Direct laser trabeculoplasty method and apparatus

Abstract

To provide apparatus and methods for treating glaucoma in a patient's eye (25).SOLUTION: A treatment laser beam is directed at the trabecular meshwork of the patient's eye to initiate reactions that promote improved drainage of aqueous humor fluid.SELECTED DRAWING: Figure 3a

Description

[Technical Field]

[0001] The present invention relates to ophthalmic treatments of the human eye, and more particularly to the treatment of glaucoma using a laser beam, in which the laser beam is directed at the trabecular meshwork to initiate a response that promotes improved drainage of aqueous humor.

[0002] The present invention relates to an ophthalmic device for treating glaucoma in a patient's eye.

[0003] The present invention further relates to a method for treating glaucoma. [Background technology]

[0004] Glaucoma, a disease that impairs vision as a result of damage to the optic nerve or retina, accounts for approximately 25% of blindness cases in developed countries. A common cause of this damage is increased pressure in the intraocular fluid known as aqueous humor. This increased intraocular pressure leads to the gradual death of retinal ganglion cells and damage to the axons that transmit visual information to the brain via the optic nerve. This aqueous humor is constantly and slowly replaced by the body through entry from the ciliary body, located just below the iris, and balanced drainage through a circular, spongy structure known as the trabecular meshwork, which surrounds the iris margin, where the iris meets the cornea and the cornea transitions into the sclera. Drainage occurs from the trabecular meshwork into a structure called Schlemm's canal and ultimately into the body's circulatory system.

[0005] The primary cause of elevated intraocular pressure is an imbalance between fluid inflow and outflow due to dysfunction of the trabecular meshwork. The trabecular meshwork functions to drain fluid through channels distributed around the trabecular meshwork, but with age, these channels become clogged with cellular debris. Previous attempts to improve drainage have included medications and surgical procedures. A more recent method, known as laser trabeculoplasty, relies on directing a pulsed, focused laser beam onto the trabecular meshwork with sufficient intensity to damage pigmented melanocytes and initiate biological changes, thereby repopulating the laser-damaged area with cells from non-filtering regions of the trabecular meshwork. These cells have been shown to behave as stem cells and produce fresh, functional cells, thereby restoring drainage through the trabecular meshwork.

[0006] Currently, delivery of a laser beam to the trabecular meshwork is accomplished by directing the laser beam obliquely through the cornea of ​​the eye with the aid of an optic placed against the eye, and then laterally directing the laser beam toward the trabecular meshwork using a mirror built into the optic. This treatment method is known as Selective Laser Trabeculoplasty, or SLT. This system requires the ophthalmologist to rotate the optic to treat multiple areas around the trabecular meshwork. When sufficient intensity is achieved, the response can be identified by the production of microbubbles. The production and detection of microbubbles indicates sufficient treatment laser energy.

[0007] This method has several disadvantages: it can be difficult for the physician to precisely direct the beam to the desired spot on the trabecular meshwork™; the procedure requires great skill to avoid risk of injury and infection; and the procedure can be quite lengthy, causing discomfort to the patient.

[0008] An improved version of this technique, proposed in a patent application by Belkin (Patent Document 1), involves directing a treatment laser beam through the sclera and into the trabecular meshwork. The drawback of this approach is that both the ideal dose and the exact location of the TM are unknown; both parameters are assumed in the application, even though in practice the exact location of the TM is unknown and the required energy dose is uncertain. The location or diameter of the TM relative to the iris varies from person to person, and it generally cannot be detected through the sclera. The beam intensity required to cause damage to melanocytes cannot be readily determined because it depends on intrascleral scattering and absorption, the magnitude of which varies from person to person, and on the positioning along the trabecular meshwork. [Prior art documents] [Patent documents]

[0009] [Patent Document 1] US Patent Application Publication No. 2015 / 0366706 (A1) [Non-patent literature]

[0010] [Non-Patent Document 1] Vol 9, No. 7 of Biomedical Optics Express - “Selective retina therapy enhanced with optical coherence tomography for dosimetry control and monitoring: a proof of concept study” by Daniel Kauffman Summary of the Invention [Problem to be solved by the invention]

[0011] It is an object of the present invention to provide a method or apparatus for treating the trabecular meshwork of the eye that allows for automated control of the positioning and intensity of the treatment laser beam and minimizes operator involvement with the procedure once it has begun. [Means for solving the problem]

[0012] This objective is achieved by determining an energy dose by detecting and analyzing backscattered reflections of light from a probe light beam directed at one or more areas near the trabecular meshwork, and delivering a treatment laser beam at that energy dose to a location through the sclera of the eye.

