Devices for use in visualization and treatment of ocular disorders

Abstract

A patient interface device may be secured to a patient's eye to dock the eye relative to an imaging and / or laser treatment system. The patient interface may include one or more actuators that enable perturbing the eye in order to impart movement to floaters in the eye. The movement of the floater may be used to move the floater into an area of the eye more conducive to visualizing, imaging, and / or treating the floater. Additionally, a fixation target is described that can facilitate the visualization of specific floaters by the patient and correlating the specific floater to floaters being imaged.

Description

DEVICES FOR USE IN VISUALIZATION AND TREATMENT OF OCULAR DISORDERSRELATED APPLICATIONS

[0001] The current application claims priority to US Provisional Application Serial No. 63 / 529,659 filed July 28th, 2023 entitled “Devices For Use In Visualization and Treatment of Ocular Disorders,” the entire contents of which are incorporated herein by reference in their entirety for all purposes.TECHNICAL FIELD

[0002] The current disclosure relates to ophthalmological devices and methods and in particular to devices for use in the treatment and visualization of vitreous floaters, also referred to as symptomatic vitreous opacities (SVOs), and other ocular disorders.BACKGROUND

[0003] Laser treatment in the human eye can require precise imaging, and laser targeting of the portion or structure of the eye being treated by the laser. The imaging and laser targeting requires maintaining the physical relationship between the imaging components, treatment components, the patient, and the eye in order to reliably image and laser target an area in the eye for treatment.

[0004] A patient interface device is a general solution for connecting and controlling relative physical positioning of the patient, eye, imaging components and laser treatment components. The patient interface device may be docked to the patient’s eye and used to maintain the physical relationship between the eye and the imaging components and laser treatment components. Various patient interface devices exist such as the LenSx® Laser SoftFit™ Patient Interface made by Alcon®, or the CATALYS™ LIQUID OPTICS Interface by Johnson & Johnson®.

[0005] Floaters have additional unique characteristics of individual turbulent motion within the vitreous which can make visualizing, imaging, tracking and treatment of the floaters difficult.BRIEF DESCRIPTION OF THE DRAWINGS

[0006] Further features and advantages of the present disclosure will become apparent from the following detailed description, taken in combination with the appended drawings, in which:

[0007] FIG. 1 depicts a system for treatment of floaters using a moveable patient interface device and patient motion control device;

[0008] FIG. 2 depicts a moveable patient interface device coupled to an imaging and treatment system;

[0009] FIGs. 3A and 3B depict a moveable patient interface device;

[0010] FIG. 4 depict docking details of a moveable patient interface device;

[0011] FIG. 5 depicts a front view further embodiment of a docking assembly;

[0012] FIG. 6 depicts a front right perspective view of the docking assembly;

[0013] FIG. 7 depicts a eye cup of the docking assembly of FIG. 5;

[0014] FIG. 8 depicts a first cross section of the eye cup of FIG. 7;

[0015] FIG. 9 depicts a second cross section of the eye cup of FIG. 7;

[0016] FIG. 10 depicts a method of treating floaters using a moveable patient interface device;

[0017] FIG. 11 depicts a method of calibrating control movement of a floater;

[0018] FIG. 12 depicts an OCT image of bubbles formed during laser treatment;

[0019] FIG. 13 depicts a method of calibrating a depth of focus for a treatment laser;

[0020] FIG. 14 depicts an OCT M-scan of bubbles formed above a reference surface;

[0021] FIG. 15A depicts a calibration curve for depth of focus;

[0022] FIG. 15B depicts a calibration surface for depth of focus;

[0023] FIG. 16 depicts components of a fixation target for use in visualizing floaters;

[0024] FIG. 17 depicts a fixation target for coupling to an imaging and treatment system; and

[0025] FIG. 18 depicts a view through the fixation target.DETAILED DESCRIPTION

[0026] In accordance with the present disclosure there is provide a moveable patient interface device comprising: an ocular interface comprising at least one optical element to dock to a patient’s eye; a moveable portion secured to the ocular interface; a portion securable to an imaging and treatment system; and at least one actuator coupled between the stationary portion and the moveable portion, wherein operation of the at least one actuator perturbs the patient’s eye when the ocular interface is docked to the patient’s eye.

[0027] In a further embodiment of the moveable patient interface device, the moveable patient interface device further comprises: at least one lens mount that releasably receives a lens component.

[0028] In a further embodiment of the moveable patient interface device, wherein the at least one actuator is capable of imparting one or more of: a rotational perturbation; a vertical translational perturbation; and a horizontal translational perturbation.

[0029] In a further embodiment of the moveable patient interface device, the portion securable to an imaging and treatment system comprises an interface for coupling to the imaging and treatment system, the interface comprising: a portion of a mechanical interface that engages with a corresponding portion of the mechanical interface of the imaging and treatment system; a portion of an optical interface that optically couples to a corresponding portion of the optical interface of the imaging and treatment system; and a portion of an electrical interface that electrically couples to a corresponding portion of the electrical interface of the imaging and treatment system.

[0030] In a further embodiment of the moveable patient interface device, the moveable patient interface device is provided as a plurality of engageable components.

[0031] In a further embodiment of the moveable patient interface device, the plurality of engageable components comprise: an ocular speculum comprising at least one mating feature; and a housing for the ocular interface, the moveable portion, the stationary portion, and the at one actuator, the housing comprising at least one corresponding mating feature corresponding to the at least one mating feature of the ocular speculum to engage the ocular speculum to the housing.

[0032] In a further embodiment of the moveable patient interface device, the plurality of engageable components comprise: an ocular speculum comprising: at least one mating feature; and a docking ring comprising: the ocular interface; at least one corresponding mating feature corresponding to the at least one mating feature of the ocular speculum to engage the ocular speculum with the docking ring; and at least one housing-mating feature; and a housing for the moveable portion, the stationary portion, and the at one actuator, the housing comprising at least one corresponding housing-mating feature corresponding to the at least one housingmating feature of the docking ring to engage the housing with the docking ring.

[0033] In a further embodiment of the moveable patient interface device, the plurality of engageable components comprise: a docking ring comprising: a suction ring for attaching the docking ring to the eye; and the ocular interface; and at least one housing-mating feature; and a housing for the moveable portion, the stationary portion, and the at one actuator, the housing comprising at least one corresponding housing-mating feature corresponding to the at least one housing-mating feature of the docking ring to engage the housing with the docking ring.

[0034] In a further embodiment of the moveable patient interface device, the docking ring comprises: one or more vacuum ports fluidically coupled to the suction ring; and one or more liquid ports for allowing a liquid or gel to be provided to a volume between the patient’s eye and an interior portion of the docking ring.

[0035] In a further embodiment of the moveable patient interface device, the docking ring comprises a meniscus lens.

[0036] In a further embodiment of the moveable patient interface device, the liquid ports are arranged between the meniscus lens and the suction ring.

[0037] In a further embodiment of the moveable patient interface device, the moveable patient interface device further comprises a controller for controlling at least the at least one actuator.

[0038] In a further embodiment of the moveable patient interface device, the at least one actuators comprise one or more of: a motor; a magnetic actuator; and a piezo-electric actuator.

[0039] In a further embodiment of the moveable patient interface device, the moveable patient interface device further comprises: an inlet port for injecting a fluid into a space between thepatient’s eye and the ocular interface when docked to the patient’s eye; and an outlet port arranged towards a top of the space to allow air and / or injected fluid to escape the space.

[0040] In accordance with the present disclosure there is provide a docking ring securable to a patient’s eye comprising: a docking surface for contacting a portion of the patient’s eye; one or more vacuum ports flu idical ly coupled with a suction ring in contact with the patient’s eye during use; one or more liquid ports fluidically coupled with a chamber defined between the patient’s eye and an interior chamber of the docking ring, wherein in use, a vacuum is applied to the one or more vacuum ports to seal the docking ring to the patient’s eye around the suction ring and a liquid or gel is supplied to the chamber through the one or more liquid ports.

