Laser treatment of media opacification

Abstract

The present disclosure provides a laser therapy system including an optical coherence tomography (OCT) imaging system that generates a plurality of profile depth scans and executes instructions on a processor to detect a location, a volume, or a combination thereof, of intraocular media opacities based on the plurality of profile depth scans. The system further includes a three-dimensional (3D) eye tracker that executes instructions on the processor to track a location, a volume, or a combination thereof, of intraocular media opacities based on the plurality of profile depth scans. The system also includes a laser system that includes a therapeutic laser, where the laser system precisely targets a plurality of ultrashort laser pulses generated by the therapeutic laser at the intraocular media opacities to at least partially remove the media opacities.

Description

[Technical field]

[0001] The present disclosure relates to vitreoretinal surgery and surgical instruments, and more particularly to laser treatment systems and associated methods for improving removal of media opacities in vitreoretinal surgery. [Background technology]

[0002] Ophthalmic surgery is surgery performed on the eye or any part of the eye. Ophthalmic surgery protects and improves the vision of tens of thousands of patients every year. However, because vision is sensitive to even the slightest changes in the eye and the characteristics of many eye structures are delicate and intricate, ophthalmic surgery is difficult to perform, and reducing minor or rare surgical errors or even slightly improving the precision of surgical skills can make a significant difference in the patient's vision after surgery.

[0003] Vitreoretinal surgery, a type of ophthalmic surgery, encompasses a variety of delicate procedures involving the interior of the eye, such as the vitreous humor, the retina, and the vitreoretinal membrane. During ophthalmic procedures such as vitreoretinal surgery, ophthalmologists typically use a non-electronic optical surgical microscope with an eyepiece to view a magnified image of the eye undergoing surgery. In recent years, vitreoretinal surgeons may use eyepiece-less digital visualization systems, such as the NGENUITY® (Novartis AG Corp., Switzerland) 3D visualization system, to aid in visualization during vitreoretinal surgery. These systems may include three-dimensional (3D) high dynamic range ("HDR") camera systems with two-dimensional (2D) complementary metal-oxide semiconductor (CMOS) sensors that allow the surgeon to view the retina on a display screen using polarized glasses, digital eyepieces, or a head-mounted display. The display screen removes the need to view the procedure using an eyepiece and allows others in the operating room to see exactly as the surgeon does. The system also allows for improved imaging under high magnification and increased depth of field compared to conventional optical analog surgical microscopes, thereby allowing for improved visualization of the eye.

[0004] Despite these advances, a common eye disease that is often difficult to effectively visualize and treat is one in which media opacification is present. Media opacification is generally caused by fine collagen fibers within the vitreous and can result from vitreous syneresis. Media opacification can scatter light entering the eye, thus worsening the quality of vision, which can appear as spots, shadows, spider webs, or various other shapes that appear to move around within the patient's visual field.

[0005] More severe symptoms of media opacification can be treated by laser vitreolysis using an yttrium aluminum garnet (YAG) laser. During this procedure, laser pulses can interact with the patient's ocular tissue to remove the media opacification. However, laser vitreolysis using a YAG laser can be limited in its effectiveness in removing the media opacification due to the high energy and low aiming accuracy of the YAG laser. This can result in a wide range of tissue being affected, and it can be extremely difficult to precisely control the focus and dose of the laser treatment to avoid harmful side effects. Summary of the Invention [Means for solving the problem]

[0006] The present disclosure provides a laser treatment system and associated methods for improving removal of media opacities in vitreoretinal surgery. The laser treatment system includes an optical coherence tomography (OCT) imaging system that generates a plurality of profile depth scans and executes instructions on a processor to detect a location, volume, or combination thereof of media opacities in the eye based on the plurality of profile depth scans. The laser treatment system also includes a 3D eye tracker that executes instructions on a processor to track a location, volume, or combination thereof of media opacities in the eye based on the plurality of profile depth scans. The laser treatment system also includes a laser system that includes a therapeutic laser, where the laser system precisely targets a plurality of ultrashort laser pulses generated by the therapeutic laser to the media opacities in the eye to at least partially remove the media opacities.

[0007] The laser therapy system and method of use may include the following additional features: i) the multiple ultrashort laser pulses may be uniformly targeted within the treatment volume; ii) the system may further include a surgical camera that is a digital camera, an HDR camera, a 3D camera, or any combination thereof; iii) the OCT imaging system may be operable to provide time-domain OCT, frequency-domain OCT, spectral-domain OCT, swept-source OCT, OCT angiography, or any combination thereof; iv) the treatment laser may be a luminance laser with a resolution of about 1 femtosecond (10 -15 sec) to about 50 picoseconds (50×10 -12seconds). v) The therapeutic laser may emit light at a wavelength of about 1,030 nm or about 1,050 nm. vi) The laser system may be a LenSx® laser (LenSx Lasers, Inc. Corp, California). vii) The laser system may further include a shaping system for modulating the phase of the laser beam to provide a phase modulated laser beam, a sweeping optical scanner for directing the phase modulated laser beam to provide a modulated and displaced laser beam, and a focusing optical system for displacing a focal plane of the modulated and displaced laser beam to provide a plurality of ablation planes. viii) The plurality of ablation planes may define a treatment volume. ix) The laser treatment system may be a component of the NGENUITY® 3D visualization system. x) The 3D eye tracker may provide at least one real-time feedback indication regarding the location and volume of the media opacity and at least one real-time feedback indication for indicating when the media opacity has been at least partially removed.

[0008] The present disclosure further provides a method for treating media opacities by identifying a location and volume of the media opacity using an OCT imaging system, tracking the location and volume of the media opacity using a 3D eye tracker, determining a treatment volume using signals related to the location and volume of the media opacity, treating the treatment volume by precisely aiming multiple ultrashort laser pulses generated by a treatment laser, and at least partially removing the media opacity.

[0009] The present disclosure further provides a method for treating a media opacity by identifying the media opacity using an OCT imaging system, tracking the media opacity using a 3D eye tracker, treating the media opacity according to a treatment plan using a laser system, providing a real-time status of the media opacity using at least one real-time feedback display, and updating the treatment plan in real-time in response to the at least one real-time feedback display. The at least one real-time feedback display may include a signal regarding the location and volume of the media opacity. Updating the treatment plan may include changing a power setting of the treatment laser, changing a duration of the treatment, changing a treatment volume, changing a treatment volume expansion, or any combination thereof. Updating the treatment plan may include stopping the treatment.

[0010] The present disclosure further provides a method for treating a media opacity by identifying the media opacity using an OCT imaging system, tracking the media opacity using a 3D eye tracker, determining a treatment plan using at least one calculated feedback indication, and treating the media opacity according to the treatment plan using a laser system, where the at least one calculated feedback indication may be based on predictions by a machine learning algorithm.