[0013] The present invention provides an uncomplicated means by which selective laser trabeculoplasty procedures can be performed through the sclera from the front of the eye without optics in contact with the eye.

[0014] Furthermore, although it is not necessary to know the exact location of the trabecular meshwork in a broad sense, the method described below can be a sufficiently accurate method for determining its location.

[0015] The present invention may further be described as a glaucoma treatment method or apparatus that focuses a pulsed treatment laser beam posterior to the sclera onto the trabecular meshwork of the eye, wherein the probe light beam is coupled to an optical coherence tomography imaging subsystem that identifies the location of the trabecular meshwork and detects when microbubbles form during the increasing energy phase of the treatment laser beam.

[0016] In another aspect, the present invention can be described as a method or apparatus for treating glaucoma that focuses a pulsed treatment laser beam posterior to the sclera onto the trabecular meshwork of the eye, characterized by sequentially projecting segmented lines of a certain size across the inner and outer radii (referenced to the center of the iris) using a scanning means, and setting the laser beam energy sufficient to cause damage to melanocytes within the trabecular meshwork.

[0017] The treatment laser beam energy is determined by performing an initial test, in which the energy is increased after each radial scan until a microbubble is formed, and its formation is detected by the change in the backscatter intensity of the probe light beam due to the creation of a gas-liquid interface.

[0018] The laser probe beam can be the same as the treatment beam, or it can be a separate laser beam with a more optimal wavelength and intensity.

[0019] In an alternative embodiment of the invention, the location of the TM is determined at multiple radial positions, e.g., 8 or 16 or more, and interpolation is performed to determine its location at various radial directions, which are recorded using digital imaging means relative to the outer diameter of the iris, which is later used as a reference position.

[0020] In this specification, we will refer to this condition as the focused beam condition, even though, as will be appreciated, the treatment beam will not be focused immediately behind the sclera due to scattering in translucent tissue.

[0021] According to an additional aspect of the present invention, the task of the present invention is solved by an ophthalmic device for treating glaucoma in a patient's eye, the ophthalmic device comprising: a treatment laser module for delivering a treatment laser beam; and a detection system for detecting microcavitations, in particular microbubbles, formed in the patient's eye, in particular in the trabecular meshwork of the patient's eye, due to the treatment laser beam.

[0022] With better knowledge of the location and / or duration and / or level of microcavitation, each microbubble, the energy delivered to the eye can be minimized as well as the duration of the treatment.

[0023] To that extent, the detection system provides additional position control to control the location of the microcavitations in the trabecular meshwork.

[0024] This alone is a successful further development of existing glaucoma treatment methods.

[0025] According to a further aspect of the present invention, the task at hand is solved by an ophthalmic device for treating glaucoma in a patient's eye, the ophthalmic device comprising a treatment laser module for delivering a treatment laser beam and a detection system for detecting the two- or three-dimensional location and / or shape, in particular potential asymmetries, of the trabecular meshwork of the patient's eye.

[0026] Because the location and / or shape is better known prior to treatment, the energy delivered to the eye can be minimized as well as the duration of the treatment.

[0027] Thus, on the one hand, by implementing additional position control in the detection system, the position and shape of the trabecular meshwork can be detected, preferably prior to activation of the treatment laser module.

[0028] That is, the setting device may also include an ophthalmic device for measuring the eye, particularly the trabecular meshwork of the eye.

[0029] On the other hand, the position of the microcavitation can be controlled by position control using the detection system.

[0030] This alone is a successful further development of existing glaucoma treatment methods.

[0031] The location of the microcavitations can also be corrected, preferably live during the procedure.

[0032] In either case, the treatment laser beam can be modulated according to the information provided by the detection system.

[0033] The detection system can be constructed in a variety of ways.

[0034] A structurally simple yet precise solution can be realized by incorporating a tomographic imaging system for detecting microcavitations into the detection system.

