Systems and methods for treating corneal ectatic disorders

Abstract

To provide systems and methods for treating corneal ectatic disorders (for instance, keratoconus).SOLUTION: To treat corneal ectatic disorders, systems and methods can precisely apply photoactivating light to specified areas of a cornea treated with a cross-linking agent. An example system includes a light source that provides a photoactivating light to photoactivate a cross-linking agent applied to an eye. The system includes optical element(s) that transmit the photoactivating light to the eye according to a pattern defined by a plurality of treatment zone. The treatment zones are delivered to different respective areas on the eye. The plurality of treatment zones include at least a first treatment zone and a second treatment zone. The first treatment zone provides a first dose of the photoactivating light. The second treatment zone provides a second dose of the photoactivating light. The first dose is greater than the second dose. The first treatment zone is disposed within an inner boundary of the second treatment zone.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62 / 733,617 (filed September 19, 2018), the contents of which are incorporated herein by reference in their entirety.

[0002] The present disclosure relates to systems and methods for treating eyes, and more particularly, to systems and methods for treating corneal ectatic disorders. [Background technology]

[0003] Corneal ectasias, or ectasias, are a group of rare, non-inflammatory eye disorders characterized by bilateral thinning of the central, paracentral, or peripheral cornea.

[0004] For example, keratoconus is a degenerative eye disease in which structural changes within the cornea weaken it and cause it to deform into an abnormal conical shape. Crosslinking treatments can strengthen and stabilize the areas weakened by keratoconus, preventing undesirable shape changes.

[0005] For example, a complication known as post-LASIK ectasia can occur due to thinning and weakening of the cornea caused by LASIK (Laser-Assisted in Situ Keratomileusis) surgery. Post-LASIK ectasia results in a progressive steepening (bulging) of the cornea. Therefore, cross-linking treatment can strengthen and stabilize the corneal structure after LASIK surgery and prevent post-LASIK ectasia. Summary of the Invention

[0006] To treat corneal ectatic disorders (eg, keratoconus), the system and method can precisely deliver photoactivating light to specific areas of the cornea that have been treated with a crosslinking agent.

[0007] One exemplary system for treating an eye includes a light source configured to provide photoactivating light to photoactivate a crosslinking agent applied to the eye. The system includes one or more optical elements configured to receive the photoactivating light and deliver the photoactivating light to the eye according to a pattern defined by a plurality of treatment zones. The treatment zones are distributed to different respective regions on the eye. The plurality of treatment zones includes at least a first treatment zone and a second treatment zone. The first treatment zone provides a first dose of photoactivating light. The second treatment zone provides a second dose of photoactivating light. The first dose is greater than the second dose. The first treatment zone is disposed within an inner boundary of the second treatment zone.

[0008] One exemplary method for treating an eye includes determining a location of a treatment area on the eye. The method includes operating at least one of a light source for photoactivating light or one or more optical elements coupled to the light source to deliver a pattern of photoactivating light according to the location of the treatment area. The photoactivating light photoactivates a crosslinking agent administered to the eye. The pattern of photoactivating light is defined by a plurality of treatment zones. The treatment zones are delivered to different respective areas on the eye. The plurality of treatment zones include at least a first treatment zone and a second treatment zone. The first treatment zone provides a first dose of the photoactivating light. The second treatment zone provides a second dose of the photoactivating light. The first dose is greater than the second dose. The first treatment zone is disposed within an inner boundary of the second treatment zone. In some cases, the treatment area may correspond to an expansion cone of the cornea, and the light source or at least one of the one or more optical elements may be operated to deliver the first treatment zone to the expansion cone and the second treatment zone to a region of the cornea outside the expansion cone. In other cases, the multiple treatment zones may include a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose and the third treatment zone being disposed within an inner boundary of the first treatment zone. The light source or at least one of the one or more optical elements may then be operated to deliver the first and third treatment zones to the expansion cone and to deliver the second treatment zone of photoactivating light to a region of the cornea outside the expansion cone. [Brief explanation of the drawings]

[0009] [Figure 1] FIG. 1 illustrates one exemplary system for delivering a cross-linking agent and photoactivating light to the cornea of ​​an eye to produce cross-links in corneal collagen, according to an embodiment of the present disclosure. [Figure 2] 1A-1C illustrate exemplary patterns of photoactivating light that may be applied to treat corneal ectatic disorders, according to aspects of the present disclosure. [Figure 3] 3A-3C illustrate one exemplary method for applying the pattern of FIG. 2 to treat corneal ectasia disorders, according to an embodiment of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0010] While the disclosure is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that it is not intended to limit the disclosure to the particular forms disclosed, but on the contrary, it is intended to cover all modifications, equivalents, and alternatives falling within the spirit of the disclosure.