[0041] In a further embodiment of the docking ring, the one or more vacuum ports comprise a plurality of vacuum ports.

[0042] In a further embodiment of the docking ring, the one or more liquid ports comprise a plurality of liquid ports.

[0043] In a further embodiment of the docking ring, the docking ring further comprises a meniscus lens defining at least a portion of the interior chamber of the docking ring.

[0044] In a further embodiment of the docking ring, the one or more liquid ports are arranged between the one or more vacuum ports and the meniscus lens.

[0045] In accordance with the present disclosure there is provide a fixation target for use in visualizing a floater, the fixation target comprising: a light source; a visualization guide comprising a visible marking on a substantially transparent surface; a housing enclosing the light source, and visualization guide; and an optical input and output port arranged adjacent the visualization guide.

[0046] In a further embodiment of the fixation target, the fixation target further comprises a diffusion material between the light source and the visualization guide.

[0047] In a further embodiment of the fixation target, the fixation target further comprises an interface on the housing to secure the housing to an imaging system.

[0048] In a further embodiment of the fixation target, the imaging system comprises an imaging and treatment system.

[0049] In a further embodiment of the fixation target, the interface comprises: a portion of a mechanical interface that engages with a corresponding portion of the mechanical interface of the imaging system; a portion of an optical interface that optically couples to a corresponding portion of the optical interface of the imaging system; and a portion of an electrical interface that electrically couples to a corresponding portion of the electrical interface of the imaging system.

[0050] In a further embodiment of the fixation target, the visible marking of the visualization guide comprises one or more of: one or more lines; one or more circles; one or more rectangles; and one or more polygons.

[0051] In a further embodiment of the fixation target, the visible marking is a grid.

[0052] In a further embodiment of the fixation target, the light source comprises a display.

[0053] In a further embodiment of the fixation target, the display is controllable to illuminate a floater, group of floaters or a region containing floaters.

[0054] In accordance with the present disclosure there is provide a method of calibrating a depth of focus of a laser treatment system, the method comprising: capturing an OCT image of a patient’s eye; determining a retina depth from the captured OCT image; firing a treatment laser at an expected depth within the vitreous of the patient’s eye; capturing an OCT image of a cavitation bubble formed from firing the treatment laser; determining an actual depth of the first laser pulse relative to the retina depth as a bubble depth of the cavitation bubble captured in the OCT image; and generating a calibration curve for use in focusing the laser treatment system, the calibration curve correlating the expected depth to the actual depth.

[0055] In a further embodiment of the method, the method further comprises capturing a plurality of cavitation bubbles in OCT images and determining actual depths of the plurality of cavitation bubbles.

[0056] In a further embodiment of the method, wherein the calibration curve is defined based on axial position of the actual depth relative to the retina depth.

[0057] In a further embodiment of the method, the calibration curve comprise a calibration surface further defined based a polar angle.

[0058] In a further embodiment of the method, the calibration curve comprises calibration volume.

[0059] A patient interface device is a general solution for connecting and controlling relative physical positioning of the patient, eye, and treatment system. Floaters have additional unique characteristics of individual turbulent motion within the vitreous which must be accounted for and adds challenges to imaging and treatment. While the patient interface device will be used to fixate the eye relative to the system, it is also desirable and important for effective imaging and treatment to induce some perturbations to the eye in order to move the floater into a more treatable location or desirable orientation. The floaters may be located in one or more zones identified in images such as a safe zone, a treatment, an unsafe zone, etc. The floaters may move among different zones, or within zones. The movement of the floater may be controlled based on movement of the eye, either under control of the moveable patient interface device or by the patient moving their eye. Safe distances from retina and lens tissues are critical, and keeping the floater in the treatment field of view and in a desirable orientation are for important the safe and efficient treatment of the floaters.

[0060] The ability to track and predict floater motion in the eye is very useful for safe and effective treatment. Artificial intelligence and machine learning approaches can be used to track and predict floater motion given a known perturbation and this can be used to drive the patient interface perturbations to achieve a desired result in terms of floater positioning and orientations. The system can learn from floater motions in general to become predictive of future positions and orientations and to define effective perturbations to move floaters into desired locations and orientations. This technique may be used to offset the effects of gravity on the floaters and have them maintain a central position. Also, because floaters have motion characteristics unique to themselves, specific target floater motions due to specific perturbations can be used to continually optimize floater location and orientation during treatment using real time feedback and control. AI / ML models may be used to detect, identify and track motion of floaters. The current motion, along with additional forces such as applied perturbations, or movements of the eye, can be used to predict floater motion. The models may be calibrated, trained or tuned for a particular floater, or class of floaters, by applying aperturbation or sequence of perturbations to the patient’s eye and monitoring the resulting motion. Additionally or alternatively, the models can be trained based on an imaging session, where the patient follows sequence of eye movements, for example by following moving gaze target, and learning the response of the floaters.

[0061] It is also desirable for the user to be able to easily add plus or minus dioptric lenses into the optical path to account for large refractive error in patients and to adjust the effective depth range for imaging and treatment for a given eye and optical system. A novel approach to do this in the patient interface is described herein.

[0062] Most femtosecond laser treatment systems used in ophthalmology, for example in cataract and refractive surgeries, require the patient to lay down on a bed and have the system dock vertically onto the eye. Laser treatment of floaters using the patient interface device described further below can be performed in the office with the patient in a sitting position rather than laying on a bed in the operating room (OR). The patient may sit at a table with a chin rest and / or head restraint to provide a more desirable treatment procedure.

[0063] Also useful in femtosecond laser treatment is the management of the bubbles produced due to the photoionization process. In the vitreous these bubbles tend to migrate vertically so that in the case of the patient laying down and facing upwards these bubbles would move to the posterior cornea and block the laser beam during treatment. In contrast, with the patient seated, the bubbles will rise upwards out of the field of focus of the treatment laser.

[0064] Laser beam and imaging optical properties must be maintained and optimized in the presence of a docking mechanism connecting the patient’s eye to the imaging and treatment system. The docking mechanism can use a compliant contact surface between the docking system and the patient’s cornea to avoid deformation I wrinkling of the tissue and the resulting optical beam distortions. This compliant solution must be practical with the patient in the seated position and with all the other constraints and design considerations described above.

[0065] The patient’s head and eye must be fixated and controlled to a reasonable extent throughout the entire treatment procedure. This requires restraint of the head while seated at the instrument, and docking onto the eye to fixate the globe relative the imaging and lasertreatment system. This overall patient interface system must also only raise intraocular pressure IOP minimally and allow safe treatment over several minutes.

[0066] The economics of these procedures requires that the overall patient interface solution be simple and low cost, with disposable and sterilizable elements as needed.

[0067] In order to treat SVOs, it is desirable to have a way to perturb SVOs during treatment while the patient’s eye is docked to the treatment system. The perturbations move and orient SVOs within a treatment I safe zone or optimize 3D positioning of the SVO for treatment. It can be desirable to translate floaters into treatable field and away from tissues I non-safe as well as rotate floaters for selective targeted treatment. It is further desirable to have a way to track and predict floater motions and to control the patient interface perturbations to achieve desired translations and rotations of tracked floaters.

[0068] In the treatment of SVOs, it is further desirable to have artificial intelligence (Al) and / or machine learning (ML) approaches for tracking and predicting floater motions and to define specific patient interface motions to translate and rotate floaters into best positions and orientations for treatment. It is desirable to optimize optical design through the patient interface to minimize docking optics and avoid optical distortions to the cornea due to fixation and docking. A compliant physical material between the docking cone and the eye may be used that is of acceptable optical quality. It may be desirable to provide optical power and elements in the patient interface. The patient interface described below may provide the ability to add plus and minus dioptric lenses to account for range of patients’ vision and adjust depth range of the focus. The design allows for the easy insertion and removal of lenses before or after docking and imaging. Additionally or alternatively, the device may comprise a permanent lens optics with different devices having different predetermined optics.