[0035] Additionally or alternatively, the detection system may comprise an optical coherence tomography (OCT) system to detect the location and / or shape, particularly potential asymmetries and / or microcavitations.

[0036] The detection system may include many more components, such as a camera, a controller, a processor, a scanner, and the like.

[0037] Even more advantageously, the device can include an eye probe subsystem that emits a coaxial probe beam, allowing for exceptional visualization of the treatment site within the eye.

[0038] Since the beam is focused posterior to the sclera of the patient's eye, on the trabecular meshwork of the patient's eye, a non-contact treatment of the eye can be performed without any problems.

[0039] The tasks of the present invention are additionally fulfilled by an ophthalmic device for treating glaucoma, comprising a treatment laser module that delivers a treatment laser beam to a scanner and a focusing objective lens, and an eye probe subsystem that emits a coaxial probe beam that is focused posterior to the sclera of the patient's eye onto the trabecular meshwork, preferably with a detector within the eye probe subsystem that senses backscattered light from the probe beam and detects the formation of microbubbles caused by damage caused by the treatment laser beam to melanocytes in the trabecular meshwork.

[0040] This solution describes a useful and feasible device that can successfully implement the present invention, particularly by minimizing the energy delivered to the eye as well as the duration of the treatment.

[0041] Furthermore, the device can be particularly advantageously equipped with an energy control system that modulates the treatment laser beam depending on the information of the detection system, so that the required energy of the treatment laser beam can be dependent on the formation of microcavitations or microbubbles and / or on the shape of the area of ​​the eye to be treated, e.g., the trabecular meshwork.

[0042] In particular, a suitably designed energy control system can determine the intensity, duration, etc. of the energy level of the treatment laser beam according to the onset, progression, intensity, etc. of microcavitation or microbubble formation.

[0043] In an alternative configuration, the eye probe subsystem can advantageously be equipped with an optical coherence tomography (OCT) system to further determine the location of the trabecular meshwork prior to delivery of the treatment laser beam, thereby enabling the device to be implemented in a structurally simple manner.

[0044] The eye probe subsystem, equipped with a photodetector, allows for more compact observation of individual treatment areas of the eye.

[0045] As will be appreciated, the treatment laser beam and the probe beam can be provided independently of each other. The construction of the apparatus can be further simplified if the probe beam is the same as the treatment laser beam.

[0046] A particularly robust and error-free design of the laser beams used can be achieved by ensuring that the wavelength of the treatment laser beam is within the absorption range of melanocytes and the probe beam is infrared.

[0047] According to a further aspect of the invention, the present task is solved by a method for treating glaucoma, which comprises determining the location and / or shape of the trabecular meshwork through the sclera and delivering a treatment laser beam to that location with a beam energy sufficient to generate microbubbles, thereby resulting in an especially localized and precise treatment, allowing the energy required to generate the microbubbles to be set very precisely.

[0048] This allows for minimizing the energy delivered to the eye as well as the duration of the treatment.

[0049] In one highly successful version of the process, the energy is controlled and adjusted based on the influence of the microbubbles, and / or the size of the microcavitations, and / or the location and / or shape of the trabecular meshwork.

[0050] Furthermore, advantageously, an optical coherence tomography system can be used in an initial step to identify the location of the trabecular meshwork, and then direct a treatment laser beam to that location and deliver a preset laser energy dose to that location or increase the energy dose until microcavitation is detected by the tomography system, thereby allowing for a more precise identification of the treatment site on the eye, which can then be treated more gently with a laser beam of appropriate intensity.

[0051] In a particularly preferred process variant, the beam follows a pattern according to input from an energy control system, e.g., a processor and controller, which can be particularly successful, allowing only enough energy to be applied to the treatment area until microbubbles are formed, indicating sufficient treatment of the trabecular meshwork.

[0052] Advantageously, the pattern can comprise radial lines or segments extending from an inner radius R1 to an outer radius R2, with the radii corresponding to the edges of the likely location of the trabecular meshwork, thereby allowing the treatment laser beam to treat only those areas of the eye that are absolutely in need of glaucoma treatment.

[0053] In this respect it can also be said that by supplementing the methods described herein with further technical features, in particular apparatus features, described herein, the methods can be successfully further developed and the method details can be expressed or formulated even more precisely.

