Visualization and treatment of media opacities in the eye

Abstract

To provide a system for treating media opacities in the vitreous media of an eye.SOLUTION: A system for treating media opacification in the vitreous media of an eye includes a visualization module adapted to provide visualization data of a portion of the eye via one or more observation beams. The system includes a laser module adapted to selectively generate a treatment beam directed toward the media turbidity to disrupt the media turbidity. The laser module and the visualization module have a shared aperture for directing the treatment beam and the one or more observation beams toward the eye, the shared aperture being disposed about the central axis. The controller is configured to obtain one or more defining parameters of the medium turbidity and to determine when the medium turbidity is within a predetermined target zone of a real-time observation window. The medium turbidity is treated with the treatment beam when the medium turbidity is within a predetermined target zone.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present disclosure relates generally to the visualization and treatment of one or more media opacities within the eye. [Background technology]

[0002] Humans have five basic senses: sight, hearing, smell, taste, and touch. Vision gives us the ability to visualize the world around us and connects us to our surroundings. Many people around the world experience problems with the quality of their vision. One condition that affects the quality of vision is the presence of opacities, sometimes called floaters, in the vitreous humor of the eye. Opacities can appear as specks or shadows of various shapes that appear to float in a patient's field of vision and scatter light entering the eye. Opacities may be caused by tiny collagen fibers within the vitreous humor. Treatment for opacities can include vitrectomy or laser vitreolysis. Because the vitreous cavity and retina are deeper than anterior tissues such as the cornea and lens, it is often difficult to effectively visualize and treat opacities. Summary of the Invention [Means for solving the problem]

[0003] Disclosed herein is a system for treating media opacities in the vitreous medium of an eye. The system includes a visualization module adapted to provide visualization data of a portion of the eye via one or more observation beams. The system includes a laser module adapted to selectively generate a treatment beam directed toward the media opacity to incise, vaporize, or destroy the media opacity. The laser module and visualization module have a shared aperture for directing the treatment beam and the one or more observation beams toward the eye, the shared aperture being aligned about a central axis.

[0004] The controller is in communication with the visualization module and the laser module, the controller having a processor and a tangible, non-transitory memory having instructions stored thereon. Execution of the instructions by the processor causes the controller to obtain one or more definition parameters of the medium opacity based at least in part on the visualization data, the one or more definition parameters including a shape and a size of the medium opacity. The controller is configured to determine, based at least in part on the one or more definition parameters, when a threshold portion of the medium opacity is within a predetermined target zone of a real-time observation window. In some embodiments, the definition parameter includes a depth of the medium opacity. The treatment beam is directed toward the medium opacity when the threshold portion of the medium opacity is within the predetermined target zone.

[0005] In some embodiments, the sensor is in communication with the controller and is configured to detect patient movement. The controller is configured to disable the treatment beam when patient movement is detected by the sensor. The controller can be configured to acquire a speckle pattern of scattered light resulting from the treatment beam, the scattered light being on the order of a wavelength of the treatment beam. In some embodiments, the system can include a joystick unit in communication with the controller and configured to enable depth selection of the visualization module.

[0006] The treatment beam can include multiple ultrashort laser pulses. The multiple ultrashort laser pulses can define individual durations on the order of femtoseconds to about 50 picoseconds. The treatment beam can travel in a direction parallel to a central axis. In some embodiments, the treatment beam can travel at an off-axis angle from the central axis, the off-axis angle being 25 degrees or greater.

[0007] In some embodiments, a corneal bonding member can be positioned proximate to the cornea of ​​the eye, the corneal bonding member configured to reduce the depth of field of the treatment beam. The visualization module can be configured to use electromagnetic radiation reflected from one or more optical devices before striking the eye, the one or more optical devices positioned such that only oblique rays strike the eye and central rays are blocked.

[0008] In some embodiments, the visualization module includes a light source, a mirror unit, a first polarizer, and a second polarizer, the second polarizer being oriented 90 degrees relative to the first polarizer. The first polarizer is adapted to polarize at least one incident beam from the light source to generate a linearly polarized wave. The mirror unit is adapted to direct the linearly polarized wave onto the eye. The second polarizer is positioned so that a reflected beam exiting the eye is projected onto the second polarizer. The visualization module may further include a birefringent prism configured to block the linearly polarized wave before it hits the eye. The birefringent prism is configured to block the reflected beam before it is projected onto the second polarizer.

[0009] In some embodiments, the visualization module includes an electronically controlled liquid lens having a response time of 1 to 5 milliseconds. The system can include a wavefront sensor configured to determine ocular aberrations in one or more observation beams exiting the eye. The deformable mirror is configured to shape the wavefront of the treatment beam based in part on the ocular aberrations determined by the wavefront sensor. The system can include a spatial light modulator adapted to shape at least one of a respective phase and a respective amplitude of the one or more observation beams. The spatial light modulator can be positioned coaxially with respect to a central axis. The spatial light modulator can be rotatable off-axis with respect to the central axis.

