Laser surgery system and method for creating intraocular markers

Abstract

In certain embodiments, an ophthalmic surgery system for creating a marker in the cornea includes controllable components, a camera, and a computer. The controllable components include a laser source, a scanner, and an objective lens. The laser source generates a laser beam. The scanner focuses the laser beam laterally and vertically. The objective lens focuses toward the eye. The camera images the eye's movement. The computer creates the marker by instructing the scanner to focus toward a peripheral region of the cornea and instructing the controllable components to create the marker in the peripheral region. The computer also determines that the marker movement is within an alert range, indicating an unacceptable amount of movement, and provides a notification in response to determining that the marker movement is within the alert range.

Description

[Technical Field]

[0001] FIELD OF THE DISCLOSURE The present disclosure relates generally to laser surgery systems and methods, and more particularly to laser surgery systems and methods for creating markers within the eye. [Background technology]

[0002] Certain ophthalmic laser surgery systems generate a pulsed laser beam to perform surgical procedures on the eye. In some procedures, the laser beam causes photoablation at specific points on the eye according to a treatment pattern. To create photoablation that precisely matches the pattern, the laser beam must be properly aligned with the eye throughout the procedure.

[0003] A patient interface (PI) is typically used to hold the eye in place during surgery. The patient interface is typically secured to the eye by a vacuum, holding the eye in place and facilitating proper alignment of the eye with the treatment pattern during surgery. Summary of the Invention [Means for solving the problem]

[0004] In certain embodiments, an ophthalmic surgery system for creating a marker in the cornea for a surgical procedure includes controllable components, a camera, and a computer. The controllable components include a laser source, a scanner, and an objective lens. The laser source generates a laser beam having ultrashort pulses. The scanner focuses the laser beam laterally and vertically. The objective lens focuses toward the eye via a patient interface. The camera images eye movement. The marker is shaped to indicate rotational movement of the eye. The computer creates the marker by instructing the scanner to focus laterally and vertically toward a peripheral region of the cornea and instructing one or more of the controllable components to create the marker in the peripheral region of the cornea. The computer also determines that the marker movement is within an alert range indicating an unacceptable amount of movement and provides one or more notifications in response to determining that the marker movement is within the alert range.

[0005] Implementations may include none, one, some, or all of the following features.

[0006] *The shape of the marker is selected from one or more of the following: polygon, line, multiple lines, multiple lines intersecting at a single point, multiple lines intersecting at multiple points, circle with a line, ellipse, and one or more alphanumeric characters.

[0007] * The computer identifies a marker corresponding to the surgical procedure and creates the identified marker on the cornea. In certain embodiments, if the surgical procedure is a lenticule extraction procedure, the computer identifies that the marker is outside and adjacent to the outer boundary of the lenticule to be extracted and creates the marker outside and adjacent to the outer boundary. In certain embodiments, if the surgical procedure is a flap creation procedure, the computer identifies that the marker is outside and adjacent to the outer boundary of the flap to be created and creates the marker outside and adjacent to the outer boundary. In certain embodiments, if the surgical procedure is cataract removal surgery, the computer identifies that the marker outlines the lens capsule of the eye and creates a marker that outlines the lens capsule of the eye.

[0008] *The notification may be an audio notification.

[0009] *The notification may be a visual notification.

[0010] The alert range includes multiple non-overlapping subset alert ranges that form a segment of the alert range. The computer provides multiple notifications, each corresponding to a subset alert range, with a first notification for a first subset alert range being different from a second notification for a second subset alert range. In certain embodiments, the first notification has a first visual characteristic that is different from a second visual characteristic of the second notification. In certain embodiments, the first notification has a first audio characteristic that is different from a second audio characteristic of the second notification. In certain embodiments, the subset alert range is an end alert range, and the computer ends the surgical procedure in response to determining that the marker movement is within the end alert range. In certain embodiments, the ophthalmic surgery system includes a display screen. The computer displays a notification icon on the display screen that includes an alert level, the alert level corresponding to the subset alert range, and visually highlights the alert level in response to determining that the marker movement is within the corresponding subset alert range.

[0011] The computer determines an alert range corresponding to the surgical procedure. In certain embodiments, if the surgical procedure is a lenticule extraction procedure, the alert range has a maximum allowable distance of 50-150 microns. In certain embodiments, if the surgical procedure is a flap creation procedure, the alert range has a maximum allowable distance of 100-500 microns. In certain embodiments, if the surgical procedure is a cataract removal procedure, the alert range has a maximum allowable distance of 100-500 microns.

[0012] In certain embodiments, a method for creating a marker on the cornea of ​​an eye for surgery includes creating a marker on the cornea by a computer. The marker has a shape capable of indicating rotational movement of the eye. The computer directs a scanner to focus a laser beam laterally and vertically toward a peripheral region of the cornea and directs one or more of a set of controllable components to create the marker in the peripheral region of the cornea. The set of controllable components includes a laser source configured to generate the laser beam, a scanner configured to focus the laser beam laterally and vertically, and an objective lens configured to focus the focus toward the eye through a patient interface. The computer also determines that movement of the marker is within an alert range indicating an unacceptable amount of movement of the marker and provides one or more notifications in response to determining that movement of the marker is within the alert range.