[0011] FIG. 1 illustrates an exemplary treatment system 100 for creating collagen cross-linking in a cornea 2 of an eye 1. The treatment system 100 includes an applicator 132 for applying a cross-linking agent 130 to the cornea 2. In an exemplary embodiment, the applicator 132 may be an eye dropper, syringe, or the like that applies the photosensitizer 130 as droplets to the cornea 2. Exemplary systems and methods for applying cross-linking agents are described in U.S. Pat. No. 10,342,697, filed April 13, 2017, entitled "Systems and Methods for Delivering Drugs to an Eye," the contents of which are incorporated herein by reference in their entirety.

[0012] The cross-linking agent 130 may be provided in a formulation that allows the cross-linking agent 130 to pass through the corneal epithelium 2 a to the underlying region within the corneal stroma 2 b. Alternatively, the corneal epithelium 2 a may be removed or otherwise incised to allow for more direct application of the cross-linking agent 130 to the underlying tissue.

[0013] The treatment system 100 includes an illumination system with a light source 110 and optical elements 112 for directing light toward the cornea 2. This light causes photoactivation of a crosslinking agent 130, producing crosslinking activity in the cornea 2. For example, the crosslinking agent can include riboflavin, and the light for photoactivation (hereinafter referred to as photoactivating light) can include ultraviolet A (UVA) light (e.g., approximately 365 nm). Alternatively, the photoactivating light can include another wavelength, such as a visible wavelength (e.g., approximately 452 nm). As described further below, corneal crosslinking improves corneal strength by creating chemical bonds within corneal tissue according to a photochemical kinetic reaction mechanism. For example, riboflavin and photoactivating light can be administered to stabilize and / or strengthen corneal tissue to address corneal ectasia disorders (e.g., keratoconus or post-LASIK ectasia). Furthermore, administration of riboflavin and photoactivated light may enable refractive correction of varying degrees, including, for example, combinations of myopia, hyperopia, astigmatism, irregular astigmatism, presbyopia, and complex corneal refractive surface correction due to corneal ectasia disorders, as well as other conditions such as corneal biomechanical changes / degenerations.

[0014] The treatment system 100 includes one or more controllers 120 that control aspects of the system 100 (including the light source 110 and / or optical elements 112). In one embodiment, the cornea 2 may be more broadly treated with the cross-linking agent 130 (e.g., using eye drops, a syringe, etc.), and photoactivating light from the light source 110 may be selectively directed to the areas of the cornea 2 to be treated according to a particular pattern.

[0015] The optical element 112 may include one or more mirrors or lenses for directing and focusing the photoactivating light emitted by the light source 110 in a specific pattern on the cornea 2. The optical element 112 may further include filters for partially blocking wavelengths of light emitted by the light source 110 and for selecting specific wavelengths of light directed at the cornea 2 for photoactivating the crosslinking agent 130. Furthermore, the optical element 112 may include one or more beam splitters for splitting the beam of light emitted by the light source 110 and may include one or more heat sinks for absorbing the light emitted by the light source 110. The optical element 112 may also accurately and precisely focus the photoactivating light to a specific focal plane within the cornea 2 (e.g., at a specific depth within the lower region 2b where crosslinking activity is desired).

[0016] Additionally, the specific characteristics of the photoactivating light can be modified to achieve a desired degree of crosslinking in selected regions of the cornea 2. One or more controllers 120 can control the operation of the light source 110 and / or optical elements 112 to precisely deliver the photoactivating light according to any combination of wavelength, bandwidth, intensity, power, location, depth of penetration, and / or treatment duration (duration of exposure cycle, duration of dark cycle, and ratio of duration of exposure cycle to dark cycle).

