Apparatus and method for attaching a hands-free lens to a microscope for use during ophthalmic surgery - Patents.com

Abstract

An apparatus is shown for mounting a lens to a microscope using an optical attachment. The apparatus includes a lens with one or more translational degrees of freedom such that the lens is configured to rotate about one or more axes of rotation relative to the microscope and the lens is configured to translate along one or more directions and / or one or more rotational degrees of freedom relative to the microscope. A system including the apparatus and the optical attachment is also shown. The optical attachment includes a lens arm and / or a viewing attachment configured to move the lens and the lens arm relative to the microscope. A method for positioning a hands-free lens relative to the microscope using the optical attachment is also shown.

Description

[Technical field]

[0001] [CROSS REFERENCE TO RELATED APPLICATIONS] This application claims priority under 35 U.S.C. § 120 to U.S. Provisional Application No. 63 / 321,285, filed March 18, 2022. [Background technology]

[0002] When examining a patient's eye under a microscope, a medical practitioner may place an additional optical device in contact with the cornea to improve visibility of intraocular structures. A variety of optical devices are known that aid the ophthalmologist in various aspects of examining the eye. For example, a goniometer lens provides the ophthalmologist with an oblique view through the cornea, thereby allowing visualization of peripheral portions of the anterior chamber that are otherwise difficult to visualize. Summary of the Invention

[0003] Primary open-angle glaucoma is a condition characterized by elevated intraocular pressure, most commonly due to narrowing of the outflow pathway through the trabecular meshwork and Schlemm's canal. These anatomical structures are located within the iridocorneal angle 901 at the periphery of the anterior chamber (see FIG. 9A). Accurate visualization of these minute structures is required if surgical intervention is required to increase aqueous humor outflow. The iridocorneal angle is normally invisible from outside the eye due to an optical phenomenon known as total internal reflection (TIR). FIG. 9B is a ray diagram showing an example of reflection and total internal reflection of light at the boundary between materials 903, 905 of different refractive indexes n1, n2, where n1 is greater than n2. In one embodiment, the first material 903 is the eye (e.g., cornea) or a solution along the surface of the eye (e.g., tears) and the second material 905 is air. As shown in the left of FIG. 9B, incident light from within the eye enters the eye-air boundary at a first angle φ1 (e.g., measured with respect to a normal 907 to the boundary) and is refracted as a refracted ray at a second angle φ2 (e.g., also measured with respect to the normal 907) that is greater than the first angle φ1. As shown in the center of FIG. 9B, incident light from within the eye enters the eye-air boundary at a first angle φ1 (in the illustrated example, greater than the first angle φ1 on the left of FIG. 9B) and is refracted along the eye-air boundary (in the illustrated example, the second angle φ2 is 90 degrees). Because incident light entering the eye-air boundary from within the eye is refracted along the eye-air boundary, the first angle φ1 in the center of FIG. 9B is known as the "critical angle." As shown on the right of Figure 9B, incident light from inside the eye is incident on the eye-air boundary at a first angle φ1 that is greater than the critical angle, and the incident light is totally internally reflected (TIR) ​​at the eye-air boundary and returns into the eye at a second angle φ2 that is equal to the first angle φ1. As shown on the right of Figure 9B, TIR occurs when the incident angle φ1 exceeds the critical angle (center of Figure 9B) at the boundary between two materials 903, 905 with refractive index difference.If a light ray approaches such a boundary at a shallow enough angle φ1 (e.g., greater than or equal to the critical angle), the light ray that exits into the second material 905 (e.g., air) with the smaller refractive index n2 may be refracted such that the angle of refraction is theoretically greater than 90 degrees (e.g., if the angle of incidence φ1 is the critical angle) or may move beyond parallel to the boundary and become reflected rather than refracted (e.g., if the angle of incidence φ1 exceeds the critical angle). The critical angle of the tear-air boundary is approximately 46°. If light from inside the eye strikes the cornea at an angle shallower than 46° (e.g., if the angle of incidence φ1 is greater than the critical angle of the eye-air boundary), TIR occurs and the light does not exit the eye (FIG. 9A).

[0004] As shown in FIG. 10, the handheld gonioscope lens 1000 essentially acts as an extension of the cornea, allowing light from the iridocorneal angle to cross the air boundary at a near right angle. The gonioscope lens 1000 includes a first surface 1003 (e.g., in contact with the eye 115) and a second surface 1005 (e.g., in contact with air). Because the lens 1000 acts as an extension of the cornea, there is minimal difference in the refractive index between the lens 1000 and the cornea, and TIR does not occur at the lens-cornea interface. In addition, because the normal to the second surface 1005 is substantially aligned with the light incident within the lens 1000 at the lens-air interface, the angle of incidence of the light incident at the lens-air interface is relatively small in magnitude, and therefore TIR does not occur at the lens-air interface. To prevent air trapping between the first surface 1003 and the eye 115, eye drops are typically placed on the first surface 1003 before placing the gonioscopic lens 1000 in contact with the eye 115. The physician (or an assistant) holds the lens 1000 over the eye 115. This allows the physician to view the internal anatomy of the eye at the iridocorneal angle 901.

[0005] The inventors of the present invention have found that most optical instruments used for ophthalmic procedures (e.g., most gonioscope lenses used in anterior segment surgery) are handheld lenses that must be manually held in place on the cornea. In most cases, the physician performs the procedure by holding the handheld gonioscope lens in one hand and the surgical instruments in the other. For simple procedures (e.g., bypass shunt placement), this is an effective way to perform such procedures, since the physician has direct and simultaneous control of the view and the instruments. For more complex procedures, the physician is restricted to using only one hand, which increases the duration and difficulty of the procedure. For this reason, in some cases, it may be beneficial or even necessary for the physician to be able to perform the procedure using two hands with another instrument. To do so, the handheld gonioscope lens is typically held by an assistant, with the understanding that the lens must be repositioned frequently by verbal instructions.

[0006] The inventors of the present invention have found that some lenses provide a self-stabilizing feature, for example a flange along the lower surface of the lens that extends the base of the lens. The inventors have found that while this stabilizing feature improves lens retention, adjustment of the lens is still required and the physician must place an instrument to manually reposition the lens. The inventors have also found that the flange presents a different problem in that it can limit access to various insertion points. The flange can also impede visualization. The inventors of the present device have recognized a need for an alternative self-stabilizing lens that can be used without the assistance of an assistant and allows for true two-handed surgery.

[0007] An example of a microscope-suspended goniolens is described in US Patent Publication No. 2013 / 0182223. The design of this complex system focuses on a counterweight-type lens holder. However, the inventors of the present invention have realized shortcomings of this suspended lens design, including that the lens only has one rotational degree of freedom (about one axis of rotation) relative to the lens arm and the attachment used to suspend the lens from the microscope, and that the lens does not feature a translational degree of freedom relative to the attachment. Thus, the inventors of the present invention have developed an improved lens arm design herein that features multiple rotational degrees of freedom (about two or more axes of rotation) and multiple translational degrees of freedom of the lens and the attachment that suspends the lens to the microscope.

[0008] Another example of a suspended goniolens is identified in U.S. Pat. No. 8,118,431 (the '431 patent). However, this design describes in its specification and abstract an attachment to a microscope objective. The above focuses on the use of a mirrored goniolens and an attachment configured to simultaneously view the surface of the eye and the interior of the eye by placing the lens between the microscope and the eye (as taught in Kitajima's U.S. Pat. Pub. No. 2006 / 0098274, as well as in the claims taught in U.S. Pat. No. 4,157,859 to Terry). The '431 patent does not teach how this lens is suspended from the objective to provide a method to compensate for patient eye movement, misalignment of the eye with respect to the optical axis of the microscope, and to provide the necessary safety features to prevent patient injury in the event of significant unintended movement of the microscope. Accordingly, the present inventors have developed an improved lens arm and lens design herein to overcome these shortcomings noted in the '431 patent.

[0009] In vitreoretinal procedures, i.e., procedures in the posterior chamber of the eye, the inventors have found that a wide-angle viewing attachment (herein "viewing attachment") is often used with ophthalmic surgical microscopes. The wide-angle viewing attachment is typically attached to the body of the microscope and suspends a wide-angle lens below the microscope objective lens in close proximity to the corneal surface. Although the viewing attachment is not intended to hold a lens in contact with the cornea, the inventors of the present device have found that this may be an effective way of positioning and holding a lens in contact with the cornea.

[0010] The assignee of the present invention (OCULUS GmbH) manufactures wide-angle viewing attachments and adapters that attach to a variety of surgical microscopes. Certain embodiments of the present invention employ the wide-angle viewing attachments and adapters in a method for attaching novel devices (e.g., for placing a hands-free lens on the cornea) to a variety of surgical microscopes.

[0011] Certain types of wide-angle viewing attachments require sterilization between uses, and in one example, the present assignee has developed an example of such a wide-angle viewing attachment (OCULUS® Binocular Indirect Ophthalmic Microscope, or "OCULUS BIOM" herein, which is disclosed in U.S. Patent No. 7,092,152, which is incorporated herein by reference).