[0054] As may be expressly noted herein, any features of the above-listed embodiments and / or references may be combined, if desired, so that effects, features and advantages are combined and achieved in a multiplicative manner.

[0055] Of course, the above examples of embodiments are merely initial designs of the present invention, and therefore the embodiments of the present invention are not limited to those variations.

[0056] All features described herein are claimed as essential to the present invention insofar as they, by themselves or in any potential combination, are novel over the state of the art.

[0057] The invention can be better understood from the following description of two preferred embodiments illustrated in the accompanying drawings. [Brief explanation of the drawings]

[0058] [Figure 1] FIG. 1 shows a cross section of an eye bordered by a trabecular meshwork. [Figure 2] FIG. 1 illustrates the anterior appearance of the eye. [Figure 3a] FIG. 1 illustrates a laser spot pattern that can be projected onto the eye. [Figure 3b] FIG. 1 illustrates a laser spot pattern that can be projected onto the eye. [Figure 3c] FIG. 1 illustrates a laser spot pattern that can be projected onto the eye. [Figure 4] FIG. 1 is a diagram showing an overview of a preferred embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0059] According to FIG. 1 , the cornea 1 of the left eye 25 of a patient (not shown) is connected to the sclera 2. A fluid-filled anterior chamber 3 is closed by the pigment epithelium or iris 4, which surrounds the lens 5. The posterior chamber 6 contains the vitreous humor and represents the largest volume of the eye. Lying between the outer edge of the cornea and the outer edge of the iris is the trabecular meshwork 7, through which drainage occurs into Schlemm's canal 8. The trabecular meshwork 7 has a triangular cross-section.

[0060] Figure 2 shows a left eye 25 as it might be viewed by a physician. As shown, the pupil 9 is surrounded by the iris 10. The adjacent white sclera 11 conceals the trabecular meshwork 12, the width of which is exaggerated and shown between dashed lines.

[0061] The width of this trabecular meshwork 7 or 12 is typically on the order of 350 μm, and its depth is on the order of 50 to 150 μm.

[0062] In a system according to a preferred embodiment of the present invention, a probe light beam 38 (see FIG. 4) is delivered and thereby scanned according to the pattern shown in FIG. 3a.

[0063] According to Figure 3a, the trabecular meshwork 13 is located within a "ring of uncertainty" 14 having an inner radius R1 and an outer radius R2.

[0064] The probe beam repeats its traverse along a short radial line 15 between inner radius R1 and outer radius R2 around the eye 25 in several orientations separated by angles 16 of about 1 to 10 degrees.

[0065] The choice of angle 16 is a compromise between treatment duration and sufficient trabecular tissue damage density.

[0066] Although radial lines 15 are shown, other strategies for traversing between inner radius R1 and outer radius R2 are possible, such as zigzag segments 15 following a circular path as in Figure 3b, or angled radial lines 15 as in Figure 3c.

[0067] Curved forms of these patterns could also be used.

[0068] The term "line" is used to refer to the path of the beam, and at the microscopic level, the reaction path is made up of a series of discrete spots corresponding to the linear array of discretized positions of the probe beam 38.

[0069] The pattern is generated by a conventional galvanometer two-axis scanner 22 (see FIG. 4) or other device.

[0070] Another critical aspect of the present procedure is the determination of the energy required to damage melanocytes within the trabecular meshwork 7, 12 or 13.

[0071] According to conventional SLT understanding, one way to ensure damage is to increase the energy until gas bubbles form within the trabecular meshwork 7, 12 or 13.

[0072] Conventionally, their occurrence has been observed by a physician, but according to the present invention, the production of microbubbles is detected by changes in the backscattered reflection of an observation or treatment laser beam 21 (see FIG. 4), preferably an observation beam.

[0073] FIG. 4 outlines a first potential embodiment of an optical arrangement that may accomplish treatment laser beam 21 delivery and bubble detection.

[0074] Referring to FIG. 4, a treatment laser module 20 generates an incident laser treatment beam 21 .

[0075] The treatment laser module 20 includes any necessary attenuators, beam dimmers, and shutters (not shown separately).

