Integrated surgical system and method for treatment within the iridocorneal angle of the eye

Abstract

To provide a system, device and method of a laser surgical treatment for glaucoma which can effectively reduce IOP and complete a single treatment.SOLUTION: Intraocular pressure in an eye is reduced by delivering each of a high resolution optical coherence tomography (OCT) beam and a high resolution laser beam through the cornea, and the anterior chamber into the irido-corneal angle along an angled beam path. The OCT beam provides OCT imaging for diagnostic purposes and surgery planning and monitoring, while the laser beam is configured to modify tissue. A volume of ocular tissue within an outflow pathway in the irido-corneal angle is modified to reduce a pathway resistance present in one or more of the trabecular meshwork, the Schlemm's canal, and the one or more collector channels by applying the laser beam to ocular tissue defining the volume to thereby cause photo-disruptive interaction with the ocular tissue to reduce the pathway resistance or create a new outflow pathway.SELECTED DRAWING: Figure 7

Description

[Technical Field]

[0001] The present disclosure relates generally to the field of medical devices and the treatment of ophthalmic diseases, and more particularly to systems, apparatus, and methods for the treatment of tissue, particularly ocular tissue structures within the iridocorneal angle of the eye, for the laser surgical treatment of glaucoma. [Background technology]

[0002] Before describing the different types of glaucoma and current diagnostic and treatment options, a brief review of the anatomy of the eye will be provided.

[0003] Eye Anatomy

[0004] Referring to Figures 1-3, the outer tissue layers of eye 1 include the sclera 2, which provides the structure and shape of the eye. In front of the sclera 2 is the cornea 3, which is composed of a transparent layer of tissue that allows light to enter the interior of the eye. Within eye 1 is the lens 4, which is connected to the eye by zonular fibers 5, which are connected to the ciliary body 6. Between the lens 4 and the cornea 3 is the anterior chamber 7, which contains a flowing, clear fluid called aqueous humor 8. Surrounding the periphery of the lens 4 is the iris 9, which forms the pupil around approximately the center of the lens. The posterior chamber 10 is located between the lens 4 and the retina 11. Light entering through the cornea 3 is optically focused through the lens 4.

[0005] Referring to FIG. 2 , the corneoscleral junction of the eye is the portion of the anterior chamber 7 at the intersection of the iris 9 and the sclera 2. The anatomical structure of the eye 1 at the corneoscleral junction includes the trabecular meshwork 12. The trabecular meshwork 12 is a fibrous network of tissue that surrounds the iris 9 within the eye 1. The base of the trabecular meshwork 12 and the edge of the iris 9 are attached together at a scleral promontory 14. The network of tissue layers that make up the trabecular meshwork 12 is porous and therefore provides an exit pathway for aqueous humor 8 to flow from the anterior chamber 7. This pathway may be referred to herein as the aqueous humor outflow pathway, aqueous outflow pathway, or simply the outflow pathway.

[0006] Referring to FIG. 3 , the pathways formed by the pores of the trabecular meshwork 12 connect a thin, porous tissue layer called the uvea 15, the sclerocorneal trabecular meshwork 16, and a set of juxtacanalicular tissues 17. The juxtacanalicular tissues 17 then abut a tissue called Schlemm's canal 18. Schlemm's canal 18 drains a mixture of aqueous humor 8 and blood from surrounding tissues through a system of collector channels 19 into the venous system. As shown in FIG. 2 , the vascular membrane of the eye, called the choroid 20, lies next to the sclera 2. A space called the suprachoroidal space 21 may exist between the choroid 20 and the suprachoroidal space 21. The entire circumferentially continuous area around the periphery of the wedge between the cornea 3 and the iris 9 is called the iridocorneal angle 13. The iridocorneal angle 13 is sometimes called the corneal angle of the eye, or simply the angle of the eye. All of the ocular tissues shown in FIG. 3 are considered to be within the corneal angle 13.

[0007] Referring to FIG. 4, two possible outflow pathways for aqueous humor 8 include the trabecular meshwork outflow pathway 40 and the uveoscleral outflow pathway 42. Aqueous humor 8 is generated by the ciliary body 6, flows from the posterior chamber 10 through the pupil into the anterior chamber 7, and then exits the eye through one or more of two different outflow pathways 40, 42. Approximately 90% of the aqueous humor 8 exits via the trabecular meshwork outflow pathway 40 by passing through the trabecular meshwork 12, entering Schlemm's canal 18, passing through one or more nerve plexuses of the collector channel 19, and then flowing through the drainage channel 41 and into the venous system. Any remaining aqueous humor 8 exits primarily through the uveoscleral outflow pathway 42. The uveoscleral outflow pathway 42 passes through the surface of the ciliary body 6 and the iris base to enter the suprachoroidal space 21 (shown in FIG. 2). Aqueous humor 8 can flow out of the suprachoroidal space 21 and exit the suprachoroidal space through the sclera 2.

[0008] The outflow of aqueous humor 8 through the trabecular outflow pathway 40 is pressure dependent, in that outflow increases as intraocular pressure increases, whereas the outflow of aqueous humor 8 through the uveoscleral outflow pathway 42 is pressure independent. Resistance to the outflow of aqueous humor 8 through the trabecular outflow pathway 40 can be linked to increased intraocular pressure in the eye, which is a well-known risk factor for glaucoma. Resistance through the trabecular outflow pathway 40 can be increased by collapse of Schlemm's canal 18 or the presence of dense collector channels 19.

[0009] Referring to Figure 5, as an optical system, the eye 1 is represented by an optical model described by an idealized, central, rotationally symmetric plane, an entrance pupil, an exit pupil, and six cardinal points (object and image space foci, first and second principal planes, and first and second nodal points). Angular directions for the human eye are often defined relative to the eye's optical axis 24, visual axis 26, pupillary axis 28, and line of sight 29. The optical axis 24 is an axis of symmetry, a line connecting the vertices of the idealized surface of the eye. The visual axis 26 connects the fovea 22 to the object through the first and second nodal points. The line of sight 29 connects the fovea to the object through the exit pupil and entrance pupil. The pupillary axis 28 is perpendicular to the posterior surface of the cornea 3 and is directed to the center of the entrance pupil. These eye axes differ from each other by only a few degrees and are within what are commonly referred to as the line of sight.

[0010] glaucoma

[0011] Glaucoma is a group of diseases that damage the optic nerve and can lead to decreased vision or blindness. It is the leading cause of irreversible blindness. Approximately 80 million people worldwide are estimated to have glaucoma, of which approximately 67 million are blind in both eyes. More than 27 million Americans over the age of 40 have glaucoma. Symptoms begin with loss of peripheral vision and can progress to blindness.

[0012] There are two forms of glaucoma: angle-closure glaucoma and open-angle glaucoma. Referring to Figures 1-4, in angle-closure glaucoma, a collapsed iris 9 within the anterior chamber 7 can obstruct and block the flow of aqueous humor 8. In open-angle glaucoma, a more common form of glaucoma, the permeability of ocular tissue can be affected by obstruction of tissue at the iridocorneal angle 13 along the trabecular outflow pathway 40 or by collapse of Schlemm's canal 18 or aqueous channels 19.

[0013] As mentioned above, elevated intraocular pressure (IOP) in the eye damages the optic nerve and is a well-recognized risk factor for glaucoma. However, not everyone with elevated IOP will develop glaucoma, and some people can develop glaucoma without elevated IOP. Nevertheless, it is desirable to reduce elevated IOP in the eye to reduce the risk of glaucoma.

[0014] Methods for diagnosing the eye condition in patients with glaucoma include visual acuity and visual field tests, mydriasis, tonometry (measurement of intraocular pressure in the eye), and pachymetry (measurement of corneal thickness). Visual acuity loss begins with a narrowing of the visual field and progresses to total blindness. Imaging methods include slit-lamp examination, observation of the iridocorneal angle with a gonioscope, and optical coherence tomography (OCT) imaging of the anterior chamber and retina.

[0015] Once diagnosed, several clinically proven treatments are available to control or reduce the intraocular pressure in the eye and slow or stop the progression of glaucoma. The most common treatments include 1) medications, such as eye drops or pills, 2) laser surgery, and 3) conventional surgery. Treatment usually begins with medication. However, the effectiveness of medications is often hindered by patient noncompliance. If medications are ineffective for a patient, laser surgery is typically the next treatment tried. Conventional surgery is invasive, carries higher risks than medications and laser surgery, and has a limited time window for effectiveness. Therefore, conventional surgery is usually reserved as a last resort for patients whose intraocular pressure cannot be controlled by medications or laser surgery.

[0016] laser surgery

[0017] 2, laser surgery for glaucoma targets the trabecular meshwork 12 to decrease the resistance to flow of aqueous humor 8 and increase aqueous humor outflow. Common laser treatments include argon laser trabeculoplasty (ALT), selective laser trabeculoplasty (SLT), and excimer laser trabeculotomy (ELT).

[0018] ALT is the first laser trabeculoplasty procedure. During the procedure, a 514 nm wavelength argon laser is applied to the trabecular meshwork 12 180° around the iridocorneal angle 13. The argon laser induces thermal interaction with the ocular tissue, thereby creating openings in the trabecular meshwork 12. However, ALT causes scarring of the ocular tissue, followed by an inflammatory response and tissue healing, which can eventually close the openings in the trabecular meshwork 12 created by ALT treatment, thereby reducing the effectiveness of the treatment. Furthermore, due to this scarring, ALT therapy generally cannot be repeated.