[0012] Another type of wide-angle viewing attachment is one that is intended for disposable use. By way of example, the present assignee has developed one such wide-angle viewing attachment (OCULUS Binocular Indirect Ophthalmic Microscope Ready, or "BIOM READY" herein, which is disclosed in U.S. Patent No. 9,155,593, which is incorporated herein by reference). In one example, the BIOM READY wide-angle viewing attachment is made by injection molding and intended for disposable use.

[0013] In one embodiment, the inventors have found it advantageous to provide a device that attaches a hands-free lens to a wide-angle viewing attachment such that the device allows the lens to be brought into contact with the eye without the need to hold the lens by hand. The inventors have found that it would be even more advantageous if such a device were designed to accommodate relative movement between the eye and the wide-angle viewing attachment (and / or microscope) along multiple degrees of freedom (e.g. translational and / or rotational). In one exemplary embodiment, the device is made to be used with any viewing attachment, such as the OCULUS BIOM or BIOM READY wide-angle viewing attachment. With the BIOM READY wide-angle viewing attachment, the device can be used as a comprehensive disposable system.

[0014] An advantageous embodiment of the proposed invention discloses a means for attaching a lens (e.g., a surgical contact lens) to a wide-angle viewing attachment (e.g., OCULUS BIOM, BIOM READY, etc.) in a manner that allows for stable, hands-free positioning of the lens over the cornea.

[0015] In a first set of embodiments, an apparatus is shown for mounting a lens to a microscope using an optical attachment. The apparatus includes a lens with one or more translational degrees of freedom, such that the lens is configured to translate along one or more first directions relative to the microscope. The apparatus also includes a lens with one or more rotational degrees of freedom, such that the lens is configured to rotate about one or more rotational axes relative to the microscope.

[0016] In a second set of embodiments, a system for attaching a lens to a microscope using an optical attachment is shown, the system including a lens and an optical attachment for attaching the lens to the microscope, the optical attachment including a lens arm and / or a viewing attachment configured to move the lens and the lens arm relative to the microscope.

[0017] In a third set of embodiments, a method of positioning a lens relative to a microscope using an optical attachment is presented. The method includes securing the lens to a first end of a lens arm of the optical attachment and securing the second end of the lens arm to a positioning mechanism of the optical attachment. The method also includes moving the lens with the positioning mechanism until the lens contacts a patient's eye. The method also includes translating the lens along one or more directions relative to the microscope based on relative movement between the first and second ends of the lens arm in one or more directions such that the lens maintains contact with the eye.

[0018] Further aspects, features, and advantages will become readily apparent from the following detailed description, by way of illustration only of certain specific embodiments and implementations, including the best mode contemplated for carrying out the invention. Other embodiments may have other different features and advantages, and its several details may be modified in various obvious respects, all without departing from the spirit and scope of the invention. Accordingly, the drawings and specification should be regarded as illustrative in nature, and not restrictive. [Brief description of the drawings]

[0019] Embodiments are illustrated by way of example, and not by way of limitation, in the figures of the accompanying drawings in which like reference numerals refer to similar elements and in which: [Figure 1] FIG. 1 illustrates an example of a system for providing a hands-free lens for use during ophthalmic surgery, according to one embodiment. [Figure 2A] FIG. 2A illustrates an example of a side view of a lens and lens arm of the system of FIG. 1, according to one embodiment. [Figure 2B] FIG. 2B illustrates an example of a front view of the lens and lens arm of the system of FIG. 1, according to one embodiment. [Figure 3A]FIG. 3A illustrates an example of the system of FIG. 1 based on relative motion between a lens and a microscope in a first direction, according to one embodiment. [Figure 3B] FIG. 3B illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a first direction, according to one embodiment. [Figure 3C] FIG. 3C illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a first direction, according to one embodiment. [Figure 4A] FIG. 4A illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 4B] FIG. 4B illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 4C] FIG. 4C illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 5A] FIG. 5A illustrates an example of a lens and lens arm undergoing relative movement in the second direction of FIGS. 4A-4C, according to one embodiment. [Figure 5B] FIG. 5B illustrates an example of a lens and lens arm undergoing relative movement in the second direction of FIGS. 4A-4C, according to one embodiment. [Figure 5C] FIG. 5C illustrates an example of a lens and lens arm undergoing relative movement in the second direction of FIGS. 4A-4C, according to one embodiment. [Figure 6A] FIG. 6A illustrates an example of a lens and lens arm of the system of FIG. 1 with relative movement in a third direction, according to one embodiment. [Figure 6B] FIG. 6B illustrates an example of a lens and lens arm of the system of FIG. 1 with relative movement in a third direction, according to one embodiment. [Figure 6C]FIG. 6C illustrates an example of a lens and lens arm of the system of FIG. 1 with relative movement in a third direction, according to one embodiment. [Figure 7A] FIG. 7A illustrates an example of the viewing attachment of FIG. 1 that can be rotated around the optical axis of the microscope, according to one embodiment. [Figure 7B] FIG. 7B illustrates an example of the viewing attachment of FIG. 1 that can be rotated around the optical axis of the microscope, according to one embodiment. [Figure 7C] FIG. 7C illustrates an example of the viewing attachment of FIG. 1 that can be rotated around the optical axis of the microscope, according to one embodiment. [Figure 8A] FIG. 8A illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a first direction, according to one embodiment. [Figure 8B] FIG. 8B illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a first direction, according to one embodiment. [Figure 8C] FIG. 8C illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 8D] FIG. 8D illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 8E] FIG. 8E illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 8F] FIG. 8F illustrates an example of the system of FIG. 1 based on relative motion between the lens and the microscope in a second direction, according to one embodiment. [Figure 9A] FIG. 9A is a diagram showing an example of the internal structure of the human eye and an example of total internal reflection. [Figure 9B] FIG. 9B is a ray diagram illustrating an example of refraction and total internal reflection of light at a boundary between materials of different refractive index. [Figure 10]FIG. 10 shows an example of a goniolens manually held on a subject's eye. [Figure 11] FIG. 11 is a flow chart illustrating an example method of providing a hands-free lens for use during ophthalmic surgery, according to one embodiment. [Figure 12A] FIG. 12A illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12B] FIG. 12B illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12C] FIG. 12C illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12D] FIG. 12D illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12E] FIG. 12E illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12F] FIG. 12F illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12G] FIG. 12G illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12H] FIG. 12H illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12I] FIG. 12I illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12J] FIG. 12J illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12K] FIG. 12K illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12L]FIG. 12L illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. [Figure 12M] FIG. 12M illustrates an example of performing one or more of the steps of the method of FIG. 11 according to an embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0020] A method and apparatus for mounting a lens to a microscope using an optical attachment (e.g., for use during surgery) is described. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the present invention. However, it will be apparent to one of ordinary skill in the art that the present invention may be practiced without these specific details. In other instances, well-known structures and devices are shown in block diagram form in order to avoid unnecessarily obscuring the present invention.

[0021] Notwithstanding that the numerical ranges and parameters defining broad ranges are approximations, the numerical values ​​set forth in the non-limiting but specific examples are conveyed as precisely as possible. However, any numerical value inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements at the time of writing. Moreover, unless otherwise clear from the context, numerical values ​​set forth herein have an implied precision as indicated by the least significant digit. Thus, a value of 1.1 means a value from 1.05 to 1.15. The term "about" is used to indicate a broader range centered on a given value, and unless otherwise clear from the context, means a broader range including both sides of the least significant digit, such as "about 1.1" meaning a range of 1.0 to 1.2. If the least significant digit is unclear, the term "about" means 2 or 1 / 2 times, for example, "about X" means a value in the range of 0.5X to 2X, for example, about 100 means a value in the range of 50 to 200. Moreover, all ranges disclosed herein should be understood to include any and all subranges subsumed therein. For example, a range "less than 10" for a parameter that has only positive numbers can include any and all subranges between a minimum value of 0 and a maximum value of 10 (and includes the endpoints), i.e., any and all subranges having a minimum value of 0 or more and a maximum value of 10 or less, e.g., 1 to 4.

[0022] Some embodiments of the invention are described below in the context of an optical device used for treating or examining a patient (e.g., examining a patient, performing surgery on a patient, etc.). In some embodiments, the invention is described in the context of a system provided that includes a lens and a device for positioning the lens and securing the lens to the body of an ophthalmic surgical microscope. In some embodiments, the system is intended to safely position the lens on the eye in a stable and unobtrusive manner for the user, avoiding the need to manually hold the lens. In another embodiment, a method of using the microscope is provided, including its installation, adding the system. In yet another embodiment, a method of forming the system is provided. For the purposes of this specification, "optical device" means a device with an eyepiece or camera and an objective lens through which a medical practitioner views an area of ​​interest on a patient for diagnostic or therapeutic purposes. In some embodiments, the optical device is a surgical microscope (e.g., an ophthalmic surgical microscope).

[0023] 1 is a diagram illustrating an example of a system 100 for providing a hands-free lens for use during ophthalmic surgery, according to one embodiment. In one embodiment, the system 100 includes a microscope 101 with an objective lens 103 that defines an optical axis 106 of the objective optics. In one embodiment, the system 100 also includes an adapter plate 105 and a sterile disk 112 that covers the adapter plate 105 (e.g., to provide a sterile barrier for the microscope 101 and the adapter plate 105). In other embodiments, the system 100 does not include the microscope 101 and the adapter plate 105.