[0076] A laser treatment beam 21 exiting treatment laser module 20 is directed to a two-axis scanner 22 from which it passes through a dichroic or partial reflector 23, through a focusing lens 24 and onto eye 25.

[0077] The eye probe system 27 consists of a probe light beam 38 and a detection system 40, which will be discussed in more detail below.

[0078] Light entering and leaving the eye probe system 27, particularly the probe beam 38, has an optical path 41 that substantially coincides with the treatment laser beam path 42, with the coupling of these optical paths 41 and 42 being achieved by the reflector 26.

[0079] This reflector 26 is preferably a dichroic mirror (not separately referenced) tailored to the reflection and transmission wavelengths envisaged.

[0080] A camera 28 captures the light reflected from the reflector 23 to locate and monitor the eye 25 .

[0081] This camera 28 also provides images that can be used to determine the scan pattern and provide a record for future reference.

[0082] To help minimize movement of the patient's eye 25, a gaze spot (not separately referenced) is provided at which the patient looks. This gaze spot is generated by a visible light lamp 29, collimated by a lens 30, and brought into a separate optical path 43 of the camera 28 by a partial reflector 31.

[0083] The treatment laser module 20 and scanner 22 are controlled by a controller 32, while a processor 33 performs the necessary electronic and data processing for the operator, camera 28 and eye probe system 27. A display 34 provides an interface for the operator.

[0084] Other components common to ophthalmic systems, such as viewing glasses for the surgeon, an illumination slit lamp, or an aiming beam, are not shown for clarity, but can be integrated with the components shown in Figure 4 by one skilled in the field of medical laser engineering.

[0085] The entire system can be moved relative to the eye 25 to focus the beams 21, 38.

[0086] In particular, the focal point of camera 28 is several hundred microns closer than that of treatment laser 21 and probe beam 38, ensuring that camera 28 is focused on sclera 2 or 11 when treatment and probe beams 21, 38 are focused below sclera 2, 11.

[0087] We now discuss the EyeProbe system 27 in more detail, noting that it can take several forms.

[0088] In particular, the present detection system 40, or at least its components, may be realized by the eye probe system 27 or its components, and vice versa.

[0089] In one suitable configuration for the above-described embodiment, the eye probe system 27 includes a photodetector 45 capable of detecting the reflected beam 38 of the probe light beam 38 .

[0090] This probe light beam 38 may be the same as the treatment laser beam 21, or it may be a separate light beam optimized for that function.

[0091] To determine the laser energy of the treatment laser beam 21 required to cause damage to the melanocytes of the trabecular meshwork 7, 12 or 13, the treatment laser beam 21 is repeatedly scanned along one of the paths of the radial segment 15 while increasing the laser energy until bubble formation is detected.

[0092] This threshold power is recorded and stored with a margin, e.g., 20%, to ensure vaporization is achieved in the other segments, and then the entire pattern is scanned with the laser set at the stored energy.

[0093] While the above embodiments and methods may be functional, it is desirable to better locate the trabecular meshwork 7, 12, or 13 in order to minimize the energy delivered to the eye and to minimize the duration of the treatment.

[0094] The specific location of the trabecular meshwork 7, 12, or 13 can be located, inter alia, by incorporating an optical coherence tomography (OCT) system 48 into the EyeProbe system 27. This arrangement represents that of a second preferred embodiment.

[0095] OCT has been successfully used to determine laser dose in retinal procedures as described in the paper "Ophthalmology and Imaging, Vol. 1, No. 1, pp. 111-114, 2013. In this case, the application is the retina, where a transparent medium is adjacent to the layer of interest.

[0096] However, the techniques of the present invention are applied through the semi-opaque sclera 2, 11 and can generate a profile of the outer layers of the eye 25, including the TM, despite both absorption and scattering.

[0097] OCT offers several different working methods, notably static depth profiling called A-scan, cross-sections along the surface of the object (in this case the eye) called B-scan, and movies made up of A-scans called M-scan.

[0098] It is when performing an M-scan that changes in reflectivity due to area, for example due to the generation of microbubbles, can be detected.

[0099] OCT systems are commercially available and are based on the scanning or spectrometer principle.

[0100] Advantageously, it is desirable to use the spectrometer principle in the present invention.

