Ophthalmic observation system

Abstract

This disclosure provides an ophthalmic observation system for visualizing the surface and internal structure of a medical patient's eye. A particular embodiment provides an ophthalmic observation system including an ophthalmic microscope, a gonioscopy device configured to relay images of the inner periphery of the patient's eye to the ophthalmic microscope, and a robotic arm configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye, and to relay images of the inner periphery of the patient's eye to the ophthalmic microscope for the user to view.

Description

Technical Field

[0001] Cross - reference to Related Applications This application claims the priority and benefit of U.S. Provisional Patent Application No. 63 / 505,037, filed on May 30, 2023, which is hereby assigned to the assignee of this application and is hereby expressly incorporated by reference in its entirety herein for all applicable purposes as if the full text were set forth herein.

Background Art

[0002] Introduction Glaucoma is an eye disease that is often related to excessive pressure inside the eye. High intraocular pressure can damage the optic nerve, which can lead to vision loss and even blindness. Glaucoma is one of the most common causes of blindness in patients over 60 years old.

[0003] Mild glaucoma may be treated through appropriate topical application of medications. In more severe glaucoma, surgery is often required. These surgeries can include canaloplasty, trabeculectomy, and insertion of implants to increase the drainage of excess fluid from the anterior chamber of the eye. These procedures can reduce the intraocular fluid pressure, and thus lower the undesirable harmful excess pressure that would otherwise reach the optic nerve if the treatment were not performed.

[0004] In some relatively new surgical techniques called minimally invasive glaucoma surgery (MIGS), an intraocular microstent can be inserted at a target site on the inner surface inside the eye. A properly inserted microstent, for example, improves the flow of intraocular fluid that exits the eye and enters the Schlemm's canal through the zonular fibers. Alternatively, certain MIGS procedures can utilize a small incision (and / or resection) of intraocular tissue to improve aqueous humor outflow into the Schlemm's canal or to facilitate the expansion of the Schlemm's canal using viscoelastic substances.

[0005] However, the effectiveness of such surgery depends on the proper placement of the intraocular incision and / or the microstent aqueous humor drainage device. This often depends on how effectively the target site for the intraocular incision or microstent placement can be visualized by the surgeon.

[0006] In many cases, the area of ​​greatest interest within a patient's eye may be completely invisible without additional assistance. Figures 1A and 1B show two partial cross-sections of a patient's eye 100 illustrating this situation. In Figure 1A, light 101 is reflected from the fibrous zonule 103 of the patient's eye 105. In most normal eyes, this light undergoes "total internal reflection" at the boundary between the outer surface of the eye 107 and the outside air. Therefore, the fibrous zonule 103 may be partially or even completely invisible to an observer from the outside. Unfortunately, it is precisely this fibrous zonule where glaucoma stents are most frequently placed, and other similar procedures are frequently performed.

[0007] To overcome this limitation, surgeons (or other medical professionals) often use handheld gonioscopy devices, including prisms, mirrors, or a combination of both, to redirect light from the inside of the eye so that it can be seen from the outside. In Figure 1B, a gonioscopy device 110 is positioned over the patient's eye 100. With saline solution filling the gap 112 between the device 110 and the outer surface of the eye 107, the gonioscopy device 110 directs light outward so that it can be seen by the user of the device.

[0008] Conventionally, such gonioscopy devices 110 are held by hand in a fixed position, which occupies one of the user's hands and can cause difficulty and fatigue for surgeons and other users.

[0009] In addition, when gonioscopy equipment such as mirrors is used, the image available to the user may be inverted compared to the actual configuration of the patient's eye. This means that the surgeon may simultaneously "invert" the image in their mind while performing extremely delicate and demanding procedures on the posterior-facing structures inside the patient's eyeball using one or more surgical instruments.

