Ophthalmic laser treatment device

Abstract

To appropriately assist in treatment using therapeutic laser light when contact lenses with multiple reflective surfaces are used. [Solution] The control unit of the ophthalmic laser treatment device performs the following steps: an irradiation plan acquisition step in which, when irradiating the patient's eye with treatment laser light using a contact lens having multiple reflective surfaces that reflect the treatment laser light in a direction intersecting the optical axis, the irradiation order of the treatment laser light to multiple irradiation sections that divide the planned irradiation area, which includes multiple irradiation spots to be irradiated with treatment laser light, is determined according to the arrangement of the multiple reflective surfaces; and an irradiation guide display step in which an irradiation guide that assists in adjusting the aiming position of the treatment laser light, which is adjusted by the operator, to the appropriate position is displayed on the internal display unit according to the progress of the irradiation plan.

Description

Technical Field

[0001] The present disclosure relates to an ophthalmic laser treatment device.

Background Art

[0002] Conventionally, in the field of ophthalmology, when treating tissues of a patient's eye with a therapeutic laser beam, a contact lens having a reflecting surface for reflecting the therapeutic laser beam may be used. For example, a contact lens having a reflecting surface may be used for treating structures such as trabecular meshwork present in the anterior chamber angle of the eyeball.

[0003] Here, a function for appropriately assisting treatment with a therapeutic laser beam when a contact lens having a reflecting surface is used has been proposed. In Patent Document 1, an ophthalmic laser treatment device displays, via a display unit inside the device, an aiming guide for assisting in adjusting the aiming position of a therapeutic laser beam to an appropriate position when irradiating a patient's eye with the therapeutic laser beam using a contact lens. The operator observes the aiming guide together with the tissue reflected on the reflecting surface and adjusts the aiming position of the therapeutic laser beam according to the observation result.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0005] By the way, there are contact lenses having a plurality of reflecting surfaces. A technique capable of appropriately assisting treatment with a therapeutic laser beam when a contact lens having a plurality of reflecting surfaces is used has been studied.

[0006] A typical object of this disclosure is to provide an ophthalmic laser treatment device that can appropriately assist in treatment with therapeutic laser light when contact lenses having multiple reflective surfaces are used. [Means for solving the problem]

[0007] An ophthalmic laser treatment device provided by a typical embodiment of this disclosure is an ophthalmic laser treatment device that irradiates the tissue of a patient's eye with a treatment laser light each time an instruction to irradiate the patient's eye with a treatment laser light is input, and comprises: a laser irradiation optical system for irradiating the patient's eye with a treatment laser light; an observation optical system for allowing an operator to observe an image of the patient's eye through an eyepiece; an internal display unit provided in the observation optical system for displaying an image to the operator through the eyepiece; and a control unit, wherein the control unit performs an irradiation plan acquisition step in which, when irradiating the patient's eye with a treatment laser light using a contact lens having a plurality of reflective surfaces that reflect the treatment laser light in a direction intersecting the optical axis, the irradiation order of the treatment laser light to a plurality of irradiation sections that divide the planned irradiation area, which includes a plurality of irradiation spots to be irradiated with a treatment laser light, is determined according to the arrangement of the plurality of reflective surfaces; and an irradiation guide display step in which an irradiation guide that assists in adjusting the aiming position of the treatment laser light, which is adjusted by the operator, to an appropriate position is displayed on the internal display unit according to the progress of the irradiation plan.

[0008] The ophthalmic laser treatment device described herein can appropriately assist in treatment using therapeutic laser light when contact lenses having multiple reflective surfaces are used. [Brief explanation of the drawing]

[0009] [Figure 1] This is an external view of the ophthalmic laser treatment device 1. [Figure 2] This is a side view of the optical system of the ophthalmic laser treatment device 1. [Figure 3] This is a view from above of the optical system of the ophthalmic laser treatment device 1. [Figure 4]This is a schematic cross-sectional view of the patient's eye E and the contact lens 26. [Figure 5] This diagram schematically shows an example of an observation area observed through the reflective surface 27 of the contact lens 26. [Figure 6] This is a perspective view of contact lens 26. [Figure 7] This figure shows the contact lens 26 in the A-A' cross-section shown in Figure 6. [Figure 8] This figure shows an example of an irradiation plan displayed in Control Box 6. [Figure 9] This is an explanatory diagram for showing how to adjust the aiming position of the illumination spot. [Figure 10] This figure shows an example of the operator's field of view during treatment with the ophthalmic laser treatment device of the embodiment. [Figure 11] This figure shows an example of a transition in a portion of the operator's field of view during treatment with the ophthalmic laser treatment device 1 of the embodiment. [Figure 12] This figure shows an example of a transition in a portion of the operator's field of view during treatment with the ophthalmic laser treatment device 1 of the embodiment. [Figure 13] This is a flowchart of the treatment control process performed by the ophthalmic laser treatment device 1 of the embodiment. [Modes for carrying out the invention]

[0010] [overview] The ophthalmic laser treatment device illustrated in this disclosure irradiates the tissue of the patient's eye with therapeutic laser light each time an instruction to irradiate therapeutic laser light is input. The ophthalmic laser treatment device comprises a laser irradiation optical system, an observation optical system, an internal display unit, and a control unit. The laser irradiation optical system irradiates the patient's eye with therapeutic laser light. The observation optical system allows the operator to observe the patient's eye through an eyepiece. The internal display unit is provided in the observation optical system and displays the image to the operator through the eyepiece. The control unit controls various aspects of the ophthalmic laser treatment device. The control unit performs an irradiation plan acquisition step and a targeting guide display step. In the irradiation plan acquisition step, the control unit acquires an irradiation plan in which the irradiation order of therapeutic laser light is determined according to the arrangement of the multiple reflective surfaces, for multiple irradiation compartments that divide the planned irradiation area, which includes multiple irradiation spots to be irradiated with therapeutic laser light, into multiple sections, when irradiating the patient's eye with therapeutic laser light using a contact lens having multiple reflective surfaces that reflect the therapeutic laser light in a direction intersecting the optical axis.

[0011] However, the multiple reflective surfaces in the contact lens have different rotation angles relative to the central axis. Also, two adjacent irradiated areas may partially overlap or may not overlap at all.

[0012] In the aiming guide display step, the control unit displays an aiming guide on its internal display unit in accordance with the progress of the irradiation plan. This guide assists in adjusting the aiming position of the treatment laser beam, which is adjusted by the operator, to the appropriate position.

[0013] According to the ophthalmic laser treatment device disclosed herein, a targeting guide is displayed on the internal display unit in accordance with the progress of the irradiation plan to assist the operator in adjusting the targeting position. Therefore, the operator can check the targeting guide while observing the patient's eye through the eyepiece (i.e., without taking their eye off the eyepiece), and adjust the targeting position of the treatment laser beam by referring to the checked targeting guide. Thus, the operator can adjust the targeting position of the treatment laser beam more appropriately.

[0014] In this case, as the irradiation plan, the irradiation order of the treatment laser light for a plurality of irradiation sections is determined according to the arrangement of a plurality of reflecting surfaces in the contact lens. Therefore, when a contact lens having a plurality of reflecting surfaces is used, the treatment with the treatment laser light can be appropriately assisted.

[0015] As the irradiation plan, at least the irradiation order of the treatment laser light for a plurality of irradiation sections may be determined at least according to the arrangement of a plurality of reflecting surfaces in the contact lens. In this case, after roughly classifying at least the plurality of irradiation sections in the irradiation planned area into a first irradiation section and a second irradiation section, the treatment laser light is irradiated to each of the first irradiation sections, and then the treatment laser light is irradiated to each of the second irradiation sections. Thus, the irradiation order of the treatment laser light for the plurality of irradiation sections is determined. An irradiation plan is obtained. Here, the first irradiation section is a plurality of irradiation sections corresponding to each of the reflecting surfaces when the rotation angles of the plurality of reflecting surfaces in the contact lens are fixed at the first angle. The second irradiation section is a plurality of irradiation sections corresponding to each of the reflecting surfaces when the rotation angles of the plurality of reflecting surfaces in the contact lens are fixed at a second angle different from the first angle. That is, during the irradiation of the treatment laser light to each of the irradiation sections belonging to the first irradiation section and during the irradiation of the treatment laser light to each of the irradiation sections belonging to the second irradiation section, the operator does not necessarily have to rotate the contact lens, so the workability is improved.

[0016] The center of the display area in the internal display unit may coincide with the optical axis of the observation optical system (hereinafter, may also be referred to as the "observation optical axis"). In this case, based on the observation optical axis of the observation optical system, an image is displayed in the display area in the internal display unit. Therefore, the operator can appropriately perform the treatment while recognizing the image presented at an appropriate position in the visual field.

[0017] Furthermore, the optical axis of the therapeutic laser light emitted by the laser irradiation optical system may coincide with the optical axis of the observation optical system. In this case, the control unit can display the image at an appropriate angle in an appropriate direction centered on the optical axis of the therapeutic laser light. Moreover, when the laser irradiation optical system emits a targeting laser beam (hereinafter sometimes referred to as "targeting beam") into the patient's eye to allow the operator to recognize the planned irradiation position of the therapeutic laser light, the optical axis of the targeting laser beam may also coincide with the optical axis of the observation optical system. In this case, the operator can see the targeting beam in the center of the observation field of view and the display area of ​​the internal display unit, making it even easier to adjust the irradiation position of the therapeutic laser light based on the targeting beam and the displayed content.