[0101] In the present invention, a profile of the trabecular meshwork 7, 12, or 13 is generated by scanning the OCT beam radially outward from the corneoscleral junction for approximately 1-2 mm. Based on this profile, the trabecular meshwork 7, 12, or 13 can be identified and located with good accuracy, and its radial location relative to the iris periphery or corneoscleral boundary can be digitally recorded.

[0102] By repeating this process at various locations around the eye 25, the processor can generate a map of the trabecular meshwork through interpolation of the results.

[0103] After locating the target for treatment, the OCT probe beam 38 is positioned at the target and kept in A-scan mode while the treatment laser beam 21 is activated.

[0104] The energy of the pulses delivered by treatment laser beam 21 is increased until a response is detected by the OCT system.

[0105] The energy is recorded and used for subsequent delivery to other areas along the periphery of the trabecular meshwork 7, 12 or 13.

[0106] An alternative dose determination technique involves keeping the treatment laser beam 21 focused on a single location on the trabecular meshwork 7, 12, or 13 and delivering repetitive low-energy pulses until a response is detected by OCT in A-scan mode, after which the treatment is paused and the target is moved to the next location.

[0107] Critical to this method is that the energy pulse must be delivered faster than the relaxation of the cells, thereby increasing the total energy within the cells to the point of microbubble formation.

[0108] Another alternative approach is to start with a lower energy dose and deliver repeated pulses of increasing energy to the same location on the trabecular meshwork 7, 12, or 13 while monitoring the OCT signal for changes corresponding to microbubble formation. Once a response is achieved, the treatment laser beam 21 is paused and advanced to the next location.

[0109] This alternative method works well if the pulse rate is slower than the thermal relaxation of the cells, allowing them to dissipate the energy from the previous pulse before the arrival of the next pulse.

[0110] With both of these methods, the same dose information can be obtained and used for subsequent locations on the trabecular meshwork 7, 12 or 13.

[0111] Although pulsed lasers are referenced herein, continuous wave (CW) lasers may also be used.

[0112] The treatment laser beam 21 is of a wavelength that can be favorably absorbed by melanocytes; typically a green laser (532 nm) is used in SLT, although longer wavelengths up to 800 nm can also be used to provide better penetration into the sclera 2, 11.

[0113] The OCT system 48 may operate in the infrared wavelength range, with good penetration within the sclera 2, 11 (800 nm to 1550 nm).

[0114] Both the treatment laser and the OCT laser can be integrated into a single module, thereby ensuring their collinearity during integration into the rest of the system.

[0115] Preferably, the entire eye is observed with the imaging camera using near-infrared light, for example, 700 nm to 900 nm, which can be generated by an LED mounted near the objective lens.

[0116] To modulate the energy of the treatment laser beam 21, the device 18 includes an energy control system 50, preferably part of the detection system 40.

[0117] This makes it much easier to adjust the dissipated energy, i.e., the beam energy, in relation to the detected microcavitations, particularly microbubbles, and / or in relation to the detected location and / or shape, particularly asymmetry, of the trabecular meshwork 7, 12, or 13. The foregoing provides an overview of the essence of the invention and does not include components or details that are well known in the art or that would be well understood by those skilled in the art of opto-mechanics. [Explanation of symbols]

[0118] 1 Cornea, 2 Sclera, 3 Anterior chamber, 4 Iris, 5 Lens, 6 Posterior chamber, 7 Trabecular meshwork, 8 Schlemm's canal, 9 Pupil, 10 Iris, 11 Sclera, 12 Trabecular meshwork, 13 Trabecular meshwork, 14 Ring of uncertainty, 15 Radial line or radial segment, 16 Angle, 18 Ophthalmic device, 20 Treatment laser module, 21 Incident treatment laser beam, 22 Two-axis scanner, 23 Dichroic or partial reflector, 24 Focusing lens, 25 Eye, 26 Reflector, 27 Eye probe subsystem, 28 Camera, 29 Red lamp, 30 Lens, 31 Partial reflector, 32 Controller, 33 Processor, 34 Display, 38 Probe beam, 40 Detection system, 41 Probe beam optical path, 42 Treatment laser beam path, 43 Separate optical path, 45 Photodetector, 48 Optical coherence tomography (OCT) system, 50 Energy control system, R1 inner radius, R2 outer radius.