[0019] SLT is designed to reduce scarring by selectively targeting pigment in the trabecular meshwork 12 and reducing the amount of heat delivered to surrounding ocular tissue. During the procedure, a 532 nm wavelength solid-state laser is applied to the trabecular meshwork 12 180–360° around the iridocorneal angle 13, creating an opening in the trabecular meshwork 12. SLT treatments can be repeated, but subsequent treatments are less effective at reducing IOP.

[0020] ELT uses a 308 nm wavelength ultraviolet (UV) excimer laser and its non-thermal interaction with ocular tissue to treat the trabecular meshwork 12 without initiating a healing response. Therefore, the IOP reduction effect is longer-lasting. However, because the laser's UV light cannot penetrate deep into the eye, the laser light is delivered to the trabecular meshwork 12 via an optical fiber inserted into the eye 1 through an opening, bringing the fiber into contact with the trabecular meshwork. This procedure is highly invasive and is generally performed at the same time as cataract treatment when the eye has already been surgically opened. Like ALT and SLT, ELT does not allow for control of the amount of IOP reduction.

[0021] None of these existing laser treatments are ideal for treating glaucoma. Therefore, there is a need for systems, devices, and methods for the laser surgical treatment of glaucoma that effectively reduce IOP without causing significant tissue scarring, thereby allowing treatment to be completed in a single procedure, which can be repeated later if necessary. Summary of the Invention

[0022] The present disclosure relates to a method for reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an iridocorneal angle with an aqueous humor outflow pathway formed by a trabecular meshwork, Schlemm's canal, and one or more collector channels branching from the Schlemm's canal. The method includes delivering an optical coherence tomography (OCT) beam and a laser beam, respectively, through the cornea and the anterior chamber into the iridocorneal angle. The method further includes modifying the volume of ocular tissue within the outflow pathway to reduce pathway resistance present in one or more of the trabecular meshwork, Schlemm's canal, and one or more collector channels by applying the laser beam to the ocular tissue to define a volume, thereby causing photodisruptive interaction with the ocular tissue to reduce pathway resistance or create a new outflow pathway.

[0023] In one aspect of this method, the OCT beam and the laser beam are each delivered to the iridocorneal angle by directing each beam into a first optical subsystem including a window coupled to the cornea and an output lens coupled to the window. The eye has a natural line of sight, and the first optical subsystem is characterized by a first optical axis that is substantially aligned with the line of sight when the first optical system is coupled to the eye. Distortion and refraction of the beams en route to the iridocorneal angle are counteracted by directing each beam into the first optical subsystem along a second optical axis offset from the first optical axis by an angle α. The output lens has a convex surface, and distortion and refraction are further counteracted by directing each beam into the convex surface of the output lens at an angle β relative to a surface normal to the convex surface.

[0024] In a further embodiment of the method, the OCT beam and the laser beam may be collinearly or non-collinearly directed into the first optical subsystem. The OCT beam is configured to provide high-resolution images, and the laser beam is configured to effect precise tissue modification. To this end, each beam may have substantially equal resolution, on the order of about 5 micrometers. The laser beam is configured to initiate destructive interactions with ocular tissue to create open channels through the trabecular meshwork leading to the anterior chamber and Schlemm's canal. To this end, the laser beam may have a wavelength between 330 nanometers and 2000 nanometers and may be delivered as multiple laser pulses having pulse durations between 20 femtoseconds and 1 nanosecond.

[0025] The present disclosure also relates to an integrated surgical system for reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an iridocorneal angle with an aqueous humor outflow pathway formed by a trabecular meshwork, a Schlemm's canal, and one or more collecting channels branching from the Schlemm's canal. The system includes a first optical subsystem, a second optical subsystem, and a control system. The first optical subsystem includes a window configured to be coupled to the cornea and an output lens configured to be coupled to the window. The second optical subsystem includes an OCT imaging device configured to output an OCT beam, a laser source configured to output a laser beam, and a plurality of components configured to perform one or more of conditioning, scanning, combining, and directing the OCT beam and the laser beam.

[0026] A control system is coupled to the second optical subsystem and configured to command the OCT imaging device to output an OCT beam and the laser source to output a laser beam for delivery through the cornea and the anterior chamber into the iridocorneal angle. The control system is also configured to command the laser source to modify the volume of ocular tissue in the outflow pathway to reduce pathway resistance present in one or more of the trabecular meshwork, Schlemm's canal, and one or more collector channels by applying the laser beam to the ocular tissue to define a volume, thereby causing photodestructive interaction with the ocular tissue to reduce pathway resistance or create a new outflow pathway.

[0027] In one embodiment of the system, the second optical subsystem is configured to direct the OCT beam and the laser beam toward the first optical subsystem. In a further embodiment, the eye is characterized by a line of sight and the first optical subsystem is characterized by a first optical axis, and the first optical subsystem is adapted to be coupled to the eye such that the first optical axis is substantially aligned with the line of sight. The OCT beam and the laser beam are directed toward the first optical subsystem along a second optical axis offset from the first optical axis by an angle α. In a further embodiment, the output lens has a convex surface, and the OCT beam and the laser beam are directed into the convex surface of the output lens at an angle β relative to a surface normal to the convex surface.

[0028] In a further aspect, the control system is further configured to instruct the OCT imaging device to acquire a diagnostic OCT image of the portion of the iridocorneal angle prior to ocular tissue modification. Based on this image, the control system determines a volume of ocular tissue to modify based on the OCT image. In a detailed aspect, the control system is configured to determine the volume of ocular tissue to modify by determining a density distribution of the collector channels around at least a portion of the circumference of Schlemm's canal, identifying regions of Schlemm's canal having a density above a threshold criterion, and including a vicinity of the identified region in the volume of ocular tissue to modify.

[0029] It is understood that other aspects of the apparatus and method will become apparent to those skilled in the art from the following detailed description, in which various aspects of the apparatus and method are shown and described by way of illustration. As will be understood, these aspects may be embodied in other different forms, and several details thereof may be modified in various other aspects. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not as restrictive.

[0030] Various aspects of systems, apparatus and methods are presented in the following detailed description, by way of example and not by way of limitation, with reference to the accompanying drawings. [Brief explanation of the drawings]

[0031] [Figure 1] 1 is a schematic cross-sectional view of the human eye and its internal anatomical structures. [Figure 2] FIG. 2 is a schematic cross-sectional view showing the iridocorneal angle of the eye of FIG. 1. [Figure 3] 3 is a schematic cross-sectional view detailing the anatomy of the iridocorneal angle of FIG. 2, including the trabecular meshwork, Schlemm's canal, and one or more water collection channels branching off from Schlemm's canal. [Figure 4] 4 is a schematic cross-sectional view showing various outflow pathways of aqueous humor through the trabecular meshwork, Schlemm's canal, and collector channels of FIG. 3. [Figure 5] 1 is a schematic cross-sectional view of a human eye showing the various axes associated with the eye; [Figure 6] 1 is a schematic cross-sectional view illustrating angled optical paths along which one or more light rays may access the iridocorneal angle of the eye. [Figure 7] FIG. 1 is a block diagram illustrating an integrated surgical system for non-invasive glaucoma surgery, including a control system, a femtosecond laser source, an OCT imaging device, a microscope, a beam conditioner and scanner, a beam combiner, a focusing objective, and a patient-interface. [Figure 8] FIG. 8 is a detailed block diagram illustrating the integrated surgical system of FIG. 7. [Figure 9a]8 is a schematic diagram showing a focusing objective of the integrated surgical system of FIG. 7 coupled to a patient contacting surface of the integrated surgical system of FIG. 7. [Figure 9b] 8 is a schematic diagram showing the focusing objective of the integrated surgical system of FIG. 7 separated from the patient-contacting surface of the integrated surgical system of FIG. 7. [Figure 9c] FIG. 9c is a schematic diagram showing the focusing objective and patient contact surface components included in FIGS. 9a and 9b. [Figure 10a] FIG. 9 is a schematic diagram showing the components of the integrated surgical system of FIGS. 7 and 8 functionally arranged to form a first optical system and a second optical subsystem that provide access to the iridocorneal angle along the angled optical path of FIG. 6. [Figure 10b] FIG. 9 is a schematic diagram showing the components of the integrated surgical system of FIGS. 7 and 8 functionally arranged to form a first optical system and a second optical subsystem that provide access to the iridocorneal angle along the angled optical path of FIG. 6. [Figure 10c] FIG. 10C is a schematic diagram showing the beam passing through the first optical subsystem of FIGS. 10a and 10b and entering the eye. [Figure 11a] FIG. 8 is a schematic diagram illustrating the surgical volume determined by the integrated surgical system of FIG. 7. [Figure 11b] FIG. 1 is a schematic diagram illustrating outflow pathways formed in a surgical volume by an integrated surgical system. [Figure 12] 1 is a flowchart illustrating a method of modifying ocular tissue at the iridocorneal angle of an eye. [Figure 13] 7 is a flowchart illustrating a method of delivering light to the iridocorneal angle of the eye along the angled light path of FIG. 6. DETAILED DESCRIPTION OF THE INVENTION

[0032] Disclosed herein are systems, devices, and methods for safely and effectively reducing intraocular pressure (IOP) in an eye to treat or reduce the risk of glaucoma. The systems, devices, and methods provide access to the iridocorneal angle of the eye and integrate laser surgical techniques with high-resolution diagnostic imaging to accurately diagnose, locate, and treat abnormal ocular tissue conditions within the iridocorneal angle that can cause elevated IOP.

