples of the same element (e.g., aa, aaa, aab, aac, abb, acc, bb, bbb, bbb, cc, and ccc, or any other order of a, b, and c).

[0064] As used herein, the term "determine" encompasses a wide variety of actions. For example, "determine" can include calculation, operation, processing, derivation, investigation, searching (e.g., searching in a table, database, or other data structure), ascertainment, etc. Furthermore, "determine" can include receiving (e.g., receiving information), accessing (e.g., accessing data in memory), etc. Additionally, "determine" can include parsing, selecting, picking, building, etc.

[0065] The methods disclosed herein include one or more steps or actions for implementing the methods. The method steps and / or actions may be interchanged without departing from the scope of the claims. In other words, unless a specific order of steps or actions is specified, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the claims. Furthermore, the various operations of the above methods can be performed by any suitable means capable of performing the corresponding functions. These means may include various hardware and / or software components and / or modules, including but not limited to circuits, application-specific integrated circuits (ASICs), or processors. Typically, where operations are illustrated in the figures, those operations may have corresponding means and functional components with similar numbering.

[0066] The various illustrative logic blocks, modules, and circuits described in connection with this disclosure may be implemented or executed using a general-purpose processor, digital signal processor (DSP), application-specific integrated circuit (ASIC), field-programmable gate array (FPGA) or other programmable logic device (PLD), discrete gate or transistor logic, discrete hardware components, or any combination thereof, designed to perform the functions described herein. The general-purpose processor may be a microprocessor, but alternatively, the processor may be any commercially available processor, controller, microcontroller, or state machine. The processor may also be implemented as a combination of computing devices, such as a combination of a DSP and a microprocessor, multiple microprocessors, one or more microprocessors incorporating a DSP core, or any other such configuration.

[0067] The processing system can be implemented using a bus architecture. Depending on the specific application and overall design constraints of the processing system, the bus can include any number of interconnect buses and bridges. The bus can link together various circuits, including processors, machine-readable media, and input / output devices. User interfaces (e.g., keypads, displays, mice, joysticks, etc.) can also be connected to the bus. The bus can also link various other circuits, such as timing sources, peripherals, voltage regulators, power management circuits, etc., which are well known in the art and therefore will not be described further. The processor can be implemented using one or more general-purpose and / or special-purpose processors. Examples include microprocessors, microcontrollers, DSP processors, and other circuit systems capable of executing software. Those skilled in the art will recognize how best to implement the described functions for the processing system, depending on the specific application and the overall design constraints imposed on the system as a whole.

[0068] If implemented in software, functionality can be stored or transmitted as one or more instructions or code on or through a computer-readable medium. Software should be interpreted broadly as instructions, data, or any combination thereof, whether referred to as software, firmware, middleware, microcode, hardware description language, or others. Computer-readable media includes both computer storage media and communication media (such as any medium that facilitates the transfer of computer programs from one place to another). The processor may be responsible for managing the bus and general processing, including the execution of software modules stored on the computer-readable storage medium. The computer-readable storage medium may be coupled to the processor, allowing the processor to read information from and write information to the storage medium. Alternatively, the storage medium may be integrated into the processor. For example, the computer-readable medium may include a transmission line, a carrier wave modulated by data, and / or a computer-readable storage medium on which instructions separate from the wireless node are stored, all accessible to the processor via a bus interface. Alternatively or additionally, the computer-readable medium or any portion thereof may be integrated into the processor, for example, in cases where it may have a cache and / or a general-purpose register file. Examples of machine-readable storage media may include RAM (random access memory), flash memory, ROM (read-only memory), PROM (programmable read-only memory), EPROM (erasable programmable read-only memory), EEPROM (electrically erasable programmable read-only memory), registers, disks, optical disks, hard disks, or any other suitable storage media, or any combination thereof. Machine-readable media may be embodied in computer program products.

[0069] Software modules can comprise a single instruction or a number of instructions, and can be distributed across several different code segments, across different programs, and across multiple storage media. Computer-readable media can include multiple software modules. Software modules include instructions that, when executed by a device such as a processor, cause the processing system to perform various functions. Software modules can include transmission modules and reception modules. Each software module can reside in a single storage device or be distributed across multiple storage devices. For example, when a triggering event occurs, a software module can be loaded from a hard disk drive into RAM. During the execution of a software module, the processor can load some instructions into a cache to improve access speed. Then, one or more cache lines can be loaded into a general-purpose register file for processor execution. When referring to the functionality of a software module, it should be understood that this functionality is implemented by the processor when executing the instructions from that software module.