[0069] It is desirable to have the patient in a sitting position with control over their head and body movement. With the patient seated, the photoionization bubbles tend to move up and out of the treatment field of view. The docking process should be simple and effective for a clinician to perform on the patient’s eye while seated at the instrument. The patient interface fixates the eye to avoid movement during treatment. The patient interface is fixed relative to the treatment system to maintain precision depth accuracy between the system, the tissues in the eye, and the floaters. The treatment system can be calibrated to ensure safe distances between thetreatment laser focus location and sensitive structures of the eye. The patient’s head is restrained to avoid movement while seated during treatment. The patient interface, and in particular the compliant ocular interface, should avoid causing excessive IOP increase during docking and enable up to several minutes per treatment.

[0070] FIG. 1 depicts a system for treatment of floaters using a moveable patient interface device. The system 100 for treating a condition of an eye 102 of a patient 104. The condition is described further below as being floaters, or SVOs, however the system 100 can be used to treat a wide range of ocular conditions include cataracts, glaucoma, retinal tears or detachments, diabetic retinopathy and macular degeneration. An optical imaging and treatment system 106 is mounted on a surface such as a table 108. The optical imaging and treatment system 106 may include components for the simultaneous imaging and treatment. The imaging may be provided by various different modalities including SLO imaging and OCT imaging. The treatment may be provided by a laser such as a femtosecond laser and may use a portion of the optical pathway, possibly including the scanning components, of the OCT imaging component. The imaging and treatment system 106 may comprise a system as described in one or more of PCT Application PCT / CA2022 / 050583, filed April 14, 2022 and entitled “BIOMEDICAL IMAGING DEVICES, SYSTEMS, AND METHODS OF USE,” and PCT Application PCT / CA2021 / 051451 Filed October 15, 2021 , and entitled “OPTHALMOLOGICAL IMAGING AND LASER DELIVER DEVICE, SYSTEM AND METHODS,” both of which are incorporated herein by reference in their entirety for all purposes.

[0071] A restraint system may be mounted on the table 108 as depicted, or on a separate surface that can be maintained in the same physical position relative to the table. The restraint system may comprise a chin rest 110 and a head restraint system. The head restraint is depicted as comprising a form of halo 112a secured 112b to the table or surface. The head restraint system may include a mesh or inflatable material or elastic material or material covering 114 that can further secure the patient’s head movement during treatment, the restraint system can incorporate sensors to understand the pressure exerted on the patient’s head. It will be appreciated that the details of the head restraint system may vary but serves to limit the patient’s head movement so that the head and eye remain in a static position relative to the treatment system. It will be appreciated that the head restraint system should preferably be comfortable to the patient and easy to use.

[0072] A moveable patient interface 116 is used to dock to the patient’s eye 102 to further restrain movement of the eye during treatment. It is noted that the moveable patient interface device is depicted in FIG. 1 as not contacting the patient’s eye for clarity of the drawing. It will be appreciated that in use, the moveable patient interface is coupled to, or docked, to the patient’s eye. For clarification, when the patient interface is moving it causes the eye to move and when it is stationary the eye remains stationary. The moveable patient interface 116 may include an ocular interface such as a lens that can contact the eye and control movement of the eye. The ocular interface may be a unique design, or comprise an existing interface although other interface devices are possible including suction rings. Generally these ocular interfaces use some kind of compliant design to avoid cornea tissue deformation optical distortions, while optimizing for eye fixation and motion control in a comfortable way for the patient.

[0073] The moveable patient interface 116 is connected to the optical imaging and treatment system 106. Although not visible in FIG. 1 , the optical imaging and treatment system 106 may be repositioned, such as raising / lowering, moving towards / away from the patient, to allow the optical imaging and treatment system to be aligned with the patient’s eye. While it is desirable to restrain the patient’s eye from movement during treatment in order to ensure that a focused laser pulse is delivered to the expected targeted location, when treating floaters it is also desirable to provide movement to the patient’s eye in order to induce movement of floaters in order to move floaters into a more desirable treatment location and / or orientation. In order to provide these controllable motions to the patient’s eye, the moveable patient interface device 116 may include one or more actuators 118 that are able to perturb the portion of the patient interface device coupled to the eye. The movement provided by the one or more actuators 118 may comprise translating movement and / or rotating movement.

[0074] During use, the patient is secured to the head restraint system 110, 112, 114 and the moveable patient interface 116 docked to the patient’s eye. An initial imaging and calibration process may occur in order to calibrate the imaging and treatment components of the system 106 in order to align the imaging and treatment components as well as co-register imaging components, and possibly previously captured images. The alignment and co-registration may be performed as described in one or more of PCT Publication WO 2122 / 077117, filed October 15, 2121 and entitled “OPTHALMOLOGICAL IMAGING AND LASER DELIVERY DEVICE,SYSTEM, AND METHODS,” and PCT Publication WO 2023 / 097391 , filed November 25, 2022 and entitled “SYSTEM AND METHOD FOR DETECTION OF FLOATERS,” the entire content of both are incorporated herein by reference in their entirety for all purposes.

[0075] With the patient docked to the patient interface device, and the patient interface device connected to the imaging and treatment system, images of the eye can be captured in order to identify floaters for diagnostics and treatment. Depending upon the location and orientation of the floaters, the moveable patient interface device can be controlled in order to perturb the patient’s eye docked to the interface device and so impart movement to the floaters in order to move them to a more desirable location and / or orientation for treatment. The imaging of the floaters may be performed in real-time and once a floater is determined to be in a suitable location and / or orientation for treatment, the treatment laser can be controlled in order to fire focused laser pulse at the floater location. The results of the treatment can be monitored from the real-time imaging and used to control the treatment. For example, in addition to focusing the laser on the floater, it may be focused near the floater in order to generate bubbles that can be used to control motion of the floater as described in PCT Publication WO 2023 / 097391 , filed November 25, 2022 and entitled “SYSTEM AND METHOD FOR DETECTION OF FLOATERS”.

[0076] The movement of the moveable patient interface can perturb the patient’s eye to impart motion to the floaters in a controllable way to enable floater positioning. The movement is generally relatively small mechanical perturbations by the actuators of the patient interface device. The perturbations can be controlled automatically or manually, and can impart motions that are vertical, horizontal, rotations, other directions, shapes, or patterns. The patient interface maintains eye fixation and intraocular pressures during the perturbations.

[0077] The motion of floaters may be tracked using real-time images and the future position of the floater predicted based on the observed motion. The motion prediction may use a machine learning and / or artificial intelligence (ML I Al) model or a physics based model for predicting the future location based on observed movement. Further, floaters have a wide range of varying shapes and sizes and as such, the floaters may first be classified into one of a number of classes based on their size, shape, and possibly other physical characteristics and then a motion model associated with the particular class used to predict future motion. The classification of a floater may be updated as the floater is treated as its physical characteristics change.

[0078] The motion models may also be able to predict motion of the floater given the observed motion and a motion imparted by one or more perturbations of the patient interface. Such a model can be calibrated, trained or tuned by observing a current motion of a floater, imparting a known perturbation and observing the resultant motion. Such a controllable motion model may be used to predict the location of a floater after applying a particular perturbation. Additionally or alternatively, such a controllable motion model may be used to specify the particular perturbations to apply to the patient interface device in order to obtain a desired floater movement relative to the eye. Calibration of floater petrubation can be used with prior knowledge that is based on an imaging system with algorithms designed to capture floater motion information.