[0010] Disclosed herein is a method for treating a media opacity in an eye using a system having a visualization module, a laser module, and a controller with a processor and a tangible, non-transitory memory having instructions recorded thereon. The method includes adapting the laser module to selectively generate a treatment beam directed toward the media opacity and acquiring visualization data of the eye via the visualization module. The method includes acquiring and storing one or more definition parameters of the media opacity based at least in part on the visualization data. The definition parameters include a shape and size of the media opacity. The method further includes determining, via the controller, when a threshold portion of the media opacity is within a predetermined target zone based at least in part on the one or more definition parameters. A treatment beam is directed toward the media opacity via the laser module when the threshold portion of the media opacity is within the predetermined target zone to destroy the media opacity.

[0011] The above and other features and advantages of the present disclosure will become readily apparent from the following detailed description of the best mode for carrying out the disclosure, when read in conjunction with the accompanying drawings. [Brief explanation of the drawings]

[0012] [Figure 1] FIG. 1 is a schematic diagram of a system for treating opacified media in the eye, the system including a controller, a visualization module, and a laser module. [Figure 2] FIG. 2 is a schematic diagram of a portion of the system of FIG. [Figure 3] FIG. 3 is a schematic partial view of a visualization module that can be used by the system of FIG. 1 according to another embodiment. [Figure 4] FIG. 4 is a schematic partial diagram of an exemplary spatial light modulator that may be used by the system of FIG. [Figure 5] FIG. 5 is a schematic flow chart of a method that can be performed by the controller of FIG. [Figure 6]FIG. 6 is a schematic diagram of an exemplary real-time observation window implemented by the system of FIG. [Figure 7] FIG. 7 is a schematic partial view of a visualization module that can be used by the system of FIG. 1 according to yet another embodiment. [Figure 8] FIG. 8 is a schematic partial view of a corneal bonding member that may be used with the system of FIG. DETAILED DESCRIPTION OF THE INVENTION

[0013] Referring to the drawings, wherein like reference numbers refer to like components, FIG. 1 schematically illustrates a system 10 having a visualization module 12, a laser module 14, and a surgical camera 15. As described below, visualization module 12 is a stereo-optical visualization system. System 10 is configured to image and treat a target site. In the illustrated embodiment, the target site is an eye 16 of a patient 18. With reference to FIG. 1, visualization module 12 and laser module 14 are at least partially disposed in a head unit 20 of a housing assembly 22, which is configured to be oriented at least partially toward eye 16. Head unit 20 can be set up to accommodate various positions of patient 18. For example, patient 18 may be in an upright seated position during an eye procedure. With reference to FIG. 1, a selector 24 can be mounted on head unit 20 to select specific features, such as magnification or zoom, focus, and other features.

[0014] Referring now to FIG. 2, a schematic diagram of a portion of system 10 is shown. As shown in FIG. 2, system 10 is configured to treat at least one opacity medium 26 of eye 16. As illustrated by first opacity medium 26A, second opacity medium 26B, and third opacity medium 26C (see FIG. 2), the opacity medium 26 may reside at various locations within the vitreous medium 28. As described below, system 10 utilizes both visualization data and beam delivery parameters to optimize treatment of the opacity medium 26. System 10 incorporates a shared aperture 30 for simultaneous visualization, imaging, and delivery of treatment to the opacity medium 26.

[0015] 2, the laser module 14 is configured to selectively generate at least one treatment beam 32 directed toward the turbid medium 26 via a laser source 34. In some embodiments, the treatment beam 32 includes multiple ultrashort laser pulses, each on the order of femtoseconds (10 -15 seconds) to approximately 50 picoseconds (50 x 10 -12 The treatment beam 32 has a duration of about 1000 s (seconds). The treatment beam 32 is optimized to at least partially ablate, vaporize, destroy, dissolve, or reduce the medium opacity 26.

[0016] 1 and 2, system 10 includes a controller C having at least one processor P and at least one memory M (or tangible, non-transitory computer-readable storage medium) on which instructions for performing method 300 shown in and described below with respect to FIG. 5 may be recorded. Memory M may store a set of controller-executable instructions, and processor P may execute the set of controller-executable instructions stored in memory M.

[0017] The visualization module 12 guides the surgeon in making a diagnosis, selecting a target site, and directing the laser vitreolysis energy. The visualization module 12 is adapted to acquire visualization data of the eye 16. As described below, the visualization module 12 can use various techniques for generating contrast, including digitally programmable epi-illumination microscopy using a spatial light modulator 200 shown in FIG. 4. Referring to FIG. 1, the controller C can be configured to process signals from the visualization module 12 for broadcast on a display 36. The display 36 can include, but is not limited to, a high-definition television, an ultra-high-definition television, smart eyewear, a projector, one or more computer screens, a laptop computer, a tablet computer, and can include a touch screen.