[0017] The parameters for photoactivation of the cross-linking agent 130 can be adjusted, for example, to reduce the time required to achieve the desired cross-linking. In one implementation, the time can be reduced from minutes to seconds. Some configurations use 5 mW / cm 2 Although the photoactivating light can be applied at an irradiance of 100 mW / cm, to reduce the time required to achieve the required crosslinking, the photoactivating light can be applied at a greater irradiance (e.g., 5 mW / cm). 2 The total dose of energy absorbed by the cornea 2 can be described as the effective dose, which is the amount of energy absorbed through an area of ​​the corneal epithelium 2a. For example, the effective dose for an area of ​​the corneal surface 2a can be, for example, about 5 J / cm 2 , or about 20 J / cm 2 , or about 30 J / cm 2The effective doses listed can be delivered from a single administration of energy or from repeated administrations of energy.

[0018] The optical element 112 of the present treatment system 100 may include a microelectromechanical system (MEMS) device, such as a digital micro-mirror device (DMD), to spatially and temporally modulate the irradiation of photoactivating light. Using DMD technology, photoactivating light from the light source 110 is projected in a precise spatial pattern created by an array of extremely small mirrors on a semiconductor chip. Each mirror represents one or more pixels of the projected light pattern. The DMD can be used to perform topography-guided crosslinking. Control of the DMD by topography can use several different spatial and temporal irradiance and dose profiles. These spatial and temporal dose profiles can be created using continuous wave irradiation, but can also be adjusted through pulsed irradiation by pulsing the irradiation source at varying frequencies and duty cycles. Alternatively, the DMD can be tuned to vary the frequency and duty cycle on a pixel-by-pixel basis, providing ultimate flexibility using continuous wave irradiation. Alternatively, both pulsed irradiation and a combination of adjusted DMD frequency and duty cycle may be combined. This spatially determined crosslinking may be combined with dosimetry, interferometry, optical coherence tomography (OCT), corneal topography, etc. for pre-treatment planning and / or real-time monitoring and adjustment of corneal crosslinking during treatment. Aspects of dosimetry systems are described in more detail below. Additionally, pre-clinical patient information may be combined with finite element biomechanical computer modeling to generate patient-specific pre-treatment plans.

[0019] To control aspects of the delivery of photoactivating light, embodiments may also employ aspects of multiphoton excitation microscopy. Specifically, rather than delivering a single photon of a specific wavelength to the cornea 2, the treatment system 100 may deliver multiple photons of longer wavelengths (i.e., lower energy) that combine to initiate crosslinking. Advantageously, longer wavelengths are scattered less within the cornea 2 than shorter wavelengths, allowing longer wavelength light to penetrate the cornea 2 more efficiently than shorter wavelengths. The shadowing effect of incident radiation deeper within the cornea is also reduced compared to conventional shorter wavelength radiation because light is absorbed much less by the photosensitizer at longer wavelengths. This allows for enhanced control over depth-specific crosslinking. For example, in some embodiments, two photons may be used, with each photon carrying approximately half the energy required to excite molecules within the crosslinking agent 130 to produce the photochemical reaction described further below. When the crosslinker molecule absorbs both photons simultaneously, it absorbs enough energy to release reactive radicals in the corneal tissue. Embodiments may also utilize lower energy photons, such that the crosslinker molecule must simultaneously absorb, for example, three, four, or five photons, to release reactive radicals. The likelihood of multiple photons being absorbed nearly simultaneously is low, thus requiring a high flux of excitation photons, which can be delivered via a femtosecond laser.

[0020] Many conditions and parameters affect the cross-linking of corneal collagen by the cross-linking agent 130. For example, the irradiance and dose of the photoactivating light affect the amount and rate of cross-linking.