[0018] The control unit may display a target area guide on its internal display unit as a aiming guide, which serves as a reference for aligning the arc-shaped or annular treatment area on the patient's eye, as observed by the operator through the observation optical system. In this case, the operator can more easily adjust the aiming position of the treatment laser beam to the appropriate position by making various adjustments so that the arc-shaped or annular treatment area observed through the observation optical system matches the displayed target area guide.

[0019] The control unit may switch the display of at least a portion of the target area guide (for example, a straight or curved portion) on its internal display unit in response to instructions input by the operator. In this case, at least a portion of the target area guide will not obstruct the aiming of the treatment laser beam when it is actually directed towards the irradiation spot.

[0020] The control unit may determine the angle of the target area guide displayed on the internal display unit according to the progress of the irradiation plan, and display the target area guide at the determined angle. In this case, since the target area guide is displayed on the internal display unit at an appropriate angle according to the progress of the irradiation plan, it becomes easier to adjust the aiming position more appropriately.

[0021] For example, the control unit may determine the angle of the target area guide according to the position or direction of the irradiation area as defined by the irradiation plan. For example, after a predetermined number of irradiations of treatment laser light are completed for one irradiation area, the control unit may rotate the angle of the displayed target area guide by a predetermined rotation angle in the direction corresponding to the other irradiation area. In this case, if the irradiation area is changed between the first irradiation area (or between the second irradiation area), the angle of the target area guide is rotated by a predetermined rotation angle that is approximately the same as the spacing between the multiple reflective surfaces in the contact lens. Also, if the irradiation area is changed between the first and second irradiation areas, the angle of the target area guide is rotated by a predetermined rotation angle that is the difference between the first angle corresponding to the first irradiation area and the second angle corresponding to the second irradiation area (or the difference plus an integer multiple of the spacing between the multiple reflective surfaces). Therefore, when treatment is performed using a contact lens with multiple reflective surfaces, the aiming position can be adjusted more appropriately.

[0022] The control unit may display an angle guide on its internal display unit, indicating the rotation angle of the contact lens's reflective surface appropriate to the progress of the irradiation plan, as a targeting guide. In this case, the operator can adjust the rotation angle of the contact lens's reflective surface or the relative position of the device to the patient's eye by referring to the angle indicated by the angle guide. Therefore, when treatment is performed using a contact lens with multiple reflective surfaces, it becomes easier to adjust the targeting position of the treatment laser beam so that the appropriate reflective surface is used according to the progress of the irradiation plan.

[0023] The control unit may further perform a rotation recommendation step in which, once irradiation of each of the first irradiation sections with therapeutic laser light is complete, the control unit recommends that the operator rotate the reflective surface of the contact lens to a second angle. In this case, the operator can appropriately determine the timing when rotation of the reflective surface of the contact lens is necessary.

[0024] The specific method for recommending the rotation of the contact lens's reflective surface can be selected as appropriate. For example, the control unit may recommend the rotation of the reflective surface by sound and / or vibration. Alternatively, the control unit may recommend the rotation of the reflective surface by controlling the display on the internal display unit (for example, by rotating the image displayed on the internal display unit by a specified angle).

[0025] The control unit may display an outer peripheral guide on its internal display unit as a aiming guide. This guide indicates at least one of the rotation angle of the contact lens's reflective surface and the direction of the irradiation spot to which the treatment laser light should be directed, which is appropriate for the progress of the irradiation plan, along the outer periphery of the operator's observation field of view via the observation optical system. In this case, the operator can easily determine the appropriate rotation angle of the reflective surface and at least one of the direction of the irradiation spot by visually observing the outer peripheral guide displayed along the outer periphery of the observation field of view.

[0026] Furthermore, the peripheral guide may be displayed in an arc or ring shape along the outer edge of the observation field. The center of the arc or ring peripheral guide may coincide with the optical axis of the observation optical system. In this case, the direction indicated by the peripheral guide coincides with the direction from the center of the observation field. Therefore, the operator can properly understand the direction indicated by the peripheral guide.

[0027] The peripheral guide may include a next-target guide that indicates the direction of the next irradiation spot among multiple irradiation spots in the irradiation plan. The control unit may move the position of the next-target guide to a position corresponding to an irradiation spot adjacent to the direction of travel defined in the irradiation plan each time the therapeutic laser light is irradiated. In this case, the operator can appropriately determine the direction of the next irradiation spot by the next-target guide that moves along the peripheral edge of the observation field.

[0028] The outer peripheral guide may include an irradiation completion guide that indicates the direction of an irradiation spot in the irradiation plan where irradiation with the therapeutic laser light has already been completed. The control unit may change the displayed next targeting guide to the irradiation completion guide each time irradiation with the therapeutic laser light is performed. In this case, the operator can understand the direction in which irradiation with the therapeutic laser light has been completed and appropriately adjust the next targeting position using the next targeting guide. It also becomes easier to understand the progress of the treatment.

[0029] The outer peripheral guide may include an un-irradiated guide indicating the direction of irradiation spots that are scheduled to be irradiated with therapeutic laser light at a later stage than the next, among multiple irradiation spots in the irradiation plan. The control unit may change the un-irradiated guide, which was displayed in the direction of the irradiation spot for the next irradiation sequence as defined in the irradiation plan, to a next-target guide each time the irradiation of therapeutic laser light is completed. In this case, the operator can also understand the direction of the spots scheduled to be irradiated with therapeutic laser light at a later stage than the next, and appropriately adjust the next targeting position using the next-target guide. It also becomes easier to understand the progress of the treatment.

[0030] The outer peripheral guide may include a section aiming guide that indicates the direction of the irradiation section, which is a division of multiple irradiation spots onto which therapeutic laser light is irradiated while the rotation angle of each reflective surface on the contact lens is fixed, or the direction of the rotation angle of the reflective surface suitable for irradiating the irradiation section with therapeutic laser light. The control unit may move the position of the section aiming guide to a position adjacent to the direction of travel determined in the irradiation plan each time that the same number of irradiations as the number of irradiation spots contained in the irradiation section have been completed. In this case, the operator can easily grasp the direction of the multiple irradiation sections, or the direction of the reflective surface for irradiating the irradiation spots within the irradiation section with therapeutic laser light, using the section aiming guide. Therefore, adjusting the angle of the reflective surface on the contact lens becomes even easier.

[0031] The control unit may display a segment aiming guide for each defined angular range in the partially rotating lens. The control unit may move the position of the segment aiming guide to a position adjacent to the direction of travel defined in the irradiation plan each time that the irradiation of the same number of treatment laser beams as the number of irradiation spots contained within one defined angular range is completed. In this case, the segment aiming guide is displayed appropriately according to the specifications of the partially rotating lens and the progress of the treatment. Therefore, even when a partially rotating lens is used, the segment aiming guide appropriately assists in adjusting the aiming position.

[0032] Furthermore, the specific configuration of the aiming guide can be modified. For example, the control unit may display an image of the treatment area irradiated by the aiming light, captured by the imaging unit when the treatment laser light was previously irradiated, on the internal display unit. In this case, the operator can understand the area irradiated by the previous treatment laser light (i.e., the area where the aiming light is visible in the displayed image) and adjust the next aiming position. This makes it easier to irradiate the treatment laser light more appropriately.

[0033] Furthermore, when displaying at least one of the angle guide and outer circumference guide mentioned above as aiming guides, the ophthalmic laser treatment device can appropriately assist the operator in adjusting the aiming position, even when the aiming guide is displayed on a display unit different from the internal display unit (for example, a display unit located outside the observation optical system).

[0034] <Embodiment> Typical embodiments of this disclosure will be described below with reference to the drawings. The ophthalmic laser treatment device 1 of this embodiment can treat the patient's eye E by irradiating the patient's eye E with therapeutic laser light.

[0035] <Overall Structure> The configuration of the ophthalmic laser treatment device 1 will be described with reference to Figures 1 to 3. As shown in Figure 1, the ophthalmic laser treatment device 1 of this embodiment comprises a table section 2, a main unit section 3, and a control box 6. The main unit section 3 and the control box 6 are installed on the table section 2.

[0036] The main unit 3 comprises various components, including a laser irradiation optical system 10, an illumination optical system 30, an observation optical system 40, an internal display unit 50, and a control unit 60 (see Figure 2), which will be described later. The main unit 3 also comprises a base unit 4 and a joystick unit 5 (operating lever). The base unit 4 is a displacement means equipped with a displacement mechanism, which allows at least a portion of the laser irradiation optical system 10, the observation optical system 40, and the internal display unit 50 to move in the vertical direction (Y direction in Figure 1), the horizontal direction (X direction in Figure 1), and the front-to-back direction (Z direction in Figure 1). The displacement means changes the positional relationship between the patient's eye and the laser irradiation optical system 10 in the vertical, horizontal, and front-to-back directions. The base unit 4 can further rotate at least a portion of the laser irradiation optical system 10, the observation optical system 40, and the internal display unit 50 in the horizontal direction, using an axis extending in the vertical direction as the pivot point. The operator can adjust the observation position of the patient's eye E and the irradiation position of the laser light (treatment laser light and aiming light) by operating the joystick unit 5 to move or rotate the laser irradiation optical system 10, observation optical system 40, and internal display unit 50, etc. In this embodiment, the joystick unit 5 (for example, the upper end of the joystick 5) is provided with operation buttons operated by the operator. In this embodiment, the operation buttons of the joystick unit 5 are used as trigger input means to input a trigger for performing the irradiation of the treatment laser light. Alternatively, a foot switch operated by the operator's foot may be used as a trigger input means to input a trigger for performing the irradiation of the treatment laser light.