[0018] 1, the controller C may be configured to process signals to and from a user interface 38 that can be operated by a surgeon or other member of the surgical team. In one example, the user interface 38 is a joystick unit 38. In one embodiment, the visualization module 12 is a stereo optical microscope with depth selection controllable via the joystick unit 38. Precise depth control helps to protect the lens 40 and retina 42 of the eye, as shown in FIG. 2.

[0019] The visualization module 12 and the laser module 14 may include an integrated processor or device controller in communication with the controller C. For example, with reference to FIG. 1 , the visualization module 12 may include a module processor 44, and the laser module 14 may include a laser processor 46. The module processor 44 and the laser processor 46 may be separate modules in communication with the controller C. Alternatively, the module processor 44 and the laser processor 46 may be incorporated into the controller C.

[0020] The surgical camera 15 may be communicatively coupled to other components of the system 10, such as the controller C and the display 36. The surgical camera 15 may include an integrated control unit 48 having a processor, memory, and an image processing unit. Referring to FIG. 1 , a visible light illumination source 49 may be used as an illumination source for the surgical camera 15. The visible light illumination source 49 may include a xenon light source, a white LED light source, or any other suitable visible light source. The surgical camera 15 may include one or more sensors configured to detect light reflected from the eye 16 and transmit a signal corresponding to the detected light to the controller C or the integrated control unit 48. The sensor may be a complementary metal-oxide semiconductor (CMOS) sensor, a charge-coupled device (CCD) sensor, or other sensor available to those skilled in the art. A digital image of the eye 16 may be shown on the display 36. The surgical camera 15 may be a digital camera, an HDR camera, a 3D camera, or a combination thereof. The surgical camera 15 may be a monochrome camera or a color camera. The surgical camera 15 may utilize respective assemblies (not shown) available to those skilled in the art for opto-mechanical focus, zoom variation, and working distance variation of the surgical camera 15.

[0021] 1 , the system 10 may include a motion sensor 50 in communication with the controller C and configured to detect movement of the patient 18. In one example, the motion sensor 50 is in contact with a structural member 52 supporting the patient 18, such as a headrest. In another example, the motion sensor 50 is in contact with the forehead of the patient 18. The controller C may be configured to disable the treatment beam 32 when movement of the patient 18 is detected by the sensor 50.

[0022] As shown in FIG. 1 , the various components of system 10 may be configured to communicate via a network 54. Network 54 may be a bus implemented in various ways, such as a serial communications bus in the form of a local area network. The local area network may include, but is not limited to, a Controller Area Network (CAN), Controller Area Network with Flexible Data Rate (CAN-FD), Ethernet, Bluetooth, Wi-Fi, and other forms of data. Other types of connections may also be used. System 10 may further include a communications interface 56 for transmitting and receiving information to and from a remote server and / or cloud unit.

[0023] The visualization module 12 is adapted to provide visualization data of the eye 16 via one or more observation beams V (see FIG. 1 ). As described below, the visualization module 12 is configured to use electromagnetic radiation reflecting from one or more optical devices before impinging on the eye 16. While an exemplary embodiment of the visualization module 12 is shown in FIG. 1 , it should be understood that the visualization module 12 can include other types of imaging devices available to those skilled in the art. Referring to FIG. 1 , the visualization module 12 includes a light source 60 that emits light in the visible range of the electromagnetic spectrum. As shown in FIG. 1 , a first observation beam B1 and a second observation beam B2 can originate from the light source 60 and pass through a collimation unit 62. The collimation unit 62 can include various fields and aperture diaphragms, as well as other optical devices available to those skilled in the art.

[0024] The first and second observation beams B1 and B2 are directed toward the eye 16 via a first and second reflecting device 64 and 66, respectively. The first and second reflecting devices 64 and 66 may be positioned at selected distances and configured to selectively reflect light of specific desired wavelengths. The first and second reflecting devices 64 and 66 may be mirrors, corner cubes, or the spatial light modulator 200 described below. The reflected light from the first and second reflecting devices 64 and 66 travels toward a first and second curved mirror 68 and 70, respectively. Referring to FIG. 1 , the first and second curved mirrors 68 and 70 direct the first and second observation beams B1 and B2, respectively, as first and second oblique rays O1 and O2 onto a portion of the eye 16 at an oblique angle of incidence. 1, the central light that normally passes through the target site and its periphery is blocked, allowing only oblique light rays from all azimuthal angles to strike the target site, which is the eye 16. This annular illumination filters out zero-order or unscattered light, resulting in an image formed from the higher-order diffracted intensities scattered by the eye 16. Thus, the portion of the eye 16 being imaged appears bright in contrast to the dark background.