[0013] Embodiments may include none, one, some, or all of the features described above with respect to the system, and / or none, one, some, or all of the following features.

[0014] The method further includes identifying a marker corresponding to the surgical procedure and creating the identified marker in the cornea.

[0015] *The alert range includes a plurality of non-overlapping subset alert ranges that form a segment of the alert range. The method further includes providing a plurality of notifications, each notification corresponding to a subset alert range, a first notification for a first subset alert range being different from a second notification for a second subset alert range, displaying a notification icon on a display screen including a plurality of alert levels, at least one alert level corresponding to the subset alert range, and visually highlighting the alert level in response to determining that movement of the marker is within a corresponding subset alert range. [Brief explanation of the drawings]

[0016] [Figure 1] FIG. 1 illustrates an example of an ophthalmic surgical system configured to create markers on the cornea of ​​an eye, according to certain embodiments. [Figure 2A-2B] 2A-2B show examples of markers created on the eye. [Figure 3] FIG. 3 shows a marker that includes a circle with a line. [Figure 4] FIG. 4 shows a marker containing alphanumeric characters. [Figure 5] FIG. 5 shows a marker that includes a line. [Figure 6] FIG. 6 shows a marker that includes a line and a circle. [Figure 7] FIG. 7 shows an example of a traffic light notification icon that may be used by the system of FIG. [Figure 8] FIG. 8 shows an example of a meter notification icon that may be used by the system of FIG. [Figure 9] FIG. 9 shows an example of a method for creating a marker on the eye that can be performed by the system of FIG. DETAILED DESCRIPTION OF THE INVENTION

[0017] With reference now to the description and drawings, exemplary embodiments of the disclosed apparatus, systems, and methods are shown in detail. The description and drawings are not intended to be exhaustive or otherwise limit the scope of the claims to the specific embodiments shown in the drawings and disclosed in the description. While the drawings represent possible embodiments, the drawings are not necessarily to scale, and certain features may be simplified, exaggerated, omitted, or partially separated to better illustrate the embodiments.

[0018] In certain ophthalmic surgical procedures, the eye is coupled to a surgical system with a patient interface (PI) to properly align the eye with the treatment pattern. A problem can arise in that the eye may move relative to the patient interface, and therefore relative to the treatment pattern. For example, a nervous patient may move their eye vigorously, creating enough shear force to cause the eye to move relative to the patient interface or even become detached from the interface. As another example, an inexperienced surgeon may inadvertently move the eye relative to the patient interface or fail to properly connect the eye to the patient interface, causing the eye to move relative to the interface. Movement of the eye relative to the patient interface can cause the eye to become misaligned with the treatment pattern. The embodiments described herein can address this issue.

[0019] 1 illustrates an example of an ophthalmic surgical system 10 configured to create markers on the cornea of ​​an eye 22, according to certain embodiments. In this embodiment, the system 10 creates markers in the cornea, tracks the movement of the markers, and provides notification that the eye has moved relative to the patient interface if the movement is within an alert range. Thus, the system 10 can be used to address the issue of the eye 22 moving relative to the patient interface, resulting in misalignment with the treatment pattern.

[0020] In the illustrated example, system 10 includes a laser device 15, a patient interface 20, a camera 38, and a control computer 30, coupled as shown. Laser device 15 includes controllable components such as a laser source 12, a scanner 16, one or more optical elements 17, and / or a focusing objective lens 18, coupled as shown. Patient interface 20 includes a contact portion 24 (having an abutment surface 26) and a sleeve 28, coupled as shown. Computer 30 includes logic 31, a memory 32 (storing a computer program 34), and a display 36, coupled as shown.

[0021] In overview, system 10 can create and track markers according to the following example operation: Laser source 12 generates a laser beam having an ultrashort pulse. Scanner 16 controls the focus of the laser beam laterally and vertically. Objective lens 18 focuses the light toward eye 22 through patient interface 20. Camera 38 images the movement of eye 22. Computer 30 creates a marker on the cornea by instructing scanner 12 to focus toward the peripheral region of the cornea and instructing controllable components to create a marker in the peripheral region. Computer 30 then determines whether the movement of the marker is within an alert range, which represents unacceptable movement of the marker. If so, computer 30 provides one or more notifications that the movement is within the alert range.