[0037] The control box 6 includes an external display unit 7 located outside the observation optical system 40 (see Figure 2). The external display unit 7 can display various images. A touch panel operation unit is provided on the surface of the external display unit 7 of the control box 6. The control box 6 displays various parameters related to treatment on the external display unit 7 and also accepts input of various instructions from the user.

[0038] <Laser irradiation optics> As shown in Figure 2, the laser irradiation optical system 10 of this embodiment includes a therapeutic laser light source 11, an aiming light source 12, an energy adjustment unit 13, a beam splitter 17, a photodetector 18, a safety shutter 19, a collimator lens 21, a dichroic mirror 22, an expander lens 23, a dichroic mirror 24, and an objective lens 25.

[0039] The therapeutic laser light source 11 emits therapeutic laser light for treating the tissue of the patient's eye E. As an example, in the laser light source 11 of this embodiment, a neodymium-doped YAG (yttrium aluminum garnet) crystal (Nd:YAG) is used as the laser rod. In addition, a wavelength conversion element (not shown) can convert the infrared laser light (wavelength: 1064 nm) emitted by the laser light source 11 into visible laser light (wavelength: 532 nm).

[0040] The targeting light source 12 emits targeting laser light (hereinafter simply referred to as "targeting light") that indicates the position where the treatment laser light is irradiated (i.e., the position of the irradiation spot). In this embodiment, a light source that emits visible laser light with a wavelength of 635 nm (red) is used as the targeting light source 12. However, it goes without saying that the wavelength of the targeting light can be changed as appropriate.

[0041] The energy adjustment unit 13 adjusts the amount of energy of the therapeutic laser light irradiated onto the tissue of the patient's eye E. In this embodiment, the energy adjustment unit 13 comprises a half-wave plate 14 and a polarizer 16. The half-wave plate 14 is rotated by a motor 15 around the optical axis of the therapeutic laser light. The polarizer 16 is positioned at a Brewster angle. The amount of energy of the therapeutic laser light is adjusted by the combination of the half-wave plate 14 and the polarizer 16.

[0042] The beam splitter 17 reflects a portion of the treatment laser light toward the photodetector 18. The photodetector 18 detects the energy of the treatment laser light by receiving the treatment laser light reflected by the beam splitter 17. The safety shutter 19 moves between on and off the optical axis of the treatment laser light by a shutter drive unit (e.g., a solenoid) 20. The safety shutter 19 is positioned on the optical axis of the treatment laser light to block the irradiation of the treatment laser light into the patient's eye E.

[0043] The collimator lens 21 makes the aiming light emitted from the aiming light source 12 into a parallel beam. The dichroic mirror 22 aligns the optical axes of the treatment laser light and the aiming light and combines them. In this embodiment, the dichroic mirror 22 combines the treatment laser light and the aiming light by reflecting the treatment laser light and transmitting the aiming light.

[0044] The expander lens 23 expands the beam of laser light (treatment laser light and aiming light) combined by the dichroic mirror 22. The laser light expanded by the expander lens 23 is reflected by the dichroic mirror 24 and passes through the objective lens 25. In this embodiment, the laser light that has passed through the objective lens 25 is irradiated onto the tissue of the patient's eye E via a contact lens 26 attached to the patient's eye E. The dichroic mirror 24 reflects light of a wavelength that is less likely to enter the operator's eye after the treatment laser light is reflected by the patient's eye E. The irradiation optical system 10 may also be provided with a configuration for adjusting the spot size of the laser light irradiated onto the tissue.

[0045] <Illumination optical system> The illumination optical system 30 illuminates the observation area, including the tissue to be treated. The illumination optical system 30 of this embodiment includes a lamp 31, a lens 32, an aperture 33, a lens group 34, and a prism 35. For example, a white light-emitting element can be used for the lamp 31. The illumination optical system 30 may also include a slit plate or the like for illuminating the observation area with slit light.

[0046] <Observation Optical System> As shown in Figures 2 and 3, the observation optical system 40 is an observation means for allowing the operator to observe the patient's eye E, and is equipped with an optical axis L3 (see Figure 3). As shown in Figure 3, the observation optical system 40 of this embodiment is equipped with an optical axis L3R for presenting the observation image to the operator's right eye EoR, and an optical axis L3L for presenting the observation image to the operator's left eye EoL. The observation optical system 30 of this embodiment may also be called binoculars. The observation optical system 40 of this embodiment is equipped with an objective lens 25, a variable magnification optical system 42 (42R, 42L), a protective filter 43 (43R, 43L), a half mirror 47, an erecting prism group 44 (44R, 44L), a field diaphragm 45 (45R, 45L), an eyepiece lens 46 (46R, 46L), etc. The operator can look through the eyepiece 46 to confirm the observation area of ​​the patient's eye E, the spot of the aiming light (in other words, the reflected light (backlight) of the aiming light reflected from the patient's eye E), etc. In this embodiment, the observation surface (object surface) provided in front of the objective lens 41 and the field diaphragm 45 located inside the device are in an optically conjugate positional relationship via the objective lens 41. That is, the observation image of the patient's eye E is formed as an aerial image at the position of the field diaphragm 45. In this embodiment, the magnification of the observation image observed by the operator is changed by the variable magnification optical system 42. The observation optical system 40 is provided with an encoder (not shown) for acquiring the magnification of the observation image by the variable magnification optical system 42.

[0047] <Internal display> As shown in Figure 2, the internal display unit 50 is provided in the observation optical system 40 and displays images to the operator via the eyepiece lens 46. The internal display unit 50 comprises a display unit 53, a lens 52, and a half mirror 51. Various images are displayed on the display unit 53. In this embodiment, an LCD (with backlight) is used as the display unit 53. In detail, in this embodiment, a color LCD capable of displaying 1600 (H) × 1200 (V) is used as the display unit 53. As shown in Figure 3, the half mirror 51 is positioned on the optical axis L3R. In detail, the half mirror 51 is positioned between the protective filter 43R and the erecting prism group 44R.

[0048] The display light emitted from the display unit 53 travels along the optical axis L5 (see Figure 3). More specifically, the display light emitted from the display unit 53 passes through the lens 52 and is then reflected by the half mirror 51 in the direction of the erecting prism group 44R. In this embodiment, the half mirror 51 is a synthesis means for combining the optical observation image observed by the observation optical system 40 with the image displayed on the display unit 53. In this embodiment, the half mirror 51 makes the optical axis L5 and the optical axis L3R coaxial. The display light reflected by the half mirror 51 travels in the order of the erecting prism group 44R, the field diaphragm 45R, and the eyepiece 46R, and is focused on the fundus of the eye of the operator looking through the eyepiece 46R. The internal display unit 50 functions as a so-called head-up display (HUD).

[0049] In this embodiment, the display unit 53 and the field diaphragm 45R are in an optically conjugate positional relationship. That is, the display image of the display unit 53 is formed as an aerial image at the position of the field diaphragm 45R. Note that the method of displaying the image to the operator via the eyepiece lens 46 is not limited to the method illustrated in this disclosure. For example, an LCD (liquid crystal panel) without a backlight may be placed as an internal display unit at the position of the field diaphragm 45R (on the optical axis L3R), and the control unit 60 may control the transmittance of each cell constituting the LCD to present information to the operator.

[0050] In this embodiment, the center of the display area in the internal display unit 50 coincides with the observation optical axis of the observation optical system 40. Therefore, the image is displayed in the display area of ​​the internal display unit 50 with reference to the observation optical axis of the observation optical system 40. Consequently, the operator can perform treatment appropriately while recognizing the image presented at an appropriate position in the observation field of view through the eyepiece lens 46.

[0051] Furthermore, in this embodiment, the optical axis of the treatment laser light irradiated by the laser irradiation optical system 10 coincides with the optical axis of the observation optical system 40 and the center of the display area in the internal display unit 50. Therefore, the internal display unit 50 can display an image at an appropriate angle in an appropriate direction centered on the optical axis of the treatment laser light. Moreover, in this embodiment, the optical axis of the aiming light irradiated by the laser irradiation optical system 10 also coincides with the optical axis of the observation optical system 40 and the center of the display area in the internal display unit 50. Therefore, since the operator can see the aiming light at the center of the observation field of view and the center of the display area of ​​the internal display unit 50, it becomes even easier to adjust the irradiation position of the treatment laser light based on the aiming light and the content displayed by the internal display unit 50.