[0025] Referring to FIG. 1, the first oblique light ray O1 and the second oblique light ray O2 may each be composed of a hollow cone of light. The first oblique light ray O1 and the second oblique light ray O2 impinge on the eye 16. Vitreous visualization is similar to reflected light microscopy (epi-illumination) in that the light source and imaging / visualization optics are on the same side of the target site. However, vitreous visualization / imaging differs in that the source of visualization data is light reflected from the retina 42 and / or sclera 71 passing through a phase object, such as a turbid medium 26 in the vitreous medium 28. Essentially, the light source is posterior to the target site. Referring to FIG. 1, the reflected beam R (from the retina 42 and / or sclera 71) is diffracted, reflected, and / or refracted by the turbid medium 26 (see FIG. 2) in the vitreous medium 28. The reflected beam R returns through the objective lens 72 and the tube lens 74.

[0026] 1 , at least one of the objective lens 72 and the tube lens 74 may be an electronically controlled liquid lens. In some embodiments, the electronically controlled liquid lens may include a core containing an optical fluid sealed with a flexible outer membrane. The focal length of the electronically controlled liquid lens can be changed by changing the curvature of the flexible outer membrane fluid, for example, via a current-controlled voice coil. In one example, the electronically controlled liquid lens has a response time of 1 millisecond.

[0027] The reflected beam R encodes the positions of multiple reflecting points within the eye 16 relative to a known reference point or relative to each other. Referring to FIG. 1 , the encoding may be captured by a detector 76 and processed via the module processor 44 and / or controller C. In one example, the detector 76 includes a light receiver coupled to an electrical device. However, it should be understood that the detector 76 may include other types of receptor devices available to those skilled in the art. In some embodiments, optical fibers may be used to deliver and / or guide the first and second observation beams B1 and B2 and direct them to strike the appropriate region of interest within the eye 16. Other methods available to those skilled in the art may be used to deliver and / or guide the various beams within the system 10. Additionally, the system 10 may include optical observation and electronic visualization.

[0028] 1, the visualization module 12 may include a steering unit 78 for steering the first observation beam B1 and / or the second observation beam B2. In one embodiment, the steering unit 78 includes a multi-axis galvanometer or a single-axis galvanometer. A single-axis galvanometer is a small, lightweight mirror that can be swung back and forth on an axis under electrical control, thereby changing the reflection direction of the path of reflected light along one axis.

[0029] The first reflecting device 64 and the second reflecting device 66 may include a spatial light modulator 200, an example of which is shown in FIG. 4. Referring to FIG. 4, the spatial light modulator 200 may include a cover layer 202 adjacent to a zero voltage electrode layer 204. The cover layer 202 may be made of silicone, glass, or other suitable material. A liquid crystal modulator 206 is disposed between the zero voltage electrode layer 204 and an array of pixel electrodes 208, including first through fourth pixel electrodes E1, E2, E3, and E4.

[0030] The spatial light modulator 200 is adapted to shape at least one of the respective phase and respective amplitude of the incident light 210 on a pixel-by-pixel basis. Referring to FIG. 4 , each of the array of pixel electrodes 208 can be configured to apply a different potential difference to the zero-voltage electrode layer 204. The potential difference of the pixel electrodes 208 can be selected directly or indirectly by a controller C. Thus, the reflected light 212 (including the first wavefront portion W1, the second wavefront portion W2, the third wavefront portion W3, and the fourth wavefront portion W4) can be shaped with variable amplitude and / or phase in the spatial dimension. The spatial light modulator 200 can include phase-only, amplitude-only, or combined phase and amplitude modulation modes. In the illustrated example, the largest potential difference is applied by the third pixel electrode E3. To reduce diffraction losses, a dielectric mirror 214 may be disposed between the liquid crystal modulator 206 and the array of pixel electrodes 208.

[0031] Better visualization of the media opacification 26 is important for accurate and effective laser vitreous dissolution. The spatial light modulator 200 provides programmable phase and / or amplitude shifts at each pixel, enabling the creation of a custom-designed wavefront entering the eye 16. By spatially selectively controlling the phase and / or amplitude of light, the boundary or edge of the media opacification 26 relative to the surrounding vitreous medium 28 can be more accurately identified and visualized. As a result, the spatial light modulator 200 provides an overall improvement in the treatment of the patient 18. The spatial light modulator 200 can be oblique or coaxial with respect to the central axis A. The spatial light modulator 200 may be positioned in the illumination and / or viewing path. The system 10 can use various other optical mechanisms and devices to convert small variations in local phase (e.g., due to optical path length differences and / or local refractive index) into corresponding brightness changes that can be visualized as differences in image contrast.