[0010] While experienced and skilled surgeons can overcome these challenges to a considerable extent, it is not easy. For example, it is estimated that misalignment may occur in perhaps 30% of glaucoma stents, which may be largely due to the difficulty in visualizing their placement or in properly positioning and aligning gonioscopy equipment between the patient's eye and the surgeon's microscope. [Overview of the Initiative] [Problems that the invention aims to solve]

[0011] Therefore, in this field, there is a substantial but unmet need for improved systems that better visualize the internal structure of the eye, in order to facilitate internal stent placement and other intraocular surgeries, and in other situations where visualization of the intraocular structure of a patient's eye is necessary or required. [Means for solving the problem]

[0012] The embodiments described herein generally relate to ophthalmic observation systems for visualizing the surface and internal structure of a medical patient's eye. Examples of such systems may include an ophthalmic microscope, a gonioscopy device configured to work with the ophthalmic microscope to provide images of the inside of a patient's eye, and a robotic arm configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye to provide images of the inside of the eye.

[0013] In one embodiment, an ophthalmic observation system is provided, which includes an ophthalmic microscope, a gonioscopy device configured to relay images of the inner periphery of a patient's eye to the ophthalmic microscope, and a robotic arm configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye, thereby relaying images of the inner periphery of the patient's eye to the ophthalmic microscope for viewing by a user.

[0014] In another embodiment, an ophthalmic observation system is provided, which includes an ophthalmic microscope; a gonioscopy device configured to relay images of the inner periphery of a patient's eye to the ophthalmic microscope; and an adjustable arm configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye, and relay images of the inner periphery of the patient's eye to the ophthalmic microscope for viewing by a user, the adjustable arm including a gripper configured to receive, hold, and release the gonioscopy device.

[0015] A more concise and specific description of the above-mentioned features of this disclosure can be obtained by referring to embodiments, some of which are shown in the accompanying drawings, so that the above-mentioned features of this disclosure can be understood in detail. However, it should be noted that the accompanying drawings only illustrate exemplary embodiments and are therefore not to be considered limiting the scope of the invention, as other equally effective embodiments are also possible. [Brief explanation of the drawing]

[0016] [Figure 1A] This shows one of two figures illustrating the conventional approach to visualizing the internal structure and location of a medical patient's eye. [Figure 1B] This shows the other of two figures illustrating the conventional approach to visualizing the internal structure and location of a medical patient's eye. [Figure 2] A perspective view of an ophthalmic observation system in a surgical environment according to the embodiments of this disclosure is shown. [Figure 3] A perspective view of another ophthalmic observation system in a surgical setting, according to the embodiments of this disclosure, is shown. [Figure 4] A perspective view of another ophthalmic observation system useful for examining a patient according to an aspect of the present disclosure is shown. [Figure 5] A perspective view of yet another ophthalmic observation system useful for examining a patient according to an aspect of the present disclosure is shown. [Figure 6] Details of a robotic arm for use in the systems shown in FIGS. 2 - 5 or similar systems according to an aspect of the present disclosure are shown. [Figure 7] A block diagram schematically showing elements of the system described herein according to an aspect of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

[0017] For ease of understanding, the same reference numbers are used, whenever possible, to refer to the same elements common to the figures. The elements and features of one embodiment may be beneficially incorporated into other embodiments without further elaboration.

[0018] The present disclosure generally relates to systems for visualizing the internal structures of the eyes of medical patients. These systems can be used, for example, during ophthalmic surgery, including the implantation of an intraocular stent or other aqueous humor drainage device to relieve intraocular pressure associated with glaucoma, but are not limited thereto. Such systems can also be used in other situations where visualization of the internal structures of the eye is necessary or desirable.

[0019] Here, various examples will be described in more detail with reference to the accompanying drawings. However, it should be understood that systems such as those disclosed herein can be implemented in various forms and are not limited to the examples described herein.

[0020] FIG. 2 shows an ophthalmic observation system 200 in a surgical environment 201 for visualizing the surface and internal structures of the eye 105 of a medical patient 208 undergoing surgery using an ophthalmic microscope 205 by a surgeon 202. The microscope 205 is supported in this figure by an adjustable overhead arm 210 of a microscope support stand 213.