[0079] The patient is depicted in FIG. 1 as being in a seated position. Advantageously, this orientation allows bubbles formed during treatment to rise out of the path of the imaging and treatment lasers and so do not obstruct further treatment. Further, the sitting position is better suited for treatment in an office environment rather than lying down. Lying down on a patient’s back also has the disadvantage of a having any bubbles formed blocking the laser path for imaging and treatment. In addition to the seated position depicted in FIG. 1 , the patient may lean forward, similar to the position used in massage chairs. Such an orientation would allow bubbles formed to move back in the eye towards the retina and could provide an additional safety barrier for the retina and could be more comfortable to the patient for longer duration treatments. The patient may also be treated in a seated position in which they lean slightly backwards which would still allow formed bubbles to travel out of the treatment and imaging optical paths.

[0080] FIG. 2 depicts a moveable patient interface device coupled to an imaging and treatment system. The moveable patient interface device 200 comprises a housing or structure having a moveable portion 202a and a stationary portion 202b. It is noted that the moveable portion and the stationary portion do not need to be completely free to move relative to each other, but rather only need to allow the moveable portion to perturb the docked eye while maintaining the stationary portion stationary relative to the imaging and treatment system. The imaging and treatment system may comprise a system as described in one or more of The imaging and treatment system 106 may comprise a system as described in one or more of PCT Application PCT / CA2022 / 050583, filed April 14, 2022 and entitled “BIO-MEDICAL IMAGING DEVICES,SYSTEMS, AND METHODS OF USE,” and PCT Application PCT / CA2021 / 051451 Filed October 15, 2021 , and entitled “OPTHALMOLOGICAL IMAGING AND LASER DELIVER DEVICE, SYSTEM AND METHODS.”

[0081] The moveable patient interface device 202, and more particularly the stationary portion 202b, comprises an interface for connecting the patient interface device to the imaging and treatment system. The interface may comprise corresponding and co-operating portions of the interface on each of the patient interface device and the imaging and treatment system. The interface may include a mechanical interface 204a the comprises one or more physical features that allow the patient interface device to be securely attached to the imaging and treatment system, an optical interface 204b providing an optical pathway between the patient interface device and the imaging and treatment system, and an electrical interface providing electrical connections, possibly for power and / or control signals. An imaging and treatment system with such an interface is described in PCT Application PCT / CA2022 / 050583, filed April 14, 2022 and entitled “BIO-MEDICAL IMAGING DEVICES, SYSTEMS, AND METHODS OF USE.” As depicted, the imaging and treatment system 206 may include one or more imaging components, depicted as an SLO imager 208 and an OCT imager 210 as well as a treatment laser 212. It will be appreciated that additional imaging and / or treatment components may be included. The optical pathways of the imaging and treatment components are combined together, for example at splitter / combiner 214 and pass through one or more optical devices 216 such as lenses, active optics, etc. and pass to the optical interface 204b. Although the optical pathways of the SLO imager, OCT Imager and Treatment laser are depicted as all being combined together at the same splitter / combiner 214, it will be appreciated that the optical pathways can be combined in different ways. For example, the optical path of the treatment laser may be combined with the optical pathway of the OCT imager and may share the same scanning components as the OCT imager. Further, it will be appreciated that the optical pathways may include additional optical, electrical, and control components not depicted in FIG. 2.

[0082] The moveable patient interface device 202 includes an ocular interface 218 for docking to the patient’s eye and controlling the movement of the globe. The ocular interface can provide a soft docking onto the cornea to avoid cornea wrinkles and distortions using a soft pad between the cornea and lens such as hydrogel, or using an optical gel like that used in imaging newborns for retinopathy of prematurity screening. The ocular interface 218 is located at the moveableportion 202a of the patient interface device. One or more actuators 220a, 220b, 220c are provided in order to controllably perturb the moveable portion 202a of the patient interface 202 and so the ocular interface 218 which can controllably impart the perturbations to the patient’s eye, depicted by rotational and translational arrows 222.

[0083] The patient interface device 202 may include one or more optical lenses to enhance the visualization and / or improve imaging and treatment optics. The lenses may also be used to compensate for patient refractive error, depth of focus, etc. As depicted in FIG. 2, the patient interface device may include a mechanism for exchanging lenses 224a, 224b. One or more different lenses can be removed from and / or inserted into the patient interface device either before the device is docked to the patient’s eye or while the device is docked to the patient’s eye. The imaging I treatment system may have a mechanism to recognize, such as via RFID, electrical connection, etc., the lens configuration that is in the patient interface for successful co-registration.

[0084] Further, the patient interface device can include light sources for illuminating and transmitting light to the eye, either using the same optical pathway as for the imaging and treatment system or using an additional optical pathway to the patient’s eye.

[0085] In use, the patient interface device 202 may first be docked to the patient’s eye using the ocular interface 218 and then the patient interface device can be connected to the imaging and treatment system. Alternatively, the patient interface device may first be connected to the imaging and treatment system and then docked to the patient’s eye. Regardless of the process order, the patient and the imaging and treatment system can be moved relative to each other in order to align the patient’s eye with the optical pathway of the imaging and treatment system, and then locked together to form a stable connection.

[0086] FIGs. 3A and 3B depict a moveable patient interface device. The device 300 for docking to an eye 302 is similar to the patient interface device described above with reference to FIG. 2, however where the device of FIG. 2 is provided as a single component, the device 300 comprises a plurality of separate components. FIG. 3A depicts the components separated from each other and FIG. 3B depict the components connected together. The reference numbers are omitted from FIG. 3B for clarity of the drawing.

[0087] The device 300 may include an ocular speculum 304 that can be secured to the patient. The ocular speculum 304 includes hooks, curves or other features 306 for engaging with the eyelid of the patient. The ocular speculum 304 further includes a mechanical connector 308 that engages with a docking ring 310. The docking ring 310 comprises a corresponding mechanical connector 312 for connecting to the ocular speculum. The docking ring may include one or more optical lenses 314 and the ocular interface 316 for docking to the patient’s eye. Rather than using a connection to the speculum to secure the docking ring to the patient, the docking ring 310 may comprise a suction ring for securing to the patient. Whether provided by the mechanical interface to the ocular speculum or a suction ring, or other means, the docking ring comprises a mechanical interface for securing the docking ring, either directly or indirectly, to the patient. The docking ring includes a mechanical interface 318 for securing a patient interface device cone or housing 320 to the docking ring.

[0088] The cone or housing (referred to cone 320 for brevity), comprises a moveable portion 322a and a stationary portion 322b. The movable portion includes a mechanical interface 324 for engaging with the mechanical interface 318 of the docking ring 310. The cone 320 may include replaceable, or interchangeable lenses 326 that can be held in position by a lens holder 328. Although a single lens 326 is depicted in the figures, the cone 320 may include a plurality of interchangeable lenses. Additionally, or alternatively, the cone 320 may include one or more fixed lenses. The exchangeable lenses can be inserted into the patient interface device and retained in a stable position. The interchangeable lenses may be used to account for different patient refractive ranges, as well as to adjust system depth treatment range.

[0089] The cone 320 comprises one or more actuators 330, 332, 334 that can controllably perturb the moveable section 322a. The actuators may comprise motors, linear actuators, magnetic actuators, piezo-electric actuators as well as other types of actuators capable of controllably moving the moveable portion 322a of the cone 320. FIGs. 3A and 3B depict three separate actuators 330, 332, 334 that can each impart a particular type of motion to the moveable section 322a. For example, actuator 330 may impart a rotational motion, actuator 332 may impart a vertical translational motion, and actuator 334 may impart a vertical translational motion. Although depicted as separate actuators providing distinct motions, a single actuator may provide multiple different motions. When multiple actuators are present,the actuators may be operated individually together in order to impart a combined motion to the moveable portion 322a of the cone 320.