[0032] According to another embodiment, the visualization module 112 is shown in FIG. 3. The visualization module 112 includes polarization devices such as a first polarizer 165 and a second polarizer 175. Referring to FIG. 3, a first incident beam I1 and a second incident beam I2 can originate from a light source 160 and pass through a collimation unit 162. The first incident beam I1 and the second incident beam I2 can be polarized by the first polarizer 165 before a mirror unit 164 directs them to an objective lens 172. The linearly polarized waves are focused onto the eye 16 and reflected back into the objective lens 172. On the return path from the eye 16, the first reflected beam R1 and the second reflected beam R2 encounter a second polarizer 175 oriented 90 degrees relative to the first polarizer 165. Only depolarized wavefronts can pass through the second polarizer 175 to reach the tube lens 174 and the detector 176, improving contrast.

[0033] Optionally, referring to FIG. 3 , the visualization module 112 may include a birefringent prism 185 (shown in phantom lines) in addition to the first polarizer 165 and the second polarizer 175. The birefringent prism 185 is positioned above the objective lens 172 and is configured to create a lateral displacement in the region of the eye 16 where the surface relief is present. The birefringent prism 185 splits the polarized wavefront (which has passed through the first polarizer 165) into two orthogonally polarized beams on its way to the eye 16. This makes it possible to visualize slight height differences on the surface. If the profile on which the first incident beam I1 or the second incident beam I2 impinges is completely flat, no features will be observed. If the profile contains surface variations, one of the first incident beam I1 or the second incident beam I2 must travel a longer path that accounts for this path difference.

[0034] 3, on the return path after passing through objective lens 172 and birefringent prism 185, first reflected beam R1 and second reflected beam R2 pass through second polarizer 175 (before encountering tube lens 174 and detector 176), where interference produces an intermediate image. Detector 176 may include photoreceptors and other electronic components to convert the path difference into a discernible contrast on the image. Visualization module 112 may include additional components, accessories, and circuitry not shown.

[0035] Referring now to FIG. 2 , a corneal bonding member 80 may be positioned in close proximity to the eye 16. The corneal bonding member 80 is adapted to eliminate corneal asphericity that may result from previous corneal surgery on the patient 18. By reducing the depth of field for laser delivery, the corneal bonding member 80 allows for a highly focused treatment beam 32 and high spatial coherence. The corneal bonding member 80 may be in the form of a plano contact lens that is fitted directly over the cornea 82 of the eye 16. The corneal bonding member 80 may be in the form of a plano contact lens supported by a delivery unit 500, an example of which is shown in FIG. 8 . Referring to FIG. 8 , the delivery unit 500 may include a hollow frame 502 supporting the corneal bonding member 80 at a first end 504. A lens 506 may be positioned at an opposite end 508 of the delivery unit 500. In some embodiments, a surface treatment of a high-viscosity thixotropic contact fluid is applied to the corneal bonding member 80 to increase friction. The corneal bonding member 80 can be configured to reduce saccade velocity by combining a high viscosity thixotropic contact fluid with a large surface area with minimal contact force.

[0036] 1-2, the laser source 34 may be a femtosecond or picosecond laser and may emit light having a wavelength of approximately 1,050 nm. A non-limiting example of a laser setting is 10 millijoules. In one example, the laser source 34 is configured to deliver infrared radiation, with a wavelength of approximately 700-1,220 nm. The laser module 14 is configured to precisely direct multiple ultrashort laser pulses in the treatment beam 32 toward the turbid medium 26. In one embodiment, the laser source 34 is constructed in a master oscillator power amplifier (MOPA) configuration with an ytterbium-doped single-mode fiber laser passively mode-locked by a semiconductor saturable absorber mirror (SESAM). The laser source 34 can be constructed with a femtosecond fiber laser, which has technical advantages in terms of cost, size, durability, and stability. In one embodiment, the laser module 14 may include a MOPA architecture using a photonic crystal fiber and a SESAM. Fiber-based femtosecond lasers using MOPAs have KHz-MHz repetition rates, allowing surgeons to operate continuously instead of infrequent short pulses (as provided by YAG lasers).

[0037] Referring to FIG. 2 , the direction of the treatment beam 32 can be varied based on the application at hand. For example, the first treatment beam 32A can travel in a direction parallel to the central axis A defined by the shared aperture 30. Referring to FIG. 2 , the shared aperture 30 is centered on and perpendicular to the central axis A. Referring to FIG. 2 , the second treatment beam 32B is directed in an off-axis direction at an off-axis angle 84 between the treatment beam 32B and a reference line 83. The reference line 83 is parallel to the central axis A. In some embodiments, the off-axis angle 84 is 25 degrees or greater. The off-axis angle 84 may be 45 degrees or greater. In some embodiments, the laser module 14 may be rotatable about the central axis A. While the laser source 34 of the laser module 14 is shown in the example of FIG. 1 as being non-coaxial with respect to the light source 60 of the visualization module 12, it should be understood that the position of the laser source 34 relative to the light source 60 may be varied. For example, the position and orientation of the laser source 34 may be varied so that it is coaxial with the light source 60.