[0021] When the cross-linking agent 130 is specifically riboflavin, the UVA light may be applied continuously (continuous wave (CW)) or as pulsed light, with this selection affecting the amount, rate, and extent of cross-linking. When the UVA light is applied as pulsed light, the duration of the exposure cycle, the dark cycle, and the ratio of the exposure cycle to the dark cycle duration affect the resulting corneal stiffening. Pulsed light exposure can be used to increase or decrease stiffening of the corneal tissue more than can be achieved with continuous wave exposure delivering the same amount or dose of energy. Light pulses of appropriate length and frequency can be used to achieve more optimal chemical amplification. For pulsed light therapy, the on / off duty cycle can be between about 1000 / 1 and about 1 / 1000. The irradiance can be adjusted to an average irradiance of about 1 mW / cm. 2 to approximately 1000 mW / cm 2 and the pulse rate can be between about 0.01 Hz and about 1000 Hz, or between about 1000 Hz and about 100,000 Hz.

[0022] The present treatment system 100 may generate pulsed light by employing a DMD (which electronically turns the light source 110 on and off) and / or by using mechanical or optoelectronic (e.g., Pockels cell) shutters, mechanical choppers, or rotating apertures. Due to the inherent modulation capabilities of the DMD's pixels and subsequent stiffening based on the modulated frequency, duty cycle, irradiance, and dose delivered to the cornea, complex biomechanical stiffness patterns can be imparted to the cornea. A particular advantage of the DMD system and method is that it allows for the creation of non-periodic, uniform-appearing illumination (which eliminates the possibility of inducing photosensitive epileptic seizures or flicker vertigo to pulse frequencies between 2 Hz and 84 Hz) due to random, asynchronous pulse topography patterning.

[0023] Although the exemplary embodiment may use a stepped on / off pulsed light function, it is understood that other functions for irradiating the cornea with light may be used to achieve a similar effect. For example, light may be irradiated to the cornea according to a sinusoidal function, a sawtooth function, or other complex function or curve, or any combination of functions or curves. In fact, it will be understood that the function may be substantially stepped, even if there may be a more gradual transition between the on / off values. Furthermore, it will be understood that the irradiance need not decrease to a value of zero during the off cycle, but may in some cases be above zero during the off cycle. The desired effect may be achieved by irradiating the cornea with light according to a curve that varies the irradiance between two or more values.

[0024] Examples of systems and methods for delivering photoactivating light are described, for example, in U.S. Patent Application Publication No. 2011 / 0237999, entitled "Systems and Methods for Applying and Monitoring Eye Therapy," filed March 18, 2011; U.S. Patent Application Publication No. 2012 / 0215155, entitled "Systems and Methods for Applying and Monitoring Eye Therapy," filed April 3, 2012; and U.S. Patent Application Publication No. 2013 / 0245536, entitled "Systems and Methods for Corneal Cross-Linking with Pulsed Light," filed March 15, 2013, the contents of which are incorporated herein by reference in their entireties. Embodiments may generate cross-linking activity within the cornea according to a circular and / or annular pattern defined by the delivery of photoactivating light (e.g., via a DMD as described above). Additionally or alternatively, embodiments may generate cross-linking activity within the cornea according to a non-circular and / or annular pattern defined by the delivery of photoactivating light (e.g., via a DMD).

[0025] Multiple patterns of photoactivating light can be applied to the eye (e.g., via a DMD) in separate treatment zones at different doses, delivered sequentially or sequentially. For example, one treatment zone can be "turned off" (i.e., delivery of the corresponding photoactivating light is stopped) while another treatment zone can be "left on" (i.e., delivery of the corresponding photoactivating light continues). Treatment zones can be formed, for example, in an annular shape around a central point of the eye. There can also be discontinuous zones where photoactivating light is not applied (e.g., a central treatment zone surrounded by a ring of no light, which is surrounded by an annular treatment zone of light). The widths of the annular zones can be different dimensions (e.g., one annular zone has a width of 1 mm and another has a width of 2 mm). Delivering photoactivating light to annular treatment zones on the periphery of the eye without a central treatment zone can result in hyperopia correction, for example, by increasing the curvature of the central region of the eye while strengthening the periphery. In some cases, the central and peripheral treatment zones can be elliptical in shape to address astigmatism, for example, by preferentially generating cross-linking activity in areas of the cornea to correct the astigmatism. Such elliptical annular treatment zones are preferentially oriented with the axis of the annular treatment zone aligned according to the orientation of the astigmatism. Elliptical treatment zones can also be irregularly asymmetric (i.e., have major and minor axes that are not perpendicular to each other and may be located with separate center points (centers of gravity)).