[0033] The integrated surgical system disclosed herein is configured to reduce intraocular pressure in an eye having a cornea, an anterior chamber, and an iridocorneal angle with an aqueous humor outflow pathway formed by a trabecular meshwork, a Schlemm's canal, and one or more collecting channels branching from the Schlemm's canal. The integrated surgical system also includes a first optical subsystem and a second optical subsystem. The first optical subsystem includes a window configured to be coupled to the cornea and an output lens configured to be coupled to the window. The second optical subsystem includes an optical coherence tomography (OCT) imaging device configured to output an OCT beam, a laser source configured to output a laser beam, and multiple components, such as lenses and mirrors, configured to condition, combine, and direct the OCT beam and the laser beam toward the first optical subsystem.

[0034] The integrated surgical system also includes a control system coupled to the OCT imaging device, the laser source, and the second optical subsystem. The controller is configured to direct the OCT imaging device to output an OCT beam and the laser source to output a laser beam for delivery through the cornea and the anterior chamber into the iridocorneal angle. In one configuration, the control system controls the second optical subsystem such that the OCT beam and the laser beam are directed into the first optical subsystem along a second optical axis that is offset from the first optical axis and extends along an angled path 30 into the iridocorneal angle.

[0035] Directing the OCT beam and laser beam along the same second optical axis into the iridocorneal angle of the eye is beneficial in that it allows for accurate assessment of the condition and directly applies the results to treatment planning and surgery in a single clinical setting. Furthermore, combining OCT imaging and laser treatment allows for precise targeting of ocular tissue, a feasible approach not available with any existing surgical system or method. The surgical precision provided by the integrated surgical system allows for only microscopic target tissue to be affected, leaving surrounding tissue unharmed. The microscopic size of the affected ocular tissue to be treated in the iridocorneal angle of the eye ranges from a few micrometers to a few hundred micrometers. For example, referring to Figures 2 and 3, the cross-sectional size of a normal Schlemm's canal 18 is an oval shape measuring tens of micrometers by a few hundred micrometers. The diameter of the collector channels 19 and veins is tens of micrometers. The thickness of the juxtacanalicular tissue 17 is several micrometers, and the thickness of the trabecular meshwork 12 is approximately 100 micrometers.

[0036] The control system of the integrated surgical system is further configured to command the laser source to modify the volume of ocular tissue in the outflow pathway to reduce pathway resistance present in one or more of the trabecular meshwork, Schlemm's canal, and one or more collector channels by applying the laser beam to the ocular tissue to define a volume, thereby causing photo-disruptive interaction with the ocular tissue to reduce pathway resistance or create a new outflow pathway.

[0037] The laser source may be a femtosecond laser, which provides a non-thermal photodisruptive interaction with ocular tissue, avoiding thermal damage to surrounding tissue. Furthermore, unlike other surgical methods, femtosecond laser treatment avoids an open incision through the eye, allowing for a non-invasive treatment. Instead of performing treatment in a sterile operating room, the non-invasive treatment can be performed in a non-sterile outpatient facility.

[0038] Additional imaging components may be included in the integrated surgical system to provide direct visual observation of the iridocorneal angle along a visual observation angle. For example, a microscope or imaging camera may be included to assist the surgeon in the process of docking the eye to the patient-contacting surface or immobilization device, positioning the ocular tissues of the eye, and observing the progress of the surgery. The visual observation angle may also pass through the cornea 3 and anterior chamber 7 along an angled optical path 30 to the iridocorneal angle 13.

[0039] Images from the OCT imaging device, which provides visual observation, and additional imaging components, such as a microscope, are combined on a display device such as a computer monitor. The various images can be registered and overlaid on a single window, enhanced, processed, and differentiated using false colors for easier understanding. Specific features can be computationally recognized by a computer processor, and image recognition and segmentation algorithms can enhance, highlight, and mark the images for display. Treatment plan geometry can also be registered with the imaging information on the display device and marked with geometric, numeric, and textual information. The same display can also be used for user input of numeric, textual, and geometric properties via keyboard, mouse, cursor, touchscreen, voice, or other user interface devices for feature selection, highlighting, and marking, and for entering location information.

[0040] OCT Imaging

[0041] The primary imaging component of the integrated surgical system disclosed herein is an optical coherence tomography (OCT) imaging device. OCT technology may be used to diagnose, locate, and guide laser surgery directed at the iridocorneal angle of the eye. For example, with reference to Figures 1-3, OCT imaging may be used to determine the structural and geometrical condition of the anterior chamber 7 to assess potential obstruction of the trabecular outflow pathway 40 and determine the accessibility of ocular tissue for treatment. As discussed above, a collapsed iris 9 in the anterior chamber 7 can impede or block the flow of aqueous humor 8, resulting in angle-closure glaucoma. In the case of open-angle glaucoma, where the macroscopic geometry of the angle is normal, the permeability of ocular tissue can be affected by obstruction of tissue along the trabecular outflow pathway 40 or by collapse of Schlemm's canal 18 or the collector channels 19.

[0042] OCT imaging can provide the spatial resolution, tissue penetration, and contrast necessary to resolve microscopic details of ocular tissue. When scanned, OCT imaging can provide two-dimensional (2D) cross-sectional images of ocular tissue. As another aspect of the integrated surgical system, the 2D cross-sectional images may be processed and analyzed to determine the size, shape, and location of ocular structures for surgical targeting. While it is also possible to reconstruct a three-dimensional (3D) image from multiple 2D cross-sectional images, this is often unnecessary. Acquisition, analysis, and display of 2D images can be faster and still provide all the information necessary for accurate surgical targeting.

[0043] Optical Coherence Tomography (OCT) is an imaging modality capable of providing high-resolution images of materials and tissues. Imaging is based on the reconstruction of spatial information of a sample from spectral information of scattered light from within the sample. Spectral information is extracted by using an interferometric technique that compares the spectrum of light entering the sample with the spectrum of light scattered from the sample. The spectral information along the direction of light propagation within the sample is then converted to spatial information along the same axis using a Fourier transform. Information transverse to the OCT beam propagation is typically collected by scanning the beam laterally and repeatedly interrogating axially during the scan. 2D and 3D images of the sample can be acquired in this manner. Image acquisition is faster when the interferometer is not mechanically scanned in time-domain OCT, but interference from a wide spectrum of light is simultaneously recorded; this implementation is called spectral-domain OCT. Faster image acquisition can also be obtained by rapidly scanning the wavelength of light from a wavelength-scanning laser, in a configuration called swept-wavelength OCT.

[0044] The axial spatial resolution limit of OCT is inversely proportional to the bandwidth of the probe light used. Both spectral-domain and swept-wavelength OCT are capable of axial spatial resolutions of less than 5 micrometers (μm) with sufficiently wide bandwidths of 100 nanometers (nm) or greater. In spectral-domain OCT, spectral interference patterns are simultaneously recorded on a multichannel detector such as a charge-coupled device (CCD) or complementary metal-oxide semiconductor (CMOS) camera, while in swept-wavelength OCT, interference patterns are recorded in successive time steps using a high-speed optical detector and electronic digitizer. While swept-wavelength OCT has the advantage of acquisition speed, both types of systems are rapidly evolving and improving, and their resolution and speed are sufficient for the purposes of the integrated surgical system disclosed herein. Standalone OCT systems and OEM components are currently commercially available from several specialty vendors, including Optovue Inc., Fremont, CA., Topcon Medical Systems, Oakland, NJ, Carl Zeiss Meditec AG, Germany, Nidek, Aichi, Japan, Thorlabs, Newton, NJ, Santec, Aichi, Japan, Axsun, Billercia, MA, and other specialty vendors.

[0045] Femtosecond Laser Source

[0046] The preferred surgical component of the integrated surgical system disclosed herein is a femtosecond laser. Femtosecond lasers provide highly localized, non-thermal photodisruptive laser-tissue interaction with minimal collateral damage to surrounding ocular tissue. Laser photodisruptive interaction is utilized in optically transparent tissue. The primary mechanism of laser energy deposition in ocular tissue is not absorption, but rather a highly nonlinear multiphoton process. This process is active only at the focal point of a pulsed laser with high peak intensity. Regions traversed by the beam but not the focal point are unaffected by the laser. Therefore, the interaction region with ocular tissue is highly localized both transversely and axially by the laser beam. The process can also be used in weakly absorbing or scattering tissue. While femtosecond lasers with photodisruptive interaction have been successfully used in ophthalmic surgical systems and commercialized in other ophthalmic laser procedures, none have been used in integrated surgical systems to access the iridocorneal angle.

[0047] In known refractive procedures, femtosecond lasers are used to create corneal flaps, pockets, tunnels, arcuate incisions, lenticular incisions, and partial- or full-thickness corneal incisions for keratoplasty. For cataract procedures, the laser creates circular cuts in the eye's lens capsule for capsulotomy and various patterns of incisions in the lens that break up the interior of the lens into smaller fragments for easier extraction. Entry incisions through the cornea open the eye for access with manual surgical devices and for the insertion of phacoemulsification and intraocular lens insertion devices. Several companies are commercializing such surgical devices, notably the Intralase system currently available from Johnson & Johnson Vision, Santa Ana, CA; the LenSx and Wavelight systems from Alcon, Fort Worth, TX; Bausch and Lomb, Rochester, NY; Carl Zeiss Meditec AG, Germany; Ziemer, Port, Switzerland; and other surgical systems from LensAR, Orlando, FL.

[0048] These existing systems were developed for their specific applications, surgery on the cornea, as well as the lens and its capsule, and are unable to perform surgery on the iridocorneal angle 13 for several reasons. First, the iridocorneal angle 13 is inaccessible to these surgical laser systems because it is too far away in the periphery and outside the surgical range of these systems. Second, the angle of the laser beam from these systems along the optical axis 24 to the eye is not adequate to reach the iridocorneal angle 13, where there is significant scattering and optical distortion at the applied wavelengths. Third, any imaging capabilities these systems may have do not have the accessibility, penetration depth, and resolution to image tissue along the trabecular outflow pathway 40 with sufficient detail and contrast.