[0038] 2 , the treatment beam 32 can interact with a modulation device 86 for various beam modification purposes. For example, the modulation device 86 can be configured to modulate the phase of the treatment beam 32 emitted by the laser source 34. The modulation device 86 can be configured to distribute the energy of the treatment beam 32 to generate multiple impingement points at its focal plane. The modulation device 86 can be positioned coaxially with respect to the central axis A. In some embodiments, the modulation device 86 is rotatable off-axis with respect to the central axis A.

[0039] 2, the modulation device 86 is a deformable mirror 88. The surface of the deformable mirror 88 can be deformed or bent by an array of actuators 90 to achieve correction of optical aberrations.

[0040] The deformable mirror 88 can be used in combination with a wavefront sensor 92 (see FIG. 2). This approach is advantageous in reducing defocus and aberrations in patients with multifocal and extended-depth-of-focus intraocular lenses. The wavefront sensor 92 is configured to determine ocular aberrations in the reflected beam R (see FIG. 1) exiting the eye 16. In one example, the wavefront sensor 92 is a Shack-Hartmann wavefront sensor having an array of lenslets coupled to an integrated detector. The lenslet array focuses spots onto the detector, and the positions of these spots can then be calculated and compared to the positions of reference spots from a reference beam. The first observation beam B1 and the second observation beam B2 (see FIG. 1) can be used as reference beams for the wavefront sensor 92. The controller C is configured to obtain local phase errors in the wavefront of the reflected beam R via the wavefront sensor 92 and use the phase errors to numerically reconstruct the wavefront, which can then be used to correct the local phase errors via the modulation device 86. The controller C can correct for wavefront errors through open-loop or closed-loop correction, as will be appreciated by those skilled in the art.

[0041] Referring now to Figure 5, there is shown a flowchart of a method 300 executable by the controller C of Figure 1. The method 300 does not have to be applied in the particular order described herein, and some blocks may be omitted. The memory M may store a set of controller-executable instructions, and the processor P may execute the set of controller-executable instructions stored in the memory M.

[0042] 5, the controller C is configured to obtain visualization data of the eye 16 via the visualization module 12. The image stream from the visualization module 12 may be sent to the module processor 44 and / or the controller C, which may be configured to prepare the image stream. The controller C may be configured to store the video and / or stereoscopic video signals in a video file, which is stored in the memory M.

[0043] According to block 304 of FIG. 5, the controller C is configured to obtain one or more definition parameters of the medium turbidities 26 based in part on the visualization data from block 302. The definition parameters include a respective shape and a respective size of each of the medium turbidities 26. In other words, the controller C is configured to extract structural features such as the shape and size of the medium turbidities 26. Each medium turbidity 26 includes a separate set of definition parameters. In some embodiments, the definition parameters may include a depth d of the medium turbidity 26 along the central axis A from a preselected reference plane (see FIG. 2). Also according to block 304, the controller C is configured to store definition parameters associated with a plurality of the medium turbidities 26.

[0044] According to block 306 of Figure 5, the controller C is configured to determine when a threshold portion of the medium turbidity 26 is within a predetermined target zone 350 of a real-time observation window 352. Figure 6 is a schematic example of the real-time observation window 352 and the predetermined target zone 350. The real-time observation window 352 is configured to reflect the visualization data from the visualization module 12 in real time. In one example, the threshold portion is 50%. The controller C makes this determination based in part on the definition parameters from block 304. The respective shapes of the real-time observation window 352 and the predetermined target zone 350 may be rectangular or circular and may be modified as needed.

[0045] 6, the real-time observation window 352 may include crossed laser lines 354 to aid in improving focus and visibility near clear tissue. In one example, the crossed laser lines 354 emit a green color. In some embodiments, the controller C does not keep track of the real-time position of the medium turbidity 26, but rather relies only on the detection of a threshold portion of the medium turbidity 26 within the predetermined target zone 350.

[0046] If the turbidity medium 26 is within the predetermined target zone 350, the method 300 proceeds to block 308, where the treatment beam 32 is directed toward the turbidity medium 26 to ablate the turbidity medium 26. The controller C may be configured to send a signal to the laser module 14 to precisely focus the treatment beam 32 toward the turbidity medium 26. If the turbidity medium 26 is not within the predetermined target zone, the method 300 loops back to block 306.

[0047] Laser pulses from the treatment beam 32 may be uniformly directed within a specific treatment volume, which may be smaller or larger than the medium opacity 26. The treatment beam 32 may be delivered in various patterns based on the application at hand. For example, the treatment beam 32 may be delivered as an array of linearly distributed spots within a single plane. The treatment beam 32 may be delivered in a small-angle or circular pattern for some types of medium opacities 26 (e.g., Weiss rings). Laser settings may include single-burst, multi-burst, or continuous delivery. As described above, the laser module 14 may include a MOPA architecture using photonic crystal fiber and SESAM. Pulse rates in the kHz range in the MOPA architecture appear continuous to the surgeon. The laser pulse energy, spot hit location, and treatment volume may be optimized to achieve maximum effectiveness in breaking down the medium opacity 26 while minimizing various factors, such as bubble formation and diffusion, laser exposure, proximity to the posterior of the eye 16, and procedure time.