[0026] The crosslinking treatment can be tailored according to one or more biomechanical characteristics of the eye, such as corneal topography (i.e., shape), corneal strength (i.e., stiffness), and / or corneal thickness. Optical correction and / or strengthening of the cornea can be achieved by administering a crosslinking agent and / or photoactivating light in one or more iterations (with adjustable characteristics for each iteration). Generally, the developed treatment plan can include multiple applications of crosslinking agent, the dosage and concentration of crosslinking agent for each application, the number and timing, duration, power, energy dose, and pattern of photoactivating light applications for each application. Furthermore, the crosslinking treatment can be adapted based on feedback information regarding biomechanical characteristics collected in real time during treatment or during interruptions in treatment.

[0027] The addition of oxygen also affects the degree of corneal hardening. In human tissue, the O2 content is extremely low compared to atmospheric air. However, the rate of crosslinking in the cornea is related to the O2 concentration at the time of photoactivating light irradiation. Therefore, it may be advantageous to actively increase or decrease the O2 concentration during irradiation to control the crosslinking rate until the desired degree of crosslinking is achieved. Oxygen may be administered during crosslinking treatment in several different ways. One approach is to supersaturate riboflavin with O2. In this way, when riboflavin is administered to the eye, a high concentration of O2 is delivered directly into the cornea along with the riboflavin, influencing reactions involving O2 when the riboflavin is exposed to photoactivating light. Another approach involves maintaining a steady state of O2 (at a selected concentration) at the surface of the cornea, exposing the cornea to a selected amount of O2, allowing O2 to enter the cornea. 1 , for example, treatment system 100 also includes an oxygen source 140 and an oxygen delivery device 142 that optionally delivers oxygen at an optionally selected concentration to cornea 2. Exemplary systems and methods for administering oxygen during cross-linking treatment are described, for example, in U.S. Patent No. 8,574,277, entitled "Eye Therapy," filed October 21, 2010, and U.S. Patent No. 9,707,126, entitled "Systems and Methods for Corneal Cross-Linking with Pulsed Light," filed October 31, 2012, the contents of which are incorporated herein by reference in their entireties. Additionally, exemplary mask devices for delivering oxygen concentrations and photoactivating light in ocular treatment are described in U.S. Provisional Patent Application Publication No. 2017 / 0156926, filed December 3, 2016, entitled "Systems and Methods for Treating an Eye with a Mask Device," the contents of which are incorporated herein by reference in their entirety. For example, a mask can be placed over the eye to provide a consistent and known oxygen concentration on the surface of the eye.

[0028] Riboflavin undergoes photoactivation upon absorption of irradiating energy (particularly light). There are two photochemical kinetic pathways for riboflavin photoactivation: Type I and Type II. The reactions involved in both the Type I and Type II mechanisms, as well as other aspects of the photochemical kinetic reactions that produce cross-linking activity, are described in U.S. Pat. No. 10,350,111, entitled "Systems and Methods for Cross-Linking Treatments of an Eye," filed April 27, 2016, the contents of which are incorporated herein by reference in their entirety.

[0029] To treat corneal ectatic disorders (e.g., keratoconus), effective cross-linking surgery precisely delivers photoactivating light to specific regions of the cornea treated with a cross-linking agent. For example, FIG. 2 illustrates an exemplary pattern 200 of photoactivating light that may be delivered to treat a corneal ectatic disorder associated with cornea 2 of eye 1. As described above, UV light may be delivered according to pattern 200 to photoactivate a cross-linking agent (e.g., lyoflavin) that has been applied to cornea 2. As illustrated, pattern 200 includes high-dose treatment zones 202a,b and low-dose treatment zone 204. High-dose treatment zones 202a,b deliver more energy via photoactivating light than low-dose treatment zone 204.