[0021] Patient 208 can be supported on the operating table 215. The ophthalmic microscope 205 is movable in three dimensions together with the support arm 210, whereby the surgeon 202 can position the ophthalmic microscope 205 with respect to the eye 105 of the patient 208 as desired. The surgeon 202 can, in some cases, simply grip the microscope 205 or the arm 210 and manually move the microscope 205 to a predetermined position. In other cases, the movement of the microscope 205, the arm 210, and / or the microscope support base 213 may be performed according to instructions from a controller by a stepper motor, a servo motor, or a similar electromechanical actuator. For example, in certain embodiments, the microscope 205 may be supported and held by the microscope support robotic arm 210 and / or the microscope support base 213, which can be automated and controllable to move the microscope 205 in a pre-programmed manner or according to commands input by the surgeon 202 or another person during the surgery. Generally, the positions of the microscope 205, the arm 210, and / or the microscope support base 213 may be lockable.

[0022] In certain embodiments, the ophthalmic microscope 205 includes a high-resolution, high-contrast stereoscopic surgical microscope. The ophthalmic microscope 205 often includes one monocular eyepiece or two binocular eyepieces 220 through which the surgeon 202 can view the relevant eye structures that the surgeon 202 needs to view to perform the surgery at an optimal magnification.

[0023] The ophthalmic microscope 205 may further include one or more relay lenses, zoom / focus optical systems, objective lenses, and other surgical observation optical systems. Generally, the ophthalmic microscope 205 may include any suitable optical or electronic components for enabling the surgeon 202 to view the eye 105 of the patient.

[0024] The ophthalmic microscope 205 also often includes, or is operationally coupled to, an imaging unit 206, which includes one or more cameras or similar electronic visualization / imaging devices, sometimes instead of, but often together with, an optical eyepiece 220. The imaging unit 206 can be used to relay images of the eye 105 to one or more display screens 222, 225, or 228 for use by the surgeon 202 or one or more assistants. In certain embodiments, the imaging unit 206 may include an OCT system, etc.

[0025] The position of the structures related to the eye 105, such as the anterior chamber angle and other peripheral structures, and the optical refractive properties of the eye 105 itself, often result in a field of view of areas of interest to the surgeon 202 that cannot be directly obtained by the ophthalmic microscope 205 and / or imaging unit 206 alone.

[0026] Typically, the surgeon 202 or assistant uses a gonioscopy instrument 230 to obtain the desired field of view. The gonioscopy instrument 230 may generally include one or more lenses, prisms, and / or mirrors configured to refract or reflect light from the structure of the eye to the microscope 205 or the surgeon's own eye, thereby allowing the surgeon 202 to see as much as necessary for performing the surgery. In certain examples, the gonioscopy instrument 230 includes direct gonioscopy instruments such as Koeppe, Barkan, Wurst, Swan-Jacob, or Richardson type gonioscopy lenses. In certain examples, the gonioscopy instrument 230 includes indirect gonioscopy instruments such as Posner, Sussman, Zeiss, or Goldmann type gonioscopy lenses.

[0027] In the ophthalmic observation system 200 shown in Figure 2, the gonioscopy instrument 230 is held and supported at the first distal end 233 of the gonioscopy support arm 235, while the support arm 235 itself is held and supported at the second proximal end 237 on the cart 240. The cart 240 has wheels 242, which allow the cart 240 to be moved within the surgical environment 201 and positioned as desired.

[0028] The gonioscopy support arm 235 may, in some cases, be a simple non-motorized device configured to hold the gonioscopy instrument 230 in a fixed position after being manually moved to a predetermined position by the surgeon 202.

[0029] In more sophisticated systems, the corner inspection support arm 235 may include robotic arms of varying degrees of complexity. Such robotic arms typically include multiple joints and links, and have controllable step motors or servo motors (or similar electromechanical actuators) at the joints between the links, and can be operated to move the end effector at the distal end of the support arm 235 to a predetermined position according to pre-programmed instructions, real-time commands issued by the user, or a combination of the two.