[0049] The integrated surgical system disclosed herein provides clear access to the iridocorneal angle 13 along an angled optical path 30. Tissues, such as the cornea 3 and the aqueous humor 8 in the anterior chamber 7, are transparent to wavelengths between approximately 400 nm and 2500 nm along this angled optical path 30, allowing femtosecond lasers operating in this range to be used. Such mode-locked lasers operate at their fundamental wavelengths with titanium, neodymium, or ytterbium active materials. Nonlinear frequency conversion techniques, frequency doubling, tripling, sum, and difference frequency mixing techniques, and optical parameter conversion known in the art can convert the fundamental wavelength of these lasers to virtually any wavelength within the aforementioned corneal transparency wavelength range.

[0050] Existing ophthalmic surgical systems that apply lasers with pulse durations longer than 1 ns have higher photodisruption threshold energies, require higher pulse energies, and have larger photodisruptive interaction areas, resulting in compromised surgical precision. However, when treating the iridocorneal angle 13, greater surgical precision is required. To this end, an integrated surgical system may be configured to apply a laser with a pulse duration of 10 femtoseconds (fs) to 1 nanosecond (ns) to generate photodisruptive interactions between the laser beam and the ocular tissue of the iridocorneal angle 13. While lasers with pulse durations shorter than 10 fs are available, such laser sources are more complex and expensive. Lasers with the desired characteristics described, e.g., pulse durations of 10 femtoseconds (fs) to 1 nanosecond (ns), are commercially available from several specialty vendors, such as Newport, Irvine, CA; Coherent, Santa Clara, CA; Amplitude Systems, Pessac, France; NKT Photonics, Birkerod, Denmark, and other specialty vendors.

[0051] Iridocorneal angle access

[0052] An important feature provided by the integrated surgical system is access to the target eye tissue at the iridocorneal angle 13. Referring to FIG. 6 , the iridocorneal angle 13 of the eye may be accessed via the integrated surgical system along an angled optical path 30 that passes through the cornea 3 and through the aqueous humor 8 in the anterior chamber 7. For example, one or more of a diagnostic imaging beam, such as an OCT beam and / or a visual observation beam, and a laser beam, may access the iridocorneal angle 13 of the eye along the angled optical path 30.

[0053] The optical system disclosed herein is configured to direct light rays along an angled optical path 30 to the iridocorneal angle 13 of the eye. The optical system includes a first optical subsystem and a second optical subsystem. The first optical subsystem has a refractive index n wThe first optical subsystem also includes a window formed of a material having a refractive index n x The exit lens also has opposing concave and convex surfaces. The concave surface of the exit lens is configured to mate with the convex surface of the window to define a first optical axis extending through the window and the exit lens. The concave surface of the window is configured to mate with the first optical axis substantially aligned with the eye's direction of vision, with a refractive index n c The cornea is configured to be releasably coupled to the cornea of ​​an eye having

[0054] The second optical subsystem is configured to output a light beam, e.g., an OCT beam or a laser beam. The optical system is configured such that the light beam is directed to be incident on the convex surface of the output lens along the second optical axis at an angle α offset from the first optical axis. The respective geometries of the output lens and window and their respective refractive indices n x and n w is configured to counteract refraction and distortion of the light rays by bending the light rays so that they are directed through the cornea 3 of the eye toward the iridocorneal angle 13. More specifically, the first optical system bends the light rays so that they exit the first optical subsystem and enter the cornea 3 at the appropriate angle to travel through the cornea and aqueous humor 8 toward the iridocorneal angle 13 in a direction along an angled optical path 30.

[0055] Accessing the iridocorneal angle 13 along an angled optical path 30 provides several advantages. The advantage of this angled optical path 30 to the iridocorneal angle 13 is that the OCT and laser beams pass through nearly transparent tissue, such as the cornea 3 and the aqueous humor 8 in the anterior chamber 7. Therefore, scattering of these beams by tissue is not significant. For OCT imaging, this allows for the use of shorter wavelengths, less than approximately 1 micrometer, for OCT to achieve higher spatial resolution. An additional advantage of the angled optical path 30 to the iridocorneal angle 13 through the cornea 3 and the anterior chamber 7 is that direct laser or OCT beam light is avoided from irradiating the retina 11. As a result, higher average power laser and OCT light can be used for imaging and surgery, resulting in faster procedures and less tissue movement during the procedure.

[0056] Another important feature provided by the integrated surgical system is access to target ocular tissue within the iridocorneal angle 13 in a manner that reduces beam discontinuities. To this end, the window and exit lens components of the first optical subsystem are configured to reduce discontinuities in optical refractive index between the cornea 3 and adjacent materials, facilitating light entry through the cornea at acute angles.

[0057] Having thus described the integrated surgical system and some of its features and advantages, a more detailed description of the system and its components is provided below.

[0058] Integrated Surgical System

[0059] 7, an integrated surgical system 1000 for non-invasive glaucoma surgery includes a control system 100, a surgical component 200, a first imaging component 300, and an optional second imaging component 400. In the embodiment of FIG. 7, the surgical component 200 is a femtosecond laser source, the first imaging component 300 is an OCT imaging device, and the optional second imaging component 400 is a visual observation device, such as a microscope, for direct or camera-assisted viewing. Other components of the integrated surgical system 1000 include a beam conditioner and scanner 500, a beam combiner 600, a focusing objective 700, and a patient-contacting surface 800.

[0060] The control system 100 may be a single computer and / or multiple interconnected computers configured to control the hardware and software components of the other components of the integrated surgical system 1000. The user-interface 110 of the control system 100 accepts instructions from a user and displays information for the user's viewing. User-input information and commands include, but are not limited to, system commands, motion control for docking the patient's eye with the system, selection of a pre-programmed or live-generated surgical plan, navigating through menu selections, setting surgical parameters, responding to system messages, determining and accepting the surgical plan, and commands to execute the surgical plan. System outputs to the user include, but are not limited to, display of system parameters and messages, display of an image of the eye, a graphical, numerical, and textual representation of the surgical plan, and the progress of the surgery.

[0061] The control system 100 is connected to the other components 200, 300, 400, 500 of the integrated surgical system 1000. Control signals from the control system 100 to the femtosecond laser source 200 function to control the internal and external operating parameters of the laser source, including, for example, power, repetition rate, and beam shutter. Control signals from the control system 100 to the OCT imaging device 300 function to control OCT beam scanning parameters, as well as the acquisition, analysis, and display of OCT images.

[0062] The laser beam 201 from the femtosecond laser source 200 and the OCT beam 301 from the OCT imaging device 300 are directed toward the beam conditioner and scanner 500 unit. Different types of scanners can be used to scan the laser beam 201 and the OCT beam 301. For scanning the beams 201 and 301 in the transverse direction, galvanometer scanners for angular scanning are available, for example, from Cambridge Technology, Bedford, MA, and Scanlab, Munich, Germany. To optimize the scanning speed, the scanner mirrors are typically sized to the smallest size that still accommodates the required scan angle and beam numerical aperture at the target position. The ideal beam size in the scanner is typically different from the beam size of the laser beam 201 or the OCT beam 301 and the size required at the entrance of the focusing objective lens 700. Therefore, beam conditioners can be applied before, after, or between the individual scanners. The beam conditioner and scanner 500 includes scanners that scan the beams in the transverse and axial directions. Axial scanning changes the depth of focus in the target region and can be accomplished by moving a lens axially in the optical path using a servo or stepper motor.

[0063] The laser beam 201 and the OCT beam 301 are combined using a dichroic, polarizing, or other type of beam combiner 600 to reach a common target or surgical volume in the eye. In an integrated surgical system 1000 with a femtosecond laser source 200, an OCT imaging device 300, and a visual observation device 400, the individual beams 201, 301, and 401 for each of these components may be individually optimized and may be collinear or non-collinear with respect to each other. The beam combiner 600 uses a dichroic or polarizing beam splitter to split and recombine light of different wavelengths and / or polarizations. The beam combiner 600 may also include optical components that change certain parameters of the individual beams 201, 301, and 401, such as beam size, beam angle, and divergence. Integrated visual illumination, observation, or imaging devices assist the surgeon in docking the eye to the system and identifying the surgical position.

[0064] To resolve ocular tissue structures in sufficient detail, the imaging components 300, 400 of the integrated surgical system 1000 may provide OCT and visual observation beams with a spatial resolution of several micrometers. The resolution of the OCT beam is the spatial dimension of the smallest feature that can be recognized in an OCT image. It is primarily determined by the wavelength and spectral bandwidth of the OCT source, the quality of the optics that deliver the OCT beam to the target location in the eye, the numerical aperture of the OCT beam, and the spatial resolution of the OCT imaging device at the target location. In one embodiment, the OCT beam of the integrated surgical system has a resolution of 5 μm or less.

[0065] Similarly, the surgical laser beam provided by the femtosecond laser source 200 may be delivered to a target location with an accuracy of a few micrometers. The resolution of a laser beam is the spatial dimension of the smallest feature at the target location that can be modified by the laser beam without significantly affecting surrounding ocular tissue. It is primarily determined by the wavelength of the laser beam, the quality of the optics delivering the laser beam to the target location in the eye, the numerical aperture of the laser beam, the energy of the laser pulses in the laser beam, and the spatial resolution of the laser scanning system at the target location. Additionally, to minimize the laser's threshold energy for photodisruptive interaction, the size of the laser spot should be approximately 5 μm or less.