[0022] Turning to the components of system 10, laser source 12 generates a laser beam having an ultrashort pulse. Ultrashort pulses refer to optical pulses having durations less than a nanosecond, such as on the order of picoseconds, femtoseconds, or attoseconds. The laser beam can have any suitable wavelength in the range of 300-1500 nanometers (nm), e.g., 300-650, 650-1050, 1050-1250, and / or 1250-1500 nm, e.g., 340-350 nm, e.g., 347 nm ± 1 nm. The focus of the laser beam can create laser-induced optical breakdown (LIOB) in tissue (e.g., the cornea), resulting in photodissection within the tissue. The laser beam can be precisely focused to provide precise photodissection and reduce or avoid unnecessary cutting of other tissue.

[0023] The scanner 16 focuses the laser beam in both lateral and longitudinal directions. The longitudinal direction refers to the direction of propagation of the laser beam, also known as the z-direction. The lateral direction refers to the direction perpendicular to the beam propagation direction, also known as the x-y plane. In certain embodiments, the abutment surface 26 of the patient interface 20 is selected as the x-y plane at z=0.

[0024] Scanner 16 can direct the laser beam laterally in any suitable manner. For example, scanner 16 can include a pair of galvanometrically driven scanner mirrors that can tilt about mutually perpendicular axes. As another example, scanner 16 can include an electro-optic crystal that can electro-optically steer the laser beam. Scanner 16 can direct the laser beam longitudinally in any suitable manner. For example, scanner 16 can include a vertically adjustable lens, a variable optical power lens, or a deformable mirror that can control the z-position of the beam focus. The components of scanner 16 can be arranged along the beam path in any suitable manner, such as in the same or different modular units.

[0025] One (or more) optical elements 17 direct the laser beam toward a focusing objective lens 18. The optical element 17 can act on (e.g., transmit, reflect, refract, diffract, collimate, condition, shape, focus, modulate, and / or act on) the laser beam. Examples of optical elements include lenses, prisms, mirrors, diffractive optical elements (DOEs), holographic optical elements (HOEs), and spatial light modulators (SLMs). In this example, the optical element 17 is a mirror. The focusing objective lens 18 focuses the focus of the laser beam toward a point on the eye 22 through the patient interface 20. In this example, the focusing objective lens 18 is an objective lens, such as an f-theta objective lens.

[0026] The patient interface 20 interfaces with the cornea of ​​the eye 22 to couple the eye 22 to the laser device 15. In this example, the patient interface 20 has a sleeve 28 coupled to a contact portion 24. The sleeve 28 removably couples to the focusing objective lens 18. The contact portion 24 may be translucent or transparent to the laser beam and has an abutment surface 26 that interfaces with the cornea. In certain embodiments, the abutment surface 26 is planar and forms a planar area on the cornea, which may define an xy plane. In other embodiments, the abutment surface 26 need not be planar and may be convex or concave, for example.

[0027] The camera 38 records images of the movement of the eye 22, including the movement of markers created within the eye 22. Examples of the camera 38 include a video, optical coherence tomography (OCT), or eye-tracking camera. The camera 38 delivers image data representing the recorded images of the eye 22 to the computer 30. The computer 30 performs image processing on the image data to determine the movement of the markers. Image processing includes recognizing the markers in the recorded images, determining the positions of the markers, and comparing the positions of the markers imaged at different times to determine the movement of the markers.

[0028] Computer 30 controls the controllable components (e.g., laser source 12, scanner 16, optical element 17, and / or focusing objective lens 18) according to computer program 34. Computer program 34 includes computer code that directs the controllable components to focus a laser beam on an area of ​​the cornea and photodisrupt at least a portion of that area to create a marker on the cornea. The marker is temporary and disappears by itself. The marker is described in more detail with reference to FIGS. 2A-6.

[0029] 2A and 2B show examples of markers 50 (50a) created on an eye 22. FIG. 2A shows an eye 22 having a pupil 42, an iris 44, a lens (not shown), and a cornea 46 having a peripheral region 48. Typically, the iris 44 and the cornea 46 each have an outer diameter in the range of 10 to 13 millimeters (mm). The cornea 46 has a peripheral region 48, which is an annular region of the cornea 46 closest to the outer periphery of the cornea 46. The peripheral region 48 can have an outer radius of Rc and an inner radius of Rc×q, where Rc represents the outer radius of the cornea 46 and q is any suitable percentage, e.g., 50 to 60, 60 to 70, 70 to 80, 80 to 90, and / or 90 to 95 percent.

[0030] The inner radius can be determined according to the surgical procedure. In some cases, the inner radius may be such that the peripheral region 48 does not interfere with (e.g., is outside of) the surgical treatment area. For example, a typical lenticule has a diameter of approximately 5-7 mm, and a typical flap has a diameter of approximately 7-10 mm. The inner radius may be selected so that the peripheral region 48 is outside the lenticule or flap area. In other cases, the inner radius may be such that the peripheral region 48 includes or forms the boundary for the surgical procedure. For example, the marker 50 may be used to outline a capsular bag having a diameter of approximately 9-10 mm. The inner radius may be selected to be smaller than or match the radius of the capsular bag.