[0030] In many cases, a gonioscopy support arm 235, including an electric robotic arm, is used to move and hold the gonioscopy instrument 230 to the desired position between the patient's eye 105 and the ophthalmic microscope 205, freeing up at least one of the surgeon's hands for other better uses. Supporting the gonioscopy instrument 230 on the gonioscopy support arm 235 can also reduce fatigue, potentially provide a more stable or finely controlled field of view, and, beyond that, is expected to help the surgeon 202 perform many of the difficult tasks that may be required in ophthalmic surgery, which in turn is expected to lead to better surgical outcomes.

[0031] Figure 3 shows another ophthalmic observation system 300 in a surgical environment 301. This system 300 shares several elements with the ophthalmic observation system 200 in Figure 2. The system 300 in Figure 3 includes, for example, an ophthalmic microscope 205 and an imaging unit 206, an overhead arm 210 and support base 213 for supporting the microscope 205 and imaging unit 206 above a patient 208 on an operating table 215, and several display screens 222, 225, and 228 for displaying images captured by the microscope 205 and / or imaging unit 206. The microscope 205 and imaging unit 206 may further be mounted on a microscope-supporting robotic support arm, as generally described above in relation to Figure 2.

[0032] However, in this second surgical system 300, the alternative gonioscopy support arm 303 is attached at its proximal end 305 to the same overhead arm 210 that supports the ophthalmic microscope 205 used by the surgeon 202 to perform surgery, in contrast to the system 200 in Figure 2, where the gonioscopy support arm 235 is attached to a wheeled cart 240. In some embodiments, the gonioscopy support arm 303 may be attached directly to the microscope 205 and / or imaging unit 206.

[0033] Similar to system 200 in Figure 2, the gonioscopy support arm 303 in Figure 3 may, in some cases, be a simple non-motorized device that the surgeon 202 can move manually as needed. In other cases, the gonioscopy support arm 303 is a robotic arm, which has varying degrees of complexity and degrees of freedom and includes motorized joints and links controllable by an external control unit and software to move and position the gonioscopy equipment in a manner that helps the surgeon 202 perform various ophthalmic procedures.

[0034] Figure 4 shows another ophthalmic observation system 400, including a gonioscopy support arm 402 configured to hold and move a gonioscopy instrument 230 useful for performing eye examinations. However, in Figure 4, the system 400 is shown connected to an examination chair 406 and other equipment as found in an optometry room, rather than in a more dedicated operating room as suggested in earlier drawings. To illustrate this, Figure 4 includes additional equipment, including a phoropter 408, which is routinely used by eye care professionals performing various non-surgical examinations and is therefore commonly found where those examinations are typically performed.

[0035] Figure 4 also shows an ophthalmic microscope 405 supported on an instrument stand 410 adjacent to the patient's examination chair 406. Similar to the systems 200 and 300 described above (Figures 2 and 3), the user uses the gonioscopy support arm 402 to move the gonioscopy instrument 230 to the desired position. The gonioscopy support arm 402 then holds the gonioscopy instrument 230 in place, while the user looks through the eyepiece 420 of the microscope 405 and moves the gonioscopy instrument 230 to the point of interest within the patient's eye.

[0036] Similar to system 200 in Figure 2, in system 400 in Figure 4, the gonioscopy support arm 402 is supported at its proximal end 413 on a wheeled cart 440 having wheels 442, and the gonioscopy equipment 230 is held at the distal end 415 opposite the support arm.

[0037] Figure 5 shows yet another ophthalmic observation system 500, which also includes a patient examination chair 406 and suggests use in an environment that may primarily be a non-surgical examination room. In this system 500, the gonioscopy instrument 230 is held at the distal end 503 of a gonioscopy support arm 505, which has a proximal end 507 supported on an instrument stand 410 that holds an examination microscope 405 and possibly other instruments such as a phoropter 408 shown in this figure.