[0011] The present disclosure further provides a medical system including a processor, an OCT imaging system coupled to the processor, a 3D eye tracker coupled to the processor, a laser system, and a memory medium coupled to the processor. The memory medium includes instructions that, when executed by the processor, cause the medical system to utilize the OCT imaging system to identify a media opacity in a patient's eye. The memory medium further includes instructions that, when executed by the processor, cause the medical system to utilize the 3D eye tracker to track a location and volume of the media opacity. The memory medium further includes instructions that, when executed by the processor, cause the medical system to utilize the laser system to at least partially remove the media opacity in the patient's eye. The laser system may include a laser that is an ultrashort pulse laser.

[0012] Aspects of the laser therapy system and its method of use may be combined with each other unless they are clearly mutually exclusive. In addition, additional features of the laser therapy system and its associated methods described above may also be combined with each other unless they are clearly mutually exclusive.

[0013] For a more complete understanding of the present disclosure and its features and advantages, reference is now made to the following description taken in conjunction with the accompanying drawings, which are not to scale and in which like numerals refer to like features, and in which: [Brief description of the drawings]

[0014] [Figure 1] FIG. 1 is a schematic diagram of a laser treatment system including a laser system, a surgical camera, an optical coherence tomography (OCT) imaging system, a 3D eye tracker, a surgical camera system, and a display. [Diagram 2] FIG. 2 is a schematic diagram of a laser system including a treatment laser, a laser beam, and a laser control device. [Diagram 3]FIG. 3 is a schematic diagram of a laser system including a treatment laser, a laser beam, a laser control device, a focusing optical system, a sweeping optical scanner, and a shaping system. [Figure 4] FIG. 4 is a flow diagram of a method for at least partially removing media opacification from a patient's eye. [Diagram 5] FIG. 5 is a flow diagram of a method for treating media opacification using at least one real-time feedback display. [Figure 6] FIG. 6 is a flow diagram of a method for treating media opacification using at least one calculated feedback indication. [Figure 7] FIG. 7 is a schematic diagram of a computer system including a laser treatment system. [Figure 8A] FIG. 8A is a schematic diagram of a medical system including a laser treatment system. [Figure 8B] FIG. 8B is a schematic diagram of a medical system including a laser treatment system. [Figure 8C] FIG. 8C is a schematic diagram of a medical system including a laser treatment system. [Figure 9] FIG. 9 is a diagram of a medical system including a laser treatment system, a surgeon, and a patient. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0015] The present disclosure provides systems, including laser treatment systems, and associated methods for improved removal of media opacities.

[0016] Vitreoretinal surgeons face unique challenges when operating inside the eye. For example, a combination of imaging techniques may be required to visualize and treat certain eye diseases. One disease that can worsen a patient's visual quality and is currently extremely difficult to treat is one in which media opacification is present. Media opacification, sometimes known as vitreous floaters, is generally caused by tiny collagen fibers within the vitreous. These collagen fibers can clump together and cast shadows on the retina, appearing to the patient as floaters. Media opacification can be caused by contraction of the vitreous, a process known as vitreous syneresis or vitreous liquefaction. In healthy eyes, hyaluronic acid can prevent collagen fibers from clumping together in the vitreous cavity and maintain the transparency of the vitreous. However, as the eye ages, hyaluronic acid can dissociate from collagen. This dissociation of hyaluronic acid can lead to collagen cross-linking and clumping, forming fibrous structures that scatter light and ultimately become media opacification.

[0017] Treatment of media opacities may be limited to either vitrectomy or laser vitreolysis. Vitreous resection is an invasive procedure that may be used in severe cases and may cause complications, such as retinal detachment, anterior vitreous detachment, and macular edema. Laser vitreolysis is generally performed using an ophthalmic laser, an yttrium aluminum garnet (YAG) laser. However, the risk / benefit ratio of this treatment is unclear. YAG lasers are generally designed to be used in the front of the eye and provide only a limited view of the vitreous, which may make it difficult to identify media opacities. The use of YAG lasers also carries a high risk of damaging the surrounding ocular tissues. In particular, the high energy and low aiming accuracy of the YAG laser may prevent precise control of the focus and dose, and a wide range of tissues are affected during laser treatment. This may risk damaging the photoreceptor cells of the retina, such as the macula and fovea. The retina is very thin (generally about 200-300 microns thick) and it is important to avoid damage to the retina during vitreoretinal surgery.

[0018] The disclosed systems and methods may provide safer and more effective removal of media opacities in vitreoretinal surgery. The disclosed laser treatment systems and methods may improve removal of media opacities compared to current systems and methods by using swept-source optical coherence tomography (OCT) to identify vitreous floaters. The laser treatment systems and methods described herein may improve removal of media opacities compared to current systems and methods by using digital eye tracking to track media opacities during treatment. The laser treatment systems and methods described herein may improve removal of media opacities compared to current systems and methods by utilizing precise targeting of an ultrashort pulsed laser to at least partially remove the media opacities. The precise targeting may reduce the risk of the laser hitting delicate areas such as the retina. In addition, the use of an ultrashort pulsed laser may cause minimal or no damage to the back of the eye even if the targeted media opacity is not hit. The laser treatment systems and methods described herein may improve removal of media opacities compared to current systems and methods by monitoring the progress of the laser treatment in real time, which allows for dose adjustments to provide the minimum dose required to at least partially remove the media opacities. The laser treatment systems and methods described herein may improve removal of media opacities compared to current systems and methods by providing a non-invasive treatment, which may be a clinic-based procedure. The laser treatment systems and methods described herein may improve removal of media opacities compared to current systems and methods by providing a treatment plan that involves customizing treatment variables and is based on at least one feedback indication.

[0019] The systems and methods described herein may improve the removal of media opacities by providing a laser treatment system that may identify, track, and treat the media opacities. The laser treatment system may identify the media opacities using an OCT imaging system. Once the media opacities are identified, the laser treatment system may then track the media opacities using a 3D eye tracker. After the media opacities are identified and tracked, the laser treatment system may treat the media opacities using a laser system. The laser system may at least partially remove the media opacities using an ultrashort pulsed laser. The laser treatment system may be a component of an eyepiece-less digital visualization system, such as the NGENUITY® (Novartis AG Corp., Switzerland) 3D visualization system. This visualization system may provide extended depth of field (up to 5 times the depth of field compared to analog microscopes), higher magnification (approximately 48% increased magnification compared to analog microscopes), higher axial and lateral resolution (approximately 50% higher compared to analog microscopes), and improved stereoscopic vision to facilitate 3D visualization capabilities. These improved visualization may result in improved removal of media opacities by the laser treatment system.

[0020] Referring now to FIG. 1, laser treatment system 100 may include a laser system 140, a surgical camera 160, an OCT imaging system 165, a 3D eye tracker 168, a surgical camera system 185, and a display 190.

