Real-time surgical reference indicium apparatus and methods for astigmatism correction

• US 10,368,948 B2
• Filed: 08/11/2016
• Issued: 08/06/2019
• Est. Priority Date: 10/20/2009
• Status: Active Grant

• Current Assignee: Alcon Incorporated
• Original Assignee: TrueVision Systems, Inc.
• Inventors: Tripathi, Ashok B.
• Primary Examiner(s): Nguyen, Vi X
• Application Number:
  US15/234,276
• Publication Number:
  US 20160346047A1
• Time in Patent Office: 1,090 Days
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2057 Details of tracking cameras
• CPC Class Codes: A61B 2034/2065 Tracking using image or pattern recognition
• CPC Class Codes: A61B 2090/0807 Indication means
• CPC Class Codes: A61B 2090/3612 with images taken automatically
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/373 using light, e.g. by using optical scanners
• CPC Class Codes: A61B 2576/00 Medical imaging apparatus involving image processing or analysis A61B1/00009, A61B6/52 and A61B8/52 take precedence; image processing per se G06T; details of algorithms for analysing medical images G06T7/0012
• CPC Class Codes: A61B 3/13 Ophthalmic microscopes
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 90/20 Surgical microscopes characterised by non-optical aspects
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 9/007 Methods or devices for eye surgery
• CPC Class Codes: A61F 9/0136 Mechanical markers

Abstract

A system, method, and apparatus for guiding an astigmatism correction procedure on an eye of a patient are disclosed. An example apparatus include a photosensor configured to record a pre-operative still image of an ocular target surgical site of the patient. The apparatus also includes a real-time, multidimensional visualization module configured to produce a real-time multidimensional visualization of the ocular target surgical site during an astigmatism correction procedure. The apparatus further includes a data processor configured to determine a virtual indicium that includes data for guiding the astigmatism correction procedure. The data processor uses the pre-operative still image to align the virtual indicium with the multidimensional visualization such that the virtual indicium is rotationally accurate. The data processor then displays the multidimensional visualization of the ocular target surgical site in conjunction with the virtual indicium.

Claims

1. An apparatus for guiding an astigmatism correction procedure on an eye of a patient, the apparatus comprising:

a data processor configured to receive a pre-operative still image of an ocular target surgical site of the patient prior to the astigmatism correction procedure and prior to cyclorotation of the eye when the patient lies down for surgery; and

a real-time, multidimensional visualization module including a photosensor and an image processor, the module configured to produce, on at least one display, real-time multidimensional visualizations of the ocular target surgical site during the astigmatism correction procedure,

wherein the data processor is configured to;

receive a virtual indicium that includes data for guiding the astigmatism correction procedure;

integrate the virtual indicium with the pre-operative still image such that the virtual indicium is rotationally accurate with respect to the target surgical site displayed within the pre-operative still image;

determine movement within the ocular target surgical site by tracking a position of at least one identifiable visual feature;

align the pre-operative still image including the virtual indicium with the multidimensional visualizations such that the pre-operative still image and the virtual indicium are rotationally accurate and track the determined movement with respect to the ocular target surgical site displayed within the multidimensional visualizations; and

display the multidimensional visualizations of the ocular target surgical site in conjunction with the pre-operative still image including the virtual indicium.

2. The apparatus according to claim 1, further comprising a control input configured to receive an instruction to change a transparency at least one of (i) a portion of the virtual indicium, and (ii) the pre-operative still image,

wherein the data processor is configured to change the transparency on the display of the at least one of (i) and (ii).

3. The apparatus according to claim 1, further comprising a control input configured to receive an instruction to lock the pre-operative still image including the virtual indicium in place with the multidimensional visualizations.

4. The apparatus according to claim 3, wherein the data processor is configured to, after locking the pre-operative still image, make the pre-operative still image transparent while displaying the virtual indicium with the multidimensional visualizations.

5. The apparatus according to claim 1, wherein the data processor is configured to align the pre-operative still image with the multidimensional visualizations by:

determining a specific visual feature within the ocular target surgical site within the pre-operative still image;

identifying the specific visual feature within the multidimensional visualizations; and

move and rotate the pre-operative still image such that the specific visual feature of the pre-operative still image is overlaid on top of the specific visual feature of the ocular target surgical site included within the multidimensional visualizations.

6. The apparatus according to claim 5, wherein at least one of the specific visual feature or the identifiable visual feature includes at least one of a vasculature, a vascular network, a vascular branching pattern, a pattern in an iris, a scratch on a cornea, a dimple on the cornea, a retinal feature, a limbus, a pupillary boundary, a deformity, a void, a blotch, a sequestered pigment cell, a scar, an intentionally placed marking, and a dark region.

7. The apparatus according to claim 5, wherein the specific visual feature is determined as being static with respect to other features within the ocular target surgical site.