[0024] In an embodiment, the system 100 includes an optical attachment for attaching the lens 113 to the microscope 101. For purposes of this specification, "optical attachment" refers to one or more components (groups) that are used, singly or collectively, to position the lens 113 at a desired position relative to the microscope 101. In an embodiment, the optical attachment includes a wide-angle viewing attachment 107 (e.g., disposable). In an exemplary embodiment, the wide-angle viewing attachment 107 is BIOM READY. In an exemplary embodiment, a first end of the wide-angle viewing attachment 107 is secured to the adapter plate 105 and a second end opposite the first end is secured to a lens arm 111 that positions the lens 113 (e.g., on the eye 115). In some embodiments, the optical attachment also includes the lens arm 111. In some embodiments, the wide-angle viewing attachment 107 has a knob 109 that can be adjusted (e.g., rotated) to vary the spacing (e.g., along the objective optical axis 106) between the second end (e.g., the lens arm 111 and the lens 113) and the objective lens 103 of the microscope. In some embodiments, the system 100 includes a lens 113 (e.g., an angle lens) and / or an optical attachment (e.g., the lens arm 111 and the wide-angle viewing attachment 107) configured to move the lens 113 and the lens arm 111 relative to the microscope 101. In some embodiments, the lens 113 is a non-prism lens, a plano-concave lens, a mirror lens, a double mirror lens, a bi-concave lens, or a combination thereof.

[0025] In one embodiment, the lens arm 111 and lens 113 define an apparatus 110 that is used to position or couple the lens 113 to the microscope 101 such that the lens 113 has one or more degrees of freedom to accommodate relative movement between the eye 115 and the microscope 101 (e.g., one or more translational degrees of freedom to accommodate relative translational movement between the eye 115 and the microscope 101, and / or one or more rotational degrees of freedom to accommodate relative rotation between the eye 115 and the microscope 101). In the illustrated embodiment of FIG. 1, the lens 113 is an angle lens and is positioned on the model eye 115. However, in other embodiments where an actual patient is present, the lens arm 111 similarly positions the lens 113 on the patient's eye (e.g., to rest gently on the cornea).

[0026] In one embodiment, the wide-angle viewing attachment 107 (e.g., BIOM READY) is configured such that the lens arm 111 and the goniolens 113 are movable in a direction toward the microscope objective (e.g., along the objective optical axis 106) without substantial resistance. In one exemplary embodiment, where the wide-angle viewing attachment 107 is BIOM READY, the technology of the wide-angle viewing attachment 107 is disclosed in U.S. Patent No. 9,155,593, which is incorporated herein by reference. The inventors of the present invention have found that this feature protects the eye from damage caused by the lens 113 during patient movement or microscope 101 movement.

[0027] In one embodiment, a global coordinate system 190 is shown in FIG. 1. The global coordinate system 190 is merely one example of a coordinate system that may be used to describe the directions of translational and / or rotational degrees of freedom of the device 110, and other coordinate systems may be employed as well. In this embodiment, the global coordinate system 190 includes three-dimensional Cartesian axes including an x-axis 192, a y-axis 194, and a z-axis 196. The z-axis 196 is defined to be parallel to the direction of gravitational acceleration. The y-axis 194 is defined such that the lens arm 111 and the lens 113 lie within a yz-plane 195 defined by the y-axis 194 and the z-axis 196 (e.g., when the lens arm 111 is in a neutral position prior to relative translational and / or rotational movement between the lens 113 and the microscope 101). The x-axis 192 is defined such that an xz plane 197 defined by the x-axis 192 and the z-axis 196 is orthogonal to a yz plane 195 .

[0028] In one exemplary embodiment, the lens arm 111 is configured to absorb relative translational motion between the lens 113 and the microscope 101 in any direction in the yz plane 195, in any direction in the xz plane 197, and / or in any direction in the xy plane defined by the x-axis 192 and the y-axis 194. In another exemplary embodiment, the lens arm 111 is configured to absorb relative rotational motion between the lens 113 and the microscope 101 along multiple rotational axes, including axes that are parallel to the x-axis 192, the y-axis 194, and the z-axis 196. For purposes of this specification, "absorbing" means that one or more conditions of the system 100 are maintained after the relative translational motion and / or the relative rotational motion. For example, one of these conditions is that the lens 113 maintains concentricity and / or spherical contact with the eye 115. In another example, one of these conditions is that the optical axis of lens 113 remains aligned with or within a threshold angle of the optical axis 106 of the microscope objective lens 103.

[0029] FIG. 2A illustrates an example side view of the lens 113 and lens arm 111 of the system 100 of FIG. 1, according to an embodiment. In an embodiment, the side view shown as FIG. 2A is along the yz plane 195. Front view 2B illustrates an example front view of the lens 113 and lens arm 111 of the system of FIG. 1, according to an embodiment. In an embodiment, the front view of FIG. 2B is along the xz plane 197. In an embodiment, the lens 113 features one or more translational degrees of freedom such that the lens 113 is configured to translate along a first direction (e.g., along the optical axis 106 of the objective, along any direction in the yz plane 195, along any direction in the xz plane 197, etc.) relative to the microscope 101. In an exemplary embodiment, the features of the lens 113 allow the lens 113 to be safely positioned on the cornea of ​​the eye 115 (e.g., the beveled edges and biocompatible material minimize the risk of corneal damage or inflammation). The inventors of the present invention have found that these degrees of freedom of translational movement enable axial positioning of the lens 113 (e.g., along the optical axis 106 of the objective optical system, or along any direction in the yz plane 195), and lateral positioning of the lens (e.g., along a direction in the xz plane 197, or along an xy plane orthogonal to the yz plane 195), independent of the focal position of the microscope 101.

[0030] 2A, the device 110 includes a lens arm 111 having a first end 240 attached to the lens 113 and a second end 242 attached to the optical attachment 107. In one embodiment, the first end 240 is fixedly attached to the lens 113 by any means understood by one of skill in the art (e.g., using a UV-curable adhesive, an acrylic adhesive, or possibly a mechanical assembly such as a press fit) and the second end 242 is fixedly attached to the optical attachment 107 (e.g., using a mechanical assembly such as a press / interference fit, or a snap clip structure). In one embodiment, the device 110 is configured such that the first end 240 is configured to move relative to the second end 242 (e.g., while remaining fixed to the positioning mechanism 107) to accommodate one or more translational degrees of freedom and / or one or more rotational degrees of freedom of the lens 115 relative to the microscope 101.

[0031] In an embodiment, the lens arm 111 has one or more parameters that are selected during the design phase of the lens arm 111. In an embodiment, the parameters include the shape of the lens arm 111. In an exemplary embodiment, the shape of the lens arm 111 is selected to include a curved surface. In an exemplary embodiment, the curved surface includes one or more bends 250, 252, 256 between the first end 240 and the second end 242. For purposes of this specification, a "bend" means a portion of the lens arm 111 between two adjacent linear segments where the lens arm 111 has a radius of curvature. Although FIG. 2A shows the lens arm 111 having three bends, this is just one exemplary embodiment and in other embodiments, fewer or more than three bends are provided. In an exemplary embodiment, the radius of curvature (R) of the bends 250, 252, 256 is selected within a range of about 1 millimeter (mm) to about 40 mm. In one exemplary embodiment, the disclosed range includes each of bends 250, 252, and 256, so there may be variation in the radius of curvature between bends 250, 252, and 256 (e.g., the radius of curvature of bend 252 is greater than the radius of curvature of bend 250).

[0032] In certain embodiments, the lens arm 111 is sized using one or more cross-sectional dimensions 244. In certain exemplary embodiments, the value of the one or more cross-sectional dimensions 244 is a value of a width or thickness of the lens arm 111 between the first end 240 and the second end 242. In certain exemplary embodiments, the value of the width or thickness of the lens arm 111 ranges from about 1 mm to about 5 mm. In some embodiments, the value of the cross-sectional dimension 244 (e.g., width or thickness) is constant between the first end 240 and the second end 242. In other embodiments, the value of the cross-sectional dimension 244 varies between the first end 240 and the second end 242.

[0033] In an embodiment, the lens arm 111 is made from a material having specific properties. In an exemplary embodiment, the lens arm 111 is made from a material having elastic properties, such as a thermoplastic elastomer (TPE) or a thermosetting elastomer (e.g., silicone, urethane, vulcanized rubber, etc.). In another exemplary embodiment, the material of the lens arm 111 is selected to have specific properties, such as an elongation of about 300%, or in the range of about 100% to about 1000%, and / or a Shore hardness of about 55A (Shore A scale) or in the range of about 30A to about 80A.

[0034] In some embodiments, the lens arm 111 is formed using one or more manufacturing processes, which in some exemplary embodiments may include injection molding, compression molding, casting, 3D printing, or any other similar process as would be understood by one of ordinary skill in the art.