[0021] The laser therapy system 100 shown in FIG. 1 is an eyepiece-less digital visualization system. The laser therapy system 100 may be included as a component of a visualization system such as the NGENUITY® (Novartis AG Corp., Switzerland) 3D visualization system. The laser therapy system 100 may further include various other electronic and mechanical components in different embodiments. Thus, while the particular optical design described with reference to FIG. 1 is specific to an ophthalmic visualization system that includes a surgical camera 160, one skilled in the art will appreciate that alternative optical arrangements to support other ophthalmic visualization systems are within the scope of the present disclosure.

[0022] The surgical camera 160 may be positioned above the eye 10. The surgical camera 160 may be a digital camera, an HDR camera, a 3D camera, or any combination thereof. The surgical camera 160 may include at least one sensor, and may include sensors 150a and 150b. The sensors 150a and 150b may be complementary metal oxide semiconductor (CMOS) sensors or charge-coupled device (CCD) sensors. The surgical camera 160 may be a monochrome camera or a color camera, and the sensors 150a and 150b may be monochrome image sensors or color image sensors. The sensors 150a and 150b may capture digital images using reflected light from the eye 10. The sensors 150a and 150b may capture digital images of the eye 10.

[0023] The laser therapy system 100 may also include a visible light illumination source 145, which may provide an illumination source for the surgical camera 160. The visible light illumination source 145 may be an internal illuminator (not shown). The visible light illumination source 145 may include a xenon source, a white LED light source, or any other suitable visible light source. The visible light illumination source 145 may illuminate the eye 10.

[0024] The surgical camera 160 may also utilize an opto-mechanical focusing system 161, a zoom system 162, and a variable working distance system 163. The surgical camera 160 may be communicatively coupled to a surgical camera system 185 and a display 190. The surgical camera system 185 may include an image processing system 170, a processor 180, and a memory medium 181. Digital images captured by the sensors 150a and 150b may be processed by the image processing system 170. The image processing system 170 may include the processor 180. The sensors 150a and 150b may detect reflected light from the eye 10 and send a signal corresponding to the detected light to the processor 180. The processor 180 may execute instructions to generate a digital image of the eye 10. The digital image of the eye 10 may be displayed on the display 190. The sensors 150a and 150b may detect light to provide a 3D image of the eye 10.

[0025] Processor 180 may include, for example, a field programmable gate array (FPGA), a microprocessor, a microcontroller, a digital signal processor (DSP), a graphics processing unit (GPU), an application specific integrated circuit (ASIC), or any other digital or analog circuitry configured to interpret and / or execute program instructions and / or process data.

[0026] The processor 180 may include any physical device capable of storing and / or executing instructions. The processor 180 may execute processor instructions to implement at least a portion of one or more systems, one or more flowcharts, one or more processes, and / or one or more methods described herein. For example, the processor 180 may execute instructions to generate a digital image of the eye 10. The processor 180 may be configured to receive instructions from a memory medium 181. In one example, the processor 180 may include the memory medium 181. In another example, the memory medium 181 may be external to the processor 180. The memory medium 181 may store instructions. The instructions stored by the memory medium 181 may be executable by the processor 180 and may be configured, coded, and / or encoded by a plurality of instructions according to at least a portion of one or more systems, one or more flowcharts, one or more methods, and / or one or more processes described herein.

[0027] The FPGA may be configured, coded, and / or encoded to implement at least a portion of one or more systems, one or more flowcharts, one or more processes, and / or one or more methods described herein. For example, the FPGA may be configured, coded, and / or encoded to generate a digital image of the eye 10. The ASIC may be configured to implement at least a portion of one or more systems, one or more flowcharts, one or more processes, and / or one or more methods described herein. For example, the ASIC may be configured, coded, and / or encoded to generate a digital image of the eye 10. The DSP may be configured, coded, and / or encoded to implement at least a portion of one or more systems, one or more flowcharts, one or more processes, and / or one or more methods described herein. For example, the DSP may be configured, coded, and / or encoded to generate a digital image of the eye 10.

[0028] A single device may include processor 180 and image processing system 170, or processor 180 may be separate from image processing system 170. In one example, a single computer system may include processor 180 and image processing system 170. In another example, a device may include an integrated circuit that may include processor 180 and image processing system 170. Alternatively, processor 180 and image processing system 170 may be incorporated into a surgical console.

[0029] The processor 180 may interpret and / or execute program instructions and / or process data stored in the memory medium 181. The memory medium 181 may be configured, in part or in whole, as application memory, system memory, or both. The memory medium 181 may include any system, device, or apparatus configured to hold and / or accommodate one or more memory devices. Each memory device may include any system, module, or apparatus (e.g., computer-readable medium) configured to hold program instructions and / or data for a period of time. One or more of the described servers, electronic devices, or other machines may include one or more similar such processors or memories that may store and execute program instructions to perform the functions of the associated machine.

[0030] The display 190 may be a head-up display mounted on a support member 198 and a base 199. The support member 198 and the base 199 may be adjustable to change the distance between the display 190 and the surgeon. The display 190 may also be ceiling mounted. The display 190 may be communicatively coupled to the surgical camera system 185. The display 190 may be a picture-in-picture display. In another example, the surgical camera 160 may be a 3D HDR camera and the display 190 may be a 3D 4K OLED surgical display. The display 190 may display a digital image of the eye 10. The display 190 may display a 3D surgical image of the eye 10. The processor 180 may be an ultra-fast 3D image processor that may optimize the 3D HDR image in real time.

[0031] The surgical camera 160 may be communicatively coupled to a surgical camera system 185 and a display 190. The display 190 may receive information from the surgical camera 160 via the surgical camera system 185. The display 190 may display a digital image of the eye 10 captured by the surgical camera 160.

[0032] The eye 10 may include a media opacity 11. The media opacity 11 may be located in the vitreous of the eye 10. The media opacity 11 may be visualized using an OCT imaging system 165. OCT may provide high-resolution, depth-resolved imaging of ocular structures using near-infrared light. The OCT imaging system 165 may include an OCT scanner 166 and an OCT controller 167. The OCT controller 167 may include a light source, an analysis unit, or a combination thereof. The OCT controller 167 may generate the OCT imaging beam 130. The OCT scanner 166 may be optically coupled to the surgical camera 160. The OCT scanner 166 may provide a profile depth scan of ocular tissues of the eye 10. The profile depth scan may provide information about ocular tissues of the eye 10 that are not readily visible from a digital image generated using the surgical camera 160. The profile depth scan may provide information about the location of the media opacity 11. The profile depth scan may provide information regarding the volume of media turbidity 11. The OCT imaging system 165 may generate an OCT image from the profile depth scan. The OCT image may be displayed on the display 190. Alternatively, the OCT image may be displayed on a separate display.