[0030] The high-dose treatment zones 202a,b are centered around and cover the extent of the ectatic cone caused by disorders such as keratoconus. Thus, the high-dose treatment zones 202a,b can reduce (i.e., flatten) the curvature of the ectatic cone. The location of the ectatic cone can be determined, for example, by evaluating a topography, tomography, and / or pachymetry of the cornea 2. As shown in FIG. 2 , the high-dose treatment zone 202a is concentrically disposed within the high-dose treatment zone 202b. The inner high-dose treatment zone 202a provides approximately 10.5 J / cm . 2and an outer high dose treatment zone 202b provides a dose of about 8.5 J / cm 2 provides a dose of

[0031] Meanwhile, the low-dose treatment zone 204 extends from the outer edges of the high-dose treatment zones 202a,b to cover the peripheral region of the cornea, but the outer edges of the low-dose treatment zone 204 do not extend beyond the limbus. Thus, the low-dose treatment zone 204 stabilizes the surrounding non-ectatic cornea. As shown in FIG. 2, the low-dose treatment zone 204 is greater than zero and approximately 5.4 J / cm 2 In some embodiments, other approaches teach away from the use of low dose treatment zones 204 in pattern 200 because it is believed that irradiating areas outside the expanding cone of photoactivating light can have an undesirable effect on the effectiveness of the photoactivating light irradiated on the expanding cone (e.g., preventing the desired flattening of the expanding cone).

[0032] 2 can be achieved by adjusting aspects of the optical element 112 as described above. For example, the DMD can be programmed via the controller 120 to define high-dose treatment zones 202a, b and low-dose treatment zones 204 as different respective pixelated shapes that are irradiated onto the cornea 2. The depth along the z-axis for delivery of the photoactivating light can be achieved by adjusting the irradiation of the photoactivating light.

[0033] 3 illustrates an exemplary method 300 for applying photoactivating light according to pattern 200. At time t=0, delivery of photoactivating light to all treatment zones 202a,b, 204 begins substantially simultaneously in operation 302. At time t=t 204 and a desired lower dose (e.g., about 5.4 J / cm 2 ) is achieved, delivery of photoactivating light to the lower treatment zone 204 stops in operation 304. At time t=t 202b and a desired higher dose (e.g., about 8.5 J / cm2 ) is achieved, delivery of photoactivating light to the outer, higher dose treatment zone 202b is stopped in a subsequent operation 306. 202a and a desired higher dose (e.g., about 10.5 J / cm 2 ) is achieved, delivery of photoactivating light to the inner higher dose treatment zone 202a is stopped in a subsequent operation 308.

[0034] The exemplary pattern 200 shown in Figure 2 may include two high-dose treatment zones 202a, b, while another pattern may include only one high-dose treatment zone. (For example, equal doses may be provided in treatment zones 202a, b, as shown in Figure 2.) Alternatively, another pattern may include three or more higher-dose treatment zones. The exemplary pattern 200 shown in Figure 2 may include one low-dose treatment zone 204, while another pattern may include multiple low-dose treatment zones outside the expandability cone.

[0035] It is also understood that the treatment zones may be positioned and / or shaped differently than that shown in FIG. 2. For example, the treatment zones may be elliptical. Further, while treatment zones 202a, b, 204 may provide a particular dose as described above, other patterns may provide different doses in each treatment zone. Additionally, the dose relationships between different treatment zones may differ from that shown in FIG. 2. For example, the dose delivered outside the expandable cone may be greater than the dose delivered toward the expandable cone.

[0036] As mentioned above, according to some aspects of the present disclosure, some or all of the steps of the procedures described and illustrated above may be automated or guided under the control of a controller (e.g., controller 120). In general, the controller may be implemented as a combination of hardware and software elements. The hardware aspects may include a combination of operably coupled hardware components including a microprocessor, logic circuitry, communication / network ports, digital filters, memory, or logic circuitry. The controller may be adapted to perform operations specified by computer-executable code, which may be stored on a computer-readable medium.