[0090] The stationary portion 322b of the cone 320 includes an interface for connecting the patient interface device 300 to an imaging and treatment system. The interface may comprise corresponding interface portions on the patient interface device and the imaging and treatment system. The interface may comprise a physical interface with co-operating physical features 336a, 336b on the patient interface device and the imaging and treatment system that engage with each other to secure the connection between the patient interface device and imaging and treatment system. The interface also includes optical components 338a, 338b that provide an optical path when the devices are connected. Similarly, an electrical interface comprises interface portions 340a, 340b on the patient interface device 320 and the imaging and treatment system. The imaging and treatment system 342 may comprise an imaging and treatment device as described in one or more of PCT Application PCT / CA2022 / 050583, filed April 14, 2022 and entitled “BIO-MEDICAL IMAGING DEVICES, SYSTEMS, AND METHODS OF USE,” and PCT Application PCT / CA2021 / 051451 Filed October 15, 2021 , and entitled “OPTHALMOLOGICAL IMAGING AND LASER DELIVER DEVICE, SYSTEM AND METHODS.” In use, when the components are connected together, an optical path 344 from the imaging and treatment system 342, through the cone 320, docking ring 310 and ocular interface 316 to the patient’s eye.

[0091] The patient interface device 300, and in particular the cone 320 may include a controller 346 that can control the actuators 330, 332, 334. The controller 346 may receive control signals over one or more electrical connections with the imaging and treatment system established over the electrical interface 340a, 340b. Alternatively, the controller may be located external to the patient interface device 320, such as in the imaging and treatment system, and the electrical interface may provide the actuator control signals directly to the actuators. Although the control signals may be communicated to the controller over a wired connection provided by the electrical interface 340a, 340b, the control signals could be communicated using a wireless communication channel.

[0092] FIG. 4 depicts docking details of a moveable patient interface device. When docking an ocular interface to a patient’s eye, a fluid, gel or hydrogel may be applied to the patient’s eye prior to docking to the eye. In previous treatments, with the patient laying on their back, suchfluids or gels can remain more or less in place while the patient interface device is docked. With the patient in a seated position, such fluids or gels may not remain on the patient’s eye. In such a scenario, the docking ring 402 may include a sealing ring 404 for sealing to the patient’s eye and defining a volume 406 between the eye and the relevant surfaces of the docking ring such as the ocular interface 316. The sealing ring may be used in providing suction to attach the docking ring firmly onto the eye, possibly with or without the use of an ocular speculum. The docking ring 402 is similar to the docking ring 312 however it includes an inlet port 408 and outlet port 410 that allow a fluid or gel to be filled into the volume 406. The outlet port 410 allows air, and possibly the fluid or gel, to escape the volume as it is filled. In order to allow air escape as the volume is filled, the outlet port 410 may be arranged at a top of the volume 406.

[0093] FIG. 4 depicts a docking ring for attaching to a patient’s eye and providing an interface between the patient’s eye and other components. A further docking ring, and docking assembly are described below with reference to FIGs. 5 - 9. The docking ring described above as well as the additional docking ring described below may be used with a moveable interface as described above or a stationary interface.

[0094] FIG. 5 depicts a front view further embodiment of a docking assembly. FIG. 6 depicts a front right perspective view of the docking assembly. FIG. 7 depicts a eye cup of the docking assembly of FIG. 5. FIG. 8 depicts a first cross section of the eye cup of FIG. 7. FIG. 9 depicts a second cross section of the eye cup of FIG. 7. The same reference numbers are used throughout FIGs. 5 - 9 to describe the same components of the docking assembly 500.

[0095] The docking assembly 500 comprises a docking ring 502. Although referred to as a docking ring it can take other shapes such as a cone or cup, etc. The docking ring provides a physical interface between the patient’s eye and other components of the system. The above has described the docking ring as providing an interface between the patient’s eye and a moveable cone. While the docking assembly 500 may be used with a moveable cone as described above, it may also be used with a stationary interface to the imaging and / or treatment system that does not perturb the patient’s eye. The stationary interface to the imaging and / or treatment system may allow some movement between the imaging and / or treatment system and the patient’s eye. Regardless of if the docking assembly 500 is used with a moveable interface or stationary interface, the docking assembly 500 provides a connection between the patient’s eye and the imaging and / or treatment system.

[0096] The docking ring 402 described above includes a ports for injecting / removing a gel or fluid into a volume between the patient’s eye and the docking ring. The docking ring 502 also includes ports for injecting I removing a liquid or gel into or out of a volume between the patient’s eye and the docking ring 502. The docking ring 502 includes additional ports that may be used to apply a vacuum to the patient’s eye in order to seal the docking ring to the patient’s eye. The docking ring includes at least one surface 504 that contacts the patient’s eye, such as the cornea or sclera and can provide a seal against the patient’s eye. The contacting surface 504 may be made of a resilient material to allow the surface to conform to the shape of the patient’s eye. Alternatively, the surface may be formed from a non-resilient material with the surface of the patient’s eye conforming to the solid surface.

[0097] With contacting surface 504 of the docking ring 502 against the patient’s eye, an interior volume is defined between the surface of the eye and the interior of the docking ring. As described further below, a vacuum can be applied to evacuate air from the interior volume of the docking ring in order to secure the docking ring 502 to the patient’s eye. The volume may be filled with a liquid or gel, either as the vacuum is being applied or after the vacuum is applied. A plurality of pipes, tubes, hoses, etc. 506 can be attached to the docking ring in order to provide the vacuum as well as provide the liquid or gel.

[0098] The docking ring 502 may be provided as a separate component as depicted in FIG. 7, that can be secured to a docking plate 508 or other structure. The docking plate 508 may provide a chamber or opening 510 in which lenses or other components of the imaging and / or treatment system can be received. The chamber or opening 510 may be accessibly from a top of the docking plate as well as from one or more locations such as from the side as depicted in FIG. 5. While the opening or chamber on the top of the docking plate can receive lenses or other components of the imaging and / or treatment system, once the docking plate is secured to other components, the opening or chamber 510 may not be directly accessible from the top. Additional access, such as from the side, may be possible in order to insert / remove component such as lenses.

[0099] Vacuum suction is used to secure the docking ring to the patient’s eye. A pair of the hoses 506 may be used for supplying the vacuum while a pair may be used for the liquid or gel. In FIG. 7, the vacuum hoses are indicated with reference number 512 and the liquid or gel hoses are indicated with reference number 514.

[0100] As can best be seen in FIG. 7 an interior volume of the docking ring 502 is provided between a hard meniscus lens 516 within the docking ring and the outer surface of the patient’s eye (not shown) when the contact surface 504 is in contract with the patient’s eye. The vacuum hoses or connected to vacuum ports in the docking ring that allow the vacuum to be drawn about a ring of the patient’s eye 518. The vacuum secures the docking ring to the patient’s eye. With the suction applied the chamber between the patient’s eye, the meniscus lens 516 and the interior of the docking ring define a chamber, which is filled, either partially or fully, with a liquid or gel. The docking ring 502 separates the interface for applying the vacuum from the interface for filling or emptying the chamber with the liquid or gel. A cross section of the docking ring showing the vacuum interface is depicted in FIG. 8 and a cross section of the docking ring showing the liquid interface is depicted in FIG. 9.