[0033] The OCT imaging system 165 may represent any configuration of OCT equipment and configuration required to visualize the eye 10. The OCT imaging system 165 may represent any configuration of OCT equipment and configuration required to visualize the media opacity 11. The OCT imaging system 165 may provide time domain OCT. The OCT imaging system 165 may provide frequency domain OCT, such as, but not limited to, spectral domain OCT, swept source OCT, and OCT angiography. The OCT scanner controller 167 may include an OCT laser 169. The OCT imaging system 165 may be a swept source OCT imaging system. In this example, the OCT laser 169 may be a short cavity swept laser that may sweep a narrow band of wavelengths with each scan. The OCT laser 169 may generate the OCT imaging beam 130 including an infrared or near infrared light beam covering a relatively narrow wavelength band (e.g., 830 nm to 870 nm, 790 nm to 900 nm, 950 nm to 1150 nm, 1000 to 1300 nm, or 1200 to 1400 nm). The OCT laser 169 may have a wavelength centered at about 1000 nm. Alternatively, the OCT laser 169 may have a wavelength centered at about 1300 nm. However, the OCT laser 169 may generate the OCT imaging beam 130 having a wavelength in any suitable spectral range. The OCT imaging system 165 may be a swept-source OCT angiography imaging system. Alternatively, the OCT imaging system 165 may be a swept-source OCT imaging system such as ANTERION® (Heidelberg Engineering GmbH, Germany).

[0034] The OCT imaging system 165 may provide at least one profile depth scan of the eye 10. The laser treatment system 100 may include a right light beam split at the partial mirror 164. The OCT scanner 166 may control the output of the OCT imaging beam 130. The partial mirror 164 may receive the OCT imaging beam 130 from the OCT scanner 166. A portion of the OCT imaging beam 130 that reaches the eye 10 may be reflected at the eye 10 as an OCT measurement beam 131. The OCT measurement beam 131 may return to the OCT imaging system 165 along substantially the same optical path as the OCT imaging beam 130 traveled. The partial mirror 164 may output the OCT measurement beam 131 to the OCT scanner 166. Once the OCT measurement beam 131 reaches the OCT scanner controller 167, the OCT scanner controller 167 may determine a profile depth scan of the eye 10. The OCT scanner controller 167 may also construct an OCT image based on the interference of the OCT measurement beam 131 with a reference arm of the OCT imaging beam 130, as known in the art.

[0035] The OCT scan controller 167 can use the image processing system 170 to output a representation of the OCT image to the display 190. The OCT scan controller 167 can perform image processing in real time at a relatively high refresh rate, which can provide near-instantaneous feedback to the surgeon for viewing and controlling the OCT images generated by the OCT scanner 166.

[0036] As used herein, "real-time" may refer to updating information at the same rate as data is received. In the context of the laser treatment system and method of the present disclosure, "real-time" may mean that OCT data is acquired, processed, and transmitted from the optical sensor at a sufficiently high data rate and sufficiently low delay that the object is smoother without any jerking or latency that is easily noticeable to the user when the data is displayed. For example, this may occur when new OCT images are acquired, processed, and transmitted at a rate of at least 30 frames per second and displayed at about 60 frames per second, and when there is a delay of less than about 1 / 30 seconds in the composite processing of the signal.

[0037] The image processing system 170 may execute image processing algorithms, such as classification, feature extraction, pattern recognition, or any combination thereof, on the processor 180 based on the profile depth scans generated by the OCT scanner 166. The profile depth scans generated by the OCT scanner 166 may include two-dimensional (2D) scan data and 3D scan data. The OCT imaging system 165 may execute instructions on the processor 180 to detect the location of the media opacity 11 in the eye 10 based on at least one profile depth scan. The OCT imaging system 165 may execute instructions on the processor 180 to detect the volume of the media opacity 11 in the eye 10 based on at least one profile depth scan. The OCT imaging system 165 may alternatively generate multiple profile depth scans. The OCT imaging system 165 may execute instructions on the processor 180 to detect the location, volume, or combination thereof of the media opacity 11 in the eye 10 based on the multiple profile depth scans.

[0038] The OCT scanner 166 may direct the OCT imaging beam 130 to a location within the eye 10 as directed by the surgeon. The OCT scanner 166 may direct the OCT imaging beam 130 to a location within the eye 10 suitable for identifying media opacities 11. The OCT scanner 166 may include any suitable optical component or combination of optical components that facilitate focusing of the OCT imaging beam 130 in the XY plane. For example, the OCT scanner 166 may include one or more of a pair of scanning mirrors, a micromirror device, a microelectromechanical system (MEMS) device, a deformable platform, a galvanometer-based scanner, a polygon scanner, a resonant PZT scanner, or any combination thereof.

[0039] The 3D eye tracker 168 may track the media opacity 11. The 3D eye tracker 168 may track the media opacity 11 after the OCT imaging system 165 identifies the media opacity 11. The 3D eye tracker 168 may track the media opacity 11 using digital eye tracking. The 3D eye tracker 168 may track the media opacity 11 using pixel-based eye tracking or scanning laser-based eye tracking. The 3D eye tracker 168 may track the location, volume, or combination thereof of the media opacity 11. The 3D eye tracker 168 may include any suitable combination of hardware, firmware, and software necessary to track the media opacity 11. Alternatively, the 3D eye tracker 168 may utilize a processor 180 and a memory medium 181 of the image processing system 170. The eye tracker 168 may execute instructions on the processor 180 to track the location, volume, or combination thereof of the media opacity based on multiple profile depth scans generated by the OCT imaging system 165. For example, the processor 180 may receive and process a profile depth scan generated by the OCT imaging system 165. The memory medium 181 may store a pre-processed profile depth scan, a post-processed profile depth scan, or a combination thereof. The processor 180 may detect a position, a volume, or a combination thereof of the medium opacity 11 based on the profile depth scan. The processor 180 may also detect a change in position, a change in volume, or a combination thereof of the medium opacity 11 based on the profile depth scan. The eye tracker 168 may track the medium opacity 11 until the medium opacity 11 is at least partially removed during surgery. Alternatively, the 3D eye tracker 168 may track the medium opacity 11 for a duration specified by the surgeon.

[0040] The 3D eye tracker 168 may automatically provide a direction of the OCT imaging beam 130 to a location within the eye 10. For example, the OCT scanner 166 may direct the OCT imaging beam 130 to a location within the eye 10 based on the signal generated by the 3D eye tracker 168. In another example, the OCT scanner 166 may include a pair of scanning mirrors, each coupled to a motor drive. The motor drive may rotate the mirrors about a vertical axis. For example, the signal generated by the 3D eye tracker 168 may be used to control the position of the coupled motor to control the XY positioning of the OCT imaging beam 130 at the eye 10. Alternatively, the 3D eye tracker 168 may be disabled in the laser treatment system 100. In this case, the location, volume, or a combination thereof of the media opacity 11 may be manually monitored by the surgeon using the OCT imaging system 165.