[0037] As described above, the controller may be a programmable processing device (e.g., an external conventional computer or an on-board field programmable gate array (FPGA) or digital signal processor (DSP)) that executes software or stored program instructions. In general, the physical processor and / or machine used by the embodiments of the present disclosure for any processing or evaluation may include one or more networked or non-networked general-purpose computer systems, microprocessors, field programmable gate arrays (FPGAs), digital signal processors (DSPs), microcontrollers, etc., programmed according to the teachings of the exemplary embodiments of the present disclosure, as will be understood by those skilled in the computer and software arts. The physical processor and / or machine may be externally networked with the image capture device or may be integrated so as to reside within the image capture device. As will be understood by those skilled in the software arts, appropriate software may be readily prepared by a programmer of ordinary skill based on the teachings of the exemplary embodiments. Furthermore, the devices and subsystems of the exemplary embodiments may be implemented by the preparation of application-specific integrated circuits or by interconnecting a number of conventional component circuits in an appropriate network, as will be understood by those skilled in the electrical arts. Thus, the exemplary embodiments are not limited to any specific combination of hardware circuitry and / or software.

[0038] Exemplary embodiments of the present disclosure may include software or stored program instructions stored on any one or combination of computer-readable media for controlling the devices and subsystems of the exemplary embodiments, for driving the devices and subsystems of the exemplary embodiments, and for enabling the devices and subsystems of the exemplary embodiments to interact with, for example, a human user. Such software may include, but is not limited to, device drivers, firmware, operating systems, development tools, application software, etc. Such computer-readable media may further include computer program products of the present disclosure for performing all or a portion (if processing is distributed) of the processing performed in the implementation. Computer code devices of the exemplary embodiments of the present disclosure may include any suitable interpretable or executable code mechanism, including, but not limited to, scripts, interpretable programs, dynamic link libraries (DLLs), Java classes and applets, complete executable programs, etc. Furthermore, portions of the processing of the exemplary embodiments of the present disclosure may be distributed for better performance, reliability, cost, etc.

[0039] Common forms of computer-readable media may include, for example, a floppy disk, flexible disk, hard disk, magnetic tape, other suitable magnetic media, CD-ROM, CDRW, DVD, other suitable optical media, punch cards, paper tape, optical mark sheets, other suitable physical media with patterns of holes or other optically recognizable indicia, RAM, PROM, EPROM, FLASH-EPROM, other suitable memory chips or cartridges, a computer-readable carrier wave, or other suitable medium.

[0040] While the present disclosure has been described with reference to one or more particular embodiments, those skilled in the art will recognize that many modifications may be made thereto without departing from the spirit and scope of the present disclosure. Each of these embodiments and obvious variations thereof is considered to be within the spirit and scope of the present disclosure. It is also contemplated that additional embodiments according to aspects of the present disclosure may combine any number of features of any of the embodiments described herein.

Claims

1. 1. A system for treating an eye, comprising: a light source configured to provide photoactivating light to photoactivate the crosslinking agent administered to the eye; and one or more optical elements configured to receive the photoactivating light and deliver the photoactivating light to the eye according to a pattern defined by a plurality of treatment zones; Equipped with the plurality of treatment zones are delivered to different respective regions on the eye, the plurality of treatment zones including at least a first treatment zone and a second treatment zone, the first treatment zone providing a first dose of photoactivating light and the second treatment zone providing a second dose of photoactivating light, the first dose being greater than the second dose, and the first treatment zone being disposed within an inner boundary of the second treatment zone; The above system.

2. 2. The system of claim 1, wherein the plurality of treatment zones includes a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose, and the third treatment zone being disposed within an inner boundary of the first treatment zone.

3. The system of claim 2 , wherein the first treatment zone and the third treatment zone are concentric circles.

4. The system of claim 1 , wherein the plurality of treatment zones are defined by pixels of the photoactivating light.

5. The system of claim 1 , wherein the one or more optical elements include a digital micromirror device configured to generate the pattern defined by the plurality of treatment zones.

6. 10. The system of claim 1, further comprising a controller including one or more processors configured to execute program instructions stored on one or more computer-readable media, the program instructions causing the one or more processors to determine a location of a treatment area on the eye and to control at least one of the light source or the one or more optical elements to deliver the pattern of photoactivating light according to the location of the treatment area.

7. 6. The system of claim 5, wherein the program instructions cause the one or more processors to determine the location of the treatment area on the cornea based on information related to at least one of corneal topography, tomography, or pachymetry.