[0101] As depicted in FIG. 8, the pair of vacuum hoses 512 can be connected to respective vacuum ports within docking ring which pass to a suction area 518 on the interior of the docking ring. The suction area may be provided as a ring around the surface of the interior of the docking ring with the pair of vacuum ports fluidically connected to the ring. The ports are depicted as being arranged 180° away from each other. While a pair of vacuum ports are depicted, it is possible to provide only a single vacuum port, or more than two vacuum ports. Further, while depicted as being space 180° apart, other spacings between the vacuum ports, when multiple vacuum ports are used, are possible.As depicted in FIG. 9, the pair of liquid hoses 514 can be connected to respective liquid ports within the docking ring which pass to an interior area 520 that will be between the meniscus lens 516 and the patient’s eye. As depicted in FIG. 9, the interior area 520 where the liquid or gel can enter the chamber can be located between the meniscus lens 516 and the suction area 518. When the suction area is provided as a suction ring, the suction may be applied to the patient’s eye between a top of the suction ring and a bottom of the suction ring. With the suction applied, the top of the suction ring seals a chamber between the patient’s eye and the meniscus lens. With the liquid ports arranged between the suction area and the meniscus as depicted, the liquid or gel can be supplied to the sealed chamber through the liquid ports. Similar to the vacuum ports, one or more liquid ports may be provided. If a single liquid port is provided, an additional port or opening within the chamber may be provided to allow gas to escape the chamber as it is filled with the liquid or gel. When multiple ports are provided one may be usedto fil the chamber with the liquid or gel, at least one may be used to provide the liquid or gel while at least one is used to evacuate the air so that no additional opening to atmosphere is needed. While an additional opening to atmosphere may not be required when multiple liquid ports are provided, one may still be provided. Regardless, once the docking ring is suctioned on to the patient’s eye, a chamber between the patient’s eye and the interior of the docking ring may be filled, partially or fully with a liquid or gel.

[0102] FIG. 10 depicts a method of treating floaters using a moveable patient interface device. The method 1000 begins with docking the patient interface on the patient’s eye (1002). The process for docking may vary depending upon the components of the patient interface device. For a patient interface device 300 as described above with reference to FIGs. 3A and 3B, the process may include securing an ocular speculum to the patient, and then securing a docking ring to the ocular speculum. The cone or housing may be secured to the imagining and treatment system and then the system moved to align and secure the cone or housing to the docking ring. Once docked, the optical systems of the imaging and treatment device can be aligned, or the alignment verified (1004) to ensure that all of the imaging and treatment systems are co-aligned. Images captured from the various imaging systems may be co-registered (1006) to ensure that the same locations in the different imaging systems are registered to each other. Additionally, previously captured images, such as those captured during a previous session, images associated with a treatment plan, or other images of the patient’s eye, may be registered to currently captured images. The depth of focus of the treatment laser may be calibrated (1008) so that the desired targeting depth matches the actual targeting depth. The calibration can be performed in various ways. One possible calibration method is described further below with reference to FIG. 14.

[0103] Once the imaging and treatment system is aligned, registered and calibrated, the imaging systems are used to identify and track one or more floaters for treatment (1010). An individual floater may be selected for treatment and the moveable patient interface controlled in order to control the motion of the selected floater (1012). As described above the control of the motion of a floater may be determined using a control motion model that predicts a resultant motion of the floater based on applied perturbations. The model can be generated, calibrated or tuned when the patient is docked to the system. Such a process is described further with reference to FIG. 11 . With the movement of the selected floater controlled in order to positionand orient the floater in a desired treatment location, the SVO may be treated (1014). The treatment includes repeated firing of the laser at the SVO. The laser may also be controlled to fire in regions surrounding the floater in order to generate bubbles that can help control the motion of the floater during treatment as described in PCT Publication WO 2023 / 097391 , filed November 25, 2022 and entitled “SYSTEM AND METHOD FOR DETECTION OF FLOATERS”. The imaging systems can monitor the treatment as it progresses in real-time. For example, the OCT imaging system may be used to capture images in real-time while the laser is firing during floater treatment in order to monitor the treatment in real-time. The results of the treatment can be monitored in the captured real-time images and used to control further treatment of the floater. For example, the treatment of the floater with the treatment laser may cause the floater to move, which could be counteracted by perturbations of the patient interface device to effectively stabilize the location of the floater during treatment. The treatment times of individual laser pulses is extremely short and as such, although the perturbations may be small they can still be enough to move the eye sufficiently to maintain the floater in position for a number of treatment pulses.

[0104] FIG. 11 depicts a method of calibrating control movement of a floater. The method 1100 can be used to calibrate or train a model used to predict a floater’s movement resulting from particular perturbations. This may be used to determine what perturbations are needed in order to control motion of a floater in a desired way. The control movement models may be associated with individual floaters or may be associated with more general floaters, possibly based on broader classes of floaters. Further, models associated with classes of floaters may be tuned for an individual floater using the method 1100. The method identifies a floater in the captured images (1102), which may include identifying the floater in different imaging modalities such as SLO images and OCT images. Once the floater is identified a first perturbation can be applied to the patient interface device (1104) and the movement evaluated in real-time captured images in order to determine the impact of the applied first perturbation on the motion of the floater (1106). The movement control models of the floater can then be updated using the first applied perturbation and the resulting motion (1108), or the impact of the perturbation of the motion.

[0105] The method 1100 is described as applying a single perturbation and determining it’s impact on the motion. Multiple perturbations can be applied and the results on the floater motion determined. Further, the plurality of perturbations may be applied sequentially withobservations of the resulting motion made in between each perturbations or multiple perturbations may be applied simultaneously, or substantially simultaneously, and the resulting motion of the combined perturbations observed.

[0106] FIG. 12 depicts an OCT image of femtosecond laser pulse induced bubbles formed during laser treatment. The image is an OCT image of a simulated floater suspended in water inside an eye phantom. The OCT imaging system captures real-time images of the volume while a treatment laser fires at the surface of the paper in order to ablate thin layers of the paper. The laser pulses cause cavitation bubbles to form which can be seen in the image as approximately grid-spaced bubbles above the general surface of the paper. The bubbles are formed at the point of focus of the laser treatment system and then travel upwards. The formation of the bubbles may be used to improve the depth calibration of the treatment laser, and capturing OCT images while performing laser treatment simultaneously allows real time monitoring of the laser treatment and the effects on the targeted floater. As will be appreciated, precise control of the location, including depth, of the focus of the treatment laser is important to ensure only the desired structures within the eye are treated with the laser. For example, it would be undesirable to inadvertently focus the treatment laser on the patient’s retina because the system had the focus depth calibrated incorrectly.

[0107] FIG. 13 depicts a method of calibrating a depth of focus for a treatment laser. The method 1300 allows the depth of focus of the treatment laser to be calibrated relative to a structure of the eye such as the retina or the lens. As described above, it is desirable to avoid mistakenly focusing the treatment laser on the retina and as such calibrating the depth of focus relative to the retina surface can provide improved safety. The method begins with determining a depth of the retina from a captured OCT image (1302). The treatment laser is then fired at an expected location (1304). The expected location is one that is far enough away from any sensitive structures that even without precise calibration the laser will be focused in a safe location. The firing of the laser will cause a bubble to be created at the actual focus point of the laser. The formed bubble is captured in an OCT image (1306) at the time of laser firing, and the depth of the bubble, and so the actual focus location, determined relative to the retina and the lens (1308). Since the retina or the lens location and bubble can be captured in the same imaging modality, namely the OCT image, it is possible to provide reliable references between the two distances and as such improve the safety margins of focusing the laser relative to theretina. The firing of the treatment laser can be repeated at various locations and the resulting bubble formation captured in the OCT images as depicted by dotted arrow 1310. Once a sufficient number of bubbles are captured, a calibration curve can be generated between the expected depths and the actual depths as determined relative to the retina (812). Illustrative calibration curves are depicted in FIGs. 15A and 15B. Placing and imaging bubbles in real-time throughout the eye can also be used to determine the photoionization threshold (i.e. the energy of laser pulse required to elicit ablation I ionization effect) throughout the volume of the eye; therefore, reducing the effective energy deposited into the eye throughout the treatment and increasing safety.