[0052] Although not shown in the diagram, the observation optical system 40 of this embodiment incorporates an imaging optical system for capturing an image of the patient's eye E, etc. The imaging optical system comprises a half mirror, an imaging lens, and an imaging element. The half mirror is positioned in either the left or right observation light path provided in the observation optical system 40. Light entering the half mirror from the observation site, etc., via the objective lens 25 is reflected by the half mirror and enters the imaging element via the imaging lens. As a result, an observation image is captured by the imaging optical system.

[0053] <Department Head> The control unit 60 controls various aspects of the laser treatment device 1. In this embodiment, the control unit 60 includes a CPU (processor) 61, ROM 62, RAM 63, and non-volatile memory 65. The CPU 61 controls each part of the laser treatment device 1. The ROM 62 stores various programs, initial values, etc. The RAM 63 temporarily stores various information. The non-volatile memory 65 is a non-transient storage medium that can retain its contents even when the power supply is cut off. For example, a USB memory detachably attached to the control unit 60, or a flash ROM built into the control unit 60, can be used as the non-volatile memory 65. In this embodiment, the control unit 60 is connected to a base unit 4, a joystick unit 5, a control box 6, a laser light source 11, an aiming light source 12, a motor 15, a photodetector 18, a shutter drive unit 20, a lamp 31, and a display unit 53, etc.

[0054] <Treatment methods for the trabecular meshwork> Referring to Figures 4 and 5, an example of a treatment method for the trabecular meshwork performed by the ophthalmic laser treatment device 1 of this embodiment will be described. In this embodiment, the trabecular meshwork, which is an annular (partially arc-shaped) tissue of the patient's eye E, is given as the treatment target site. For example, Selective Laser Trabeculoplasty (SLT) is a treatment method that irradiates the trabecular meshwork at the angle of the patient's eye E with treatment laser light in order to increase the outflow of aqueous humor from the patient's eye E. In SLT, the treatment laser light is irradiated multiple times over the entire circumference or a part of the annular trabecular meshwork.

[0055] As shown in Figure 4, in the treatment of the trabecular meshwork in this embodiment, a contact lens 26 is fitted to the cornea C of the patient's eye E. As an example, the contact lens 26 can be a gonioscope or a Goldmann triangular mirror used to observe the angle A of the patient's eye E. The contact lens 26 is provided with a reflective surface (reflecting mirror) 27. The angle A is observed through the reflective surface 27. Therefore, as shown in Figure 5, in this embodiment, the entire angle A (all around) is not observed simultaneously, but a part of the angle A is observed in a fan shape. The range of the fan-shaped portion of the annular angle A observed through the reflective surface 27 is within an angular range of less than 180 degrees with respect to the center of the annular angle A. Furthermore, the reflective surface 27 of the contact lens 26 reflects the treatment laser light and aiming light in a direction intersecting the optical axis extending from the objective lens 25 (see Figures 2 and 3) toward the patient's eye E, thereby irradiating the trabecular meshwork TM, which is the treatment target site, with the treatment laser light and aiming light. In other words, in this embodiment, treatment of the trabecular meshwork is performed by irradiating the trabecular meshwork TM of the corner A with treatment laser light via the reflective surface 27 in the observation state illustrated in Figure 5.

[0056] The operator adjusts the rotation angle of the contact lens 26 (i.e., the angle of rotation around the axis of the contact lens 26) to adjust the reflection direction of the treatment laser light by the reflective surface 27 of the contact lens 26, as viewed from the operator's line of sight in the observation optical system 40. The operator also adjusts the aiming position of the treatment laser light and aiming light on the tissue of the patient's eye E to the spot S to be treated by moving the base unit 4 using the joystick unit 5. Once the aiming position has been adjusted, the operator inputs an instruction to irradiate the spot S with the treatment laser light by operating the operation buttons on the joystick 5 or a foot switch, etc. Note that in SLT, the treatment laser light is irradiated at a lower output (energy and irradiation time) than in argon laser trabeculoplasty (ALT) in order to minimize thermal denaturation of tissue. Therefore, it is difficult for the operator to visually observe changes in the condition of the treatment site (e.g., treatment scars) before and after the procedure. Furthermore, a known technique for SLT involves fixing the spot size of the treatment laser beam and targeting beam to a predetermined size (e.g., 400 μm) and intermittently irradiating the trabecular meshwork TM with multiple adjacent irradiation spots. Figure 5 schematically shows a part of the technique in which treatment laser beams are intermittently irradiated with multiple adjacent irradiation spots. It should be noted that in SLT, it is difficult to visually inspect the treatment area. In other words, the irradiated spots (spots S) that have been irradiated with treatment laser beams are not visually inspected by the operator as shown in Figure 5.

[0057] <Contact lenses> Referring to Figures 6 and 7, an example of a contact lens 26 used in the treatment of the trabecular meshwork in this embodiment will be described. The contact lens 26 shown in Figures 6 and 7 has multiple reflective surfaces. Specifically, the contact lens 26 shown in this embodiment is a four-sided mirror lens having four (four) reflective surfaces 27.

[0058] More specifically, the contact lens 26 shown in Figure 6 comprises a lens barrel 26A and an optical section 26B. The lens barrel 26A is substantially cylindrical and is held by multiple fingers of the user. The optical section 26B is fixed to the lens barrel 26A. The tip of the optical section 26B (bottom of the page in Figure 6) becomes a contact section 26D that makes contact with the patient's eye. A light-transmitting window is formed in the contact section 26D.

[0059] Reflective surfaces 27 are formed on the inside of the optical section 26B. Four reflective surfaces 27 are arranged at 90° intervals around the axis AX1. Figure 7 shows the AA' cross-section of the optical section 26 in Figure 6. The AA' cross-section includes the axis AX1 and passes through the centers of two opposing reflective surfaces 27 out of the four reflective surfaces. As shown in Figure 7, each reflective surface 27 is inclined at an angle of approximately 62° with respect to a plane perpendicular to the axis AX1. With the pupil center of the patient's eye E and the center of the light-transmitting window 29 roughly aligned, most of the area around the entire circumference of the iridocorneal angle (at least half of the area) can be observed through the four reflective surfaces 27 and treated with laser light. Therefore, by further rotating the contact lens 26 by about 45°, observation and treatment with laser light can be performed on the remaining portion.

[0060] In this embodiment, the irradiation of the entire circumference of the trabecular meshwork TM with therapeutic laser light is performed while maintaining a state in which the center of the pupil of the patient's eye E and the center of the light-transmitting window 29 are approximately aligned. In this case, the joystick unit 5 is operated to adjust the aiming position to the area observed on each of the four reflective surfaces 27.

[0061] Referring to Figure 8, an example of a treatment laser light irradiation plan in this embodiment will be described. Figure 8 is a diagram showing an overview of the irradiation plan when irradiating with treatment laser light using the contact lens 26 shown in Figures 6 and 7.

[0062] In this embodiment, the irradiation sequence of the treatment laser light to multiple irradiation sections is determined as an irradiation plan. In this embodiment, each of the eight divisions of the entire circumference of the annular treatment target area (trabecular meshwork™ in this embodiment) is referred to as a section. The eight sections C1 to C8 shown in Figure 8 are broadly divided into a first section (sections C1 to C4 in this embodiment) and a second section (sections C5 to C8 in this embodiment). The first section C1 to C4 and the second section C5 to C8 are arranged alternately one by one. Sections C1 to C4 correspond to the reflective surfaces of the contact lens 26 when the rotation angles of the four reflective surfaces are positioned at 0°, 90°, 180°, and 270° with respect to the axis AX1. Sections C5 to C8 correspond to the reflective surfaces of the contact lens 26 when the rotation angles of the four reflective surfaces are positioned at 45°, 135°, 225°, and 315° with respect to the axis AX1.

[0063] Up to 12 to 13 irradiation spots can be arranged in one section. However, the number and spacing of irradiation spots in each section may be changed according to the operator's instructions. For example, the control unit 60 may have the operator input the spacing between two adjacent spots and calculate the number of planned irradiation spots according to the parameters of the irradiation area (e.g., the circumferential length of the treatment area) and the input spacing between spots.

[0064] As an example, in this embodiment, the planned irradiation area and the number of planned irradiation spots are set collectively for each section. The operator may select any combination of the eight sections via a control panel or the like. For convenience, the section in which the planned irradiation area and the number of planned irradiation spots are set will be referred to as the irradiation section.

[0065] When multiple irradiation areas are selected, the order in which the treatment laser light is irradiated to each of the multiple irradiation areas is determined according to the arrangement of the four reflective surfaces 27 in the contact lens 26. That is, the irradiation order is determined so that the treatment laser light is irradiated to each of the first irradiation areas, and then to each of the remaining second irradiation areas. The multiple irradiations of the treatment laser light in each irradiation area are performed sequentially in either a clockwise or counterclockwise direction.

[0066] As one specific example, let's describe the case where the irradiation area and the number of irradiation spots are set around the entire circumference of the irrigation angle A. In this case, all eight sections are set as irradiation sections. As an example of the irradiation plan in this case, the irradiation order is determined by the order of the numbers written inside each section, as shown in Figure 8. That is, first, the four sections C1 to C4 belonging to the first section are scheduled to be irradiated with the treatment laser light in order, and then the four sections C5 to C8 belonging to the second section are scheduled to be irradiated with the treatment laser light in order. During the irradiation of the four sections C1 to C4 belonging to the first section, and during the irradiation of the four sections C5 to C8 belonging to the second section, there is no need to change the orientation of the contact lens 26 for the patient's eye E. After the irradiation of all sections belonging to the first section is completed, and before the irradiation of the second section with the treatment laser light is started, by changing the orientation of the contact lens 26 only once, it becomes possible to irradiate the entire circumference of the irrigation angle A with the treatment laser light.