[0031] The marker 50 can have any suitable size and shape. In certain embodiments, the marker 50 has a size and shape that can easily indicate translation and / or rotation of the eye 22. For example, the marker 50 has a size that is large enough to allow the camera 38 to easily detect movement of the marker 50, but small enough to minimize optical breakage of the eye 22. As another example, the marker 50 has a shape that allows the camera 38 to detect translation and / or rotation of the marker 50.

[0032] The marker 50 can be placed in any suitable location in the peripheral region 48. In certain embodiments, the location of the marker 50 can be determined according to the surgical procedure, such as relative to the treatment zone and / or field of view of the surgery. For example, in a lenticule extraction procedure, the treatment zone, i.e., the lenticule, can be up to about 8 millimeters (mm) in diameter, and the field of view can be about 12 mm in diameter. The marker 50 can be outside but close to the outer boundary of the lenticule (e.g., within 0.010-2 mm, such as 0.015 mm), but within the field of view. As another example, in a flap creation procedure, the marker 50 can be outside but close to the outer boundary of the flap. As yet another example, in a cataract removal procedure, the marker 50 can outline the lens capsule of the eye.

[0033] Example shapes include a polygon (e.g., a triangle or square), a line, multiple lines (e.g., an equals sign), multiple lines intersecting at a single point (e.g., a plus sign, cross, or asterisk), multiple lines intersecting at multiple points (e.g., a star), a circle with a line, an oval, and one or more alphanumeric characters (e.g., text including letters, numbers, and / or symbols in any language). In the illustrated example, the marker 50a is shaped like an equals sign. FIG. 2A shows the marker 50a with zero rotation so that the equals sign is horizontal. FIG. 2B shows the marker 50a rotated five degrees so that the equals sign is tilted at an angle.

[0034] 3-6 show different types of markers 50. Fig. 3 shows markers 50 including markers 50b (50b-1, 50b-2), each of which is a circle with a line. The line of marker 50b-1 is aligned with a vertical line passing through the center of eye 22 (e.g., the center of the pupil, the vertex of the eye, or the crown of the eye), and the line of marker 50b-2 is aligned with a horizontal line passing through the center.

[0035] 4 shows a marker 50c that includes alphanumeric characters. In certain embodiments, the characters can provide information such as a timestamp, a patient identifier, or a company name.

[0036] 5 shows markers 50 including markers 50d (50d-1 to 50d-8). Each marker 50d is aligned with a line passing through the center of eye 22. For example, markers 50d-1 and 50d-5 are aligned with a vertical line passing through the center, and markers 50d-3 and 50d-7 are aligned with a horizontal line passing through the center.

[0037] 6 shows markers 50, including marker 50d and marker 50e. Marker 50e is a circle that can provide a boundary for a treatment area, for example, the outline of a lenticule, flap, or capsule.

[0038] Returning to FIG. 1 , recall that computer 30 instructs controllable components of laser device 15 to create markers 50. In certain embodiments, computer 30 determines the type of marker 50 to create by identifying markers 50 that correspond to a surgical procedure. In this embodiment, certain characteristics of marker 50 (e.g., size, shape, location, and / or position) may be more appropriate for a particular surgical procedure. For example, computer 30 may determine that (1) for a lenticule extraction procedure, marker 50 may be outside of but adjacent to the outer boundary of the lenticule; (2) for a flap creation procedure, marker 50 may be outside of but adjacent to the outer boundary of the flap; and / or (3) for a cataract removal procedure, marker 50 may outline the lens capsule of the eye.

[0039] Also, recall that computer 30 determines when movement of marker 50 is within an alert range and provides a notification in response to that determination. The alert range represents an unacceptable amount of movement of marker 50 that represents an unacceptable amount of movement of eye 22. Unacceptable movement can be movement that causes eye 22 to deviate from the treatment pattern such that a notification should be provided and / or surgery should be terminated. The alert range can be represented as movement of a distance d greater than a maximum allowable distance Q, expressed in set notation as {d|d>Q}, where Q is any suitable number, for example, 50-500 microns.

[0040] In certain embodiments, the alert range includes a plurality of non-overlapping subset alert ranges that form a partition of the alert range. A partition of a set is a collection of mutually exclusive subsets of the set such that the union of the subsets equals the set. For example, the alert range {d|d > Q} can be partitioned into {d|Q1 < d ≤ Q2, Q2 < d ≤ Q3, ..., Qn < d}, where Q = Q1. Subset alert ranges closer to the maximum allowable distance Q indicate less deviation than subset alert ranges further from the maximum allowable distance Q. Thus, movement within a subset alert range closer to the maximum allowable distance Q may be less urgent than movement within a more distant range. In certain embodiments, the subset alert range may be an end alert range representing unacceptable movement such that the surgery should be terminated.