[0041] The laser system 140 may treat the media opacity 11. The laser system 140 may treat the media opacity 11 after the OCT imaging system 165 identifies the media opacity 11 and the 3D eye tracker 168 tracks the media opacity 11. The laser system 140 may include a therapeutic laser 141 and a laser control device 143. The therapeutic laser 141 may provide a laser beam 142. The therapeutic laser 141 may be an ultrashort pulse laser. In one example, the therapeutic laser 141 may be an OCT laser 169. The therapeutic laser 141 may be any laser capable of providing a laser beam 142 that may at least partially remove the media opacity 11 during treatment with minimal or no damage to the posterior portion of the eye 10. The laser system 140 may at least partially remove the media opacity 11 by photodisruptive laser fragmentation by the therapeutic laser 141.

[0042] For example, the treatment laser 141 may have a pulse duration of approximately 1 picosecond (10 -12 In another example, the therapeutic laser 141 may provide a pulse of less than about 1 femtosecond (10 -15 sec) to about 1 picosecond (10 -12In a further example, the therapeutic laser 141 may provide a pulse with a duration of about 0.01 picoseconds to 50 picoseconds. In yet another example, the therapeutic laser 141 may provide a pulse with a duration of about 1 femtosecond (10 -15 sec) to about 50 picoseconds (50×10 -12 The pulse may be provided with a duration of 100 Hz to 200 Hz (seconds).

[0043] The laser system 140 may be a LenSx® laser (LenSx Lasers, Inc. Corp, California). Alternatively, the laser system 140 may include a therapeutic laser 141 that is a femtosecond laser, a shaping system, a sweeping optical scanner, and a focusing optical system, as described in U.S. Patent Application Publication No. 2019 / 0159933, filed October 5, 2018, the entire disclosure of which is incorporated herein by reference. The laser system 140 may be controlled by a control device 143. For example, the control device 143 may control the intensity of the therapeutic laser 141, the focus of the laser beam 142, the position of the laser beam 142, or any combination thereof.

[0044] The laser system 140 may treat the media turbidity 11 by precisely targeting multiple ultrashort laser pulses of the laser beam 142 at the media turbidity 11 to at least partially remove the media turbidity 11. Each successive ultrashort laser pulse may be precisely targeted at the media turbidity 11 using a signal generated by the 3D eye tracker 168. The use of the eye tracker 168 in a visualization system, such as the NGENUITY® 3D visualization system, in combination with components of a surgical camera system 185, allows for very precise targeting of the laser beam 142. In particular, the focused femtosecond laser pulses of the laser beam 142 may be precisely targeted at the media turbidity 11 to at least partially remove the media turbidity 11.

[0045] In one example, the laser system 240 may treat the media turbidity 11 as shown in FIG. 2. The laser system 240 may include a therapeutic laser 241, a laser beam 242, and a laser control device 243. The therapeutic laser 241 may provide the laser beam 242. The eye tracker 168 may send a signal to the laser system 240 to precisely focus the laser beam 242 on the media turbidity 11. The therapeutic laser 241 may be a femtosecond or picosecond laser and may emit light at a wavelength of about 1,050 nm. In another example, the therapeutic laser 241 may be an OCT laser 169. The laser system 240 may treat the media turbidity 11 by precisely targeting a plurality of ultrashort laser pulses of the laser beam 242 on the media turbidity 11 to at least partially remove the media turbidity 11. The laser pulses from the laser beam 242 may be uniformly targeted within the treatment volume 205. The laser system 240 may determine a treatment volume 205 using signals related to the location and volume of the media opacity 11 tracked by the 3D eye tracker 168. The treatment volume 205 may be approximately the same volume as the media opacity 11. Alternatively, the treatment volume 205 may be larger than the media opacity 11 due to the volume expansion 206. The volume expansion 206 may result in a treatment volume that is approximately 5%, 10%, 15% or 20% larger than the volume of the media opacity 11. Alternatively, the volume expansion 206 may result in any treatment volume necessary to at least partially remove the media opacity 11 with minimal or no damage to the posterior portion of the eye 10. The treatment volume 205 may change during treatment if the location and volume of the media opacity 11 changes.

[0046] The ultrashort laser pulse from the laser beam 242 can result in a laser 201 impact spot within the treatment volume 205. Generally, photodisruptive laser fragmentation results in the formation of gas bubbles, so the laser pulse can be precisely aimed to minimize disruption due to bubble formation. The laser pulse energy, location of the laser 201 impact spot, and treatment volume 205 can be optimized to achieve the highest effectiveness of breaking down the media opacity 11 while minimizing the effects of gas diffusion, laser exposure, damage to the posterior of the eye 10, and treatment time.

[0047] In another example, the laser system 340 may treat the medium turbidity 11 as shown in FIG. 3. The laser system 340 may include a treatment laser 341, a laser beam 342, a laser control device 343, a focusing optical system 346, a sweeping optical scanner 347, and a shaping system 348. The treatment laser 341 may be a femtosecond laser. The treatment laser 341 may emit light at a wavelength of about 1,030 nm in the form of 400 femtosecond pulses. The treatment laser 341 may have a power of 20 W and a frequency of 500 kHz. The treatment laser 341 may provide a laser beam 342. The laser system 340 may treat the medium turbidity 11 by precisely targeting a plurality of ultrashort laser pulses of the laser beam 342 at the medium turbidity 11 to at least partially remove the medium turbidity 11. The laser beam 342 may provide ultrashort laser pulses to a specific treatment volume 305. The treatment volume 305 can be approximately the same volume as the media opacification 11. Alternatively, the treatment volume 305 can be larger than the media opacification 11 due to the volume expansion 306. The volume expansion 306 can result in a treatment volume that is approximately 5%, 10%, 15% or 20% larger than the volume of the media opacification 11. Alternatively, the volume expansion 306 can result in any treatment volume necessary to at least partially remove the media opacification 11 with minimal or no damage to the posterior portion of the eye 10.

[0048] The laser beam 342 may provide ultrashort laser pulses to the treatment volume 305 using a shaping system 348, a sweeping optical scanner 347, and a focusing optical system 346. The laser control device 343 may control the shaping system 348, the sweeping optical scanner 347, and the focusing optical system 346. The shaping system 348 may modulate the phase of the laser beam 342a emitted by the treatment laser 341. This may distribute the energy of the laser beam to generate multiple impingement points at the focal plane of the laser beam. The multiple impingement points may define an ablation pattern. The shaping system 348 may emit a phase modulated laser beam 342b. The shaping system 348 may include a spatial light modulator. The shaping system 348 may include a liquid crystal on silicon spatial light modulator.

[0049] The sweeping optical scanner 347 may direct the phase modulated laser beam 342b emitted by the shaping system 348 to displace the ablation pattern along a displacement path that may be located in the focal plane 310. The displacement path may be predefined by the surgeon. The sweeping optical scanner 347 may emit a modulated and displaced laser beam 342c. The sweeping optical scanner 347 may include at least one optical mirror. The at least one optical mirror may pivot about at least two axes to direct the phase modulated laser beam 342b.