[0070] 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, references to singular elements, unless specifically stated otherwise, are not intended to mean “one and only one”, but rather “one or more.” Unless otherwise specifically stated otherwise, the term “some” means one or more. No element of any claim shall be interpreted in accordance with 35 U.SC §112(f) unless such elements are expressly referred to by the phrase “means for…” or, in the case of a method claim, by the phrase “steps for…”. All structural and functional equivalents of elements of the various aspects described throughout this disclosure that are known to or will be known hereafter by one of ordinary skill in the art are expressly incorporated herein by reference and are intended to be covered by the claims. Furthermore, nothing disclosed herein is intended to be offered to the public, whether or not such disclosure is expressly referred to in the claims.

Claims

1. A system for performing ophthalmic surgery, the system comprising: Actuator; One or more diagnostic devices, the one or more diagnostic devices being configured to perform ophthalmic measurements; One or more treatment devices, the one or more treatment devices being configured to assist in performing ophthalmic treatment on a patient's eye; as well as A controller, coupled to the actuator and configured to cause the actuator to move the one or more diagnostic devices and the one or more therapeutic devices into and out of the area in front of the patient's eye.

2. The system as claimed in claim 1, wherein, The actuator is a robotic arm.

3. The system as described in claim 2, wherein, The controller is configured to cause the robotic arm to perform the following operations: Attached to the one or more treatment devices; Release the one or more treatment devices; Attached to the one or more diagnostic devices; as well as Release the one or more diagnostic devices.

4. The system of claim 3, further comprising a diagnostic dock and a treatment dock, the controller being configured to release the one or more diagnostic devices onto the diagnostic dock and the one or more treatment devices onto the treatment dock.

5. The system as claimed in claim 1, wherein, The actuator is a first robotic arm fixed to one or more diagnostic devices and a second robotic arm fixed to one or more therapeutic devices.

6. The system of claim 5, further comprising a separator positioned between a first base of the first robotic arm and a second base of the second robotic arm.

7. The system as claimed in claim 1, wherein, The one or more diagnostic devices include optical coherence tomography (OCT) imaging devices.

8. The system of claim 1, wherein, The one or more diagnostic devices include a refractometer.

9. The system as claimed in claim 1, wherein, The one or more diagnostic devices include an optical coherence tomography (OCT) imaging device and a refractometer.

10. The system of claim 1, wherein, The one or more treatment devices include one or more treatment lasers.

11. The system of claim 10, wherein, The one or more therapeutic lasers are configured to perform laser-assisted in situ keratomileusis (LASIK) treatment.

12. The system of claim 10, wherein, The one or more therapeutic lasers are configured to perform small incision microlentotomy (SMILE) treatment.

13. The system of claim 1, further comprising a robotic arm including an end effector, the controller being configured to cause the robotic arm and the end effector to remove a microlens from the patient's eye.

14. A method comprising: Position the patient's head within the restraint device; While the patient's head remains within the restraint device: (a) The controller activates one or more actuators to move one or more diagnostic devices configured to perform ophthalmic measurements to an area in front of the patient's eye; (b) The controller activates one or more diagnostic devices to obtain measurement data; (c) The controller activates the one or more actuators to move the one or more diagnostic devices out of the area; (d) The controller activates one or more actuators to move one or more treatment devices configured to perform ophthalmic treatments into the area; as well as (e) The controller activates the one or more treatment devices to perform the ophthalmic treatment based on the measurement data.

15. The method of claim 14, wherein, The measurement data is the refractive error of the eye.

16. The method of claim 15, wherein, The ophthalmic treatment mentioned is laser-assisted in situ keratomileusis (LASIK).

17. The method of claim 15, wherein, The ophthalmic treatment mentioned is Small Incision Lens Extraction (SMILE).

18. The method of claim 15, wherein, The refractive error is a first refractive error, and the method further includes, after performing (e): (f) The controller activates the one or more actuators to remove the one or more treatment devices from the area; (g) The controller activates one or more actuators to move one or more diagnostic devices into the area; (h) The controller activates the one or more treatment devices to measure the second refractive error of the patient's eye; (i) The controller activates one or more actuators to move one or more diagnostic devices out of the area; (j) The controller activates one or more actuators to move one or more treatment devices into the area; and (e) The controller activates the one or more treatment devices to perform the ophthalmic treatment based on the second refractive error.

19. The method of claim 14, wherein, The one or more actuators are a single robotic arm.

20. The method of claim 14, wherein, The one or more actuators include: A first robotic arm connected to the one or more diagnostic devices; A second robotic arm connected to the one or more treatment devices.

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