[0066] The visual observation beam 401 is acquired by the visual observation device 400 using fixed non-scanning optics, while the OCT beam 301 of the OCT imaging apparatus 300 is scanned laterally in two transverse directions. The laser beam 201 of the femtosecond laser source 200 is scanned in two transverse directions, and the depth of focus is scanned axially.

[0067] In actual embodiments, beam conditioning, scanning, and optical path combining are specific functions performed on the laser, OCT, and visual observation optical beams. These functions may be performed in a different order than shown in FIG. 7 . The specific optical hardware that manipulates the beams to achieve these functions can have multiple configurations for how the optical hardware is arranged. They can be arranged to manipulate individual optical beams separately, or in other embodiments, a single component may combine functions and manipulate different beams. For example, a single set of scanners can scan both the laser beam 201 and the OCT beam 301. In this case, separate beam conditioners set the beam parameters for the laser beam 201 and the OCT beam 301, and then a beam combiner combines the two beams for a single set of scanners to scan the beams. While many combinations of optical hardware configurations are possible for an integrated surgical system, the following sections provide detailed descriptions of example configurations.

[0068] Beam Delivery

[0069] In the following description, the term "beam" may refer to one of a laser beam, an OCT beam, or a visual observation beam, depending on the context. A combined beam refers to two or more of a laser beam, an OCT beam, or a visual observation beam that are collinearly or nonlinearly combined. Exemplary combined beams include a combined OCT / laser beam, which is a collinear or noncollinear combination of an OCT beam and a laser beam, and a combined OCT / laser / visual beam, which is a collinear or noncollinear combination of an OCT beam, a laser beam, and a visual beam. In the case of a collinearly combined beam, different beams may be combined using a dichroic or polarizing beam splitter and delivered along the same optical path by multiplexing the different beams. In the case of a noncollinearly combined beam, different beams are delivered simultaneously along different optical paths separated spatially or by an angle therebetween. In the following description, any of the above beams or combined beams may be collectively referred to as a light ray. The terms distal and proximal may be used to designate the direction of beam travel or the physical location of components relative to one another within an integrated surgical system. The distal direction refers to the direction toward the eye, and thus the OCT beam output by the OCT beam imaging device travels distally toward the eye. The proximal direction refers to the direction away from the eye, and thus the OCT return beam from the eye travels proximally toward the OCT imaging device.

[0070] Referring to FIG. 8 , an example integrated surgical system is configured to deliver a laser beam 201 and an OCT beam 301, respectively, distally toward an eye 1 and receive an OCT return beam and a visual observation beam 401, respectively, returning from the eye 1. Regarding laser beam delivery, the laser beam 201 output by the femtosecond laser source 200 passes through a beam conditioner 510, where basic beam parameters, such as beam size and divergence, are set. The beam conditioner 510 may also include additional functions for setting the beam power or pulse energy, and may block the beam to turn its functions on and off. After exiting the beam conditioner 510, the laser beam 210 enters an axial scan lens 520. The axial scan lens 520 may include a single lens or a group of lenses and is movable in an axial direction 522 by a servo motor, a stepper motor, or other control mechanism. Axial movement of the axial scan lens 520 in the axial direction 522 changes the axial distance of the focal point of the laser beam 210 at the focal point.

[0071] According to certain embodiments of the integrated surgical system, the intermediate focus 722 is set to be within and scannable within a conjugate surgical volume 721 that is the image conjugate of the surgical volume 720, as determined by the focusing objective 700. The surgical volume 720 is the spatial extent of the region of interest within the eye where diagnostic imaging and surgery are performed. In the case of glaucoma surgery, the surgical volume 720 is near the iridocorneal angle 13 of the eye.

[0072] A pair of transverse scan mirrors 530, 532 rotated by galvanometer scanners scans the laser beam 201 in two essentially orthogonal transverse directions, e.g., the x and y directions. The laser beam 201 is then directed towards a dichroic or polarizing beam splitter 540, where it is reflected towards a beam combining mirror 601 configured to combine the laser beam 201 with the OCT beam 301.

[0073] Regarding OCT beam delivery, the OCT beam 301 output by the OCT imaging device 300 passes through a beam conditioner 511, an axially movable focusing lens 521, and a transverse scanner consisting of scan mirrors 531 and 533. The focusing lens 521 is used to set the focal position of the OCT beam in the conjugate surgical volume 721 and the actual surgical volume 720. The focusing lens 521 is not scanned to obtain the OCT axial scan. The axial spatial information of the OCT image is obtained by Fourier transforming the spectra of the OCT return beam 301 and reference beam 302 recombined by interferometry. However, if the surgical volume 720 is divided into several axial segments, the focusing lens 521 can be used to readjust the focus. In this way, the optimal imaging spatial resolution of the OCT beam image can be extended beyond the Rayleigh range of the OCT signal beam, at the expense of the time spent scanning at multiple ranges.

[0074] Traveling distally toward eye 1 and after scan mirrors 531 and 533, OCT beam 301 is combined with laser beam 201 by beam combiner mirror 601. The OCT beam 301 and laser beam 201 components of combined laser / OCT beam 550 are multiplexed, travel in the same direction, and are focused at intermediate focus 722 within conjugate surgical volume 721. After being focused in conjugate surgical volume 721, combined laser / OCT beam 550 propagates to second beam combining mirror 602, where it is combined with visual observation beam 401 to form combined laser / OCT / visual beam 701.

[0075] The distally traveling combined laser / OCT / visual beam 701 then passes through focusing objective 700 and patient-contacting window 801, which reimages the intermediate focus 722 of the laser beam in conjugate surgical volume 721 to a focus in surgical volume 720. Focusing objective 700 reimages intermediate focus 722 through patient-contacting window 801 onto the ocular tissue in surgical volume 720.

[0076] The scattered OCT return beam 301 from the ocular tissue travels proximally back to the OCT imaging device 300 along the same path as described above in reverse. The reference beam 302 from the OCT imaging device 300 passes through a reference delay path and returns to the OCT imaging device via a movable mirror 330. The reference beam 302 is interferometrically combined with the OCT return beam 301 as it returns within the OCT imaging device 300. The delay of the reference delay path can be adjusted by moving the movable mirror 330 to equalize the optical paths of the OCT return beam 301 and the reference beam 302. For best axial OCT resolution, the OCT return beam 301 and the reference beam 302 are also dispersion compensated to equalize the group velocity dispersion in the two arms of the OCT interferometer.

[0077] As the combined laser / OCT / visual beam 701 is delivered through the cornea 3 and anterior chamber 7, the combined beam passes through the posterior and anterior surfaces of the cornea at acute angles away from normal incidence. These surfaces in the path of the combined laser / OCT / visual beam 701 create excessive astigmatism and coma that must be compensated for.

[0078] 9a and 9b, in one embodiment of the integrated surgical system 1000, the optical components of the focusing objective 700 and the patient-contacting surface 800 are configured to minimize spatial and chromatic aberrations and distortions. Figure 9a shows the configuration when the eyes 1, the patient-contacting surface 800, and the focusing objective 700 are all coupled together. Figure 9b shows the configuration when the eyes 1, the patient-contacting surface 800, and the focusing objective 700 are all separated from each other.

[0079] The patient-contacting surface 800 optically and physically couples the eye 1 to the focusing objective 700, which in turn optically couples to the other optical components of the integrated surgical system 1000. The patient-contacting surface 800 serves multiple functions: it immobilizes the eye relative to the components of the integrated surgical system, creates a sterile barrier between the components and the patient, and provides optical access between the eye and the instruments. The patient-contacting surface 800 is a sterile, single-use, disposable device that is detachably coupled to the eye 1 and the focusing objective 700 of the integrated surgical system 1000.

[0080] The patient-contacting surface 800 includes a window 801 having a concave surface 812 facing the eye and a convex surface 813 facing the objective lens opposite the concave surface. Window 801 therefore has a meniscus shape. Referring to FIG. 9c, concave surface 812 has a radius of curvature r e and the convex surface 813 has a radius of curvature r w The concave surface 812 is configured to couple to the eye by direct contact or by an index-matching material, liquid, or gel disposed between the concave surface 812 and the eye 1. The window 801 may be formed of glass and has a refractive index n w In one embodiment, window 801 is formed from fused silica and has a refractive index n w Fused silica has the lowest refractive index of any common, inexpensive glass. Fluoropolymers such as Teflon AF are another type of low-index material that have a lower refractive index than fused silica, but their optical quality is lower than glass and they are relatively expensive for mass production. In another embodiment, window 801 is formed from common glass BK7, which has a refractive index n of 1.50. w A radiation-resistant variety of this glass, BK7G18 by Schott AG, Mainz, Germany, allows gamma sterilization of the patient-contacting surface 800 without changing the optical properties of the window 801 upon gamma irradiation.

[0081] 9a and 9b, window 801 is surrounded by walls 803 of patient-contacting surface 800 and an immobilization device, such as a suction ring 804. When suction ring 804 is in contact with eye 1, an annular cavity 805 is formed between the suction ring and the eye. When a vacuum is applied to suction ring 804 and the cavity via a vacuum tube or vacuum pump (not shown in FIGS. 9a and 9b), the vacuum force between the eye and the suction ring adheres the eye to patient-contacting surface 800 during surgery. Removing the vacuum releases or separates eye 1.

[0082] The end of the patient contact surface 800 opposite the eye 1 includes an attachment interface 806 configured to attach to the housing 702 of the focusing objective 700, thereby fixing the position of the eye relative to other components of the integrated surgical system 100. The attachment interface 806 may operate on mechanical, vacuum, magnetic, or other principles, and may be separable from the integrated surgical system.