[0035] In an embodiment, one or more parameter values ​​of the lens arm 111 mentioned above are selected during the design phase of the lens arm 111 to meet certain criteria regarding the relative motion between the eye 115 and the microscope 101. For example, one or more of these parameter values ​​are selected depending on the relative motion between the eye 115 and the microscope 101, and the lens arm 111 is configured to rotate the lens 113 on the eye 115 about one or more rotational axes and / or translate the lens 113 and the eye 115 relative to the microscope 101 such that the lens 113 maintains concentric and / or spherical contact with the eye 115 and the optical axis of the lens 113 remains aligned (or within an angular threshold) with the optical axis 106 of the microscope objective lens 103.

[0036] 2B is a diagram illustrating an example of a front view of the lens 113 and lens arm 111 of the system 100 of FIG. 1, according to one embodiment. The front view of FIG. 2B is a cross-sectional view along the xz plane 197. In one embodiment, FIG. 2B illustrates the neutral position of the lens 113 and lens arm 111 aligned in the yz plane 195 (see the dashed yz plane 195 in FIG. 2B) prior to any translation of the eye 115 relative to the microscope 101 or rotation of the lens 113 relative to the eye 115.

[0037] 3A-3C are diagrams illustrating an example of the system 100 of FIG. 1 based on relative movement between the lens 113 and the microscope 101 in a first direction, according to an embodiment. In an embodiment, the first direction is the y-axis 194. As described herein, in some embodiments, the lens arm 111 has one or more spring characteristics (e.g., a neutral position, a compressed position, an extended position, etc.). In an embodiment, FIG. 3A illustrates the lens arm 111 in a neutral position 302, which is defined as the position of the lens 113 relative to the microscope 101 prior to any translational movement of the lens 113 relative to the microscope 101 along the y-axis 194. In an exemplary embodiment, the neutral position 302 is also defined as the position of the lens 113 relative to the microscope 101 after one or more initialization steps of the system 100 (see, e.g., step 1113 of FIG. 11 ) prior to a medical practitioner using the system 100 to observe the interior of the eye 115.

[0038] In an embodiment, FIG. 3B shows the lens arm 111 in a retracted position 304. In an embodiment, the retracted position 304 of the lens arm 111 is caused by a relative movement between the eye 115 and the microscope 101 along the y-axis 194 (e.g., to the right when referring to FIG. 3B). In an exemplary embodiment, the relative movement is a translational movement of the eye 115 relative to the microscope 101 along the y-axis 194 (e.g., to the right when referring to FIG. 3B). The translational movement may be caused by a patient moving during a medical procedure. In another exemplary embodiment, the relative movement is a translational movement of the microscope 101 relative to the eye 115 along the y-axis 194 (e.g., to the left when referring to FIG. 3B). The translational movement may be caused by manual manipulation of the microscope 101 by a medical professional in the xy-plane (e.g., using a foot pedal device to control the movement of the microscope 101 in the xy-plane). In one exemplary embodiment, the compressed location 304 can accommodate lateral movement along the y-axis 194 of up to about 30 mm, or in a range of about 20 mm to about 40 mm.

[0039] In an embodiment, FIG. 3C shows the lens arm 111 in an extended position 306. In an embodiment, the extended position 306 of the lens arm 111 is caused by a relative movement between the eye 115 and the microscope 101 along the y-axis 194 (e.g., to the left when referring to FIG. 3C). In an exemplary embodiment, the relative movement is a translational movement of the eye 115 relative to the microscope 101 along the y-axis 194 (e.g., to the left when referring to FIG. 3C). The translational movement may be caused by a patient moving during a medical procedure. In another exemplary embodiment, the relative movement is a translational movement of the microscope 101 relative to the eye 115 along the y-axis 194 (e.g., to the right when referring to FIG. 3C). The translational movement may be caused by manual manipulation of the microscope 101 by a medical professional in the xy-plane (e.g., using a foot pedal device to control the movement of the microscope 101 in the xy-plane).

[0040] In an embodiment, FIG. 3C illustrates an axis of rotation 320 about which the lens arm 111 is configured to rotate in the yz-plane 195. In an exemplary embodiment, the first end 240 is configured to rotate relative to the second end 242 about the axis of rotation 320. In some exemplary embodiments, this rotation accommodates rotation of the lens 113 relative to the eye 115 to ensure that certain conditions are maintained during the relative translational movements in the yz-plane 195 described with respect to FIGS. 3A-3C (e.g., the lens 113 maintains concentricity and / or spherical contact with the eye 115 and / or the optical axis of the lens 113 remains aligned with or within an angular threshold of the microscope optical axis 106 during the relative translational movements described with respect to FIGS. 3A-3C). In other embodiments, the lens arm 111 is configured to rotate about an axis of rotation other than axis of rotation 320 to accommodate relative translational movements between the eye 115 and the microscope 101 in other directions.

[0041] In one embodiment, the first end 240 of the lens arm 111 is not only configured to accommodate relative translational movement between the eye 115 and the microscope along the y-axis 194, but is further configured to simultaneously accommodate rotation of the lens 113 with respect to the eye 115 during this relative translational movement. The present inventors have found that this preferably ensures that the lens 113 maintains concentric and / or spherical contact with the eye 115 and / or that the optical axis of the lens 113 remains aligned (or within an angular threshold) with the optical axis 106 of the microscope, as the lens 113 accommodates translational movement between the eye 115 and the microscope 101.

[0042] Although Figures 3A-3C show lens arm 111 accommodating relative translational movement between eye 115 and microscope 101 in one direction (e.g., along y-axis 194, in yz plane 195), in other embodiments lens arm 111 accommodates relative translational movement in any direction (e.g., any direction in yz plane 195). Figures 4A-4C show an exemplary embodiment of lens arm 111 that accommodates relative translational movement in yz plane 195 in a different direction than that of Figures 3A-3C.

[0043] 4A-4C are diagrams illustrating an example of the system 100 of FIG. 1 based on a relative movement between the lens 113 and the microscope 101 in a second direction, according to an embodiment. In an embodiment, the second direction is the optical axis 106 of the microscope 101. In an embodiment, FIG. 4A shows the lens arm 111 in a neutral position 402, which is defined as the position of the lens 113 relative to the microscope 101 prior to any translational movement of the lens 113 relative to the microscope 101 along the optical axis 106. In an exemplary embodiment, the neutral position 402 is also defined as the position of the lens 113 relative to the microscope 101 after one or more initialization steps of the system 100 (see, e.g., step 1113 of FIG. 11 ) before a medical practitioner uses the system 100 to observe the interior of the eye 115.

[0044] In an embodiment, FIG. 4B shows the lens arm 111 in a retracted position 404. In an embodiment, the retracted position 404 of the lens arm 111 is caused by a relative movement 401 between the eye 115 and the microscope 101 along the optical axis 106 (e.g., toward the objective lens 103). As shown in FIG. 4B, this relative movement reduces the spacing between the lens arm 111 and the positioning mechanism 107 from an initial value (e.g., about 5 mm) to a retracted spacing 408 (e.g., less than about 1 mm). In an exemplary embodiment, this relative movement (e.g., toward the objective lens 103) is a translational movement of the eye 115 relative to the microscope 101 along the optical axis 106. This translational movement may occur due to patient movement during a medical procedure. In another exemplary embodiment, this relative movement (e.g., toward the eye 115) is a translational movement of the microscope 101 relative to the eye 115 along the optical axis 106. This translational movement may result from manual manipulation of the microscope 101 by a medical professional (e.g., using the microscope's focus adjustment or adjusting knob 109 on the positioning mechanism 107) along the optical axis 106. In one exemplary embodiment, the retracted position 404 can accommodate movement along the optical axis 106 up to about 20 mm, or in a range of about 15 mm to about 25 mm.

[0045] In an embodiment, FIG. 4C shows the lens arm 111 in an extended position 406. In an embodiment, the extended position 406 of the lens arm 111 is caused by a relative movement between the eye 115 and the microscope 101 along the optical axis 106 (e.g., away from the objective lens 103). As shown in FIG. 4C, this relative movement increases the spacing between the lens arm 111 and the positioning mechanism 107 from an initial value (e.g., about 5 mm) to an extended spacing 410 (e.g., about 15 mm). In an exemplary embodiment, this relative movement is a translational movement of the eye 115 relative to the microscope 101 along the optical axis 106 (e.g., away from the objective lens 103). This translational movement may occur due to patient movement during a medical procedure. In another exemplary embodiment, this relative movement is a translational movement of the microscope 101 relative to the eye 115 along the optical axis 106 (e.g., away from the eye 115). This translational movement may occur due to manual manipulation of the microscope 101 by a medical practitioner (eg, by using the focus adjustment knob of the positioning mechanism 107) along the optical axis 106.

[0046] Although Figures 4A-4C show the lens arm 111 absorbing relative translational movement between the eye 115 and the microscope 101 in one direction (e.g., along the optical axis 106 in the yz plane 195), in other embodiments, the lens arm 111 absorbs relative translational movement in any direction (e.g., any direction in the yz plane 195).

[0047] In one embodiment, the first end 240 of the lens arm 111 is not only configured to accommodate relative translational movement between the eye 115 and the microscope along the optical axis 106 in Figures 4A-4C, but is further configured to simultaneously accommodate rotation of the lens 113 with respect to the eye 115 during this relative translational movement. The inventors of the present invention have found that this preferably ensures that the lens 113 maintains concentric and / or spherical contact with the eye 115 and / or that the optical axis of the lens 113 remains aligned (or within an angular range) with the optical axis 106 of the microscope as the lens arm 111 accommodates translational movement between the eye 115 and the microscope 101 along the optical axis 106. This accommodation of rotation of the lens 113 by the lens arm 111 is described below with respect to Figures 5A-5C.

