LASER FIDUCIALS FOR AXIS ALIGNMENT IN CATARACT SURGERY

• US 20140343541A1
• Filed: 04/17/2014
• Published: 11/20/2014
• Est. Priority Date: 04/17/2013
• Status: Active Grant

• Current Assignee: AMO Development LLC (Johnson & Johnson)
• Original Assignee: OptiMedica Corporation (Johnson & Johnson)
• Inventors: Scott, David D., Dewey, David, Gonzalez, Javier
• Granted Patent: US 10,219,945 B2
• Time in Patent Office: Days
• US Class Current: 606/4
• CPC Class Codes: A61B 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61B 90/20 Surgical microscopes characterised by non-optical aspects
• CPC Class Codes: A61B 90/25 Supports therefor
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 2/16 Intraocular lenses
• CPC Class Codes: A61F 2009/00878 Planning
• CPC Class Codes: A61F 2009/00887 Cataract
• CPC Class Codes: A61F 2009/00889 Capsulotomy
• CPC Class Codes: A61F 9/00754 for cutting or perforating the anterior lens capsule, e.g. capsulotomes
• CPC Class Codes: A61F 9/008 using laser
• CPC Class Codes: A61F 9/00834 Inlays; Onlays; Intraocular lenses [IOL]

Abstract

A fiducial is generated on an internal anatomical structure of the eye of a patient with a surgical laser. A tonic artificial intraocular lens (IOL) is positioned so that a marker of the tonic IOL is in a predetermined positional relationship relative to the fiducial. This positioning aligns the tonic IOL with the astigmatic or other axis of the eye. The toric IOL is then implanted in the eye of the patient with high accuracy.

Claims

1. A method of implanting an implantable device in an eye of a patient, the method comprising:

generating a fiducial on an anatomical structure of the eye; and

placing the implantable device so that a marker of the implantable device is in a positional relationship relative to the fiducial.

2. The method of claim 1, wherein the eye is retained with a patient interface coupled to the eye with suction and wherein the fiducial is generated when the eye is retained with the patient interface.

3. The method of claim 1, wherein the implantable device comprises an intraocular lens and wherein the marker and the fiducial are visible to a user with a camera image or an operating microscope image provided to the user when the intraocular lens has been placed.

4. The method of claim 1, wherein a user inputs a treatment axis of an astigmatism of the eye and wherein a first fiducial and a second fiducial are generated on an internal anatomical structure of the eye to define the treatment axis extending across a pupil of the eye and wherein the marker comprises a first marker and a second marker placed on opposite sides of the implantable device to define a lens axis of an intraocular lens and wherein the marker and the fiducial are visible to a user to determine an alignment of the treatment axis with the lens axis.

5. The method of claim 4, wherein the first fiducial and the second fiducial are located on the cornea away from an entrance pupil of the eye and wherein the first marker, the second marker, the first fiducial and the second fiducial are displayed in an image visible to a user.

6. The method of claim 1, wherein a measurement structure of the eye is measured with a laser system when the patient has been placed on a patient support of the laser system and wherein the fiducial is generated on the anatomical structure of the eye in response to the orientation of the measurement structure.

7. The method of claim 6, wherein the measurement structure of the eye comprises one or more of a cornea of the eye, an iris of the eye or a crystalline lens of the eye and wherein the orientation comprises one or more of an angle of an astigmatic axis of the cornea, a rotational angle of the iris about a pupil of the eye or an astigmatic axis of the lens of the eye.

8. The method of claim 1, wherein the implantable device comprises an artificial intraocular lens and the positional relationship comprises a pre-determined positional relationship.

9. The method of claim 8, wherein the artificial intraocular lens comprises a tonic intraocular lens.

10. The method of claim 1, wherein the implantable device is positioned so that the fiducial in the positional relationship relative to the fiducial to align a vision correcting axis of the implantable device with an aberration axis of the eye.

11. The method of claim 10, wherein the aberration axis of the eye comprises an astigmatic axis.

12. The method of claim 10, wherein the aberration axis of the eye comprises an axis of a higher order aberration and the implantable device corrects a higher order aberration of the eye comprising one or more of coma, trefoil or spherical aberration.

13. The method of claim 1, wherein the fiducial placed on the internal anatomical structure of the eye has a shape comprising one or more of a dot, a line, a rectangle, an arrow, a cross, a trapezoid, a rectangle, a square, a chevron, a pentagon, a hexagon, a circle, an ellipse, or an arc.

14. The method of claim 1, wherein the marker of the implantable device has a shape comprising one or more of a dot, a line, a rectangle, an arrow, a cross, a trapezoid, a rectangle, a square, a chevron, a pentagon, a hexagon, a circle, an ellipse, or an arc.

15. The method of claim 1, wherein the fiducial has a shape corresponding to a shape of the marking of the implantable device.

16. The method of claim 15, wherein the shape of the fiducial is similar to the shape of the marking.

17. The method of claim 15, wherein the shape of the fiducial is the complementary to the shape of the marking.

18. The method of claim 1, wherein the fiducial is generated on the anatomical structure of the eye by marking the anatomical structure with a laser.

19. The method of claim 1, wherein the internal anatomical structure comprises an internal structure of one or more of the limbus, the cornea, the sclera, in the lens capsule, the iris, the stroma, or in the crystalline lens nucleus and wherein the internal structure is visible to a user when implantable lens is placed.

20. The method of claim 19, wherein the fiducial is generated at least on the periphery of the cornea or on the limbus.

21. The method of claim 1 wherein placing a fiducial on an anatomical structure of the eye comprises generating at least two fiducials on the anatomical structure of the eye.

22. The method of claim 21, wherein the at least two fiducials generated on the anatomical structure of the eye comprises a first fiducial and a second fiducial.

23. The method of claim 22, wherein a shape of the first fiducial is different from a shape of the second fiducial.

24. The method of claim 22, wherein a shape of the first fiducial is the same as a shape of the second fiducial.

25. The method of claim 21, wherein the at least two fiducials form a line corresponding to an axis of the eye and wherein the implantable device comprises at least two marks to determine a centration of the lens with respect to a pupil of the eye when the at least two marks are positioned near the at least two fiducials.

26. The method of claim 25, wherein the axis comprises an astigmatic axis of the eye.

27. The method of claim 25, wherein the line formed from the at least two fiducials is aligned with, parallel to, transverse to, or perpendicular to the axis of the eye.

28. The method of claim 1, wherein the fiducial is created on the anatomical structure prior to coupling the eye to a patient interface.

29. An apparatus, the apparatus comprising:

a laser to generate a laser beam;

a scanner to scan the laser beam;

a processor operatively coupled to the laser and the scanner, wherein the processor comprises a tangible medium configured with instructions to perform any one or more of the steps of the above method claims.

30. An apparatus for implanting an implantable device in an eye of the patient, the apparatus comprising:

a laser to generate a laser beam;

a scanner to scan the laser beam onto the eye of a patient to generate a fiducial on an anatomical structure of the eye; and

a patient interface to couple to the eye with suction.

31. The apparatus of claim 30, further comprising an operating microscope to provide an image of the generated fiducial to a user.

32. The apparatus of claim 30, further comprising a user input for inputting a treatment axis of an astigmatism of the eye and wherein the scanner is configured to generate a first fiducial and a second fiducial on an internal anatomical structure of the eye to define the treatment axis extending across a pupil of the eye.