[0041] In certain embodiments, computer 30 determines an alert range corresponding to a surgical procedure. In certain surgeries (e.g., creation of a lenticule), higher precision may be required than in other surgeries (e.g., creation of a flap). For example, since a lenticule has a shape with refractive properties, the incision of the lenticule needs to be accurately aligned with the treatment pattern. Flaps typically have a flat-bed incision without refractive properties, so alignment does not need to be as accurate. Thus, the maximum allowable distance Q of the alert range may be more stringent for surgeries requiring more precision. For example, in the case of lenticule extraction surgery, the maximum allowable distance Q can range from 50 to 150 microns. As another example, in the case of flap creation surgery, the maximum allowable distance Q can range from 100 to 500 microns. As yet another example, in the case of cataract removal surgery, the maximum allowable distance Q can range from 50 to 500.

[0042] Computer

[0043] In certain embodiments, the computer 30 provides multiple notifications for multiple subset alert ranges. In some examples, each notification corresponds to a specific subset alert range, and the computer 30 provides different notifications for different subset alert ranges, e.g., a first notification for a first subset alert range is different from a second notification for a second subset alert range. For example, the first notification may have a first visual characteristic that is different from a second visual characteristic of the second notification. As another example, the first notification may have a first audio characteristic that is different from a second audio characteristic of the second notification. In certain embodiments, the computer 30 terminates the surgical procedure in response to determining that the marker movement is within the termination alert range. Examples of visual notification icons for multiple subset alert ranges are described with reference to FIGS. 7 and 8 .

[0044] FIG. 7 shows an example of a traffic light notification icon 70 (70a) that may be used by the system 10 of FIG. 1. The notification icon 70 is a graphical element (which may be presented via the display 36) that provides a notification when movement of the marker 50 reaches an alert range. In particular embodiments, the notification icon 70 includes alert levels 72 (72a, 72b, 72c). The alert levels 72 may correspond to subset alert ranges. When movement of the marker 50 enters a subset alert range, the icon 70 may visually highlight (e.g., illuminate, point, flash, outline, or otherwise highlight) the corresponding alert level 72.

[0045] In the illustrated example, alert level 72a is a green light, alert level 72b is a yellow light, and alert level 72c is a red light. When movement falls within a subset alert range, icon 70 may highlight (e.g., make brighter or more luminous) the corresponding light. Green alert level 72a may correspond to no movement of marker 50 or movement that does not reach the alert level, i.e., movement is within an acceptable range. Yellow alert level 72b may correspond to a subset alert range that is closest to the minimum alert value, i.e., movement is unacceptable but not enough to require termination of surgery. Red alert level 72c may correspond to a subset alert range that is a termination alert range, i.e., movement requires termination of surgery.

[0046] Figure 8 shows an example of a meter notification icon 70 (70b) that may be used by the system 10 of Figure 1. The notification icon 70b includes alert levels 72 (72a-72e). In the illustrated example, alert level 72a is green, alert level 72b is yellow-green, alert level 72c is yellow, 72d is orange, and alert level 72e is red.

[0047] A particular alert level 72 may correspond to a subset alert range. When movement of the marker 50 falls within a subset alert range, the icon 70 may highlight (e.g., point to) the corresponding level 72. A green alert level 72a may correspond to no movement of the marker 50 or movement that does not reach the alert level, i.e., movement is within an acceptable range. A yellow-green alert level 72b may correspond to the subset alert range closest to the minimum alert value, i.e., movement is unacceptable but close to acceptable. A yellow alert level 72c may correspond to the next closest subset alert range, i.e., movement is unacceptable but not enough to require termination of surgery. An orange alert level 72d may correspond to the next closest subset alert range, i.e., movement is unacceptable and approaching the point where termination of surgery is required. A red alert level 72e may correspond to a subset alert range that is a termination alert range, i.e., movement requires termination of surgery.

[0048] FIG. 9 illustrates an example of a method for creating a marker 50 on the eye 22 that may be performed by the system 10 of FIG. 1 . In certain embodiments, the computer 30 performs the method by instructing components of the system 10 to perform the operations of the method. The marker 50 may be created during a surgical procedure, such as a lenticule extraction, flap creation, or cataract removal procedure. The method begins at step 100, where the computer 30 receives a request to create a marker 50 on the cornea 46 of the eye 40. The marker 50 may have a shape that can indicate translational and / or rotational movement of the eye 22. In certain embodiments, the request may be received from a user of the system 10 (e.g., a surgeon) or from a computer program 34 for automated surgery.

[0049] The computer 30 identifies the requested markers 50 at step 110. In certain embodiments, the computer 30 may identify markers 50 corresponding to the surgical procedure. For example, a lenticule extraction procedure may use markers 50 that are external to and adjacent to the outer boundary of the lenticule to be extracted. As another example, a flap creation procedure may use markers 50 that are external to and adjacent to the outer boundary of the flap to be created. As yet another example, a cataract surgery may use markers 50 that outline the capsule of a cataractous lens.