[0048] 5A-5C are diagrams illustrating an example of lens 113 and lens arm 111 being moved relatively in the second direction of FIGS. 4A-4C, according to one embodiment. In one embodiment, FIG. 5B shows a view of lens 113 and lens arm 111 in neutral position 402 (FIG. 4A) prior to relative translational movement of eye 115 with respect to microscope 101 along optical axis 106. As shown in FIG. 5B, in this embodiment, optical axis 506 of lens 113 is aligned with optical axis 106 of microscope 101 in neutral position 402.

[0049] In one embodiment, Figure 5A shows a view of the lens 113 and lens arm 111 in the compressed position 402 (Figure 4B) after a relative translation of the eye 115 with respect to the microscope 101 (e.g., away from the objective lens 103) along the optical axis 106. In this embodiment, Figure 5A shows that this relative translation causes the optical axis 506 of the lens 113 to be tilted by an angle 507 with respect to the optical axis 506. In one exemplary embodiment, the angle 507 is less than an angle threshold (e.g., about 30 degrees) or 0 degrees (e.g., in the case where the optical axis 506 remains aligned with the optical axis 106).

[0050] In one embodiment, Figure 5C shows a view of the lens 113 and lens arm 111 in the extended position 406 (Figure 4C) after a relative translational movement of the eye 115 with respect to the microscope 101 (e.g., towards the objective lens 103) along the optical axis 106. In this embodiment, Figure 5C shows that this relative translational movement causes the optical axis 506 of the lens 113 to be tilted by an angle 508 with respect to the optical axis 106. In one exemplary embodiment, the angle 508 is less than the aforementioned angle threshold.

[0051] In one embodiment, the lens arm 111 is configured to rotate about a rotation axis 320 such that the lens 113 rotates on the eye 115 to keep the optical axis 506 of the lens 113 aligned with the optical axis 106 of the microscope during the relative translational movement between the eye 115 and the microscope 101 along the optical axis 106 described above with reference to Figures 5A-5C (Figure 5A). The inventors have found that this preferably ensures that the medical practitioner can continue to view an internal region of the eye 115 (e.g., the anterior chamber) despite this relative translational movement along the optical axis 106, or at least with minimal readjustment of the microscope 101.

[0052] 5A-5C illustrate relative movement between the eye 115 and the microscope along the optical axis 106 (e.g., by moving the eye, adjusting the focus of the microscope, or using the knob 109), but embodiments of the invention are not limited to accommodating relative movement along the optical axis 106. As previously discussed, the device 110 is also configured to accommodate relative movement in any other direction within the yz plane 195 (e.g., along the y-axis 194, described with respect to FIGS. 3A-3C). In an exemplary embodiment, accommodating relative movement along the y-axis 194 in FIGS. 3A-3C illustrates extension of the lens arm 111 along the y-axis 194 to prevent rotation about the axis of rotation 320, shown in FIGS. 5A-5C. In embodiments of the present invention, the rotational movement of the lens 113 is driven by relative translational movement between the eye 115 and the microscope 101 to satisfy the boundary condition of concentric contact between the lens 113 and the eye 115 and / or to keep the lens optical axis 506 and the microscope optical axis 106 aligned. Thus, in these embodiments, the rotational and translational movements of the lens 113 are not independent of each other. However, in some embodiments, the degree to which a translational movement causes the lens 113 to rotate can be influenced by the design and materials of the lens arm 111. In one exemplary embodiment, if the lens arm 111 is a straight lens arm (e.g., without flexures 250, 252, 256), even a small translational movement along the y-axis 194 will result in a very significant rotation (e.g., about the rotation axis 320). In another exemplary embodiment, if the lens arm 111 includes flexures 250, 252, 256, this rotational behavior is dramatically reduced. Thus, during the design stage of the lens arm 111, one or more parameters of the design (e.g., whether or not flexures are provided, how many flexures are provided, the radius of curvature of each flexure, etc.) are selected such that the lens arm 111 is configured to rotate the required amount during translation in any direction such that these boundary conditions are maintained (e.g., concentric contact between the eye 115 and the lens 113 is maintained).

[0053] 6A-6C are diagrams illustrating an example of lens 113 and lens arm 111 of system 100 of FIG. 1 being moved relatively in a third direction, according to an embodiment. In an embodiment, the third direction is along an x-axis 192. In an embodiment, lens arm 111 accommodates the relative movement along x-direction 192 based on rotation of lens arm 111 about rotation axis 620 (FIG. 6A). In an exemplary embodiment, rotation axis 620 is parallel to y-axis 194.

[0054] In one embodiment, Figure 6B shows the device 110 in a neutral position 602, similar to the position shown and described with respect to Figure 2B, in which the lens 113 and lens arm 111 are aligned along the yz plane 195 after one or more steps (e.g., steps 1101-1113 of Figure 11) to set an initial position of the system 100 prior to using the system 100 to observe the interior of the eye 115.

[0055] In one embodiment, FIG. 6A illustrates a first tilted position 604 of the device 110 based on a relative movement 610 along the x-axis 192 between the eye 115 and the microscope 101. In one embodiment, this relative movement 610 occurs due to a lateral movement of the eye 115 (e.g., to the left as viewed in FIG. 6B ) in the xz plane 197, or due to a lateral movement of the microscope 101 (e.g., to the right as viewed in FIG. 6B ) in the xz plane 197. As shown in FIG. 6A , based on this relative lateral movement 610 along the x-axis 192, the lens arm 111 rotates about a rotation axis 620 such that the lens arm 111 and the lens 113 also undergo a lateral movement 610 to ensure that the lens 113 remains in contact with the eye 115. Additionally, during this rotation of the lens arm 111 around the rotation axis 620, the lens 113 is configured to rotate around the eye 115 to maintain concentric and / or spherical contact with the eye 115 and / or such that the optical axis 506 of the lens 113 remains aligned (or within an angular threshold) with the optical axis 106 of the microscope objective lens 103.

[0056] In an embodiment, FIG. 6C illustrates a second tilt position 606 of the device 110 based on a relative movement 612 along the x-axis 192 between the eye 115 and the microscope 101. In an embodiment, this relative movement 612 occurs due to a lateral movement of the eye 115 (e.g., to the right as viewed in FIG. 6B) in the xz plane 197, or due to a lateral movement of the microscope 101 (e.g., to the left as viewed in FIG. 6B) in the xz plane 197. As shown in FIG. 6C, based on this relative lateral movement 612 along the x-axis 192, a lateral movement 620 is also made to the lens arm 111 and the lens 113, so that the lens arm 111 rotates about a rotation axis 620 to ensure that the lens 113 remains in contact with the eye 115. Additionally, during this rotation of the lens arm 111 around the rotation axis 620, the lens 113 is configured to rotate around the eye 115 to maintain concentric and / or spherical contact with the eye 115 and / or such that the optical axis 506 of the lens 113 remains aligned (or within an angular threshold) with the optical axis 106 of the microscope objective lens 103.

[0057] In one exemplary embodiment, lens 113 is an injection molded, optically clear plastic, such as polymethylmethacrylate (PMMA), polystyrene (PS), or polycarbonate (PC), hi another exemplary embodiment, lens 113 is a machined glass or quartz / silica lens.

[0058] In an embodiment, one or more features of the lens 113 allow the lens 113 to move freely within the range of motion provided by the lens arm 111. In an exemplary embodiment, one or more features of the lens arm 111 allow the lens 113 to pivot back and forth, pivot left and right, and / or move in a translational direction (e.g., perpendicular to the objective optical axis 106 for optimal positioning, or in any other direction) and / or rotate about a rotational axis (e.g., axis 320, axis 620, or a third axis orthogonal to both axes 320, 620) while being held by the lens arm 111. In an exemplary embodiment, the lens arm 111 also has features that allow it to connect to and be held by hardware (e.g., viewing attachment 107) typically used for non-contact wide-angle viewing lenses for vitreoretinal surgery. In an exemplary embodiment, one or more features of the lens arm 111 ensure alignment of the imaging lens 113 to the optical axis 106 and positioning at the proper focal length.

[0059] In an exemplary embodiment, the viewing attachment 107 is configured to move the lens 113 into contact with the patient's eye 115. In an exemplary embodiment, the viewing attachment 107 includes an interface (e.g., knob 109) for manually adjusting the position of the lens 113 (e.g., along the objective optical axis 106) relative to the microscope 101.

[0060] In yet another exemplary embodiment, the lens 113 is configured to translate relative to the lens arm 111 in a first direction (e.g., along the objective optical axis 106) through a first range, and the lens 113 is configured to translate relative to the viewing attachment 107 through a second range greater than the first range. In an exemplary embodiment, the first range is about 15 mm, or in a range from about 1 mm to about 25 mm. In another exemplary embodiment, the second range is about 35 mm, or in a range from about 25 mm to about 45 mm.