[0067] In this explanation, it is assumed that the irradiation order for Section 1 is set first, but the irradiation order for Section 2 may also be set first. Furthermore, the section in which the treatment laser light irradiation begins among the eight sections C1 to C8 may be predetermined or may be selected by the operator. Similarly, the irradiation order within the four sections C1 to C4 belonging to Section 1 may also be predetermined or may be selected by the operator. The same applies to Section 2.

[0068] In this embodiment, a contact lens 26 with multiple reflective surfaces is exemplified as having four mirrors, but it is not necessarily limited to this, and the number of contact lenses 26 may be any integer of two or more. In this case, the position of the compartments, the number of compartments, and the irradiation order of the treatment laser light to each irradiation compartment in the irradiation plan can be determined according to the number of reflective surfaces of the contact lens 26.

[0069] Referring to Figure 9, a method for adjusting the aiming position of the irradiation spot will be described. In this embodiment, there are two methods for adjusting the aiming position of the irradiation spot of the treatment laser light: adjusting the positional relationship between the patient's eye E and the laser irradiation optical system 10 by operating the joystick unit 5, and performing at least one of the rotational operation and / or movement operation of the reflective surface 27 of the contact lens 26. Figure 9(A) shows the state after the most recent irradiation of the treatment laser light has been completed. In the state shown in Figure 9(A), the position of the irradiated spot SS, where irradiation of the treatment laser light has been completed, and the position of the aiming light AI coincide. The operator needs to adjust the position of the aiming light AI (i.e., the aiming position of the irradiation spot) from the state shown in Figure 9(A) to the position of the next irradiation spot (in the example shown in Figure 9, the position to the right of the position of the irradiated spot SS).

[0070] Figure 9(B) shows the state in which the aiming position has been adjusted to the position of the next irradiation spot by operating the joystick unit 5 (i.e., while the angle of the reflective surface 27 of the contact lens 26 is fixed) from the state shown in Figure 9(A). In Figure 9(B), the positions of the irradiated spot SS and the treatment target area (trabecular meshwork TM in this embodiment) at the time of completion of the treatment laser beam are schematically shown by dotted lines. However, in reality, there is no treatment mark on the irradiated spot SS at the time of completion of the previous irradiation, so it is difficult to accurately adjust the aiming position by operating the joystick unit 5.

[0071] Furthermore, Figure 9(C) shows the state in which the aiming position has been adjusted to the position of the next irradiation spot by rotating the reflective surface 27 of the contact lens 26 (i.e., without operating the joystick unit 5) from the state shown in Figure 9(A). In Figure 9(C) as well, the positions of the irradiated spot SS and the treatment target area at the time of completion of the treatment laser beam are schematically shown by dotted lines. However, in reality, even in Figure 9(C), there is no treatment mark on the irradiated spot SS at the time of completion of the previous irradiation, and it is difficult to accurately adjust the aiming position by rotating the reflective surface 27. In this disclosure, a guide is displayed on the internal display unit 50 to assist the operator in adjusting the aiming position.

[0072] Referring to Figures 10 to 13, the treatment control process performed by the ophthalmic laser treatment device 1 of this embodiment will be described. In this embodiment, an example is given of a case in which treatment is performed using a contact lens 26 having multiple reflective surfaces 27 as shown in Figures 6 and 7. The adjustment pattern for the aiming position of the treatment laser light performed in this embodiment is a pattern in which the relative position of the ophthalmic laser treatment device 1 with respect to the eye under examination is mainly moved when adjusting the aiming position for each of the multiple irradiation spots contained within one irradiation section (hereinafter referred to as the "movement adjustment pattern"). However, in the movement adjustment pattern, in addition to moving the relative position of the ophthalmic laser treatment device 1 with respect to the eye under examination, the contact lens may also be rotated. As mentioned above, the irradiation section in this embodiment is a section that includes an area in which the treatment laser light is scheduled to be irradiated a specified number of times M (M≧2) (i.e., irradiation of each of the specified number of irradiation spots) among the multiple sections obtained by dividing the entire circumference of the trabecular meshwork into multiple sections (eight in this embodiment) in the irradiation plan. In this description of the embodiment, it is assumed that the center of the display area in the internal display unit 50, the observation optical axis of the observation optical system 40, the optical axis of the treatment laser beam, and the optical axis of the aiming beam all coincide at the center O. In other words, the operator visually perceives the spot AI of the aiming beam at the center of the observation field of view and the center of the display area of ​​the internal display unit 50. The treatment laser beam is irradiated onto the same spot as the spot AI of the aiming beam.

[0073] First, with reference to Figure 10, an example of the operator's field of view during treatment with the ophthalmic laser treatment device 1 of this embodiment will be described. The ophthalmic laser treatment device 1 allows the operator to understand the spacing between multiple irradiation spots by displaying a spot spacing guide 90 on the internal display unit 50. The spot spacing guide 90 shows the operator the appropriate spacing between multiple irradiation spots to which the treatment laser light is to be irradiated.

[0074] As shown in Figure 10, the ophthalmic laser treatment device 1 of this embodiment adjusts the intervals between multiple indicators included in the spot spacing guide 90 to match the appropriate intervals between multiple irradiation spots. Therefore, the operator can easily adjust the intervals between irradiation spots of the treatment laser light to the appropriate interval by matching the distance traveled when moving the targeting position of the treatment laser light from the previous irradiation spot to the next irradiation spot with the intervals between the multiple indicators included in the spot spacing guide 90. Thus, treatment can be performed more appropriately according to the treatment plan.

[0075] In this embodiment, the ophthalmic laser treatment device 1 displays a spot spacing guide 90 in the display area of ​​the internal display unit 50 at a position (slightly above the position in Figure 10) that is spaced apart from the targeting position of the treatment laser light (the position on which the targeting light AI is projected in Figure 10). In the example shown in Figure 10, the spot spacing guide 90 is displayed on the opposite side of the iris from the treatment site (the trabecular meshwork in this embodiment). However, the spot spacing guide may also be displayed on the iris side of the treatment site.

[0076] The ophthalmic laser treatment device 1 displays a next-target indicator 90A on the spot spacing guide 90 at a position corresponding to the optical axis of the treatment laser beam, for aligning the position of the next irradiation spot. Each time the treatment laser beam is irradiated, the ophthalmic laser treatment device 1 moves one appropriate interval between multiple irradiation spots in the opposite direction to the treatment progression direction defined in the irradiation plan. The ophthalmic laser treatment device 1 also moves the position of the next-target indicator 90A within the spot spacing guide 90 in the progression direction defined in the irradiation plan by one appropriate interval between multiple irradiation spots. As a result, the position of the next-target indicator 90A is maintained at a position corresponding to the target position. The operator can further easily adjust the next target position by considering the position of the next-target indicator 90A on the optical axis of the treatment laser beam (which also coincides with the optical axis of the targeting light if a targeting light is irradiated) and aligning the position on the tissue to be irradiated with the next treatment laser beam.

[0077] Of the multiple indicators in the spot spacing guide 90, all indicators other than the next targeting indicator 90A are either the irradiated indicator 90B, which corresponds to a spot where the treatment laser light has already been irradiated, or the unirradiated indicator 90C, which corresponds to a spot where the treatment laser light will be irradiated at a later date. The ophthalmic laser treatment device 1 displays each of the next targeting indicator 90A, the irradiated indicator 90B, and the unirradiated indicator 90C in a different manner (i.e., in a manner that can be identified by the operator). Therefore, the operator can easily grasp the positional relationship between the next targeting indicator 90A, the irradiated indicator 90B, and the unirradiated indicator 90C, making it easier to proceed with treatment more smoothly.

[0078] Each time the ophthalmic laser treatment device 1 is irradiated with treatment laser light, it moves the entire spot spacing guide 90 in the opposite direction to the direction of travel determined in the irradiation plan by the appropriate spacing of multiple irradiation spots. The operator can further easily adjust the aiming position by adjusting the aiming position each time so that the position of the multiple indicators that move each time the treatment laser light is irradiated is at a constant position on the observation image observed through the observation optical system 40. The operator can appropriately adjust each of the multiple aiming positions by appropriately adjusting the positional relationship between the characteristic sites present in the tissue included in the observation image and the multiple indicators of the spot spacing guide 90. For example, the operator can identify one characteristic site on the observation image and, each time the spot spacing guide 90 moves by the appropriate spacing of irradiation spots (i.e., each time the treatment laser light is irradiated), issue a movement instruction to the device so that a specific indicator among the multiple indicators (e.g., the leftmost indicator, or the second indicator from the left, etc.) coincides with the identified characteristic site. In other words, if the spot spacing guide 90 includes multiple indicators, matching at least one of the indicators (a specific indicator) to a feature area will appropriately adjust each of the multiple aiming positions.