[0050] In step 112, computer 30 determines an alert range. In certain embodiments, computer 30 may determine an alert range corresponding to a surgical procedure. For example, a lenticule extraction procedure may use an alert range having a maximum allowable distance Q of 50 to 150 microns. As another example, a flap creation procedure may use an alert range having a maximum allowable distance Q of 100 to 500 microns. As yet another example, a cataract surgery may use an alert range having a maximum allowable distance Q of 50 to 500 microns.

[0051] The computer 30 instructs the laser source 12 to generate a laser beam and instructs the scanner 16 to focus the beam toward the peripheral region 48 of the cornea 46, step 114. The controllable component creates a marker 50 in the peripheral region 48, step 116. The computer 30 monitors the movement of the marker 50, step 118, using the camera 38.

[0052] The surgical procedure may be completed at step 120. If the procedure is complete, the method proceeds to step 128 where computer 30 terminates the procedure. If the procedure is not complete, the method proceeds to step 122.

[0053] In step 122, computer 30 checks whether the movement of marker 50 is within the alert range. If the movement is not within the alert range, the method returns to step 118, where computer 30 continues to monitor the movement of marker 50. If the movement is within the alert range, the method proceeds to step 124.

[0054] In step 124, computer 30 checks whether the alert range is an end alert range. The end alert range indicates when the surgical procedure should be terminated. For example, the end alert range may indicate that the eye is so misaligned that treatment will be ineffective. If the alert range is not an end alert range, the method proceeds to step 126.

[0055] At step 126, computer 30 provides a notification that the movement is within the alert range. In certain embodiments, the alert range has multiple non-overlapping subset alert ranges that form segments of the alert range, and computer 30 provides a notification for each subset alert range. In certain cases, computer 30 provides separate notifications for different subset ranges. For example, a first notification for a first subset alert range may be different from a second notification for a second subset alert range. The notifications may be visually distinct (e.g., the first notification has a first visual characteristic that is different from a second visual characteristic of the second notification) or audibly distinct (e.g., the first notification has a first audio characteristic that is different from the audio characteristic of the second notification). The method then returns to step 118, where computer 30 continues to monitor movement of marker 50.

[0056] If the alert range is the end alert range at step 124, the method proceeds to step 128 where computer 30 ends the surgery. The method then ends.

[0057] Components of the systems and devices disclosed herein (e.g., control computer 30) may include interfaces, logic, and / or memory, any of which may include computer hardware and / or software. An interface (e.g., display 36) can receive input to and / or send output from a component and is typically used to exchange information between, for example, software, hardware, peripherals, a user, and combinations thereof. A user interface (e.g., a graphical user interface (GUI)) is a type of interface that allows a user to interact with a computer. Examples of interfaces include a display screen, a touchscreen, a keyboard, a mouse, a gesture sensor, a microphone, and a speaker.

[0058] Logic (e.g., logic 31) can perform the operations of a component. Logic can include one or more electronic devices that process data, e.g., execute instructions to generate output from input. Examples of such electronic devices include computers, processors, microprocessors (e.g., central processing units (CPUs)), and computer chips. Logic can include computer software that encodes instructions that can be executed by the electronic device to perform operations. Examples of computer software include computer programs, applications, and operating systems.

[0059] A memory (e.g., memory 32) can store information and may include a tangible, computer-readable, and / or computer-executable storage medium. Examples of memory include computer memory (e.g., random access memory (RAM) or read-only memory (ROM)), mass storage media (e.g., hard disks), removable storage media (e.g., compact discs (CDs) or digital video or versatile discs (DVDs)), databases, network storage (e.g., servers), and / or other computer-readable media. Certain embodiments may be directed to memory encoded with computer software.

[0060] While the present disclosure has been described with respect to particular embodiments, modifications to the embodiments (e.g., changes, substitutions, additions, omissions, and / or other modifications) will be apparent to those skilled in the art. Accordingly, modifications can be made to the embodiments without departing from the scope of the invention. For example, modifications can be made to the systems and devices disclosed herein. As will be apparent to those skilled in the art, components of the systems and devices may be integrated or separated, or operations of the systems and devices may be performed by more, fewer, or other components. As another example, changes can be made to the methods disclosed herein. As will be apparent to those skilled in the art, the methods may include more, fewer, or other steps, and the steps may be performed in any suitable order.