8. 8. The system of claim 7, wherein the treatment area corresponds to an expansion cone in the cornea, and the one or more processors control the light source or at least one of the one or more optical elements to deliver the first treatment zone to the expansion cone and deliver the second treatment zone to an area of ​​the cornea outside the expansion cone.

9. 8. The system of claim 7, wherein the plurality of treatment zones includes a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose, the third treatment zone being positioned within an inner boundary of the first treatment zone, and the one or more processors control at least one of the light source or the one or more optical elements to deliver the first treatment zone and the third treatment zone to the diverging cone and to deliver the second treatment zone of the photoactivating light to a region of the cornea outside the diverging cone.

10. At least one of the light source or the one or more optical elements simultaneously initiating delivery of the first treatment zone and the second treatment zone to the eye; ceasing delivery of the second treatment zone after the second dose has been delivered; ceasing delivery of the first treatment zone after the first dose has been delivered, the delivery of the second treatment zone being stopped before the delivery of the first treatment zone is stopped; By The system of claim 1 , configured to deliver the first dose of photoactivating light and the second dose of photoactivating light.

11. 2. The system of claim 1, wherein at least one of the light source or the one or more optical elements is configured to deliver the photoactivating light to one or more depths along an axis extending below the surface of the eye by adjusting an irradiance of the photoactivating light in each of the plurality of treatment zones, and the pattern of photoactivating light is defined along a plane intersecting the axis.

12. 1. A method for treating an eye, comprising: determining the location of a treatment area on the eye; and operating at least one of a light source for photoactivating light or one or more optical elements coupled to the light source to deliver a pattern of photoactivating light according to the location of the treatment area; It encompasses the photoactivating light photoactivates a crosslinking agent administered to the eye, the pattern of activation light being defined by a plurality of treatment zones, the treatment zones being delivered to different respective areas on the eye, the plurality of treatment zones including at least a first treatment zone and a second treatment zone, the first treatment zone providing a first dose of the photoactivating light and the second treatment zone providing a second dose of the photoactivating light, the first dose being greater than the second dose, and the first treatment zone being disposed within an inner boundary of the second treatment zone. The above method.

13. 13. The method of claim 12, wherein the plurality of treatment zones includes a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose, and the third treatment zone being disposed within an inner boundary of the first treatment zone.

14. 13. The method of claim 12, wherein the one or more optical elements include a digital micromirror device configured to generate the pattern defined by the plurality of treatment zones.

15. 13. The method of claim 12, wherein determining the location of the treatment area on the eye comprises determining the location of the treatment area on the cornea based on information related to at least one of corneal topography, tomography, or pachymetry.

16. 13. The method of claim 12, wherein the treatment area corresponds to an ectatic cone in the cornea, and wherein at least one of the light source or one or more optical elements is operated to deliver the first treatment zone to the ectatic cone and to deliver the second treatment zone to a region of the cornea outside the ectatic cone.

17. 17. The method of claim 16, wherein the plurality of treatment zones includes a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose, the third treatment zone being positioned within an inner boundary of the first treatment zone, and at least one of the light source or one or more optical elements being operated to deliver the first treatment zone and the third treatment zone to an ectatic cone and to deliver the second treatment zone of the photoactivating light to a region of the cornea outside the ectatic cone.

18. At least one of the light source or the one or more optical elements simultaneously initiating delivery of the first treatment zone and the second treatment zone to the eye; ceasing delivery of the second treatment zone after the second dose has been delivered; stopping delivery of the first treatment zone after the first dose has been delivered, and delivery of the second treatment zone is stopped before delivery of the first treatment zone is stopped.

13. The method of claim 12, wherein the first dose of photoactivating light and the second dose of photoactivating light are operated by

19. 13. The method of claim 12, wherein at least one of the light source or the one or more optical elements is further operated to deliver the photoactivating light to one or more depths along an axis extending below the surface of the eye by adjusting an irradiance of the photoactivating light in each of the plurality of treatment zones, and the pattern of the photoactivating light is defined along a plane transverse to the axis.

20. 13. The method of claim 12, further comprising administering the cross-linking agent to the eye.

Images