[0061] 7A-7C are diagrams illustrating an example of the viewing attachment 107 of FIG. 1 rotating about the optical axis 106 of the microscope 101, according to one embodiment. Although the microscope 101 is not shown in FIGS. 7A-7C, the adapter plate 105 is shown with an optical axis 707 that is typically aligned with the optical axis 106 of the microscope 101 when the adapter plate 105 is attached to the microscope 101. Although FIG. 7B illustrates the viewing attachment 107 being rotated in a counterclockwise direction 705, in other embodiments, the viewing attachment 107 and lens arm 111 may be rotated in a clockwise direction (e.g., opposite to the direction 705).

[0062] In an embodiment, rotation of the viewing attachment 107 relative to the objective optical axis 106 of the microscope is provided, thereby providing the surgeon with a wider field of view for procedures when surgery is required in different peripheral regions of the eye. In an embodiment, FIGS. 7A-7C show the adapter plate 105 in two different positions. In this embodiment, the adapter plate 105 is formed in two parts, an upper part 701 and a lower part 703 that is configured to pivot (e.g., about an optical axis 707 that is aligned with the optical axis 106 of the microscope). In an exemplary embodiment, the upper part 701 is attached to the microscope 101. The upper part 701 is then fixed in place, while the lower part 703 can rotate (e.g., more than 360 degrees) about the optical axis 707. In an exemplary embodiment, a method of using the viewing attachment 107 includes using the rotation feature of the adapter 105 (e.g., up to about ±30 degrees in each direction to allow rotation of the goniolens 113 on the eye 115). This preferably expands the viewing area of ​​the iridocorneal angle 901 (FIG. 9A). In FIGS. 7B and 7C, the lower portion 703 of the adapter 105 is rotated counterclockwise by a specific angle (e.g., 30 degrees), so that the goniolens 113 is also rotated counterclockwise by this specific angle.

[0063] 8A and 8B are diagrams illustrating an example of the system 100 of FIG. 1 based on relative motion in a first direction (e.g., along the y-axis 194) between the lens 113 and the microscope 101, according to an embodiment. In an embodiment, the system 100 illustrated in FIGS. 8A and 8B features a different lens arm design than the lens arm 111. In an exemplary embodiment, the lens arm of FIGS. 8A and 8B, like the lens arm 111, has one or more spring characteristics (e.g., neutral position, extended position, etc.). In an exemplary embodiment, FIG. 8A illustrates a neutral position 802 similar to the neutral position 402 of FIG. 4A for the lens arm 111 design. In another exemplary embodiment, FIG. 8B illustrates an extended position 806 similar to the extended position 406 of FIG. 4C for the lens arm 111 design. In one embodiment, one or more differences in the design parameters of the lens arm of Figures 8A and 8B relative to lens arm 111 include the location of the moments controlling the rotation axes 320, 620, and material selection to adjust resistance to relative movement between the patient's eye and the microscope (such as axial displacement 401 and lateral displacement 610).

[0064] 8C and 8D are diagrams illustrating an example of the system 100 of FIG. 1 based on relative motion in a second direction (e.g., along the x-axis 192) between the lens 113 and the microscope, according to an embodiment. In an exemplary embodiment, the lens arm of FIG. 8C and 8D, like the lens arm 111, has one or more spring characteristics (e.g., neutral position, extended position, etc.). In an exemplary embodiment, FIG. 8C illustrates a first tilt position similar to the first tilt position 604 of FIG. 6A for the lens arm 111 design. In another exemplary embodiment, FIG. 8D illustrates an extended position similar to the extended position of FIG. 5C for the lens arm 111 design.

[0065] 8E and 8F are diagrams illustrating an example of the system 100 of FIG. 1 based on relative movement in a second direction between the lens 113 and the microscope 101, according to an embodiment. In an embodiment, the second direction is along the optical axis 106 of the microscope objective lens 103. In an embodiment, FIG. 8E is similar to the compressed position 404 of FIG. 4B (e.g., after the eye 115 has translated along the objective optical axis 106 toward the lens 103). In another embodiment, FIG. 8F is similar to the extended position 406 of FIG. 4C (e.g., after the eye 115 has translated along the objective optical axis 106 away from the lens 103).

[0066] In an embodiment, as shown in FIG. 2A, the lens 113 includes a first surface 182 (e.g., a bottom surface) that contacts the eye 115 (e.g., a cornea). In an exemplary embodiment, the first surface 182 has a curvature (e.g., a concave surface) based on the curvature of the cornea such that the first surface 182 remains in contact and concentric with the cornea (e.g., while rotating about the axis 320, 620). In an exemplary embodiment, the curvature of the first surface 182 is approximately equal to the curvature of the cornea (e.g., within ±20%). In an embodiment, the lens 113 includes a second surface 180 (e.g., a top surface). In some embodiments, the lens 113 is a non-prism lens and / or a plano-concave lens (e.g., there is no angle between the axes of the first surface 182 and the second surface 180).

[0067] As shown in FIG. 2A, the lens 113 is positioned on the eye 115. In an exemplary embodiment, the ophthalmic surgical microscope 101 is tilted at a certain angle (e.g., about 30 degrees, or an angle ranging from about 20 degrees to about 50 degrees) from the vertical (e.g., z-axis 196). In an exemplary embodiment, this tilting of the microscope 101 is performed by a surgeon when performing surgery related to the iridocorneal angle 901 (FIG. 9A). Thus, the microscope 101 does not need to be tilted at this angle for other procedures (e.g., surgery not related to the iridocorneal angle and / or observing the eye for non-surgical purposes such as diagnosis). In an embodiment, the first surface 182 is configured to be maintained in contact with the eye 115 such that light from within the eye 115 passes from the cornea to the lens 113 with minimal refraction (e.g., such that the difference between the refractive indices of the eye 115 and the lens 113 is minimal at the interface between the eye 115 and the lens 113). In one exemplary embodiment, to prevent undesired refraction at the eye 115 and lens 113 interface, a solution is dropped between the eye 115 and lens 113 (see FIG. 12F) to reduce instances of air gaps between the eye 115 and lens 113 (e.g., inducing unwanted refraction at the eye / air and / or air / lens interfaces). In another exemplary embodiment, the second surface 180 is angled such that light incident on the second surface 180 from within the lens 113 has a minimal angle of incidence with respect to a normal to the second surface 180. The present inventors have found that by minimizing the angle of incidence on the second surface 180 in this manner, light incident on the second surface 180 is less likely to be totally internally reflected (TIR) ​​into the lens 113, but instead will pass through the second surface 180 and be transmitted along the objective optical axis 106.

[0068] In one embodiment, the lens 113 is configured to maintain concentricity in contact with the subject's eye 115 and has multiple translational degrees of freedom (e.g., along a first direction, such as along the direction of the objective optical axis 106 in the yz plane 195, along any second direction in the yz plane 195, such as the y axis 194, along any third direction in the xz plane 197, such as the x axis 192, or along any direction in the xy plane) and multiple rotational degrees of freedom (e.g., about the first rotation axis 320, the second rotation axis 620, or a third rotation axis orthogonal to the first and second rotation axes) to accommodate eye movement in any of these directions such that the lens 113 maintains concentricity in contact with the eye 115 during movement in any of these directions. As shown in Figures 4A-4C, rotation of lens 113 about a first axis of rotation 320 is provided to maintain contact and concentricity in the case of axial displacement 401 or 403 along optical axis 106. As shown in Figures 6A-6C, rotation of lens 113 about a second axis of rotation 620 is provided to maintain contact and concentricity in the case of lateral displacement (e.g., movement along x-direction 192).

[0069] In another embodiment, the lens 113 is configured to be in contact and concentric with the subject's eye 115 such that a second degree of freedom of rotation (e.g., about a second rotation axis 620) accommodates lateral movement of the eye 115 in a lateral direction (e.g., x-axis 192) perpendicular to the first direction (e.g., y-axis 194 or optical axis 106) such that the lens 113 remains in contact and concentric with the eye 115 during this movement in the lateral direction. In an exemplary embodiment, FIGS. 6A-6C show the lateral displacement 610 or 612 accommodated by rotation about the second rotation axis 620. In an exemplary embodiment, the lateral displacement 610 or 612 is in the range of about ±4 mm, or about ±1 mm to about ±15 mm. In yet another exemplary embodiment, the axial displacement 401 or 403 is in the range of about ±4 mm, or about ±1 mm to about ±15 mm.

[0070] In some embodiments, the rotation of the lens 113 about the second axis of rotation 620 is based on the lens 113 and lens arm 111 pivoting about the axis of rotation 620 such that the lens 113 pivots on the eye 115 while maintaining concentricity and / or spherical contact with the eye 115 (FIGS. 6A and 6C). In some exemplary embodiments, the lens 113 pivots on the eye 115 as the lens 113 and lens arm 111 pivot about the second axis of rotation 620, as shown in FIG. 6A or 6C.