[0083] The focusing objective lens 700 includes an aspheric exit lens 710 having a concave surface 711 facing the eye and a convex surface 712 opposite the concave surface. Thus, the exit lens 710 has a meniscus shape. The exit lens 710 shown in Figures 9a and 9b is an aspheric lens, allowing for greater design freedom, but in other configurations, the exit lens may be a spherical lens. Alternatively, constructing the exit lens 710 as a compound lens rather than a single lens allows for greater design freedom to optimize the optical components while preserving the main characteristics of the optical system presented here. Referring to Figure 9c, the concave surface 711 has a radius of curvature r y , and convex surface 712 is characterized by an aspheric shape. Aspheric convex surface 712 combines with spherical concave surface 711 to result in output lens 710 with a variable thickness, where the outer edge 715 of the lens is thinner than the central apex region 717 of the lens. Concave surface 711 is configured to mate with convex surface 813 of window 801. In one embodiment, output lens 710 is formed of fused silica and has a refractive index n of 1.45. x It has.

[0084] FIGS. 10a and 10b are schematic diagrams of the components of the integrated surgical system of FIGS. 7 and 8 functionally arranged to form an optical system 1010 having a first optical subsystem 1001 and a second optical subsystem 1002, which provides access to a surgical volume 720 at the iridocorneal angle. FIGS. 10a and 10b each include components of the focusing objective 700 and patient-contacting surface 800 of FIG. 9a. However, for simplicity, the focusing objective and patient-contacting surface are not included in their entirety in FIGS. 10a and 10b. Also, to further simplify FIG. 10a, the planar beam-folding mirror 740 of FIGS. 9a and 9b is not included, and the combined laser / OCT / visual beam 701 shown in FIG. 9a is not folded or stretched. Those skilled in the art will understand that adding or removing the planar beam-folding mirror does not change the fundamental operation of the optical system formed by the first and second optical subsystems. FIG. 10c is a schematic diagram of a beam passing through the first optical subsystem of FIGS. 10a and 10b.

[0085] 10a, a first optical subsystem 1001 of an integrated surgical system 1000 includes an output lens 710 of the focusing objective lens 700 and a window 801 of the patient-contacting surface 800. The output lens 710 and the window 801 are positioned relative to one another to define a first optical axis 705. The first optical subsystem 1001 is configured to receive a beam, e.g., a combined laser / OCT / visual beam 701, incident on a convex surface 712 of the output lens 710 along a second optical axis 706 and direct the beam toward a surgical volume 720 at the iridocorneal angle 13 of the eye.

[0086] During a surgical procedure, the first optical subsystem 1001 may be assembled by interfacing the convex surface 813 of the window 801 with the concave surface 711 of the output lens 710. To this end, the focusing objective 700 is docked with the patient-contacting surface 800. As a result, the concave surface 711 of the output lens 710 is bonded to the convex surface 813 of the window 801. Bonding may be by direct contact or by a layer of index-matching fluid. For example, when docking the patient-contacting surface 800 to the focusing objective 700, a droplet of index-matching fluid may be applied between the contacting surfaces to eliminate any air gap between the two surfaces 711, 813, helping the combined laser / OCT / visual beam 701 pass through the gap with minimal Fresnel reflections and distortion.

[0087] To direct the beam towards the surgical volume 720 of the iridocorneal angle 13 of the eye, the first optical subsystem 1001 is designed to take into account the refraction of the beam 701 as it passes through the exit lens 710, the window 801, and the cornea 3. To this end, and with reference to FIG. 10c, the refractive index n x and the refractive index n of the window 801 w is the refractive index n of the cornea 3 c is selected taking into consideration, so that the beam is appropriately bent through the first optical subsystem 1001 so that when the beam 701 exits the subsystem and passes through the cornea 3, the optical path is approximately aligned to be within the iridocorneal angle 13.

[0088] Continuing to refer to FIG. 10c, we begin with the interface between window 801 and cornea 3. At the interface where combined laser / OCT / visual beam 701 exits window 801 and enters cornea 3, i.e., the interface between the concave surface 812 of the window and the convex surface of cornea 3, if the angle of incidence is too acute, excessive refraction and distortion will occur. To minimize refraction and distortion at this interface, in one embodiment of first optical subsystem 1001, the refractive index of window 801 is closely matched to the refractive index of cornea 3. For example, as discussed above with reference to FIGS. 9a and 9b, window 801 may have a refractive index less than 1.42 to closely match cornea 3, which has a refractive index of 1.36.

[0089] Excessive refraction and distortion at the interface where combined laser / OCT / visual beam 701 exits window 801 and enters cornea 3 may be further offset by controlling the bending of beam 701 as it passes through exit lens 710 and window 801. To this end, in one embodiment of first optical subsystem 1001, the refractive index n w is the refractive index n of the output lens 710 x and the refractive index of the cornea 3, n c 8. As a result, at the interface where combined laser / OCT / visual beam 701 exits output lens 710 and enters window 801, i.e., the interface between output lens concave surface 711 and window convex surface 813, the beam passes through a high-to-low refractive index change, causing the beam to bend in a first direction. Then, at the interface where combined laser / OCT / visual beam 701 exits output lens 710 and enters cornea 3, i.e., the interface between output lens concave surface 812 and cornea convex surface, the beam passes through a low-to-high refractive index change, causing the beam to bend in a second direction opposite the first direction.

[0090] The shape of the window 801 is selected to be a meniscus lens. Therefore, the angle of incidence of light has similar values ​​on both surfaces 812, 813 of the window 801. The overall effect is that the convex surface 813 bends light away from the surface normal, and the concave surface 812 bends light toward the surface normal. This effect is similar to when light passes through a plane-parallel plate. Refraction at one surface of the plate is offset by refraction at the other surface, and the direction of light passing through the plate remains unchanged. Refraction at the convex surface 712 of the entrance lens 710, located distal to the eye, is minimized by setting the curvature at the entrance surface so that the angle of incidence β of light 701 at the entrance surface is close to the surface normal 707 to the entrance surface at intersection point 708.

[0091] Here, output lens 710, window 801, and eye 1 are arranged as an axisymmetric system about first optical axis 705. In practice, the axisymmetric system is an approximation due to manufacturing and alignment errors of optical components, natural deviations from symmetry of the eye, and alignment errors of the eye relative to window 801 and output lens 710 in clinical settings. However, for design and practical purposes, eye 1, window 801, and output lens 710 are considered to be an axisymmetric first optical subsystem 1001.

[0092] 10a, the second optical subsystem 1002 is optically coupled to the first optical subsystem 1001 at an angle α relative to the first optical axis 705 of the first optical subsystem 1001. An advantage of this arrangement is that both optical subsystems 1001, 1002 can be designed with a much lower numerical aperture compared to an axially designed system where all optical components share a common optical axis.

[0093] The second optical subsystem 1002 includes a relay lens 750 that creates a conjugate surgical volume 721 of the surgical volume 720 within the eye, as described above with reference to Figure 8. The second optical subsystem 1002 includes various other components, collectively shown as an optical subsystem block 1003. With reference to Figure 8, these components may include a femtosecond laser source 200, an OCT imaging device 300, a visual observation device 400, a beam conditioner and scanner 500, and a beam combiner 600.

[0094] The second optical subsystem 1002 may include a mechanical component (not shown) configured to rotate the entire subsystem about the first optical axis 705 of the first optical subsystem 1001, thereby allowing optical access to the entire 360° circumference of the iridocorneal angle 13 of the eye 1.

[0095] 10b, placement flexibility for each of the first and second optical subsystems 1001, 1002 may be provided by interposing an optical assembly 1004 between the optical output of the second optical subsystem 1002 and the optical input of the first optical subsystem 1001. In one embodiment, the optical assembly 1004 may include one or more planar beam folding mirrors 740, prisms (not shown), or optical gratings (not shown) configured to receive the optical output of the second optical subsystem 1002, e.g., the combined laser / OCT / visual beam 701, and redirect or adjust the combined laser / OCT / visual beam to direct the beam to the optical input of the first optical subsystem 1001 while preserving the angle α between the first optical axis 705 and the second optical axis 706.

[0096] In another configuration, the optical assembly 1004 of the planar beam folding mirror 740 further includes a mechanical component (not shown) configured to rotate the assembly about the first optical axis 705 of the first optical subsystem 1001 while the second optical subsystem 1002 remains stationary. Thus, the second optical axis 706 of the second optical subsystem 1002 can be rotated about the first optical axis 705 of the first optical subsystem 1001. This allows optical access to the entire 360° circumference of the iridocorneal angle 13 of the eye 1.

[0097] 9a, 9b, and 9c, the design of first optical subsystem 1001 is optimized for angled optical access at angle α relative to first optical axis 705 of first optical subsystem 1001. Optical access at angle α cancels out optical aberrations of first optical subsystem 1001. Table 1 shows the optimization results for access angle α=72° using the Zemax optical design software package. This design is a practical embodiment for image-guided femtosecond glaucoma surgery. TIFF0007778108000001.tif63170

[0098] This design produces diffraction-limited focusing of a 1030 nm wavelength laser beam and an 850 nm wavelength OCT beam with a numerical aperture (NA) of 0.2 or less. In one design, the optical aberrations of the first optical subsystem are canceled to the extent that the Strehl ratio of the first optical subsystem is greater than 0.9 for beams with a numerical aperture greater than 0.15 at the iridocorneal angle. In another design, the optical aberrations of the first optical subsystem are partially canceled, and the remaining uncanceled aberrations of the first optical system are canceled by the second optical subsystem to the extent that the Strehl ratio of the combined first and second optical subsystems is greater than 0.9 for beams with a numerical aperture greater than 0.15 at the iridocorneal angle.