[0038] Figure 6 shows details of a relatively advanced robotic arm 600 that may be used in any of the systems 200, 300, 400, or 500 shown in Figures 2-5.

[0039] The robotic arm 600 in Figure 6 includes a support base 602, which in some systems may be configured to be attached to a movable cart, a fixed support structure, or another device configured to bring the arm 600 close to a patient. The robotic arm 600 further includes a first arm joint 605 that is rotatable with respect to the support base 602 around a first axis of rotation 608.

[0040] The second arm joint 610 is fixed to the first arm joint 605 via the first link 613. The second arm joint 610 is rotatable around the second pivot axis 615 with respect to the first arm joint 605 and the first link 613. In certain embodiments, the second pivot axis 615 is perpendicular to the first pivot axis 608.

[0041] The second link 617 attaches the third arm joint 620 to the second arm joint 610. The third arm joint 620 can rotate with respect to the second link 617 around the third pivot axis 622. In certain embodiments, the third pivot axis 622 is parallel to the second pivot axis 615.

[0042] The third link 625 extends between the third arm joint 620 and the fourth arm joint 628. The fourth arm joint 628 rotates with respect to the third link 625 around the fourth pivot axis 630. In certain embodiments, the fourth pivot axis 630 is parallel to the second pivot axis 615.

[0043] The fourth link 633 connects the fourth arm joint 628 to the fifth arm joint 635. The fifth arm joint 635 rotates with respect to the fourth link 633 around the fifth pivot axis 637. In certain embodiments, the fifth pivot axis 637 is perpendicular to the first pivot axis 608.

[0044] A fifth link 640, attached to the fifth arm joint 635, carries a sixth arm joint 642, which rotates with respect to the fifth link 640 around a sixth pivot axis 645. In certain embodiments, the sixth pivot axis 645 is perpendicular to the fifth pivot axis 637. The sixth arm joint 642 carries the sixth and final link 648. In this embodiment, a working element in the form of a gripper 650 extends from the sixth link 648 in a direction perpendicular to the sixth pivot axis 645 of the arm.

[0045] In some systems, this common type of robotic arm 600 can be controlled by a foot pedal for hands-free positioning. Such control, in an advantageous configuration, can allow movement along three main vertical x, y, and z axes.

[0046] In some embodiments, the robot arm 600 may include internal force and torque sensors for detecting forces applied to the arm by its user. In response to the detection of such forces and torques by the sensors, a counter command is transmitted to the arm's internal servo control unit, thereby moving the arm to the user's desired position.

[0047] In yet another embodiment, the arm 600 may be provided with a camera or similar device for tracking the position of the working end of the arm relative to the patient's eye and maintaining the position of the arm accordingly.

[0048] The gripper 650 includes gripping elements 652 and 655 that are operable to grasp and release small objects, including various gonioscopy instruments useful for performing ophthalmic and optometric procedures, either alone or in combination with various microscopes and other instruments. Thus, the gripper may be configured to receive, hold, and release one or more gonioscopy instruments. In certain configurations, the gripping elements 652 and 655 may be electrically and mechanically controlled to be powered on and operable to open and close to receive, hold, and release gonioscopy instruments. In other configurations, the gripping elements 652 and 655 may simply be spring-loaded, so that they can be separated by the user to receive the gonioscopy instrument 230 and then returned by spring force to grip the instrument in place. In yet another configuration, the gonioscopy instrument 230 may be permanently fixed in place, and the gripping elements may be immovable or absent during normal use, with the instrument 230 being directly fixed to the last joint 642 or link 648 of the arm 600. The use of a movable gripper can often be advantageous in allowing the use of a wide range of conventional gonioscopy equipment, depending on the user's preferences and past experience.