[0079] In this embodiment, the ophthalmic laser treatment device 1 displays one of the elements of each of the multiple indicators included in the spot spacing guide 90 in a straight line. In this embodiment, the ophthalmic laser treatment device 1 displays the multiple indicators 90A, 90B, and 90C included in the spot spacing guide 90 in a straight line along a virtual straight-line angular reference line AL (which is not actually displayed on the internal display unit 50). In this embodiment, the centroid of each of the multiple indicators is displayed in a straight line along the angular reference line AL. Each time the treatment laser light is irradiated, the ophthalmic laser treatment device 1 moves the spot spacing guide 90 along the straight-line direction in which the elements of the multiple indicators are arranged. In this case, the operator can perform the treatment more appropriately by aligning the direction in which the elements of the multiple indicators are arranged with the direction in which the targeting position of the treatment laser light is moved to the next irradiation spot.

[0080] Furthermore, the spot spacing guide 90 in this embodiment includes an indicator 90D. The indicator 90D indicates the direction of one of the multiple reflective surfaces 27 on the contact lens 26 that corresponds to the displayed spot spacing guide 90. In this embodiment, the indicator 90D is positioned at one of the positions spaced apart from a virtual linear angular reference line AL. As an example, in this embodiment, the indicator 90D is displayed near the indicators (indicators 90A, 90B, 90C) arranged in a row on the spot spacing guide 90 (in 10, slightly above and spaced apart). The side of the spot spacing guide 90 on which the indicator 90D is located indicates that it is the reflective surface 27 that corresponds to the displayed spot spacing guide 90. The operator can grasp the relative position of the patient's eye E and the laser irradiation optical system 10 from the indicator 90D and the direction of curvature of the trabecular fiber TM, and can adjust the relative position to a position corresponding to an appropriate reflective surface 27 as needed. In particular, in this embodiment, since the aiming light AI and the spot spacing guide 90 are shown approximately at the center of the operator's field of view, it is difficult to determine which side the reflective surface 27 corresponds to the displayed spot spacing guide 90 is on based solely on the position of the spot spacing guide 90. In contrast, the indicator 90D is useful because it indicates which side the reflective surface 27 corresponds to the displayed spot spacing guide 90 is on.

[0081] The ophthalmic laser treatment device 1 of this embodiment displays an outer peripheral guide 75 on the internal display unit 50 as a targeting guide. The outer peripheral guide 75 includes a next targeting guide 75A, an irradiation completion guide 75B, and an unirradiated guide 75C. The outer peripheral guide 75 indicates at least one of the rotation angle of the contact lens's reflective surface suitable for the progress of the irradiation plan (i.e., the direction in which the reflective surface 27 is positioned relative to the central axis AX1 of the contact lens 26), and the direction in which the irradiation spot to be irradiated with the treatment laser light is located (the direction in which the irradiation spot is located in the observation image using the contact lens 26). The outer peripheral guide 75 is displayed along the outer edge of the observation field of view by the operator via the observation optical system 40. As described above, the observation optical axis by the observation optical system 40 and the center of the display area of ​​the internal display unit 50 coincide. Therefore, by displaying the outer peripheral guide 75 along the outer edge of the observation field of view with reference to the center of the display area of ​​the internal display unit 50, the operator can easily grasp the appropriate direction.

[0082] In detail, in this embodiment, multiple peripheral guides 75 are arranged in an arc or ring shape along the outer edge of the observation field. Furthermore, when the control unit 60 moves one peripheral guide 75, it moves it along the arc or ring line along the outer edge of the observation field. The center of the arc or ring line on which the peripheral guide 75 is displayed (in other words, the center of the peripheral guide 75, or the center of curvature of the peripheral guide 75) coincides with the observation optical axis of the observation optical system 40. Therefore, the operator can properly grasp the direction indicated by the peripheral guide 75.

[0083] The outer peripheral guide 75 includes a next-target guide 75A. The next-target guide 75A indicates the appropriate direction for the irradiation spot to be next irradiated with therapeutic laser light, from among multiple irradiation spots defined in the irradiation plan. Each time therapeutic laser light is irradiated, the control unit 60 moves the position of the next-target guide 75A to a position corresponding to an irradiation spot adjacent to the direction of travel defined in the irradiation plan. For example, in the case of an irradiation plan that irradiates 100 times clockwise around the entire circumference of the trabecular meshwork TM, the next-target guide 75A should be moved 3.6 degrees relative to the center O. Therefore, the operator can appropriately determine the direction of the irradiation spot to which the target position will be adjusted next by the next-target guide which moves along the outer peripheral of the observation field.

[0084] The outer peripheral guide 75 includes an irradiation completion guide 75B. The irradiation completion guide 75B indicates the direction of the irradiation spot where irradiation with the therapeutic laser light has already been completed, among the multiple irradiation spots defined in the irradiation plan. Each time irradiation with the therapeutic laser light is completed, the control unit 60 changes the next targeting guide 75A, which was displayed until immediately before irradiation, to the irradiation completion guide 75B. Therefore, the operator can understand the direction in which irradiation with the therapeutic laser light has been completed and appropriately adjust the next targeting position using the next targeting guide 75A. It also becomes easier to understand the progress of the treatment.

[0085] The outer peripheral guide 75 includes an unirradiated guide 75C. The unirradiated guide 75C indicates the direction of the irradiation spot that is scheduled to be irradiated with treatment laser light at a later date, among the multiple irradiation spots defined in the irradiation plan. Each time the irradiation of treatment laser light is completed, the control unit 60 changes the unirradiated guide 75C, which was displayed in the direction of the irradiation spot for the next irradiation sequence defined in the irradiation plan, to the next targeting guide 75A, thereby transitioning to the next targeting guide 75A. In this case, the operator can also understand the direction of the irradiation spot that is scheduled to be irradiated with treatment laser light at a later date, and appropriately adjust the next targeting position using the next targeting guide 75A. It also becomes easier to understand the progress of the treatment.

[0086] The control unit 60 displays the next targeting guide 75A, the irradiation completion guide 75B, and the unirradiated guide 75C in a distinguishable manner (i.e., in different display modes). Therefore, the operator can easily recognize the type of outer peripheral guide 75 being displayed. The control unit 60 may selectively display one or two of the next targeting guide 75A, the irradiation completion guide 75B, and the unirradiated guide 75C. In this case, it is desirable to display at least the next targeting guide 75A. It is even more desirable to display both the next targeting guide 75A and the irradiation completion guide 75B. The next targeting guide 75A may be, for example, a straight line extending to the center O through which the optical axis of the observation optical system 40 passes. It is sufficient that the next targeting guide 75A guides the direction in which the reflective surface 27 of the contact lens 26 should be pointed.

[0087] Furthermore, the ophthalmic laser treatment device 1 of this embodiment displays the total number of irradiation spots specified in the irradiation plan. In the example shown in Figure 10, the number in the denominator of "SHOTS" represents the total number of irradiation spots. The number of irradiation spots for which treatment has been completed (i.e., the total number of irradiation spots for which irradiation with the treatment laser light has been completed and the number of irradiation spots for which irradiation was skipped) is also displayed. In the example shown in Figure 10, the number in the numerator of "SHOTS" represents the number of irradiation spots for which treatment has been completed. Each time irradiation with the treatment laser light or irradiation is skipped, "1" is added to the numerator of "SHOTS". In addition, in the example shown in Figure 10, the type of aiming light AI being used and the energy of the treatment laser light are also displayed.

[0088] The treatment flow using the spot spacing guide 90 will be explained using the examples shown in Figures 11 and 12. In Figures 11 and 12, in order to facilitate understanding of the display transitions of the spot spacing guide 90, the portion of the operator's field of view other than the vicinity of the spot spacing guide 90 displayed on the internal display unit 50 is omitted. Figures 11 and 12 show an example in which the irradiation is performed by changing the irradiation section for the actual trabecular meshwork areas below (Figure 11) corresponding to irradiation section C1 and to the left (Figure 12) corresponding to irradiation section C2, based on the irradiation plan set in advance by the operator. In Figures 11 and 12, the lower trabecular meshwork is reflected by the reflective surface of the contact lens and enters the operator's field of view. Therefore, in Figures 11 and 12, the image is inverted vertically, and the lower trabecular meshwork is reflected. In Figures 11 and 12, when treatment of the irradiation spot progresses from right to left (i.e., counterclockwise) on the reflective surface, in the actual lower trabecular meshwork, treatment of the irradiation spot progresses from right to left (i.e., clockwise).

[0089] First, as shown in Figure 11(a), the control unit 60 determines the angle of the spot spacing guide 90 to be displayed on the internal display unit 50 according to the progress of the irradiation plan, and displays the spot spacing guide 90 at the determined angle. The spot spacing guide 90 shown in Figure 11 is a guide for performing a specified number of irradiations, 10 times (i.e., a maximum of 10 times), on the lower region of the actual trabecular meshwork TM. The indicators of the spot spacing guide 90 shown in Figure 11(a) are arranged horizontally to treat the lower region of the trabecular meshwork TM. The control unit 60 displays the next targeting indicator 90A in the spot spacing guide 90 in an identifiable manner for aligning the targeting position of the next treatment laser beam. In the example shown in Figure 11(a), the control unit 60 first displays the next targeting indicator 90A at the position of the indicator located at the opposite end of the treatment progression direction defined in the irradiation plan (in Figure 11(a), the indicator located at the right end). Of the multiple indicators on the spot spacing guide 90, the indicators other than those that overlap with the next targeting indicator 90A are considered un-irradiated indicators, corresponding to at least a portion of the spot that will be irradiated with treatment laser light after the next time. Furthermore, the control unit 60 displays the multiple indicators on the spot spacing guide 90 so that the next targeting indicator 90A corresponds to the position on the optical axis of the treatment laser light irradiated by the laser irradiation optical system 10. As mentioned above, the position where the next targeting indicator 90A is displayed does not need to perfectly coincide with the optical axis of the treatment laser light. In other words, the next targeting indicator 90A only needs to be displayed at a position corresponding to the targeting position of the treatment laser light so that the operator can recognize the targeting position where the treatment laser light will be irradiated.