[0099] proofreading

[0100] The femtosecond laser source 200, OCT imaging device 300, and visual observation device 400 of the integrated surgical system 1000 are first individually calibrated to ensure their internal consistency and then cross-calibrated for system consistency. An essential part of system calibration is ensuring that when the surgical focus of the laser beam 201 is focused at a location in the surgical volume 720 as identified by the OCT imaging device and / or visual observation device 400, the achieved focus position matches the focused focus position within a specific tolerance, typically within 5-10 μm. Additionally, the graphic and cursor output, images, and overlays displayed on a user interface 110, such as a computer monitor, as well as user input of the location of the ocular tissue surgical volume 720 accepted from the user interface 110, should correspond to the actual location in the tissue within a predetermined tolerance of similar accuracy.

[0101] One embodiment of this spatial calibration procedure begins with imaging the calibrated scale and scaling factor of the OCT beam imaging device 300 and / or visual observation device 400 and their displays such that the scale values ​​on the display match the actual scale of the calibration target. Next, a laser calibration pattern is exposed or burned onto a transparent calibration target, followed by imaging of the calibration pattern. The intended and actual burned patterns are then compared using the imaging system of the integrated surgical system 1000 or by a separate microscope. If they do not match within the specified tolerances, the scaling parameters of the surgical pattern are rescaled by adjusting the scaling of the laser beam scanner. This procedure is repeated as necessary until all spatial calibrations are within tolerance.

[0102] Laser surgery using eye tissue modification

[0103] The ocular anatomy relevant to surgical treatments enabled by the integrated surgical system 1000 disclosed herein is illustrated in Figures 1-4. To reduce IOP, laser treatment targets ocular tissues that affect the trabecular outflow pathway 40. These ocular tissues may include the trabecular meshwork 12 within the iridocorneal angle 13, the scleral promontory 14, the uvea 15, the sclerocorneal trabecular meshwork 16, the juxtacanalicular tissue 17, Schlemm's canal 18, and the collector channels 19.

[0104] Disclosed herein are laser patterns that are particularly effective for affecting the trabecular outflow pathway 40. Because the laser interaction volume is small, on the order of a few micrometers (μm), the interaction of each laser shot of a repetitive laser with ocular tissue locally disrupts the ocular tissue at the laser's focal point. The laser pulse duration for the photodisruptive interaction with ocular tissue can range from a few femtoseconds to a few nanoseconds, and the pulse energy can range from a few nanojoules to tens of microjoules. The laser pulse at the focal point undergoes a multiphoton process, breaking molecular chemical bonds and locally photolyzing tissue material, creating gas bubbles in the wet tissue. The breakdown of tissue material and the mechanical stresses caused by the bubble formation fragment the tissue, creating distinct, continuous cuts when the laser pulses are brought close together along geometric lines and surfaces.

[0105] For the following discussion, the basic interaction volume is referred to as a cell. The size of the cell is determined by the extent of the laser-tissue interaction. When the laser spots, or cells, are closely spaced along a line, the laser creates a narrow microscopic channel. Wider channels can be created by placing multiple laser spots in close proximity within the cross section of the channel. For example, a cylindrical channel can be created by first calculating the coordinates of the position and size of the entire cylinder. Then, using the cell size as a parameter, the coordinates of each cell in the densely packed cell arrangement within the cylindrical volume are calculated. The cell arrangement mimics the arrangement of atoms in a crystal structure.

[0106] The simplest approach is to calculate a cubic lattice structure, where individual cells are arranged in regularly spaced rows, columns, and planes. Cell coordinates can be calculated sequentially from cell to cell in row, column, and plane order. Laser scanner hardware can also follow this regular sequence, scanning the laser beam without unnecessary jumps. Channels can be created with different cross sections: elliptical, rectangular, square, or other regular or irregular cross sections. Channels cut into ocular tissue can conduct aqueous humor, with conductivity increasing with the cross-sectional area of ​​the channel.

[0107] 11a and 11b show cross-sectional views of the iridocorneal angle where a surgical laser is scanned to affect a surgical volume 900 (FIG. 11a) and create a channel opening 920 (FIG. 11b). The surgical volume 900 within the trabecular meshwork extends from the anterior chamber 7 through the inner wall of Schlemm's canal 18. The laser scan modifies the ocular tissue within the surgical volume 900 to create the channel opening 920. The channel opening 920 reduces the IOP of the eye by reducing flow resistance within the ocular tissue and increasing the flow of water from the anterior chamber 7 into Schlemm's canal 18. The size of the channel opening 920 determines the reduction in outflow resistance and the longevity of effectiveness.

[0108] Image guidance is essential in this procedure to accurately locate structures and monitor treatment success. Minimizing the size and volume of the ocular tissue being treated also helps minimize the amount of gas created and the amount of gas-induced tissue displacement. As the tissue expands with the distending gas, sudden tissue displacement can occur when the gas escapes from the enclosed volume and the gas-filled void collapses. Such sudden tissue displacement can result in discontinuities in the surgical incision and should be avoided or minimized.

[0109] Another consideration for creating surgical patterns in ocular tissue is the potential for gas bubbles to create a shadow effect as the incision progresses. Generally, the incision progression should begin at a location farther from the laser and progress toward a location closer to the laser to minimize the shadow effect. When the laser is tightly focused to a diffraction-limited focal point and the threshold pulse energy for photodisruptive interaction is lowered, the amount of gas is also lower. When the laser is operated at a low threshold, the size of the local interaction volume and the size of the gas bubbles are smaller. This means that the cells filling the surgical volume should be tightly packed.

[0110] Table 2 shows the surgical laser and treatment pattern parameters for multiple incisions of different sizes. The range of parameter sets is limited by the maximum permissible exposure (MPE) limits of the laser light entering the eye, as well as the practical range of laser repetition rate and scanner scanning speed. TIFF0007778108000002.tif44170

[0111] With respect to MPE, the angled optical path 30 of FIG. 6 is most advantageous because the light beam transmitted through the tissue from the femtosecond laser source 200 or OCT imaging device 300 does not directly reach the retina. This is in contrast to known corneal and cataract surgeries, in which direct laser or OCT light transmitted through the tissue reaches the retina. Therefore, the angled optical path 30 of FIG. 6 allows for the use of higher beam average power. Higher average power of the surgical laser results in faster procedure times. Higher average power of the OCT beam results in faster OCT image acquisition times with the same image quality, or better image quality with the same image acquisition time. Regarding cell size and laser pulse energy, smaller cell sizes and pulse energies are preferred to minimize the amount of gas created in the tissue.

[0112] Experimental findings in the linear perfusion model with ELT treatment (Liu et al., 2005) and clinical findings were 0.24 mm 2 ~0.4mm2 This indicates that a channel cross-section of approximately 100 μm can achieve sufficient IOP reduction. As can be seen from Table 2, the surgical laser procedure performed by the integrated surgical system disclosed herein can generate channel cross-sections similar to those of Liu et al. and can be completed in less than 10 seconds.

[0113] 12 is a flowchart of a method for reducing intraocular pressure in an eye having a cornea, an anterior chamber, and an iridocorneal angle with an aqueous humor outflow pathway formed by a trabecular meshwork, a Schlemm's canal, and one or more collecting channels branching from the Schlemm's canal. The method may be performed by the integrated surgical system 1000 of FIGS. 7-10b.

[0114] In step 1202, an OCT beam 301 is delivered through the cornea 3 and the anterior chamber 7 into the iridocorneal angle 13. In one embodiment, the OCT beam 301 is delivered to the iridocorneal angle 13 by directing the OCT beam to a first optical subsystem 1001 that has a resolution of about 5 micrometers or less and includes a window 801 coupled to the cornea 3 and an exit lens 710 coupled to the window.

[0115] In step 1204, an OCT image of a portion of the iridocorneal angle 13 is acquired based on the OCT beam 301 delivered to the iridocorneal angle through the first optical subsystem 1001. To this end, the OCT return beam 301 is received through the first optical subsystem 1001 and processed in the OCT imaging device 300 using known OCT imaging techniques.

[0116] In step 1206, a surgical volume 900 of ocular tissue to be modified is determined based on the OCT image. The surgical volume 900 may be determined based on a 2D cross-sectional OCT image displayed on the control system 100 of the integrated surgical system 1000. The visual observation beam 401 may also be used to determine the surgical volume 900. For this purpose, the visual observation beam 401 may be acquired from the iridocorneal angle 13 through the first optical subsystem 1001 by the microscope 400, and the volume 900 of ocular tissue to be modified may be determined by presenting the OCT image and the visual observation signal superimposed on a display screen of the control system 100. Alternatively, the OCT image and the visual observation signal may be registered on the display screen.

[0117] In one embodiment, Schlemm's canal 18 is characterized by a circumference, and the surgical volume 900 of ocular tissue to be modified is determined based on the density of the collecting channels 19 around the circumference. In this case, the density distribution of the collecting channels 19 around at least a portion of the circumference of Schlemm's canal 18 is determined based on OCT images. Regions of Schlemm's canal 18 having a density above a threshold criterion are identified, and the vicinity of the identified region is included in the volume of ocular tissue to be modified. The criterion may be the 50th percentile, 75th percentile, or above the 75th percentile of the distribution. In another embodiment, the volume 900 of ocular tissue to be modified is near one or more of the collecting channels 19.