[0049] The apparatus, which may be included within the robotic arm 600 or together with other means for holding the gripper or gonioscopy instrument 230, may, in an advantageous embodiment, include a mechanism (e.g., a roll and pitch mechanism) for rotating the gonioscopy instrument 230 around at least two vertical axes of rotation, thereby properly aligning the gonioscopy instrument 230 and bringing it into good contact with the surface of the eye.

[0050] It should be noted that the robot arm 600 in Figure 6, and the various arm configurations in other drawings of this disclosure, are illustrative only, and the exact configurations of these arms may vary considerably from system to system. However, generally, it may be preferable for a robot arm to include elements that provide at least six degrees of freedom of motion. One commercially available robot arm of a common type shown in Figure 6 is the Model UR5e robot arm supplied by Universal Robots, a robotics equipment manufacturer headquartered in Odense, Denmark.

[0051] Figure 7 is a block diagram showing elements of a system 700 according to an aspect of the present disclosure, which is used by a surgeon or other person to view the internal location of a medical patient's eye 105. Such a system 700 may include a microscope 705 with one or two eyepieces 720 for direct monocular or binocular viewing.

[0052] Light from the patient's eye 105 enters the microscope 705 via the gonioscopy device 230, which, as mentioned above, counteracts the total internal reflection that would normally occur on the surface of the eye, thereby making it possible to observe the internal structure of the eye with the microscope 205.

[0053] The gonioscopy device 230 can be moved to an appropriate position relative to the eye 105 by a robotic arm 703 and held there. The robotic arm 703 may include a servo motor or similar motion control device 708 for controlling the movement of the arm. Some configurations include an external motion control input device 707, by which a user of the system can issue commands to control the movement of the arm. Certain external motion control input devices 707 may include a force-torque (FT) sensor that responds to forces and torques applied by the user to the robotic arm 703, a foot pedal system, a joystick, a keyboard, or other suitable control device on which the user can transmit desired motion commands to the arm 703. Some robotic arms may be equipped with a force-torque sensor that can operate in response to the detection of a force or torque exceeding a predetermined permissible limit applied to an element of the robotic arm. Such a configuration can help prevent damage to the patient's eye by preventing the robotic arm from applying an unacceptably large force to the eye. The motion control device then operates the robotic arm according to the user's commands to provide the desired movement.

[0054] In many cases, the microscope 705 of the system may be operationally coupled with an imaging unit 706 which includes a camera or other visualization / imaging device for electronically capturing images from the microscope 705 and transmitting them for external display. These systems often include an electronic image processing unit 710 which communicates with the imaging unit 706 and processes the images for display on one or more video monitors or other visual display devices 712 which communicate with the electronic image processing unit 710.

[0055] The image processing device 710 may include hardware and software or other processing mechanisms for "reverse-inverting" an image that would normally appear inverted when the gonioscopy device 230 includes one or more image inversion mirrors, and then displaying it appropriately in some systems.

[0056] The above description has shown, described, and pointed out various features and configurations applicable in various embodiments. However, it should be understood that various omissions, substitutions, and modifications in the form and details of the exemplary equipment may be made without departing from the spirit of this disclosure. Similarly, it should be understood that the various types of features described herein may be used in various combinations by omitting individual features as desired and as needed. None of these features should be considered necessary in any particular combination unless it is clearly required otherwise in the description. As should be understood, the elements and combinations described herein may be embodied in various forms, some of which may not provide all of the features and benefits described herein, since some features may be used or implemented separately from others. Accordingly, the scope of protection may be defined primarily by the accompanying claims rather than by the foregoing description, and these claims may be interpreted to include the entire range of equivalents that are legitimate and lawful to these claims.

[0057] Exemplary Embodiments Embodiment 1: An ophthalmic observation system comprising an ophthalmic microscope, a gonioscopy device configured to relay images of the inner periphery of a patient's eye to the ophthalmic microscope, and an adjustable arm configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye, and to relay images of the inner periphery of the patient's eye to the ophthalmic microscope for viewing by the user, wherein the adjustable arm includes a gripper configured to receive, hold, and release the gonioscopy device.