[0050] The focusing optical system 346 can displace the focusing plane 310 of the modulated and displaced laser beam 342c, thereby providing ablation planes 311, 312, 313, 314, or 315. The focusing optical system 346 can include at least one motorized lens that can be displaced within the optical path of the laser beam 342c.

[0051] Thus, shaping system 348 may enable simultaneous generation of several impingement points that define an ablation pattern, sweeping optical scanner 347 may enable displacement of the ablation pattern in focusing plane 310, and focusing optical system 346 may enable depthwise displacement of focusing plane 310 to effect ablation in successive planes 311, 312, 313, 314, and 315. Ablation planes 311, 312, 313, 314, and 315 may define treatment volume 305.

[0052] FIG. 4 presents a flow diagram of a method for at least partially removing a media opacity from a patient's eye. In step 400, a media opacity, such as media opacity 11, is identified using an OCT imaging system, such as OCT imaging system 165. The OCT imaging system may identify the location and volume of the media opacity. In step 410, the media opacity identified using the OCT imaging system is tracked using a 3D eye tracker, such as 3D eye tracker 168. This step may involve the 3D eye tracker executing instructions on a processor, such as processor 180, to track the location, volume, or a combination thereof of the media opacity based on multiple profile depth scans generated by the OCT imaging system. In step 420, a treatment volume, such as treatment volume 205, is determined. The treatment volume may be determined using signals related to the location and volume of the media opacity detected by the OCT imaging system and tracked by the 3D eye tracker. In step 430, the treatment volume may be treated by precisely targeting multiple ultrashort laser pulses, which may include precisely targeting focused femtosecond laser pulses, to at least partially remove the media opacity. This method allows the surgeon to at least partially remove the media opacity with minimal or no damage to the posterior segment of the patient's eye. Additionally, the treatment is non-invasive and may be an office-based procedure.

[0053] During laser surgery using the laser treatment system 100, an OCT imaging system, such as the OCT imaging system 165, a 3D eye tracker, such as the 3D eye tracker 168, or a combination thereof, may provide at least one real-time feedback indication of the progress of the treatment. The real-time feedback indication may include an OCT image to provide a status of the media opacity 11. The OCT image may be provided during treatment with a laser beam, such as the laser beam 142, the laser beam 242, or the laser beam 342, after treatment with the laser beam is completed, or a combination thereof. The real-time feedback indication may also include a signal regarding the location and volume of the media opacity 11 identified by the OCT imaging system 165 and tracked by the 3D eye tracker 168. The real-time feedback indication may be provided to the surgeon to inform him that the media opacity 11 has been at least partially removed.

[0054] At least one calculated feedback indication may be provided prior to or during a laser procedure using the laser treatment system 100. The calculated feedback indication may include, for example, a recommended treatment volume based on previous patient treatment results for a particular size and volume of media opacity, a recommended duration of treatment based on previous patient treatment results for a particular laser power setting of the therapeutic laser, a recommended laser power setting of the therapeutic laser based on predictions from a machine learning algorithm developed from a test set of pre-operative and post-operative OCT images from a previous laser procedure, or any combination thereof.

[0055] The media opacities 11 may be treated using the laser treatment system 100 according to a treatment plan. The treatment plan may involve customizing treatment variables, including, but not limited to, power settings of the treatment laser, duration of treatment, treatment volume, volume expansion, or any combination thereof. The treatment variables may be determined taking into account treatment factors, including, but not limited to, the volume of the patient's eye, the volume of the media opacity, the dimensions of the media opacity, the age of the patient, the medical history of the patient, any feedback indications, pre-operative OCT images of the patient's eye, post-operative OCT images of the patient's eye, patient surveys, recurrence rate of media opacities after treatment, efficacy of previous treatments, or any combination thereof.

[0056] The treatment plan may be based, at least in part, on at least one real-time feedback indication, such as an OCT image provided during treatment, or a signal regarding the location and volume of the media opacity 11. The at least one real-time feedback indication may be used by the surgeon to increase or decrease the power setting of the treatment laser, such as the treatment laser 141, during the laser treatment. The at least one real-time feedback indication may also enable the surgeon to update the treatment plan or stop the treatment in real time when the media opacity 11 has been at least partially removed. This allows the surgeon to at least partially remove the media opacity using a minimal amount of laser power. Additionally, this provides the desired treatment result with minimal risk of damage to the patient's eye.

[0057] FIG. 5 presents a flow diagram of a method for treating a media opacity using at least one real-time feedback display according to the present disclosure. In step 500, a media opacity is identified and tracked. The media opacity may be identified by an OCT imaging system, such as OCT imaging system 165. The media opacity may be tracked by an eye tracker, such as 3D eye tracker 168. In step 510, the media opacity is treated with a laser system, such as laser system 140, laser system 240, or laser system 340, according to a treatment plan. In step 520, during the laser treatment, at least one real-time feedback display may provide a real-time status of the media opacity. The real-time feedback display may include signals related to the location and volume of the media opacity detected by OCT imaging system 165 and tracked by 3D eye tracker 168. In step 530, the surgeon may update the treatment plan in real time in response to the at least one real-time feedback display. The treatment plan may be updated by changing the power settings of the therapeutic laser, the duration of the treatment, the treatment volume, the volume expansion, or any combination thereof. In another example, the surgeon may stop the treatment when at least one real-time feedback indication indicates that the volume of the media opacity is near zero, indicating that the media opacity has been at least partially removed. This allows the surgeon to at least partially remove the media opacity using a minimal amount of laser power.

[0058] In a further example, the treatment plan may be determined, at least in part, based on at least one calculated feedback indication. The at least one calculated feedback indication may include a recommended value of a treatment variable based on a prediction by a machine learning algorithm developed from a test data set. The test data set may include at least one treatment factor. For example, the recommended value of the treatment variable may be based on a prediction by a machine learning algorithm developed from a test set of pre-operative and post-operative OCT images. In another example, the machine learning algorithm may provide a prediction regarding optimal power settings of a treatment laser to remove a particular volume of media opacity. The treatment plan may also be based, at least in part, on a combination of real-time feedback indications and calculated feedback indications.

[0059] FIG. 6 presents a flow chart for a method for treating media opacities using at least one calculated feedback indication according to the present disclosure. In step 600, media opacities are identified and tracked. The media opacities may be identified by an OCT imaging system, such as OCT imaging system 165. The media opacities may be tracked by an eye tracker, such as 3D eye tracker 168. In step 610, a treatment plan is determined based on the at least one calculated feedback indication. An example of the calculated feedback indication may include recommended values ​​of treatment variables based on predictions by a machine learning algorithm developed from a test data set. In step 620, the media opacities are treated with a laser system, such as laser system 140, laser system 240, or laser system 340, according to the treatment plan determined based on the at least one calculated feedback indication.