Claims

1. An ophthalmic device (18) for treating glaucoma in a patient's eye (25), A treatment laser module (20) that supplies a treatment laser beam (21), The system includes a detection system (40) that detects the location and / or potential asymmetry of the trabecular meshwork (7, 12, 13) of the patient's eye (25), and detects microbubbles formed in the trabecular meshwork (7, 12, 13) of the patient's eye (25) due to the treatment laser beam (21), The detection system (40) An optical coherence tomography (OCT) system for detecting the location and / or potential asymmetry of the trabecular meshwork (7, 12, 13) of the patient's eye (25), An ophthalmic apparatus comprising a photodetector (45) for detecting the aforementioned microbubbles.

2. The apparatus (18) according to claim 1, comprising an eye probe subsystem (27) that emits a coaxial probe beam (38).

3. The apparatus (18) according to claim 1 or 2, wherein the beam group (21, 27A) is focused to the trabecular meshwork (7, 12, 13) of the patient's eye (25) posterior to the sclera (2, 11) of the patient's eye (25).

4. An ophthalmic device (18) according to claim 1 for treating glaucoma, A treatment laser module (20) that supplies a treatment laser beam (21) to a scanner (22) and an objective focusing lens (24), It comprises an eye probe subsystem (27) that emits a coaxial probe beam (38), The device (18) focuses the beam group (21, 38) towards the trabecular meshwork (7, 12, 13) posterior to the sclera (2, 11) of the patient's eye (25). An ophthalmic device comprising an eye probe subsystem (27) equipped with a detector (45) which detects backscattered light originating from the probe beam (38) and detects the formation of microbubbles caused by the treatment laser beam (21) damaging melanin cells in the trabecular meshwork (7, 12, 13).

5. An apparatus (18) according to any one of claims 1 to 4, comprising an energy control system (50) that modulates the treatment laser beam (21) while depending on information from the detection system (40).

6. An apparatus (18) according to any one of claims 1 to 5, further comprising an eye probe subsystem (27) equipped with an optical coherence tomography (OCT) system, wherein the OCT system further determines the location of the trabecular meshwork (7, 12, 13) prior to supplying the treatment laser beam (21).

7. An apparatus (18) according to any one of claims 1 to 6, comprising an eye probe subsystem (27) equipped with a photodetector (45).

8. An apparatus (18) according to any one of claims 1 to 7, wherein the probe beam (38) is replaced by the treatment laser beam (21).

9. An apparatus (18) according to any one of claims 1 to 8, wherein the wavelength of the treatment laser beam (21) is within the absorption range of melanocytes, and the probe beam (38) is infrared.

10. A method for operating an ophthalmic device (18) comprising a controller (32) and a processor (33), The aforementioned processor (33) A step of identifying the location and shape of the trabecular meshwork (7, 12, 13) using an optical coherence tomography (OCT) system (48), The controller (32) directs the treatment laser beam (21) towards the location of the trabecular meshwork (7, 12, 13), The processor (33) performs the step of detecting microbubbles in the fiber column network (7, 12, 13) using a photodetector with backscattered probe light, Execute How to operate ophthalmic equipment.

11. A method for operating the ophthalmic device (18) according to claim 10, In the aforementioned directing step, the controller (32) controls and adjusts the energy of the treatment laser beam (21) taking into account the effects of microbubbles or microcavitation, and / or the location and / or potential asymmetry of the trabecular meshwork (7, 12, 13), in an ophthalmic device operating method.

12. A method for operating an ophthalmic device (18) according to claim 10 or 11, In the aforementioned directing step, the controller (32) either delivers a preset amount of laser energy to the location or increases the amount of energy until microbubbles are detected by the optical coherence tomography (OCT) system (48), in a method of operating an ophthalmic device.

13. A method for operating an ophthalmic device (18) according to any one of claims 10 to 12, wherein in the directing step, the processor (33) inputs a pattern for tracking the beam group of the treatment laser beam (21).

14. A method for operating an ophthalmic device (18) according to claim 13, wherein the pattern comprises radial lines (15) extending from a certain inner radius (R1) to a certain outer radius (R2), and these radii correspond to the ends of the expected positions of the trabecular meshwork (7, 12, 13).

Images