[0058] Embodiment 2: The ophthalmic observation system of Embodiment 1, wherein the adjustable arm includes a proximal end attached to a structure configured to support an ophthalmic microscope.

[0059] Embodiment 3: The ophthalmic observation system of Embodiment 1, wherein the adjustable arm includes a proximal end attached to a wheeled cart.

[0060] Embodiment 4: An ophthalmic observation system of Embodiment 1, comprising an ophthalmic microscope and an electronic visualization device configured to capture images from the ophthalmic microscope and transmit them for external display on a visual display device.

[0061] Embodiment 5: The ophthalmic observation system of Embodiment 4, further comprising an electronic image processing device configured to process images from an ophthalmic microscope before the images are displayed on a visual display device.

[0062] Embodiment 6: The ophthalmic observation system of Embodiment 1, further comprising a motion control input device that receives commands from a user corresponding to desired movements of an adjustable arm, and is then operable to operate the adjustable arm to provide the desired movement in accordance with these commands.

Claims

1. In ophthalmic observation systems, Ophthalmic microscope and A gonioscopy device configured to relay images of the inner periphery of the patient's eye to the ophthalmic microscope, A robotic arm is configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye, and to relay the image of the internal periphery of the patient's eye to the ophthalmic microscope for the user to view. An ophthalmic observation system including [specific component].

2. The ophthalmic observation system according to claim 1, wherein the robotic arm includes a gripper configured to receive, hold, and release the gonioscopy instrument.

3. The ophthalmic observation system according to claim 2, wherein the gripper is powered on and is operable to open and close to receive, hold, and release the gonioscopy instrument.

4. The ophthalmic observation system according to claim 1, wherein the robotic arm includes a proximal end attached to a structure configured to support the ophthalmic microscope.

5. The ophthalmic observation system according to claim 1, wherein the robotic arm includes a proximal end mounted on a wheeled cart.

6. The ophthalmic observation system according to claim 1, wherein the ophthalmic microscope includes an electronic visualization device configured to capture an image from the ophthalmic microscope and transmit it for external display on a visual display device.

7. The ophthalmic observation system according to claim 6, wherein the visual display device includes a video monitor.

8. The ophthalmic observation system according to claim 6, further comprising an electronic image processing device configured to process the image from the ophthalmic microscope before the image is displayed on the visual display device.

9. The ophthalmic observation system according to claim 8, wherein the gonioscopy device includes a mirror that inverts at least a portion of the image of the internal periphery of the patient's eye, and the electronic image processing device is configured to invert the inverted portion of the image.

10. The ophthalmic observation system according to claim 1, further comprising a motion control input device capable of receiving commands from the user corresponding to desired movements of the robotic arm, and operating the robotic arm in accordance with these commands to provide the desired movements.

11. The ophthalmic observation system according to claim 10, wherein the motion control input device includes at least one force and torque sensor that responds to the force and torque applied by the user to the robot arm, joystick, and foot pedal system.

12. In ophthalmic observation systems, Ophthalmic microscope and A gonioscopy device configured to relay images of the inner periphery of the patient's eye to the ophthalmic microscope, An adjustable arm configured to hold the gonioscopy device in a predetermined position relative to the ophthalmic microscope and the patient's eye, and to relay the image of the internal periphery of the patient's eye to the ophthalmic microscope for the user to view, the adjustable arm includes a gripper configured to receive, hold, and release the gonioscopy device, An ophthalmic observation system including [specific component].

13. The ophthalmic observation system according to claim 12, wherein the adjustable arm includes an electric robotic arm.

14. The ophthalmic observation system according to claim 13, wherein the electric robotic arm is configured to move with at least six degrees of freedom.

15. The ophthalmic observation system according to claim 13, further comprising a motion control input device that receives a command from the user corresponding to a desired movement of the adjustable arm, and is operable to operate the adjustable arm in accordance with the command to provide the desired movement.

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