[0060] The laser therapy system 100 may be used in combination with a computer system 700, as shown in Figure 7. The computer system 700 may include a processor 710, a volatile memory medium 720, a non-volatile memory medium 730, and an input / output (I / O) device 740. The volatile memory medium 720, the non-volatile memory medium 730, and the I / O device 740 may be communicatively coupled to the processor 710.

[0061] The term "memory medium" may refer to "memory," "storage device," "memory device," "computer-readable medium," and / or "tangible computer-readable storage medium." For example, memory medium may include, without limitation, storage media such as direct access storage devices including hard disk drives, sequential access storage devices such as tape disk drives, compact disks (CDs), random access memories (RAMs), read-only memories (ROMs), CD-ROMs, digital versatile disks (DVDs), electrically erasable programmable read-only memories (EEPROMs), flash memories, non-transitory media, or any combination thereof. As shown in FIG. 7, non-volatile memory medium 730 may include processor instructions 732. Processor instructions 732 may be executed by processor 710. In one example, one or more portions of processor instructions 732 may be executed via non-volatile memory medium 730. In another example, one or more portions of processor instructions 732 may be executed via volatile memory medium 720. One or more portions of processor instructions 732 may be transferred to volatile memory medium 720.

[0062] The processor 710 may execute the processor instructions 732 in implementing at least a portion of one or more systems, one or more flowcharts, one or more processes, and / or one or more methods described herein. For example, the processor instructions 732 may be configured, coded, and / or encoded with instructions executable by a processor in accordance with at least a portion of one or more systems, one or more flowcharts, one or more methods, and / or one or more processes described herein. Although the processor 710 is shown as a single processor, the processor 710 may be or may include multiple processors. One or more of the storage medium and memory medium may be a software product, a program product, and / or an article of manufacture. For example, the software product, the program product, and / or an article of manufacture may be configured, coded, and / or encoded with instructions executable by a processor in accordance with at least a portion of one or more systems, one or more flowcharts, one or more methods, and / or one or more processes described herein.

[0063] The processor 710 may include any suitable system, device, or apparatus operable to interpret and execute program instructions, process data, or both stored in a memory medium and / or received over a network. The processor 710 may further include one or more microprocessors, microcontrollers, DSPs, ASICs, or other circuitry configured to interpret and execute program instructions, process data, or both.

[0064] I / O device(s) 740 may include any means or means for enabling, permitting, and / or enabling a user to interact with computer system 700 and associated components by facilitating input from and output to a user. Facilitating input from a user allows the user to operate and / or control computer system 700, and facilitating output to a user allows computer system 700 to display the effects of the user's operations and / or controls. For example, I / O device(s) 740 may enable a user to input data, instructions, or both into computer system 700 and otherwise operate and / or control computer system 700 and its associated components. I / O devices may include user interface devices such as a keyboard, mouse, touch screen, joystick, handheld lens, tool tracking device, coordinate input device, or any other I / O device suitable for use in the system.

[0065] The I / O devices 740 may include, among other things, one or more buses, one or more serial devices, and / or one or more network interfaces that may facilitate and / or allow the processor 710 to implement at least a portion of one or more systems, processes, and / or methods described herein. In one example, the I / O devices 740 may include a storage interface that may facilitate and / or allow the processor 710 to communicate with an external storage device. The storage interface may include, among other things, one or more of a Universal Serial Bus (USB) interface, a SATA (Serial ATA) interface, a PATA (Parallel ATA) interface, and a Small Computer System Interface (SCSI). In a second example, the I / O devices 740 may include a network interface that may facilitate and / or allow the processor 710 to communicate with a network. The I / O devices 740 may include one or more of a wireless network interface and a wired network interface. In a third example, the I / O device 740 may include one or more of a Peripheral Component Interconnect (PCI) interface, a PCI Express (PCIe) interface, a Serial Peripheral Interconnect (SPI) interface, and an Inter-Integrated Circuit (I2C) interface, among others. In a fourth example, the I / O device 740 may include circuitry that may allow the processor 710 to communicate data with one or more sensors. In a fifth example, the I / O device 740 may facilitate and / or allow the processor 710 to communicate data with one or more of the display 750 and the laser therapy system 100, among others. As shown in FIG. 7, the I / O device 740 may be coupled to a network 770. For example, the I / O device 740 may include a network interface.

[0066] Network 770 may include a wired network, a wireless network, an optical network, or any combination thereof. Network 770 may include and / or be coupled to various types of communication networks. For example, network 770 may include and / or be coupled to a local area network (LAN), a wide area network (WAN), the Internet, a public switched telephone network (PSTN), a cellular telephone network, a satellite telephone network, or any combination thereof. A WAN may include a private WAN, a corporate WAN, a public WAN, or any combination thereof.

[0067] 7 illustrates computer system 700 as external to laser treatment system 100, laser treatment system 100 may include computer system 700. For example, processor 710 may be or may include processor 180.

[0068] 8A to 8C show an example of a medical system 800. As shown in FIG. 8A, the medical system 800 may include a laser treatment system 100. As shown in FIG. 8B, the medical system 800 may include the laser treatment system 100 and a computer system 700. The laser treatment system 100 may be communicatively coupled to the computer system 700. As shown in FIG. 8C, the medical system 800 may include the laser treatment system 100, which may include the computer system 700.

[0069] The laser therapy system 100 may be used as a component of a medical system 900, as shown in FIG. 9 . The medical system 900 may include the laser therapy system 100, which may be included in a surgical console 985. The medical system 900 may include a computer system 700. The laser therapy system 100 may be communicatively coupled to the computer system 700. The surgeon 910 may view a digital image of the eye 10 of the patient 920 on a display 990 using a surgical camera 160, an OCT imaging system 165, or a combination thereof. The surgeon 910 may identify media opacities in the eye 10 using the OCT imaging system 165. The surgeon 910 may track the media opacities in the eye 10 using a 3D eye tracker 168. The surgeon 910 may treat the media opacities in the eye 10 using the laser system 140.

[0070] The inclusion of the laser treatment system 100 in the medical system 900 may enable the surgeon 910 to identify, track, and treat media opacities in the eye 10, which may improve removal of media opacities in vitreoretinal surgery compared to removal without the laser treatment system 100. The medical system 900 may include a laser system 140, an OCT imaging system 165, a 3D eye tracker 168, an image processing system 170, a processor 180, and a memory medium 181, such as those of the laser treatment system 100. The memory medium 181 may be coupled to the processor 180 and may include instructions that, when executed by the processor, cause the medical system to utilize the laser treatment system 100 under the supervision of the surgeon 910 to at least partially remove media opacities in the eye 10 of the patient 920. Although FIG. 9 illustrates the computer system 700 included in the laser treatment system 100, the computer system 700 may be external to the laser treatment system 100. For example, processor 710 may be or may include processor 180 , or processor 710 may be separate from processor 180 .