[0061] To assist the Patent Office and readers in interpreting the claims, applicants note that no claim or claim element is intended to invoke 35 U.S.C. §112(f) unless the words "means for" or "step for" are expressly used in a particular claim. Use of other terms in the claims (e.g., "mechanism," "module," "device," "unit," "component," "element," "member," "apparatus," "machine," "system," "processor," or "controller") is understood by applicants to refer to structures known to those of ordinary skill in the relevant art and is not intended to invoke 35 U.S.C. §112(f). The present application includes the following aspects. [Aspect 1] 1. An ophthalmic surgical system for creating a marker on a cornea of ​​an eye for a surgical procedure, comprising: A plurality of controllable components, a laser source configured to generate a laser beam having a plurality of ultrashort pulses; a scanner configured to focus the laser beam laterally and vertically; an objective lens configured to be focused toward the eye via a patient interface; a plurality of controllable components, each comprising: a camera configured to image the eye movements; A computer, creating the marker on the cornea having a shape capable of indicating rotational movement of the eye, directing the scanner to direct the focal point laterally and vertically toward a peripheral region of the cornea; directing one or more of the controllable components to create the markers in the peripheral region of the cornea; By creating determining that the movement of the marker is within an alert range indicating an unacceptable amount of movement of the marker; providing one or more notifications in response to determining that the movement of the marker is within the alert range; and a computer configured to perform the An ophthalmic surgery system comprising: [Aspect 2] An eye surgery system as described in aspect 1, wherein the shape of the marker is selected from one or more of a polygon, a line, multiple lines, multiple lines intersecting at a single point, multiple lines intersecting at multiple points, a circle with a line, an ellipse, and one or more alphanumeric characters. [Aspect 3] The computer identifying the marker corresponding to the surgical procedure; creating the identified markers on the cornea; 2. The ophthalmic surgery system of claim 1, wherein the ophthalmic surgery system is configured as follows: [Aspect 4] the surgical procedure is a lenticule extraction procedure; The computer Identifying that the marker is outside and adjacent to the outer boundary of the lenticule being extracted; creating the marker adjacent to the exterior of the outer boundary; 4. The ophthalmic surgery system of claim 3, wherein the ophthalmic surgery system is configured as follows: [Aspect 5] the surgical procedure is a flap creation procedure, The computer Identifying that the marker is outside and adjacent to the outer boundary of the flap to be created; creating the marker adjacent to the exterior of the outer boundary; 4. The ophthalmic surgery system of claim 3, wherein the ophthalmic surgery system is configured as follows: [Aspect 6] the surgical procedure is cataract removal surgery; The computer Identifying that the marker outlines a lens capsule of the eye; creating the marker outlining the lens capsule of the eye; 4. The ophthalmic surgery system of claim 3, wherein the ophthalmic surgery system is configured as follows: [Aspect 7] An ophthalmic surgery system as described in aspect 1, wherein one of the one or more notifications is an audio notification. [Aspect 8] An ophthalmic surgery system as described in aspect 1, wherein one of the one or more notifications is a visual notification. [Aspect 9] the alert range includes a plurality of non-overlapping subset alert ranges forming a partition of the alert range; the computer is configured to provide a plurality of notifications, each notification corresponding to a subset alert range, and a first notification relating to a first subset alert range being different from a second notification relating to a second subset alert range; 2. An ophthalmic surgery system according to embodiment 1. [Aspect 10] An ophthalmic surgery system as described in aspect 9, wherein the first notification has a first visual characteristic that is different from a second visual characteristic of the second notification. [Aspect 11] 10. The ophthalmic surgery system of claim 9, wherein the first notification has a first audio characteristic that is different from a second audio characteristic of the second notification. [Aspect 12] a subset alert range among the plurality of subset alert ranges is an end alert range; the computer is configured to terminate the surgical procedure in response to determining that the movement of the marker is within the termination alert range. 10. An ophthalmic surgery system according to embodiment 9. [Aspect 13] the ophthalmic surgical system further comprising a display screen; The computer displaying a notification icon on the display screen that includes a plurality of alert levels, at least one alert level corresponding to a subset alert range; visually highlighting the at least one alert level in response to determining that the movement of the marker is within the corresponding subset alert range; 10. The ophthalmic surgery system of claim 9, configured to perform the following: [Aspect 14] 2. The ophthalmic surgery system of claim 1, wherein the computer is further configured to determine the alert range corresponding to the surgical procedure. [Aspect 15] the surgical procedure is a lenticule extraction procedure; The alert range has a maximum allowable distance of 50 to 150 microns. 15. An ophthalmic surgery system according to embodiment 14. [Aspect 16] the surgical procedure is a flap creation procedure, The alert range has a maximum allowable distance of 100 to 500 microns. 15. An ophthalmic surgery system according to embodiment 14. [Aspect 17] the surgical procedure is cataract removal surgery; The alert range has a maximum allowable distance of 100 to 500 microns. 15. An ophthalmic surgery system according to embodiment 14. [Aspect 18] 1. A method of creating a marker on the cornea of ​​an eye for a surgical procedure, comprising: creating, by a computer, the marker in the cornea having a shape capable of indicating rotational movement of the eye; directing a scanner to focus a laser beam having a plurality of ultrashort pulses laterally and vertically toward a peripheral region of the cornea; directing one or more of a set of controllable components to create the marker in the peripheral region of the cornea, the set of controllable components comprising a laser source configured to generate the laser beam, the scanner configured to direct the focal point of the laser beam laterally and vertically, and an objective lens configured to direct the focal point toward the eye via a patient interface; By creating determining, by the computer, that movement of the marker is within an alert range indicating an unacceptable amount of movement of the marker; providing, by the computer, one or more notifications in response to determining that the movement of the marker is within the alert range; and A method comprising: [Aspect 19] identifying the marker corresponding to the surgical procedure; creating the identified markers on the cornea; 20. The method of embodiment 18, further comprising: [Aspect 20] the alert range includes a plurality of non-overlapping subset alert ranges forming a partition of the alert range; providing a plurality of notifications, each notification corresponding to a subset alert range, a first notification relating to a first subset alert range being different from a second notification relating to a second subset alert range; displaying a notification icon on a display screen that includes a plurality of alert levels, at least one alert level corresponding to a subset alert range; visually highlighting the at least one alert level in response to determining that the movement of the marker is within the corresponding subset alert range; 20. The method of embodiment 18, further comprising:

Claims

1. 1. An ophthalmic surgical system for creating a marker on a cornea of ​​an eye for a surgical procedure, comprising: A plurality of controllable components, a laser source configured to generate a laser beam having a plurality of ultrashort pulses; a scanner configured to focus the laser beam laterally and vertically; an objective lens configured to be focused toward the eye via a patient interface; a plurality of controllable components, each comprising: a camera configured to image the eye movements; A computer, identifying the marker corresponding to the surgical procedure; creating the identified marker on the cornea having a shape capable of indicating rotational movement of the eye; directing the scanner to direct the focal point laterally and vertically toward a peripheral region of the cornea; directing one or more of the controllable components to create the markers in the peripheral region of the cornea; By creating determining that the movement of the marker is within an alert range indicating an unacceptable amount of movement of the marker; providing one or more notifications in response to determining that the movement of the marker is within the alert range; and a computer configured to perform the An ophthalmic surgery system comprising:

2. 2. The ophthalmic surgical system of claim 1, wherein the shape of the marker is selected from one or more of a polygon, a line, multiple lines, multiple lines intersecting at a single point, multiple lines intersecting at multiple points, a circle with a line, an ellipse, and one or more alphanumeric characters.

3. the surgical procedure is a lenticule extraction procedure; The computer Identifying that the marker is outside and adjacent to the outer boundary of the lenticule being extracted; creating the marker adjacent to the exterior of the outer boundary; The ophthalmic surgical system of claim 1 , configured as follows:

4. the surgical procedure is a flap creation procedure, The computer Identifying that the marker is outside and adjacent to the outer boundary of the flap to be created; creating the marker adjacent to the exterior of the outer boundary; The ophthalmic surgical system of claim 1 , configured as follows:

5. the surgical procedure is cataract removal surgery; The computer Identifying that the marker outlines a lens capsule of the eye; creating the marker outlining the lens capsule of the eye; The ophthalmic surgical system of claim 1 , configured as follows:

6. The ophthalmic surgery system of claim 1 , wherein a notification of the one or more notifications is an audio notification.

7. The ophthalmic surgery system of claim 1 , wherein a notification of the one or more notifications is a visual notification.

8. the alert range includes a plurality of non-overlapping subset alert ranges forming a partition of the alert range; the computer is configured to provide a plurality of notifications, each notification corresponding to a subset alert range, and a first notification relating to a first subset alert range being different from a second notification relating to a second subset alert range; The ophthalmic surgical system of claim 1 .

9. The ophthalmic surgery system of claim 8 , wherein the first notification has a first visual characteristic that is different from a second visual characteristic of the second notification.

10. The ophthalmic surgery system of claim 8 , wherein the first notification has a first audio characteristic that is different from a second audio characteristic of the second notification.

11. A subset alert range among the plurality of subset alert ranges is an end alert range, the computer is configured to terminate the surgical procedure in response to determining that the movement of the marker is within the termination alert range. The ophthalmic surgical system of claim 8 .

12. the ophthalmic surgical system further comprising a display screen; The computer displaying a notification icon on the display screen that includes a plurality of alert levels, at least one alert level corresponding to a subset alert range; visually highlighting the at least one alert level in response to determining that the movement of the marker is within the corresponding subset alert range; The ophthalmic surgical system of claim 8 , configured to:

13. The ophthalmic surgery system of claim 1 , wherein the computer is further configured to determine the alert range corresponding to the surgical procedure.

14. the surgical procedure is a lenticule extraction procedure; the alert range having a maximum allowable distance of 50 to 150 microns; The ophthalmic surgical system of claim 13.

15. the surgical procedure is a flap creation procedure, the alert range having a maximum allowable distance of 100 to 500 microns; The ophthalmic surgical system of claim 13.

16. the surgical procedure is cataract removal surgery; the alert range having a maximum allowable distance of 100 to 500 microns; The ophthalmic surgical system of claim 13.

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