[0108] FIG. 14 depicts an OCT M-scan (sequence of A-scan over time) of bubbles formed above a reference surface. The OCT scan captured over a period time shows a series of bubbles 1402 that are formed above the surface 1404 such as the retina of a patient. It is possible to generate a calibration curve for the focus depth of the treatment laser by correlating the targeted depth that each bubble was expected to be formed at to the actual depth above the retina as captured in the OCT images.

[0109] FIG. 15A depicts a calibration curve for depth of focus. FIG. 15B depicts a calibration surface for depth of focus. The depth calibration process described above with reference to FIG. 14 can be repeated. This can be done at various locations and depths, such as 3mm, 3.5mm, 4mm above the retina, in the eye to have a precise depth calibration and location targeting throughout the eye. As depicted in FIG. 15A the calibration spots, or bubble locations are fit to an expected performance curve to relate the intended optical focusing (Iopto) depth of treatment to the actual axial position p* relative to the retina at srwith some external tuning parameter. In some optical systems it may be beneficial to also calibrate with a polar angle 9 in order to provide a calibration surface as depicted in FIG. 15B. Further extensions of the calibration to include the azimuth are possible. The above has described a process of calibrating a depth of focus of the treatment laser based on a locations of bubble formations. A similar process can be performed for calibrating a photoionization threshold at various locations within the eye.

[0110] The above has described various devices, systems, and methods that are useful in the laser treatment of floaters. In order to provide useful treatment of the floaters it may beneficial for a patient to be able to visualize a particular floater in order to communicate with a doctor ortechnician. For example, a patient may have a number of floaters in their field of view at a time, and if one is of particular relevance, it would be beneficial to provide an improved way to communicate the particular floater to a doctor or technician so that it can be targeted for treatment and diagnosis.

[0111] FIG. 16 depicts components of a fixation target for use in visualizing floaters. The fixation target 1600 is depicted as a device in isolation in FIG. 16 however it could be incorporated into an imaging and treatment system as described further below. The fixation target comprises a housing 1602 that encloses, in order, a light source 1604, a diffusing medium 1606 and a fixation guide 1608. The light source 1604 can be provided as a single point or multiple point light source. The diffusing medium 1604 diffuses the light so that individual light sources are not visible to the patient. The light source 1602 and the diffusing medium provide a light background that the patient can look at against which the floaters will be readily visible. In addition to the light source 1602 and the diffusing medium, the fixation target includes a visualization guide 1608 that helps the patient to identify individual floaters, or groups of floaters to a doctor or technician. The visualization guide 1608 comprises a generally transparent or translucent plate with visible reference markings on it that allow the patient to communicate floater locations relative to visible reference markings. The visible reference markings can have a known location in other imaging modalities allowing floaters to be identified in those imaging modalities.

[0112] The fixation target 1600 is described as having a light source as a single or multi-point light source. It is possible to provide the light source as a small display such as an LED display. In such a case, depending upon the size of individual LEDs, the diffusing medium could be omitted. Using a display as the light source can advantageously provide moveable gaze targets that can be controlled to move the patient’s eye, for example by tracking a dot moving across the display, such as described in PCT Publication WO 2023 / 097391 , filed November 25, 2022 and entitled “SYSTEM AND METHOD FOR DETECTION OF FLOATERS”. This eye movement can be used during an imaging process for example to possibly move floaters. Additionally, by varying the colour of a portion of the display, it may be possible to effectively “highlight” a floater, group of floaters, or general floater location.

[0113] FIG. 17 depicts a fixation target for coupling to an imaging and treatment system. The fixation target 1702 may be co-registered with the other imaging / treatment systems so thatfeedback in one system can be meaningfully applied to the other. The fixation target 1702 is depicted as being coupled to imaging and treatment system 1604 that can be used to image and treat an eye 1606. It is noted that the docking of the patient interface device described above for treatment may not be necessary for imaging procedures such as evaluating a patient for possible floater treatment as the head and eye do not need to be as reliably fixed since no laser treatments are performed. The fixation target 1702 may comprise a housing that includes a number of mechanical interface components 1708a that engage with corresponding mechanical interface components 1708 of the imaging and treatment system 1704. An optical interface component 1710a of the fixation target cooperates with an optical interface component 1710b of the imaging and treatment system to provide an optical path between the patient’s eye and the fixation target. One or more electrical connections can be established by corresponding electrical interface components 1712a, 1712b on the fixation target and imaging and treatment system respectively. The fixation target comprises a light source 1714, which may be provided as a single light source, multiple light sources or as a display. A diffusing medium 1716 can be arranged adjacent the light source to diffuse the light from the source and a visualization guide 1718 can be arranged adjacent the diffusing medium so that visible reference markings on the guide 1718 appear to the patient to be overlaid on the light source. The visible reference markings on the guide can be one or more lines, circles rectangles etc. that provide one or more references that a patient can see their floaters relative to. For example, the visible reference markings could be provided as a grid and the patient can indicate that the floater that appears the largest is in the upper left quadrant. It will be appreciated that various arrangements of visible reference markings are possible with varying degrees of resolution. The fixation target 1702 may include a controller 1702 for controlling the light source 1714. The optical interface 1710a acts as an input / output port, although if no imaging components are present in the fixation target as depicted in FIG. 17, no light needs to return.

[0114] The fixation target is coupled to the imaging and treatment system and the optical pathway from the fixation target can be coupled at a splitter combiner 1722 with other optical pathways and delivered to the patient’s eye through one or more optical devices such as lenses, mirrors, etc. The additional optical pathways may include the optical pathways of imaging and treatment components depicted as an SLO imager 1726, an OCT imager 1728 and possibly a treatment laser 1730. While it could be possible to perform some laser treatments without the patient’s head and eye fully restrained such as by using the patient interface device describedabove, it is considered that if the fixation target is used, and so the patient is able to move their gaze and as such is not fixed by the patient interface device, only imaging is performed and as such the system does not require the treatment laser. It is possible to perform imaging operations with the treatment laser 1730 present in the imaging and treatment system.

[0115] FIG. 18 depicts a view through the fixation target. As can be seen, the background of the fixation target provides a light and diffused background against which a patient’s floaters would be easily visible. Also clearly visible in FIG. 18 is the visible reference markings, which form a grid providing four quadrants labelled as A, B, C, and D. Accordingly, a patient can communicate floater information to a doctor or technician more easily such as what quadrant a floater is in, which direction it is move, for example from quadrant D to quadrant C, etc.

[0116] It will be appreciated by one of ordinary skill in the art that the system and components shown in FIGs. 1 - 18 can include components not shown in the drawings. For simplicity and clarity of the illustration, elements in the figures are not necessarily to scale, are only schematic and are non-limiting of the elements structures. It will be apparent to persons skilled in the art that a number of variations and modifications can be made without departing from the scope of the invention as defined in the claims.

[0117] Although certain components and steps have been described, it is contemplated that individually described components, as well as steps, can be combined together into fewer components or steps or the steps can be performed sequentially, non-sequentially or concurrently. Further, although described above as occurring in a particular order, one of ordinary skill in the art having regard to the current teachings will appreciate that the particular order of certain steps relative to other steps can be changed. Similarly, individual components or steps can be provided by a plurality of components or steps. One of ordinary skill in the art having regard to the current teachings will appreciate that the components and processes described herein can be provided by various combinations of software, firmware and / or hardware, other than the specific implementations described herein as illustrative examples.

[0118] The techniques of various embodiments can be implemented using software, hardware and / or a combination of software and hardware. Various embodiments are directed to apparatus, e.g. a node which can be used in a communications system or data storage system. Various embodiments are also directed to non-transitory machine, e.g., computer, readablemedium, e.g., ROM, RAM, CDs, hard discs, etc., which include machine readable instructions for controlling a machine, e.g., processor to implement one, more or all of the steps of the described method or methods.