[0118] In step 1208, the OCT beam 301 and the laser beam 201 are delivered through the cornea 3 and the anterior chamber 7 into the iridocorneal angle 13, respectively. In one embodiment, the OCT beam 301 and the laser beam 201 have substantially equal resolution, for example, about 5 micrometers or less, and each beam is delivered to the iridocorneal angle by directing each beam to a first optical subsystem 1001 that includes a window 801 coupled to the cornea 3 and an exit lens 710 coupled to the window. The OCT beam 301 and the laser beam 201 may be directed collinearly along the same optical path to the first optical subsystem 1001, for example, by beam multiplexing. Alternatively, the OCT beam 301 and the laser beam 201 may be directed non-collinearly simultaneously to the first optical subsystem along spatially separated or angled optical paths.

[0119] Distortions and aberrations in beams 201, 301 due to entering the eye at an oblique angle are offset by directing each beam at an angle into first optical subsystem 1001. To this end, eye 1 includes a line of sight, and first optical subsystem 1001 is positioned relative to the eye to include a first optical axis 705 that is substantially aligned with the line of sight of the eye. Beams 201, 301 are input to first optical subsystem 1001 by directing each beam along a second optical axis 706 that is offset from the first optical axis 705 by an angle α into convex surface 713 of output lens 710. Additionally, each beam 201, 301 may be directed into convex surface 713 of output lens 710 at an angle β relative to a surface normal 707 to the convex surface.

[0120] In step 1210, the volume 900 of ocular tissue within the trabecular meshwork outflow pathway 40 is modified to reduce pathway resistance present in one or more of the trabecular meshwork 12, Schlemm's canal 18, and one or more collector channels 19 by applying a laser beam 201 to the ocular tissue defining the volume. To this end, a laser beam 201 having a wavelength between 330 nanometers and 2000 nanometers may be scanned in multiple directions to interact with the ocular tissue defining the surgical volume 900. The laser beam 201 may be applied continuously or as multiple laser pulses having pulse durations between 20 femtoseconds and 1 nanosecond. The laser beam 201 effects a photodisruptive interaction with the ocular tissue to reduce pathway resistance or create a new outflow pathway 40. In one embodiment, the photodisruptive interaction with the ocular tissue creates an open channel 902 through the trabecular meshwork connecting the anterior chamber and Schlemm's canal.

[0121] Iridocorneal angle access

[0122] Figure 13 shows a ray of light with respect to the viewing direction and refractive index n c 10 is a flowchart of a method for orienting the iridocorneal angle of an eye having a cornea of ​​10. The method may be performed by the integrated surgical system 1000 of FIGS.

[0123] In step 1302, a first optical subsystem 1001 and a second optical subsystem 1002 are positioned relative to each other. The first optical subsystem has a refractive index n w The first optical subsystem also includes a window 801 formed of a material having a refractive index n xThe window 801 includes an exit lens 710 formed of a material having a refractive index of 0.5 or less. The exit lens 710 has a concave surface 711 and a convex surface 712 opposite the concave surface. The concave surface 711 of the exit lens 710 is configured to mate with the convex surface 813 of the window 801 to define a first optical axis 705 extending through the window and the exit lens. The concave surface 812 of the window 801 is configured to detachably mate with the cornea 3 of the eye such that the first optical axis 705 is substantially aligned with the eye's direction of vision.

[0124] In step 1304, the light beam output by the second optical subsystem 1002 is directed along the second optical axis 706 to be incident on the convex surface 712 of the output lens 710 at an angle α offset from the first optical axis 705. To this end, the second optical subsystem 1002 or another intermediate optical assembly 1004 may be configured to determine a measure of angular separation between the first and second optical axes and adjust the orientation of the second optical axis until the angle of separation is angle α. The angle α is typically greater than 30°. More specifically, the angle α may be between 60° and 80°. Even more specifically, the angle α is approximately 72°.

[0125] In step 1306, the light beam output from the second optical subsystem 1002 may also be directed to intersect the convex surface 712 of the output lens 710 at an intersection point at an angle β between the second optical axis 706 and a surface normal 707 to the convex surface of the output lens. Again, the second optical subsystem 1002 or another intermediate optical assembly 1004 may be configured to determine a measure of angular separation between the second optical axis and the surface normal 707 and adjust the orientation of the second optical axis until the angle of separation is angle β.

[0126] In some configurations, for example, as shown in FIG. 10b, the second optical subsystem 1002 may be configured to be positioned relative to the first optical subsystem 1001 such that the light beam 701 is output by the second optical subsystem along an axis offset from the second optical axis 706. In these cases, in the directing process of block 1304, the light beam 701 is received by the optical assembly 1004 sandwiched between the first optical subsystem 1001 and the second optical subsystem 1002 and redirected to be approximately aligned with the second optical axis 706. The second optical axis 706 may be rotated about the first optical axis 705 while maintaining the second optical axis offset from the first optical axis by an angle substantially equal to the angle α, thereby enabling treatment around the circumference of the iridocorneal angle 13. In a configuration where the second optical axis 706 intersects the convex surface 712 of the exit lens 710 at an intersection point 708 at an angle β between the second optical axis and a surface normal 707 to the convex surface of the exit lens, the orienting process of block 1306 involves rotating the second optical axis about the first optical axis while still maintaining an angle between the second optical axis and the surface normal that is substantially equal to angle β.

[0127] Various aspects of this disclosure are provided to enable those skilled in the art to practice the invention. Various modifications to the exemplary embodiments presented throughout this disclosure will be apparent to those skilled in the art. Accordingly, the claims are not limited to the various aspects of this disclosure, but are to be accorded the full scope consistent with the language of the claims. All structural and functional equivalents to the various components of the exemplary embodiments described throughout this disclosure that are known or later become known to those skilled in the art are expressly incorporated herein by reference and are intended to be encompassed by the claims. Furthermore, nothing disclosed herein is intended to be dedicated to the public, regardless of whether such disclosure is expressly recited in the claims. No claim element shall be construed under the provisions of 35 U.S.C. § 112, paragraph 6, unless expressly recited using the phrase "means for," or, in the case of a method claim, unless the element is recited using the phrase "step for."

[0128] It is to be understood that the embodiments of the invention described herein are merely illustrative of the application of the principles of the invention, and reference herein to details of the illustrated embodiments is not intended to limit the scope of the claims, which recite those features regarded as essential to the invention.

Claims

1. 1. An integrated surgical system for treating an eye, comprising: a laser source configured to output a laser beam; an output lens configured to optically couple to the cornea; one or more laser scanner components optically coupled to receive the laser beam; an optical assembly optically coupled to receive the laser beam and direct the laser beam along an angled optical path that extends through the cornea, the anterior chamber, and the trabecular meshwork to Schlemm's canal to an optical input of the output lens; a control system coupled to the laser source and the one or more laser scanner components and configured to process a volume of ocular tissue extending through the trabecular meshwork of the eye; wherein the control system comprises: instructing the one or more laser scanner components to scan the laser beam through a volume of ocular tissue; commanding the laser source to apply laser energy through the laser beam while the laser beam is scanned through the volume of ocular tissue. wherein the laser energy is configured to cause a photodisruptive interaction with the ocular tissue; 1. An integrated surgical system for treating an eye, wherein the optical assembly is configured to revolve about a first optical axis of the optical assembly independently of corresponding movement of the output lens, the output lens being axially symmetric with respect to the first optical axis.

2. The integrated surgical system of claim 1 , wherein one or more of the one or more laser scanner components are configured to revolve with the optical assembly.

3. The integrated surgical system of claim 1 , wherein the laser source is configured to orbit with the optical assembly.

4. The integrated surgical system of claim 1 , wherein the optical assembly includes one or more beam folding mirrors.

5. The integrated surgical system of claim 1 , wherein the optical assembly includes a prism.

6. The integrated surgical system of claim 1 , wherein the optical assembly includes an optical grating.

7. further comprising an optical coherence tomography (OCT) device configured to output an OCT beam; and one or more OCT scanner components optically coupled to receive the OCT beam; 2. The integrated surgical system of claim 1, wherein the optical assembly is optically coupled to receive the OCT beam and direct the OCT beam along the angled optical path that extends through the cornea and the anterior chamber to the iridocorneal angle to an optical input of the output lens.

8. The integrated surgical system of claim 7 , wherein one or more of the one or more OCT scanner components are configured to revolve with the optical assembly.

9. The integrated surgical system of claim 7 , wherein the OCT device is configured to revolve with the optical assembly.

10. 1. An integrated surgical system for treating an eye, comprising: an optical coherence tomography (OCT) device configured to output an OCT beam; an output lens configured to optically couple to the cornea; one or more OCT scanner components optically coupled to receive the OCT beam; an optical assembly optically coupled to receive the OCT beam and direct the OCT beam along an angled optical path that extends through the cornea, the anterior chamber, and the trabecular meshwork to Schlemm's canal to an optical input of the output lens; a control system coupled to the OCT device and the one or more OCT scanner components and configured to image a volume of ocular tissue extending through the trabecular meshwork of the eye; Including, the control system is configured to instruct the one or more OCT scanner components to scan the OCT beam through a volume of ocular tissue; 1. An integrated surgical system for treating an eye, wherein the optical assembly is configured to revolve about a first optical axis of the optical assembly independently of corresponding movement of the output lens, the output lens being axially symmetric with respect to the first optical axis.

11. The integrated surgical system of claim 10 , wherein one or more of the one or more OCT scanner components are configured to revolve with the optical assembly.

12. The integrated surgical system of claim 10 , wherein the OCT device is configured to orbit with the optical assembly.

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