[0071] Laser therapy system 100, computer system 700, medical system 800, medical system 900, and components thereof may be combined with other elements of the treatment tools and systems described herein, unless clearly mutually exclusive. For example, laser therapy system 100 may be combined with medical system 800 and used with other visualization systems, computer systems, and medical systems described herein.

[0072] The subject matter disclosed above should be considered as illustrative and not restrictive, and the appended claims are intended to encompass all such modifications, enhancements, and other embodiments that fall within the true spirit and scope of the present disclosure. For example, while laser treatment systems are most commonly required to improve the removal of media opacities in vitreoretinal surgery, the systems and methods described herein can be used where useful in other procedures, such as purely diagnostic procedures that are not otherwise considered surgical procedures. The present disclosure also includes the following aspects. [Aspect 1] 1. A laser treatment system comprising: 1. An optical coherence tomography (OCT) imaging system, comprising: Generate multiple profile depth scans, Executing instructions on a processor to detect a location, volume, or a combination thereof of media opacities within an eye based on the multiple profile depth scans. an optical coherence tomography (OCT) imaging system operable to: 1. A 3D eye tracker, comprising: Executing instructions on the processor to track a location, a volume, or a combination thereof, of the media opacity within the eye based on the plurality of profile depth scans. and a 3D eye tracker capable of operating as described above. 1. A laser system including a therapeutic laser, comprising: A plurality of ultrashort laser pulses produced by the therapeutic laser are precisely targeted at the media opacity within the eye to at least partially remove the media opacity. and a laser system capable of operating as described above. 1. A laser treatment system comprising: [Aspect 2] 2. The laser treatment system of claim 1, wherein the multiple ultrashort laser pulses are uniformly targeted within a treatment volume. [Aspect 3] 2. The laser therapy system of claim 1, wherein the OCT imaging system is operable to provide time-domain OCT, frequency-domain OCT, spectral-domain OCT, swept-source OCT, OCT angiography, or any combination thereof. Aspect 4 The therapeutic laser has a wavelength of about 1 femtosecond (10-15 sec) to about 50 picoseconds (50×10 -12 2. The laser treatment system of claim 1, wherein the laser treatment system generates a pulse having a duration of about 100 .mu.m (.mu.m) or less. Aspect 5 2. The laser treatment system of claim 1, wherein the therapeutic laser emits light at a wavelength of about 1,030 nm or about 1,050 nm. Aspect 6 The laser system includes: a shaping system operable to modulate the phase of the laser beam to provide a phase modulated laser beam; a sweeping optical scanner operable to direct the phase modulated laser beam to provide a modulated and displaced laser beam; a focusing optical system operable to shift a focal plane of the modulated and shifted laser beam to provide a plurality of ablation planes; 2. The laser treatment system of embodiment 1, further comprising: Aspect 7 7. The laser treatment system of claim 6, wherein the multiple ablation surfaces define a treatment volume. Aspect 8 The 3D eye tracker is providing at least one real-time feedback indication regarding the location and the volume of the media turbidity; providing at least one real-time feedback indication to indicate when said media turbidity has been at least partially removed; 2. The laser treatment system of claim 1, further operable to: Aspect 9 1. A method for treating media opacity, comprising: Identifying the location and volume of the media opacity using an OCT imaging system; tracking the location and the volume of the media opacity using a 3D eye tracker; determining a treatment volume using signals related to the location and the volume of the media opacity; treating the treatment volume by precisely aiming a plurality of ultrashort laser pulses produced by a treatment laser; at least partially removing said medium turbidity; A method comprising: Aspect 10 1. A method for treating media opacity, comprising: Identifying media opacity using an OCT imaging system; Tracking the medium opacity using a 3D eye tracker; and treating the media opacity according to a treatment plan using a laser system; providing a real-time status of said media turbidity using at least one real-time feedback indication; updating the treatment plan in real time in response to the at least one real time feedback indication; A method comprising: Aspect 11 11. The method of embodiment 10, wherein the at least one real-time feedback indication includes a signal related to a location and volume of the media turbidity. Aspect 12 The method of claim 10, wherein updating the treatment plan includes changing the power settings of a therapeutic laser, changing the duration of treatment, changing the treatment volume, changing the treatment volume expansion, or any combination thereof. Aspect 13 11. The method of embodiment 10, wherein updating the treatment plan comprises ceasing treatment. Aspect 14 1. A method for treating media opacity, comprising: Identifying media opacity using an OCT imaging system; Tracking the medium opacity using a 3D eye tracker; and determining a treatment plan using at least one calculated feedback display; treating the media opacity according to the treatment plan using a laser system; A method comprising: Aspect 15 15. The method of embodiment 14, wherein the at least one calculated feedback indication is based on a prediction by a machine learning algorithm.

Claims

1. A laser treatment system (100), comprising:

1. An optical coherence tomography (OCT) imaging system, comprising: Generate multiple profile depth scans, Executing instructions on a processor to detect a location, volume, or a combination thereof of media opacities within an eye based on the multiple profile depth scans. an optical coherence tomography (OCT) imaging system (165) operable to 1. A 3D eye tracker comprising: Executing instructions on the processor to track a location, a volume, or a combination thereof, of the media opacity within the eye based on the plurality of profile depth scans. a 3D eye tracker (168) operable to 1. A laser system including a therapeutic laser, comprising: A plurality of ultrashort laser pulses produced by the therapeutic laser are precisely targeted at the media opacity within the eye to at least partially remove the media opacity. a laser system (140) operable to the laser system comprising: a shaping system (348) operable to modulate the phase of the laser beam to provide a phase modulated laser beam; a sweeping optical scanner (347) operable to direct the phase modulated laser beam to provide a modulated and displaced laser beam; a focusing optical system (346) operable to shift the focal plane of the modulated and shifted laser beam to provide multiple ablation planes; The laser treatment system further comprises:

2. 10. The laser treatment system of claim 1, wherein the multiple ultrashort laser pulses are uniformly targeted within a treatment volume.

3. 10. The laser therapy system of claim 1, wherein the OCT imaging system is operable to provide time domain OCT, frequency domain OCT, spectral domain OCT, swept-source OCT, OCT angiography, or any combination thereof.

4. The treatment laser (341) has a pulse duration of about 1 femtosecond (10 －１５ sec) to about 50 picoseconds (50×10 －１２ 2. The laser treatment system of claim 1, wherein the laser treatment system generates pulses having a duration of about 100 .mu.m (100 .mu.m) or less.

5. The laser treatment system of claim 1 , wherein the treatment laser (341) emits light at a wavelength of about 1,030 nm or about 1,050 nm.

6. The laser treatment system of claim 1 , wherein the multiple ablation planes define a treatment volume.

7. The 3D eye tracker (168) providing at least one real-time feedback indication regarding the location and the volume of the media turbidity; providing at least one real-time feedback indication to indicate when said media turbidity has been at least partially removed; The laser treatment system of claim 1 , further operable to:

Images