[0048] From block 308, the method 300 proceeds to block 310 to evaluate whether one or more exit conditions are met. An exemplary exit condition may be that the medium turbidity 26 has reached a minimum allowable size. If an exit condition is met, the method 300 ends. If not, the method 300 loops back to block 302.

[0049] In some embodiments, the controller C may be configured to acquire a speckle pattern of scattered light resulting from the treatment beam 32, the scattered light being on the order of the wavelength of the treatment beam 32. The turbid medium 26 scatters light when the treatment beam 32 is directed toward it. The scattered light originates from various locations within the eye 16 and travels at different lengths, resulting in constructive and destructive interference. The interference varies randomly in space, generating a randomly varying intensity pattern called speckle. In other words, speckle arises from interference between coherent light rays scattered with different phases and amplitudes. The scattered light causes irregularities in the material that can be on the order of the wavelength of the laser light illuminating the scattering material.

[0050] The laser module 14 can include other modes of operation. For example, the laser module 14 can include a manual mode in which the surgeon manually identifies the opacification medium 26 in pitch, yaw, and depth, presses a trigger via the visualization module 12 to capture an image of the opacification medium 26, and activates the laser module 14. If no movement of the opacification medium 26 or the eye 16 is detected, the laser module 14 fires. The manual mode can include closed-loop tracking.

[0051] In an alternative embodiment, the visualization module 12 can incorporate a slit-based confocal imaging module that uses infrared light with a rolling shutter, as opposed to an opto-mechanical slit. Slit confocal imaging requires less light than a confocal point source. Confocal imaging reduces the depth of field, which is advantageous for vitreous visualization, and reduces scattered light, thereby improving the signal-to-noise ratio. The system 10 can also include a slit-scanning confocal stereoscopic visualization option with a spatial light modulator 200 that uses reflected light. In some embodiments, the visualization module 12 can use an annular phased-array 3D ultrasound unit available to those skilled in the art.

[0052] Referring to FIG. 7 , a visualization module 412 according to yet another embodiment is shown. The visualization module 412 includes a coaxial illumination unit 420 having a slit lamp 422 that generates respective beams that interact with a first reflector 424 and a second reflector 426. At least one of the first reflector 424 and the second reflector 426 includes a spatial light modulator 200 (shown in FIG. 4 ). The first reflector 424 and the second reflector 426 may be coaxial with respect to the central axis A of FIG. 1 . Referring to FIG. 7 , the visualization module 412 includes an oblique illumination unit 430 having a slit lamp 432 that generates respective beams that interact with a reflector 434. The reflector 434 includes a spatial light modulator 200 (shown in FIG. 4 ). The oblique illumination unit 430 may be rotatable relative to the target site or eye 16 via a swivel arm 438 attached to the housing 428. In other words, the reflector 434 may be rotatable off-axis relative to the central axis A. The coaxial illumination unit 420 and the oblique illumination unit 430 can include various lenses 420, 422 for light focusing and other accessories (not shown) for magnification and steering.

[0053] It will be understood that different features described in one embodiment may be used independently of one another or may be combined with one or more desired features from other embodiments. For example, spatial light modulator 200 may be used in an adaptive optics approach for visualization-only applications (without laser vitreous dissolution). Spatial light modulator 200 may be used with or without corneal bonding member 80. Spatial light modulator 200 may be used in a coaxial or oblique illumination path, and / or a stereo / ophthalmic surgeon visualization path.

[0054] The controller C of FIG. 1 may be an integral part of other controllers integrated with the laser module 14 and visualization module 12, 112 or a separate module operatively connected thereto. The controller C of FIG. 1 includes computer-readable media (also referred to as processor-readable media), including non-transitory (e.g., tangible) media involved in providing data (e.g., instructions) that can be read by a computer (e.g., by a computer processor). Such media may take many forms, including, but not limited to, non-volatile and volatile media. Non-volatile media may include, for example, optical or magnetic disks and other persistent memory. Volatile media may include, for example, dynamic random access memory (DRAM), which may constitute primary storage. Such instructions may be transmitted over one or more transmission media, including coaxial cables, copper wire, and fiber optics, including the wires that comprise a system bus coupled to the computer's processor. Some forms of computer readable media include, for example, a floppy disk, flexible disk, hard disk, magnetic tape or other magnetic media, CD-ROM, DVD or other optical media, punch cards, paper tape or other physical media with patterns of holes, RAM, PROM, EPROM, Flash EEPROM or other memory chip or cartridge or other computer readable medium.