[0090] The operator adjusts the rotation angle of the contact lens and at least one of the relative positions of the patient's eye E and the laser irradiation optical system 10, which are changed by the joystick unit 5, so that the position of the next targeting indicator 90A included in the spot spacing guide 90 corresponds to the irradiation spot of the first treatment laser beam in the treatment area of ​​the patient's eye E (trabecular meshwork in this embodiment). If there are any characteristic areas in the tissue of the patient's eye E included in the observed image, it is desirable for the operator to understand the positional relationship between at least one of the multiple indicators (a specific indicator) in the spot spacing guide 90 and the characteristic area of ​​the tissue. In this case, in subsequent treatment procedures, the operator can smoothly proceed with treatment for each of the multiple irradiation spots by adjusting the positional relationship between the specific indicator and the characteristic area of ​​the tissue to the same positional relationship. As shown in Figure 11(b), the operator inputs a command to perform irradiation of the treatment laser beam with the position of the next targeting indicator 90A aligned to the position corresponding to the irradiation spot of the first treatment laser beam in the treatment area of ​​the patient's eye E (trabecular meshwork in this embodiment). As a result, the treatment laser beam is irradiated onto the spot S through which the optical axis of the laser irradiation optical system 10 passes.

[0091] As shown in Figure 11(c), once the irradiation of the treatment laser light is complete, the control unit 60 moves all the indicators on the spot spacing guide 90 in the opposite direction to the treatment progression direction defined in the irradiation plan (clockwise, or leftward in Figure 11) by the appropriate interval of one irradiation spot. The control unit 60 also moves the position of the next targeting indicator 90A in the direction of progression defined in the irradiation plan by the appropriate interval of one irradiation spot. As a result, the position of the next targeting indicator 90A is maintained at the position corresponding to the target position. Furthermore, the control unit 60 changes the indicator that the next targeting indicator 90A was superimposed on during the previous irradiation of the treatment laser light to an indicator that has already been irradiated. As shown in Figure 11(d), the operator can adjust the target position of the next treatment laser light by mainly operating the joystick unit 5 and moving the tissue visible in the observation image in the treatment progression direction defined in the irradiation plan by the interval of each of the multiple indicators on the spot spacing guide 90. Furthermore, the operator can adjust the targeting position of the next treatment laser beam by adjusting the positional relationship between at least one of several indicators (a specific indicator) and the characteristic site of the tissue to the same positional relationship as the previous time. Therefore, the targeting position is easily adjusted appropriately. The operator inputs the instruction to perform irradiation of the treatment laser beam with the position of the next targeting indicator 90A aligned to the position corresponding to the targeting position of the next treatment laser beam (as shown in Figure 11(d)).

[0092] As shown in Figure 11(e), once the irradiation of the second irradiation spot with the therapeutic laser light is complete, the control unit 60 moves all the indicators on the spot spacing guide 90 further in the opposite direction of travel as defined in the irradiation plan, by the appropriate spacing of one irradiation spot. The control unit 60 also moves the position of the next targeting indicator 90A in the direction of travel as defined in the irradiation plan, by the appropriate spacing of one irradiation spot. As a result, the position of the next targeting indicator 90A is maintained at the position corresponding to the targeting position. The operator inputs the instruction to perform irradiation of the therapeutic laser light with the position of the next targeting indicator 90A aligned with the position corresponding to the next irradiation spot of the therapeutic laser light (as shown in Figure 11(f)). This procedure is repeated until the irradiation of the therapeutic laser light to all of the multiple spots within one irradiation area (12 spots in the example shown in Figures 11 and 12) is complete. As mentioned above, the irradiation area is the angular range of an arc-shaped region where treatment laser light is to be irradiated a specified number of times M times (M≧2, in this embodiment M=12) based on the spot spacing guide 90.

[0093] Once the prescribed number of M treatment laser beam irradiations (12 irradiations in the example shown in Figures 11 and 12) for one irradiation area are complete, the state shown in Figure 12(a) is reached. The control unit 60 automatically rotates the entire index of the spot spacing guide 90 in the direction of travel by the angle of one irradiation area. The control unit 60 also displays the next targeting index 90A at a position that overlaps with the index located at the opposite end of the treatment direction determined in the irradiation plan. Furthermore, the control unit 60 sets all other indexes of the spot spacing guide 90, except for the index where the next targeting index 90A overlaps, as unirradiated indexes. The control unit 60 displays the multiple indexes of the spot spacing guide 90 and the next targeting index 90A so that the next targeting index 90A corresponds to the position on the optical axis of the treatment laser beam irradiated by the laser irradiation optical system 10. As a result, the observed image is in the state shown in Figure 12(b). The operator rotates the reflective surface of the contact lens clockwise, in the direction of treatment (see Figure 12(c)). As mentioned above, the treatment laser light is then repeatedly applied to all of the multiple spots within the new irradiation area.

[0094] Furthermore, in this embodiment, the ophthalmic laser treatment device 1 can also receive user instructions to rotate the entire spot spacing guide 90 before the irradiation of the treatment laser light to all of the multiple irradiation spots within the irradiation area being treated is completed (i.e., during treatment of the irradiation spots within the irradiation area). When the ophthalmic laser treatment device 1 receives instructions to rotate the entire spot spacing guide 90 before the treatment to all of the multiple irradiation spots within the irradiation area being treated is completed, it rotates the entire spot spacing guide 90 by an angle corresponding to the range of treatment that has progressed within the irradiation area that was being treated. Therefore, even if the treatment in each irradiation area is not yet complete, the operator can rotate the entire spot spacing guide 90 and then move on to treatment in the next irradiation area.

[0095] Furthermore, the ophthalmic laser treatment device 1 of this embodiment can also receive instructions from the user (hereinafter referred to as "skip instructions") to omit the irradiation of the treatment laser light to the next irradiation spot specified in the irradiation plan. When a skip instruction is received, the ophthalmic laser treatment device 1 moves the spot spacing guide 90 by the appropriate interval of one irradiation spot in the direction of travel specified in the irradiation plan, or in the opposite direction, without irradiating the treatment laser light. Therefore, if there are non-irradiated areas where it is not appropriate to irradiate the treatment laser light, the operator can input a skip instruction to skip the irradiation of the treatment laser light to the non-irradiated areas and then resume treatment from the irradiation spot scheduled thereafter. Thus, treatment can proceed more smoothly. In other words, the ophthalmic laser treatment device 1 is equipped with a skip means for skipping the irradiation step of the treatment laser light to some of the multiple irradiation spots specified in the treatment plan. Therefore, the treatment plan makes it easier to appropriately balance convenience (e.g., guidance for irradiation of treatment laser light) and flexible treatment through skipping methods (e.g., a procedure to omit irradiation of treatment laser light to non-irradiated areas discovered after the start of treatment according to the treatment plan).

[0096] As described above, in this embodiment as well, a spot spacing guide 90, which allows the user to understand the appropriate spacing between multiple irradiation spots, is displayed on the internal display unit 50 according to the progress of the irradiation plan. Therefore, the operator can check the spot spacing guide 90 while observing the patient's eye E through the eyepiece 46 (i.e., without taking their eye off the eyepiece 46), and adjust the multiple targeting positions of the treatment laser beam by referring to the checked spot spacing guide 90.

[0097] Furthermore, the control unit 60 changes the spacing between multiple indicators of the spot spacing guide 90 displayed on the internal display unit 50 according to the magnification of the observation optical system 40. Therefore, even if the observation magnification is changed, the spot spacing guide 90 corresponding to the appropriate spacing of the multiple irradiation spots is displayed on the internal display unit 50.

[0098] Referring to Figure 13, the treatment control process in this embodiment will be described. First, the control unit 60 acquires a treatment laser light irradiation plan for the patient's eye E (S81). The treatment plan acquired in S81 specifies the angle between two adjacent irradiation spots, the angle of one irradiation section, the number of times M the treatment laser light is irradiated within each irradiation section, the total number N the treatment area to be irradiated with the treatment laser light, the irradiation spot to irradiate the treatment laser light first, the irradiation order of the treatment laser light (including the irradiation direction), and so on.

[0099] The control unit 60 displays the spot spacing guide 90 on the internal display unit 50 at an angle corresponding to the arrangement of the first irradiation section (S82). The control unit 60 sets the value of the total irradiation counter "n", which identifies the cumulative number of times the treatment laser light has been irradiated onto the entire treatment target area, to "0" (S83). Furthermore, the control unit 60 sets the value of the section irradiation counter "m", which identifies the number of times the treatment laser light has been irradiated within a single irradiation section, to "0" (S84). The control unit 60 sets the display position of the next targeting indicator 90A, which is the indicator for the next irradiation of the treatment laser light, to a position that overlaps with the indicator located at the opposite end in the direction of progression of the irradiation sequence (S85).