[0071] In one embodiment, the first surface 182 (e.g., the bottom surface in contact with the eye 115) is concave with a curvature based on the curvature of the eye, such that the first surface 182 is in contact with and concentric with the eye. In another embodiment, the bottom / first surface 182 of the lens 113 is concave with a radius of curvature matching the radius of curvature of the cornea (e.g., about 8 mm, or in the range of about 7 mm to about 9 mm), such that the lens 113 (e.g., made of a material with a refractive index similar to the human cornea) minimizes the refractive power of the cornea. In another exemplary embodiment, the second / top surface 180 of the lens 113 may have different design specifications, each used to visualize different regions or anatomical features inside the eye and / or to control the magnification of the image. In one exemplary embodiment, the second / top surface 180 is convex. In yet another exemplary embodiment, the second surface / top surface 180 is angled at a particular angle (e.g., about 40 degrees, or an angle ranging from about 30 degrees to about 50 degrees). In other embodiments, the lens 113 is a prism lens for gonioscopy. In still other embodiments, the lens 113 is a plano-concave lens, a biconcave lens, and / or a convex-concave lens with a spherical or aspheric surface. In some embodiments, the lens 113 has an anti-reflective coating. In still other embodiments, the lens 113 is made from a material that is stable to gamma radiation.

[0072] In one embodiment, a safety feature is provided by the device 110 to prevent potentially damaging forces from being applied to the eye during intended (focusing) or unintended microscope movements. In one embodiment, the range of motion of this safety feature should exceed the focal range required to view the ocular structure to be examined, as well as the maximum anticipated unintended microscope movements. In one embodiment, this safety feature is achieved by a configuration that ensures continuous contact of the lens-cornea interface by allowing tilt, rotation, and axial movement of the lens 113 to compensate for small patient and eye movements, and by allowing lateral misalignment of the eye relative to the optical axis 106 of the microscope. The inventors of the present invention have found that this feature allows for constant and minimal contact forces to be applied to the eye to prevent compression of the anterior chamber during the procedure.

[0073] In one embodiment, second surface 180 is angled at approximately 50 degrees (or in the range of approximately 40 degrees to approximately 60 degrees) relative to first surface 182 to accommodate a wide range of microscope angles and ocular anatomical structures in visualizing the iridocorneal angle 901 (FIG. 9A).

[0074] Figure 11 is a flow diagram illustrating an example method 1100 of providing a hands-free lens for use during ophthalmic surgery, according to an embodiment. For purposes of explanation, the steps are illustrated in Figure 11 as an integrated set of steps in a particular order, but in other embodiments, one or more steps, or portions thereof, may be performed in a different order, overlap in time, performed sequentially or in parallel, or omitted, or one or more additional steps may be added, or the method may be modified in some manner or combination. Figures 12A-12M show examples of one or more steps of method 1100 being performed.

[0075] In one embodiment, a non-sterile adapter plate is attached and secured using thumb screws (FIG. 12A) in step 1101. Additionally, in one embodiment, a sterile disk 1201 is placed over the adapter plate 105 (FIG. 12B).

[0076] In one embodiment, in step 1105, the lens 113 and the lens arm 111 are attached to the viewing attachment. In one embodiment, in step 1105, the lens arm 111 is secured to the viewing attachment 107 using various mechanisms. In one embodiment, after the lens 113 and the lens arm 111 are secured to the viewing attachment 107 in step 1105, the viewing attachment 107 is adjusted so that the lens 113 is in a top position (e.g., the highest position of the viewing attachment's range of movement in an upward direction). In one exemplary embodiment, in step 1105, the knob 109 of the viewing attachment 107 is rotated in a first direction 1207 to move the lens 113 and the lens arm 111 in a first direction 1209 (FIG. 12C). In this exemplary embodiment, the knob 109 is rotated in the direction 1207 until the lens 113 is in a top position on the viewing attachment 107. In another embodiment, in step 1105, a viewing attachment is used and the knob is rotated until the lens 113 is in the uppermost position.

[0077] In one embodiment, in step 1107, a viewing attachment is attached to the microscope 101. In one embodiment, in step 1107, a portion of the viewing attachment 107 (FIG. 12D) is moved in a direction 1211 such that the portion of the viewing attachment 107 is received in a slot in the adapter plate 105. In one exemplary embodiment, in step 1107, the portion of the viewing attachment 107 is moved into the slot in the adapter plate 105 until the viewing attachment 107 is securely engaged with the adapter plate 105.

[0078] In one embodiment, in step 1109, the objective lens 103 of the microscope 101 is focused to an appropriate distance. In one embodiment, in step 1309, the objective lens 103 is focused on the iris of the eye 115. Figure 12E shows an example of step 1109, where the objective lens 103 is focused on the iris of the eye 115.

[0079] In some embodiments, after step 1109, a gel is placed on the eye 115. Figure 12F illustrates an embodiment in which this step is performed. In these embodiments, the gel is applied to the surface of the eye 115 to prevent and / or minimize total internal reflection (TIR) ​​that occurs at the interface between the eye 115 and the lens 113 by eliminating / minimizing any air gap between the eye 115 and the lens 113.

[0080] In an embodiment, in step 1111, the observation attachment is moved to a working position (e.g., a position where a surgeon can view the eye for purposes of performing one or more surgical procedures and / or diagnose one or more ocular conditions). In an embodiment, in step 1111, the observation attachment 107 (e.g., in addition to the lens 113 and the lens arm 111) is rotated in direction 1213 (FIGS. 12G-12H) to the working position. In an exemplary embodiment, the working position is a position where the lens 113 is aligned with the optical axis 106 of the objective optics of the objective lens 103 (FIG. 12H). As shown in FIG. 12H, in an embodiment, the lens 113 and the lens arm 111 are moved in direction 1209 to a top position (step 1105), and then the observation attachment 107 is rotated in direction 1213 until the lens 113 and the lens arm 111 are in the working position.

[0081] In one embodiment, in step 1113, the viewing attachment is adjusted to move the lens 113 to establish contact with the eye 115 (e.g., cornea). In one embodiment, in step 1113, the viewing attachment 107 is adjusted by rotating the knob 109 in a second direction 1220 (FIG. 12I) that is opposite the first direction 1207 (FIG. 12C) of step 1105. In one exemplary embodiment, in step 1113, the viewing attachment is adjusted so that the lens 113 is slowly lowered in a downward direction 1215 (FIG. 12I) that is opposite from the upward direction 1209 of step 1105. In one exemplary embodiment, in step 1113, adjustment of the viewing attachment is stopped once the lens 113 is in full contact with the cornea. In an exemplary embodiment, once full contact between the lens 113 and the cornea is established in step 1113, the focus of the microscope objective lens 103 is adjusted to optimize the lens 113's view of the eye 115 at the iridocorneal angle 901 (e.g., to correct for changes in optical path length with the lens 113 in place). In an exemplary embodiment, moving the lens down to focus in step 1113 may compress the flexible lower arm slightly, causing a temporary increase in intraocular pressure. In an exemplary embodiment, method 1100 preferably ensures that the pressure of the lens 113 against the eye 115 does not exceed a threshold force (e.g., approximately 1 Newton (N)).

[0082] In one embodiment, the viewing attachment is adjusted in step 1113 to move the lens 113 to a neutral position 402, 502 (FIGS. 4A and 5A), thereby facilitating axial movement of the lens 113 relative to the lens arm 111 (and the viewing attachment). In one exemplary embodiment, the viewing attachment is adjusted in step 1113 until the lens arm 111 is an intermediate distance 1250 away from the viewing attachment 107. In one exemplary embodiment, the intermediate distance 1250 is the distance between the lens arm 111 and the viewing attachment 107 when the device 110 is in the neutral position 402, 502. In another exemplary embodiment, the value of the intermediate distance 1250 is between the values ​​of the retracted distance 408 and the extended distance 410 when the lens arm 111 is in the retracted position 404 and the extended position 406, respectively. Thus, in step 1113, the lens arm 111 is moved until it is at an intermediate position along the optical axis 106. The inventors have found that this preferably facilitates axial translation of the lens 113 relative to the microscope 101 in both directions along the optical axis 106 (e.g., the direction in which the lens 113 moves away from the microscope 101 or the direction in which the lens 113 moves towards the microscope 101), regardless of which direction the axial translation is in.

[0083] In an embodiment, after the lens 113 is placed between the eye 115 and the objective lens 103 in step 1113, the objective lens 103 of the microscope 101 is refocused. In an embodiment, when the objective lens 103 is focused, the microscope 101 tends to move slightly toward the eye 115 (e.g., along the optical axis 106). Thus, in this step, the lens arm 111 moves from the neutral position 402 to the retracted position 404 (FIGS. 4A-4B), so that the lens arm 111 moves within the retracted spacing 408 of the observation attachment 107 (FIG. 12K). Thus, the inventors have found that by facilitating axial translational movement of the microscope 101 relative to the eye 115 along the optical axis 106 of the microscope objective lens 103, the apparatus 110 can favorably accommodate the initial setup of the system 100.