[0119] Some embodiments are directed to a computer program product comprising a computer- readable medium comprising code for causing a computer, or multiple computers, to implement various functions, steps, acts and / or operations, e.g. one or more or all of the steps described above. Depending on the embodiment, the computer program product can, and sometimes does, include different code for each step to be performed. Thus, the computer program product may, and sometimes does, include code for each individual step of a method, e.g., a method of operating a communications device, e.g., a wireless terminal or node. The code can be in the form of machine, e.g., computer, executable instructions stored on a computer-readable medium such as a RAM (Random Access Memory), ROM (Read Only Memory) or other type of storage device. In addition to being directed to a computer program product, some embodiments are directed to a processor configured to implement one or more of the various functions, steps, acts and / or operations of one or more methods described above. Accordingly, some embodiments are directed to a processor, e.g., CPU, configured to implement some or all of the steps of the method(s) described herein. The processor can be for use in, e.g., a communications device or other device described in the present application.

[0120] Numerous additional variations on the methods and apparatus of the various embodiments described above will be apparent to those skilled in the art in view of the above description. Such variations are to be considered within the scope.

Claims

WHAT IS CLAIMED IS:1 . A moveable patient interface device comprising: an ocular interface comprising at least one optical element to dock to a patient’s eye; a moveable portion secured to the ocular interface; a portion securable to an imaging and treatment system; and at least one actuator coupled between the stationary portion and the moveable portion, wherein operation of the at least one actuator perturbs the patient’s eye when the ocular interface is docked to the patient’s eye.

2. The moveable patient interface device of claim 1 , further comprising: at least one lens mount that releasably receives a lens component.

3. The moveable patient interface device of claim 1 or 2, wherein the at least one actuator is capable of imparting one or more of: a rotational perturbation; a vertical translational perturbation; and a horizontal translational perturbation.

4. The moveable patient interface device of any one of claims 1 to 3, wherein the portion securable to an imaging and treatment system comprises an interface for coupling to the imaging and treatment system, the interface comprising: a portion of a mechanical interface that engages with a corresponding portion of the mechanical interface of the imaging and treatment system; a portion of an optical interface that optically couples to a corresponding portion of the optical interface of the imaging and treatment system; and a portion of an electrical interface that electrically couples to a corresponding portion of the electrical interface of the imaging and treatment system.

5. The moveable patient interface device of any one of claims 1 to 4, wherein the moveable patient interface device is provided as a plurality of engageable components.

6. The moveable patient interface device of claim 5, wherein the plurality of engageable components comprise: an ocular speculum comprising at least one mating feature; and a housing for the ocular interface, the moveable portion, the stationary portion, and the at one actuator, the housing comprising at least one corresponding mating feature corresponding to the at least one mating feature of the ocular speculum to engage the ocular speculum to the housing.

7. The moveable patient interface device of claim 5, wherein the plurality of engageable components comprise: an ocular speculum comprising: at least one mating feature; and a docking ring comprising: the ocular interface; at least one corresponding mating feature corresponding to the at least one mating feature of the ocular speculum to engage the ocular speculum with the docking ring; and at least one housing-mating feature; and a housing for the moveable portion, the stationary portion, and the at one actuator, the housing comprising at least one corresponding housing-mating feature corresponding to the at least one housing-mating feature of the docking ring to engage the housing with the docking ring.

8. The moveable patient interface device of claim 5, wherein the plurality of engageable components comprise: a docking ring comprising: a suction ring for attaching the docking ring to the eye; and the ocular interface; and at least one housing-mating feature; and a housing for the moveable portion, the stationary portion, and the at one actuator, the housing comprising at least one corresponding housing-mating featurecorresponding to the at least one housing-mating feature of the docking ring to engage the housing with the docking ring.

9. The moveable patient interface device of claim 8, wherein the docking ring comprises: one or more vacuum ports fluidically coupled to the suction ring; and one or more liquid ports for allowing a liquid or gel to be provided to a volume between the patient’s eye and an interior portion of the docking ring.

10. The moveable patient interface device of claim 9, wherein the docking ring comprises a meniscus lens.11 . The moveable patient interface device of claim 9, wherein the liquid ports are arranged between the meniscus lens and the suction ring.

12. The moveable patient interface device of any one of claims 1 to 8, further comprising a controller for controlling at least the at least one actuator.

13. The moveable patient interface device of any one of claims 1 to 9, wherein the at least actuators comprise one or more of: a motor; a magnetic actuator; and a piezo-electric actuator.

14. The moveable patient interface device of any one of claims 1 to 10, further comprising: an inlet port for injecting a fluid into a space between the patient’s eye and the ocular interface when docked to the patient’s eye; and an outlet port arranged towards a top of the space to allow air and / or injected fluid to escape the space.

15. A docking ring securable to a patient’s eye comprising: a docking surface for contacting a portion of the patient’s eye;one or more vacuum ports flu idical ly coupled with a suction ring in contact with the patient’s eye during use; one or more liquid ports fluidical ly coupled with a chamber defined between the patient’s eye and an interior chamber of the docking ring, wherein in use, a vacuum is applied to the one or more vacuum ports to seal the docking ring to the patient’s eye around the suction ring and a liquid or gel is supplied to the chamber through the one or more liquid ports.

16. The docking ring of claim 15, wherein the one or more vacuum ports comprise a plurality of vacuum ports.

17. The docking ring of claim 15, wherein the one or more liquid ports comprise a plurality of liquid ports.

18. The docking ring of any one of claims 15 to 17, further comprising a meniscus lens defining at least a portion of the interior chamber of the docking ring.

19. The docking ring of claim 18, wherein the one or more liquid ports are arranged between the one or more vacuum ports and the meniscus lens.

20. A fixation target for use in visualizing a floater, the fixation target comprising: a light source; a visualization guide comprising a visible marking on a substantially transparent surface; a housing enclosing the light source, and visualization guide; and an optical input and output port arranged adjacent the visualization guide.21 .The fixation target of claim 20, further comprising a diffusion material between the light source and the visualization guide.

22. The fixation target of claim 20 or 21 , further comprising an interface on the housing to secure the housing to an imaging system.

23. The fixation target of claim 22, wherein the imaging system comprises an imaging and treatment system.

24. The fixation target of any one of claims 20 to 23, wherein the interface comprises: a portion of a mechanical interface that engages with a corresponding portion of the mechanical interface of the imaging system; a portion of an optical interface that optically couples to a corresponding portion of the optical interface of the imaging system; and a portion of an electrical interface that electrically couples to a corresponding portion of the electrical interface of the imaging system.

25. The fixation target of any one of claims 20 to 24, wherein the visible marking of the visualization guide comprises one or more of: one or more lines; one or more circles; one or more rectangles; and one or more polygons.

26. The fixation target of claim 25, wherein the visible marking is a grid.

27. The fixation target of any one of claims 20 to 26, wherein the light source comprises a display.

28. The fixation target of claim 27, wherein the display is controllable to illuminate a floater, group of floaters or a region containing floaters.

29. A method of calibrating a depth of focus of a laser treatment system, the method comprising: capturing an OCT image of a patient’s eye; determining a retina depth from the captured OCT image; firing a treatment laser at an expected depth within the vitreous of the patient’s eye; capturing an OCT image of a cavitation bubble formed from firing the treatment laser;determining an actual depth of the first laser pulse relative to the retina depth as a bubble depth of the cavitation bubble captured in the OCT image; and generating a calibration curve for use in focusing the laser treatment system, the calibration curve correlating the expected depth to the actual depth.

30. The method of claim 29, further comprising capturing a plurality of cavitation bubbles in OCT images and determining actual depths of the plurality of cavitation bubbles.31 . The method of claim 29 or 30, wherein the calibration curve is defined based on axial position of the actual depth relative to the retina depth.

32. The method of claim 31 , wherein the calibration curve comprise a calibration surface further defined based a polar angle.

33. The method of claim 31 , wherein the calibration curve comprises calibration volume.

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