[0100] The control unit 60 determines whether the operator has entered an instruction to perform irradiation with the treatment laser light (S87). If no irradiation instruction has been entered (S87: NO), the control unit 60 determines whether an instruction to omit irradiation with the treatment laser light to the next irradiation spot specified in the irradiation plan (i.e., a "skip instruction") has been entered (S88). If no skip instruction has been entered (S88: NO), the control unit 60 determines whether an instruction to rotate the entire spot spacing guide 90 before the irradiation of all multiple irradiation spots in the irradiation section being treated (hereinafter referred to as an "intermediate rotation instruction") has been entered (S89). If no instructions have been entered in S87 to S89, the determinations in S87 to S89 are repeated and the system enters a standby state. During this time, the operator adjusts the aiming position of the treatment laser light.

[0101] When an instruction to perform irradiation of the treatment laser light is input (S87:YES), the treatment laser light is irradiated (S90). The control unit 60 adds "1" to the values ​​of the total irradiation counter "n" and the section irradiation counter "m" (S91). The control unit 60 determines whether the value of the total irradiation counter "n" has reached the total number of times "N" that the treatment laser light is irradiated to the entire treatment target area (S92). If the prescribed number of irradiations of the treatment laser light to all irradiation spots (including the number of times irradiation was skipped in this embodiment) has not been completed (i.e., "n" has not reached "N") (S92:NO), the control unit 60 determines whether the prescribed number of irradiations of the treatment laser light to the irradiation section under treatment has been completed (i.e., whether the value of the section irradiation counter "m" has reached the number of times "M" that the treatment laser light is irradiated to one irradiation section) (S93). If irradiation of the treatment laser beam into the irradiation area during treatment is not complete (S93:NO), the control unit 60 moves the entire spot spacing guide 90 in the opposite direction to the direction of travel of the irradiation spot by the appropriate spacing between multiple irradiation spots (S94). In addition, S94 also executes control to move the next targeting indicator 90A by the appropriate spacing. After that, the process returns to S87.

[0102] When irradiation of one irradiation area with the treatment laser light is complete (S93:YES), the control unit 60 rotates the entire spot spacing guide 90 by the angle of one irradiation area (specified angle) (S95). The control unit 60 resets the next targeting indicator 90A and the unirradiated indicator (S98), and the process returns to S84. When irradiation of all irradiation spots with the treatment laser light is complete (S92:YES), the process ends.

[0103] Furthermore, if a skip instruction is entered before an instruction to perform irradiation of the treatment laser light is entered (S88:YES), the control unit 60 adds "1" to the values ​​of the total irradiation counter "n" and the section irradiation counter "m" (S91), and then executes the processes of S92-S95 and S98. In other words, if irradiation of the treatment laser light to all irradiation spots is not completed (if "n" has not reached "N") (S92:NO), the control unit 60 moves the entire spot spacing guide 90 by one appropriate interval between multiple irradiation spots in the direction of the irradiation spot's movement, or in the opposite direction of the movement, without irradiating the treatment laser light (S94). The direction in which the spot spacing guide 90 is moved may be determined according to the instructions entered by the operator. Furthermore, if "n" reaches "N" (S92: YES), the control unit 60 rotates the entire spot spacing guide 90 by a specified angle (S95) to reset the targeting indicator 90A and the unilluminated indicator for the next time (S98).

[0104] Furthermore, if an intermediate rotation instruction is input before the instruction to perform irradiation of the treatment laser light is input (S89:YES), the control unit 60 calculates the angle corresponding to the range in which treatment has progressed within the irradiation area that was being treated as the angle by which the spot spacing guide 90 should be rotated (S96). The specific method for calculating the rotation angle in S96 can be selected as appropriate. For example, let A be the angle between two adjacent irradiation spots when viewed from the center of a virtual circle through which multiple planned irradiation spots pass, and let m be the number of irradiation spots in which treatment has progressed within the irradiation area that was being treated (in this embodiment, this matches the value of the irradiation counter m within the area). In this embodiment, the control unit 60 calculates the angle corresponding to the range in which treatment has progressed within the irradiation area that was being treated by "A degrees × m". The number of irradiation spots in which treatment has progressed, "m", also includes the number of irradiation spots in which irradiation of the treatment laser light was skipped due to a skip instruction. The control unit 60 rotates the entire spot spacing guide 90 by the angle calculated in S96 in the direction of progression defined in the treatment plan (S97). If the number of irradiation spots where treatment has progressed ("m") is "0", the angle calculated in S96 will be "0 degrees", and therefore the spot spacing guide 90 will not rotate in S97. After that, the next targeting indicator 90A and the unirradiated indicator are reset (S98), and the process returns to S84.

[0105] While embodiments of the technology disclosed herein have been described in detail above, these are merely illustrative and do not limit the scope of the claims. The technologies described in the claims include various modifications and changes to the embodiments illustrated above. [Explanation of Symbols]

[0106] 1. Ophthalmic laser treatment device 6. Control Box 7 External display 10 Laser irradiation optical system 26. Contact lenses (partially rotating lenses) 26A Grip 26B Rotating base 27 Reflective surface 28 Interval index 40 Observation Optical System 46 Eyepieces 50 Internal display 60 Control Unit 61 CPU 71A, 71B Target Area Guide 75 Outer perimeter guide 75A Next Aim Guide 75B Irradiation Completion Guide 75C Unirradiated Guide 75D Section Aiming Guide 90,91 Spot Spacing Guide 90A, 91A Next target indicator

Claims

1. An ophthalmic laser treatment device that irradiates the patient's eye tissue with a therapeutic laser beam each time an instruction to perform irradiation of the therapeutic laser beam is input, A laser irradiation optical system that irradiates the patient's eye with therapeutic laser light, An observation optical system that allows the operator to observe the patient's eye through an eyepiece, The observation optical system includes an internal display unit that displays an image to the operator via the eyepiece, Control unit and Equipped with, The control unit, A step to acquire an irradiation plan in which, when irradiating the patient's eye with therapeutic laser light using a contact lens having multiple reflective surfaces that reflect therapeutic laser light in a direction intersecting the optical axis, the irradiation order of therapeutic laser light is determined according to the arrangement of the multiple reflective surfaces for multiple irradiation sections that divide the planned irradiation area, which includes multiple irradiation spots to be irradiated with therapeutic laser light, into multiple sections, and A targeting guide display step, which displays a targeting guide on the internal display unit in accordance with the progress of the irradiation plan, to assist in adjusting the targeting position of the treatment laser beam, which is adjusted by the operator, to the appropriate position, An ophthalmic laser treatment device characterized by performing the following.

2. An ophthalmic laser treatment device according to claim 1, The control unit, An ophthalmic laser treatment device that acquires an irradiation plan in which the irradiation order of treatment laser light to multiple irradiation areas is determined such that, when the rotation angle of the multiple reflective surfaces of the contact lens is fixed to a first angle, treatment laser light is irradiated to each of the first irradiation areas, which are the multiple irradiation areas corresponding to each of the multiple reflective surfaces of the contact lens, and then when the rotation angle of the multiple reflective surfaces of the contact lens is fixed to a second angle different from the first angle, treatment laser light is irradiated to each of the second irradiation areas, which are the multiple irradiation areas corresponding to each of the multiple reflective surfaces.

3. An ophthalmic laser treatment device according to claim 1 or 2, The control unit, An ophthalmic laser treatment device characterized by further performing a rotation recommendation step, in accordance with the progress of the irradiation plan, which recommends to the operator that the reflective surface of the contact lens be rotated to a second angle once the irradiation of each of the first irradiation sections of the first irradiation section has been completed.

4. An ophthalmic laser treatment device according to any one of claims 1 to 3, An ophthalmic laser treatment device characterized in that the center of the display area in the internal display unit coincides with the optical axis of the observation optical system.

5. An ophthalmic laser treatment device according to any one of claims 1 to 4, The control unit, An ophthalmic laser treatment device characterized in that an angle guide indicating the rotation angle of the reflective surface of the contact lens suitable for the progress of the irradiation plan is displayed on the internal display unit as the aiming guide.

6. An ophthalmic laser treatment device according to claim 5, An ophthalmic laser treatment device characterized in that an angle guide indicating the rotation angle of the reflective surface of the contact lens suitable for the progress of the irradiation plan is displayed on the internal display unit as a target area guide that serves as a reference for aligning the arc-shaped or annular treatment target area of ​​the patient's eye, which is observed by the operator through the observation optical system.

7. An ophthalmic laser treatment device according to any one of claims 1 to 6, The control unit, An ophthalmic laser treatment device characterized in that, along the outer periphery of the field of view observed by the operator via the observation optical system, an outer periphery guide indicating at least one of the rotation angle of the reflective surface of the contact lens suitable for the progress of the irradiation plan, and the direction of the irradiation spot to which the treatment laser light should be irradiated, is displayed on the internal display unit as a aiming guide.

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