8. The apparatus according to claim 1, wherein the data processor is configured to:

determine patient pre-operative data from the pre-operative still image of the ocular target surgical site including at least one of a vertical axis, a visual axis, an optical axis, a steep k, and a flat k; and

determine the virtual indicium based on the patient pre-operative data.

9. The apparatus according to claim 1, wherein the data processor is configured to receive the virtual indicium from a surgeon before the astigmatism correction procedure.

10. The apparatus according to claim 1, wherein the virtual indicium integrated into the pre-operative still image is both rotationally and positionally accurate with respect to the target surgical site.

11. The apparatus according to claim 1, wherein the first pre-operative still image is recorded under at least one of a natural dilation and a chemical dilation while the patient is in an upright and level position.

12. The apparatus according to claim 1, wherein the data processor is configured to display the virtual indicium at one or more desired depths with respect to the display of the multidimensional visualizations.

13. The apparatus according to claim 1, wherein the virtual indicium includes information for making at least one limbal relaxing incision, at least one corneal relaxing incision, at least one astigmatic keratotomy incision, or a combination thereof, and

wherein the astigmatism correction procedure includes at least one of:

a) a limbal relaxing incision;

b) a corneal relaxing incision;

c) an astigmatic keratotomy incision; and

d) an intra-ocular lens implantation incision.

14. The apparatus according to claim 13, wherein at least a portion of the incision of any one of a) to d) is performed by a laser.

15. The apparatus according to claim 1, wherein the data processor is configured to display the virtual indicium in conjunction with the multidimensional visualizations after detecting that the pre-operative still image is locked into place with the multidimensional visualizations.

16. The apparatus according to claim 1, further comprising a control interface operating in conjunction with the data processor configured to:

display the pre-operative still image within a computer display;

receive the virtual indicium provided by a surgeon with respect to a position of tissue within the target surgical site displayed by the pre-operative still image; and

cause the data processor to integrate the virtual indicium with the pre-operative still image such that the virtual indicium is displayed in the selected position with respect to adjacent tissue.

17. The apparatus according to claim 1, wherein the data processor is configured to cause at least one of the pre-operative still image and the virtual indicium to be stereoscopic.

18. The apparatus according to claim 1, wherein the virtual indicium includes a graphical representation of at least one of a) a size of components of the eye, b) a shape of components of the eye, c) an optical characteristic of the eye, d) a magnitude of the astigmatism of the eye, e) a direction of the astigmatism of the eye, f) an angular gradation marking, g) a cross-hatch marking showing the vertical axis of the eye, h) a visual axis of the eye, i) a diameter of a limbus of the eye, j) a diameter of a pupil of the eye, k) a residual astigmatism of the eye, l) a steep meridian of the astigmatism of the eye, m) a flat meridian of the astigmatism of the eye, n) a gradation from the vertical axis of the eye, o) a gradation from a horizontal axis of the eye, p) a direction of an incision, and q) an order of at least two incisions.

19. A method for guiding an astigmatism correction procedure on an eye of a patient, the method comprising:

receiving in a data processor from a pre-operative still image of an ocular target surgical site of the patient prior to the astigmatism correction procedure and prior to cyclorotation of the eye when the patient lies down for surgery;

producing, via a real-time, multidimensional visualization module including a photosensor and an image processor, real-time multidimensional visualizations of the ocular target surgical site during the astigmatism correction procedure;

determining, via the data processor, a virtual indicium that includes data for guiding the astigmatism correction procedure;

integrating, via the data processor, the virtual indicium with the pre-operative still image such that the virtual indicium is rotationally accurate with respect to the target surgical site displayed within the pre-operative still image;

determining, via the processor, movement within the ocular target surgical site by tracking a position of at least one identifiable visual feature;

aligning, via the data processor, the pre-operative still image including the virtual indicium with the multidimensional visualizations such that the pre-operative still image and the virtual indicium are rotationally accurate and track the determined movement with respect to the ocular target surgical site displayed within the multidimensional visualizations; and

causing, via the data processor, the multidimensional visualizations of the ocular target surgical site to be displayed in conjunction with the pre-operative still image including the virtual indicium.

20. The method according to claim 19, wherein the pre-operative still image is aligned with the stereoscopic multidimensional visualizations by:

determining, via the data processor, a specific visual feature within the ocular target surgical site within the pre-operative still image;

identifying, via the data processor, the specific visual feature within the stereoscopic multidimensional visualizations; and

move, via the data processor, and rotate the pre-operative still image such that the specific visual feature of the pre-operative still image is overlaid on top of the specific visual feature of the ocular target surgical site included within the stereoscopic multidimensional visualizations.

21. The method according to claim 19, the method further comprising:

displaying, via the data processor, the pre-operative still image within a computer display;

receiving, via a control interface operating in conjunction with the data processor, the virtual indicium provided by a surgeon with respect to a position of tissue within the target surgical site displayed by the pre-operative still image; and

integrating, via the data processor, the virtual indicium with the pre-operative still image such that the virtual indicium is displayed in the selected position with respect to adjacent tissue.