[0084] In an embodiment, by adjusting the position of the lens 113 on the eye 115 in step 1115, the relative movement between the eye 115 and the microscope 101 is facilitated in one or more translational degrees of freedom and / or one or more rotational degrees of freedom. In an embodiment, the one or more translational degrees of freedom include accommodating relative translational movement between the eye 115 and the microscope 101 in any direction in the yz plane 195 (e.g., along the y axis 194, along the optical axis 106), in any direction in the xz plane 197 (e.g., along the x axis 192), and in any direction along the xy plane. In another embodiment, the one or more rotational degrees of freedom include accommodating relative rotation of the eye 115 around the microscope 101, or rotation of the lens 113 on the eye 115 (e.g., rotation around the first rotation axis 320, the second rotation axis 620, or a third rotation axis perpendicular to both axes 320, 620). In one embodiment, in step 1115, relative translational movement between the eye 115 and the microscope 101 in any of these directions is facilitated based on translational movement of the lens arm 111 relative to the microscope 101 in the same direction. In another embodiment, in step 1115, concentricity and / or spherical contact between the lens 113 and the eye 115 is maintained during this translational movement based on rotational movement of the lens 113 on the eye 115 about one or more of the first rotational axis 320, the second rotational axis 620, or a third rotational axis orthogonal to both axes 320, 620.

[0085] In an embodiment, in step 1117, the viewing attachment (and lens 113) is rotated relative to the microscope 101. In an embodiment, in step 1117, the viewing attachment 107 is rotated about the optical axis 106 of the microscope objective lens 103. In an exemplary embodiment, the viewing attachment 107 is rotated in a counterclockwise direction 705 (FIG. 12L) or a clockwise direction 705′. In an embodiment, step 1117 is performed to achieve an extended view of the anterior chamber of the eye at an angle (e.g., the iridocorneal angle 901). In an exemplary embodiment, in step 1117, the viewing attachment is rotated in a direction 705, 705′ over a range of angles (e.g., about 30 degrees). In another exemplary embodiment, the lens 113 is not moved away from the cornea during the rotation of step 1117, thereby providing the surgeon with an expanded view of the eye 115 along that angle (e.g., an expanded view of the anterior chamber of the eye at the iridocorneal angle 901, where the anterior chamber may be observed at the angle 901 from different directions, etc.).

[0086] In some embodiments, in step 1119, the viewing attachment is moved out of the working position. In some embodiments, step 1119 is performed after a procedure (e.g., eye surgery). In some embodiments, in step 1119, the viewing attachment 107 (and lens 113) is moved out of the working position. In some exemplary embodiments, step 1119 is the reverse of step 1111, where the viewing attachment 107 is adjusted to move the lens 113 in an upward direction 1209 and / or rotated along a direction 1213′ to move the viewing attachment 107 (and lens 113) out of the working position ( FIG. 12M ).

[0087] In the foregoing specification, the invention has been described with reference to specific embodiments thereof. However, it will be apparent that various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention. The specification and drawings are therefore to be regarded as illustrative rather than restrictive. Throughout this specification and claims, unless the context otherwise requires, the word "comprise" and its variations such as "comprises" and "comprising" will be understood to mean the inclusion of a stated item, element or step of an item, or group, element or step, but not the exclusion of any other item, element or step of an item, or group, element or step. Furthermore, the indefinite article "a" or "an" means one or more items, elements or steps modified by the article.

Claims

1. 1. An apparatus for attaching a lens to a microscope using an optical attachment, the apparatus comprising: a lens having one or more translational degrees of freedom such that the lens is configured to translate along one or more directions relative to the microscope; and the lens having one or more rotational degrees of freedom such that the lens is configured to rotate about one or more axes of rotation relative to the microscope; An apparatus comprising at least one of the following:

2. the microscope includes an objective lens defining an optical axis of an objective optical system; the one or more directions include a first direction along an optical axis of the objective optical system; 2. The apparatus of claim 1.

3. the microscope includes an objective lens defining an optical axis of an objective optical system; the one or more directions include a first direction angled with respect to an optical axis of the objective optical system; 2. The apparatus of claim 1.

4. the lens having a plurality of degrees of freedom of translation that define a plurality of directions such that the lens is configured to translate in any of a plurality of directions relative to the microscope; 2. The apparatus of claim 1.

5. the optical attachment comprises a lens arm and a positioning mechanism for moving the lens and the lens arm relative to the microscope; The apparatus further includes a lens arm having a first end attached to the lens and a second end attached to the positioning mechanism; the first end is configured to move from a first position to a second position relative to the second end to accommodate the translational movement of the lens in a first direction of the one or more directions.

2. The apparatus of claim 1.

6. when the first end is in the first position, an optical axis of the lens is aligned with an optical axis of an objective lens of the microscope; when the first end is in the second position, the optical axis of the lens is aligned within an angular threshold of the optical axis of the objective lens.

6. The apparatus of claim 5.

7. the first end is configured to translate relative to the second end in the first direction to accommodate the translation of the lens in the first direction; the first end is configured to rotate about one or more rotational axes relative to the second end such that an optical axis of the lens remains aligned within a threshold angle of an optical axis of an objective lens of the microscope when the first end moves from the first position to the second position.

6. The apparatus of claim 5.

8. when the first end is in the first position, the lens and the lens arm are disposed in a first plane; the axis of rotation is angled relative to the first plane; 8. The apparatus of claim 7.

9. The one or more rotation axes are A first rotation axis perpendicular to the first plane; A second rotation axis perpendicular to the first rotation axis; a third rotation axis perpendicular to the first rotation axis and the second rotation axis; Equipped with 9. The apparatus of claim 8.

10. the one or more translational degrees of freedom accommodate movement of the eye in the first of the one or more directions such that the lens remains in contact with and concentric with the eye during movement of the eye in the first direction; and wherein the one or more rotational degrees of freedom accommodate lateral movement of the eye in the lateral direction different from the first direction such that the lens maintains contact and concentricity with the eye during movement of the eye in the lateral direction. the lens is configured to be in contact with and concentric with the subject's eye; 2. The apparatus of claim 1.

11. the lens arm having a curved surface between the first end and the second end; 6. The apparatus of claim 5.

12. the bending surface defines one or more bends; The radius of curvature of the one or more bends is a translation of the first end relative to the second end in the first direction to accommodate the translation of the lens in the first direction; rotation of the first end about one or more rotational axes relative to the second end such that an optical axis of the lens remains aligned within an angular threshold of an optical axis of an objective lens of the microscope as the first end moves from the first position to the second position; is selected to absorb at least one of 12. The apparatus of claim 11.

13. The lens arm is a curved surface disposed between the first end and the second end, the curved surface having a first range of radius of curvature values; a material having a second range of elasticity values; a dimension having a third range of dimension values; Equipped with The first range of radius of curvature values, the second range of elasticity values, and the third range of dimensional values, a translation of the first end relative to the second end in the first direction to accommodate the translation of the lens in the first direction; rotation of the first end about one or more rotational axes relative to the second end such that an optical axis of the lens remains aligned within an angular threshold of an optical axis of an objective lens of the microscope as the first end moves from the first position to the second position; Selected to absorb 6. The apparatus of claim 5.

14. The lens has a first surface configured to contact the patient's eye and a second surface opposite the first surface.

2. The apparatus of claim 1.

15. the first surface is concave with a curvature based on the curvature of the eye such that the first surface is in contact with and concentric with the eye.

15. The apparatus of claim 14.

16. the first surface is concentric in contact with the eye; the second surface is configured such that incident light entering the second surface from an interface between the first surface and the eye is not totally internally reflected.

15. The apparatus of claim 14.

17. The lens of claim 1 ; The optical attachment according to claim 1 , the optical attachment comprises a lens arm and a positioning mechanism configured to move the lens and the lens arm relative to the microscope; system.

18. The positioning mechanism is configured to move the lens into contact with the patient's eye.

20. The system of claim 17.

19. the positioning mechanism comprises an interface for adjusting the position of the lens relative to the microscope.

20. The system of claim 17.

20. the microscope includes an objective lens defining an optical axis of an objective optical system; The positioning mechanism is configured to move the lens along an optical axis of the objective optical system.

20. The system of claim 17.

21. 1. A method for positioning a lens relative to a microscope using an optical attachment, the method comprising: securing the lens to a first end of a lens arm of the optical attachment; securing a second end of the lens arm to a positioning feature of the optical attachment; moving the lens with the positioning mechanism until the lens contacts the patient's eye; translating the lens along one or more directions relative to the microscope based on relative movement between the first end and the second end of the lens arm in the one or more directions such that the lens maintains contact with the eye; A method for providing the same.

22. The relative movement between the first end and the second end of the lens arm comprises: a translation between the first end and the second end along the one or more directions to accommodate the translation of the lens along the one or more directions; and rotation of the first end about one or more rotation axes relative to the second end, such that the optical axis of the lens remains oriented within a threshold angle of the optical axis of the microscope objective lens during the translational step; At least one of:

22. The method of claim 21.

23. the microscope includes an objective lens defining an optical axis of an objective optical system; Securing the second end further includes securing the positioning mechanism to the microscope; said moving includes moving the lens along an optical axis of the objective using the positioning mechanism until the lens is in contact with and concentric with the eye of the patient; The method further comprises rotating the lens about one or more rotational axes relative to the microscope based on a rotation of the first end of the lens arm relative to the second end of the lens arm such that an optical axis of the lens remains aligned within a threshold angle of an optical axis of the objective optics after the translational step.

22. The method of claim 21.

24. said moving includes moving the lens until the lens contacts the eye and the lens is centrally located within the range of translational movement in the one or more directions.

22. The method of claim 21.

25. further comprising rotating the positioning mechanism, the lens arm, and the lens about an optical axis of the objective optical system.

24. The method of claim 23.

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