Femtosecond Laser Trabecular Meshwork Treatment With OCT Targeting
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Solution Overview
Problem
Existing glaucoma treatments using laser pulses, such as ALT, SLT, and ELT, are not effective for all patients, have limited durability, require invasive procedures, or are complex and costly, and face challenges in visualizing and targeting the trabecular meshwork.
Innovation Solution
A non-invasive laser system with integrated 3D imaging and scanning capabilities creates partial or full holes in the trabecular meshwork, using femtosecond to nanosecond pulses, with beam-expanding optics and scanning units, and advanced diagnostic imaging for precise targeting and visualization.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional laser treatments (ALT, SLT) are used, then aqueous humor outflow is increased and intraocular pressure is reduced, but the effect wears off over time (1-3 years) and tissue damage limits repeat treatments
Solution Approach 1:
The patent changes the laser pulse parameters from traditional nanosecond pulses to femtosecond pulses (100-10,000 times shorter duration), fundamentally altering the tissue interaction mechanism. This parameter change enables permanent structural modification of the trabecular meshwork without the progressive tissue damage that limits repeat treatments in conventional therapies.
Solution Approach 2:
The patent replaces the thermal/mechanical damage mechanisms of traditional laser treatments with photodisruption. The femtosecond laser pulses create permanent structural changes in the trabecular meshwork through non-thermal photodisruptive effects, eliminating the need for repeated treatments to maintain effect and allowing multiple repeat procedures without cumulative tissue damage.
2Reliability
If excimer laser trabeculostomy (ELT) is used to create holes in the trabecular meshwork, then IOP lowering effect is achieved with long-term patency, but UV wavelength light does not penetrate the cornea and aqueous humor requiring invasive surgical procedures
Solution Approach 1:
The patent changes the laser wavelength parameter to 1940-2000 nm, which is transmitted through the cornea and aqueous humor. This parameter change allows non-invasive delivery of photodisruptive energy to the trabecular meshwork, eliminating the need for surgical incisions and fiber probe insertion while maintaining the ability to create permanent openings.
Solution Approach 2:
The patent uses the cornea and aqueous humor as intermediary media that transmit the 1940-2000 nm laser energy to the trabecular meshwork. This intermediary approach allows the laser to work through the eye's natural optical pathways without requiring invasive surgical access, combining non-invasive delivery with effective trabecular meshwork treatment.
3Ease of manufacture
If conventional laser systems are used, then treatment can be performed in office settings, but targeting precision and visualization of the trabecular meshwork are insufficient
Solution Approach 1:
The patent integrates multiple functions into a single system: the same 1940-2000 nm laser beam used for treatment also serves as the illumination source for optical coherence tomography (OCT) imaging. This multi-functionality enables real-time visualization and targeting guidance while maintaining office-based simplicity, as no separate surgical microscope or complex imaging system is required.
Solution Approach 2:
The patent incorporates real-time OCT imaging feedback that allows dynamic visualization of the trabecular meshwork during the laser treatment. This feedback mechanism enables precise targeting and adjustment of laser pulses based on live tissue morphology, significantly improving targeting accuracy while keeping the procedure simple and office-based through automated control.
4Reliability
If multiple laser pulses (50-100 pulses) are applied to treat 180-360 degrees of the anterior angle, then comprehensive coverage is achieved, but treatment time increases and complexity increases
Solution Approach 1:
The patent segments the trabecular meshwork treatment into discrete, map-guided zones rather than applying numerous overlapping pulses across 180-360 degrees. The segmentation map approach identifies specific treatment locations and depths, reducing the number of pulses needed while maintaining comprehensive coverage through strategic rather than exhaustive treatment.
Solution Approach 2:
The patent performs preliminary mapping and segmentation of the trabecular meshwork anatomy before treatment. This preliminary action creates a customized treatment map that guides the laser pulses to the most critical areas, eliminating the need for extensive 50-100 pulse procedures and reducing overall treatment complexity while ensuring complete and effective treatment.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The system allows for repeated, effective reduction of intraocular pressure by enhancing aqueous humor outflow without invasive surgery, reducing complexity and cost, and improving targeting accuracy.
Implementation Method 1
a laser can be used to create openings or channels to open sections through the trabecular meshwork of an eye when photo disruptive laser pulses are used
Implementation Method 2
The ALT laser, with a typical setting of 600 mW and 0.1 s pulse duration (at 514 nm or 532 nm), causes a thermal tissue interaction
Implementation Method 3
In SLT treatment, the laser causes cavitation bubbles in the target tissue due to its shorter pulse duration of about 3 nanoseconds and higher peak power
Data Source
AI summary
Laser-based ophthalmic systems and methods can be used to treat glaucoma and other conditions of the eye. The laser system can be used to form openings or partial-thickness channels in the trabecular meshwork to promote aqueous humor outflow. Scanning approaches provided herein can create either fully perforating “full hole” ablations or partial-disruption “soft holes.”