[0055] The lookup tables, databases, data repositories, or other data stores described herein may include various types of mechanisms for storing, accessing, and retrieving various types of data, including a hierarchical database, a set of files in a file system, a proprietary application database, a relational database management system (RDBMS), etc. Each such data store may be contained within a computing device employing a computer operating system such as those described above, or may be accessed over a network in one or more of a variety of ways. The file system may be accessible from the computer operating system and may include files stored in various formats. The RDBMS may employ Structured Query Language (SQL) in addition to a language for creating, saving, editing, and executing stored procedures, such as the PL / SQL language described above.

[0056] While the detailed description and drawings or figures support and explain the present disclosure, the scope of the present disclosure is defined solely by the claims. While the best mode and some alternative embodiments for carrying out the claimed disclosure have been described in detail, various alternative designs and embodiments exist for carrying out the disclosure defined in the appended claims. Furthermore, the features of the embodiments shown in the drawings or described herein should not necessarily be understood as independent embodiments. Rather, each of the characteristics described in one of the example embodiments can be combined with one or more other desirable characteristics from other embodiments, resulting in other embodiments not described in words or with reference to the drawings. Accordingly, such other embodiments are encompassed within the scope of the appended claims.

Claims

1. 1. A system for treating media opacification in the vitreous media of an eye, comprising: a visualization module adapted to provide visualization data of a portion of the eye via one or more observation beams; a laser module adapted to selectively generate a treatment beam directed toward the medium opacity to destroy the medium opacity; 10. A system wherein the laser module and the visualization module have a shared aperture for directing the treatment beam and the one or more observation beams toward the eye, the shared aperture being disposed about a central axis.

2. a controller in communication with the visualization module and the laser module, the controller having a processor and a tangible, non-transitory memory having instructions recorded thereon; 2. The system of claim 1, wherein execution of the instructions by the processor causes the controller to obtain one or more definition parameters of the medium opacity based at least in part on the visualization data, the one or more definition parameters including a shape and size of the medium opacity and a depth of the medium opacity.

3. The controller: determining when a threshold portion of the medium turbidity is within a predetermined target zone based at least in part on the one or more defining parameters; The system of claim 2 , configured to direct the treatment beam toward the medium opacity when the threshold portion of the medium opacity is within the predetermined target zone.

4. a sensor in communication with the controller and configured to detect patient movement; The system of claim 2 , wherein the controller is configured to disable the treatment beam when movement of the patient is detected by the sensor.

5. 3. The system of claim 2, wherein the controller is configured to acquire a speckle pattern of scattered light resulting from the treatment beam, the scattered light being on the order of a wavelength of the treatment beam.

6. 10. The system of claim 1, wherein the treatment beam comprises a plurality of ultrashort laser pulses, the plurality of ultrashort laser pulses defining respective durations on the order of femtoseconds to about 50 picoseconds.

7. The system of claim 1 , wherein the treatment beam travels in a direction parallel to the central axis.

8. The system of claim 1 , wherein the treatment beam travels at an off-axis angle from the central axis, the off-axis angle being 25 degrees or greater.

9. 10. The system of claim 1, further comprising a corneal bonding member positioned proximate to a cornea of ​​the eye, the corneal bonding member configured to reduce a depth of field of the treatment beam.

10. 2. The system of claim 1, wherein the visualization module is configured to use electromagnetic radiation reflected from one or more optical devices before hitting the eye, and the one or more optical devices are positioned such that only oblique light rays hit the eye and central light rays are blocked.

11. the visualization module includes a light source, a mirror unit, a first polarizer, and a second polarizer, the second polarizer being oriented at 90 degrees relative to the first polarizer; the first polarizer is adapted to polarize at least one incident beam from the light source to generate a linearly polarized wave; the mirror unit is adapted to direct the linearly polarized wave onto the eye; the second polarizer is positioned such that the reflected beam exiting the eye is projected onto the second polarizer; 2. The system of claim 1, wherein the visualization module further comprises a birefringent prism configured to block the linearly polarized wave before it hits the eye, the birefringent prism configured to block the reflected beam before it is projected onto the second polarizer.

12. The system of claim 1 , wherein the visualization module includes an electronically controlled liquid lens having a response time of 1 to 5 milliseconds.

13. a wavefront sensor configured to determine ocular aberrations in the one or more viewing beams exiting the eye; 10. The system of claim 1, further comprising: a deformable mirror configured to shape the wavefront of the treatment beam based in part on the ocular aberrations determined by the wavefront sensor.

14. 10. The system of claim 1, further comprising a spatial light modulator adapted to shape at least one of a respective phase and a respective amplitude of the one or more observation beams, the spatial light modulator being disposed coaxially with respect to the central axis.

15. 10. The system of claim 1, further comprising a spatial light modulator adapted to shape at least one of a respective phase and a respective amplitude of the one or more observation beams, the spatial light modulator being rotatable off-axis relative to the central axis.

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