CORNEAL TOPOGRAPHY MEASUREMENT AND ALIGNMENT OF CORNEAL SURGICAL PROCEDURES

• US 20150018674A1
• Filed: 04/18/2014
• Published: 01/15/2015
• Est. Priority Date: 04/18/2013
• Status: Active Grant

• Current Assignee: AMO Development LLC (Johnson & Johnson)
• Original Assignee: OptiMedica Corporation (Johnson & Johnson)
• Inventors: Scott, David D., Gonzalez, Javier, Dewey, David, Schuele, Georg, Bareket, Noah
• Granted Patent: US 10,485,704 B2
• Time in Patent Office: Days
• US Class Current: 600/427
• CPC Class Codes: A61B 3/10 Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
• CPC Class Codes: A61B 3/107 for determining the shape or measuring the curvature of the cornea
• CPC Class Codes: A61B 5/0073 by tomography, i.e. reconstruction of 3D images from 2D projections A61B5/0066 takes precedence
• CPC Class Codes: A61F 2009/00846 Eyetracking
• CPC Class Codes: A61F 2009/00853 Laser thermal keratoplasty or radial keratotomy
• CPC Class Codes: A61F 2009/0087 Lens
• CPC Class Codes: A61F 2009/00872 Cornea
• CPC Class Codes: A61F 2009/0088 based on wavefront
• CPC Class Codes: A61F 2009/00882 based on topography
• CPC Class Codes: A61F 2009/00887 Cataract
• CPC Class Codes: A61F 2009/00889 Capsulotomy
• CPC Class Codes: A61F 9/00825 for photodisruption
• CPC Class Codes: A61F 9/00827 Refractive correction, e.g. lenticle
• CPC Class Codes: A61F 9/00829 Correction of higher orders

Abstract

Methods and apparatus are configures to measure an eye without contacting the eye with a patient interface, and these measurements are used to determine alignment and placement of the incisions when the patient interface contacts the eye. The pre-contact locations of one or more structures of the eye can be used to determine corresponding post-contact locations of the one or more optical structures of the eye when the patient interface has contacted the eye, such that the laser incisions are placed at locations that promote normal vision of the eye. The incisions are positioned in relation to the pre-contact optical structures of the eye, such as an astigmatic treatment axis, nodal points of the eye, and visual axis of the eye.

Claims

1. A method of treating an eye of a patient, the eye having a cornea, the method comprising:

generating one or more of a first image or a first shape profile of the eye when the eye is separated from a patient interface;

covering the cornea with an optic of the patient interface; and

generating one or more of a second image or a second shape profile of the eye with the optic of the patient interface over the cornea, wherein the patient interface alters distortion of one or more of the second image or the second shape profile of the eye.

2. The method of claim 1, further comprising determining one or more of a position or an orientation of the eye in response to the first image and the second image when the patient interface has been placed over the cornea.

3. The method of claim 1, further comprising:

measuring a shape profile of the cornea of the eye when at least the eye of the patient is supported with a patient support of a laser surgery system; and

wherein the shape profile is measured and the first image is generated before a suction ring of a patient interface is placed on the eye;

wherein the second image is generated when the patient is supported with the patient support of the laser surgery system.

4. The method of claim 3, wherein the shape profile is used to determine an axis of treatment of an astigmatism of the eye, the shape profile comprising one or more of a keratometry reading of the eye, a corneal topography of the eye, an optical coherence tomography of the eye, a Placid disc topography of the eye, a reflection of a plurality of points from the cornea topography of the eye, a grid reflected from the cornea of the eye topography, a Hartmann-Shack topography of the eye, a Scheimpflug image topography of the eye, a confocal tomography of the eye, or a low coherence reflectometry of the eye.

5. The method of claim 4, wherein the shape profile is used to determine an axis of treatment of a plurality of arcuate incisions, the plurality of arcuate incisions extending along an arc transverse to the axis of treatment.

6. The method of claim 5, wherein locations of the plurality of arcuate incisions are displayed on the second image of the eye distorted with the patient interface and wherein locations of the plurality of arcuate incisions are mapped from first locations of the first image to second locations of the second image, the second locations corresponding to distortion of the eye with the patient interface and wherein the first image and the second image are generated with a camera of the laser surgery system.

7. The method of claim 1, further comprising:

modifying the first image to provide a distorted first image comprising distortion similar to the second image; and

providing the distorted first image on a display visible to a user.

8. The method of claim 7, wherein a user adjusts one or more of a location or an angle of the first distorted image on the display and wherein locations of a plurality of laser beam pulses are adjusted in response to the location or the angle of the first distorted image on the display.

9. The method of claim 7, wherein the distorted first image is overlaid on the second image on the display to determine the position and the angle of the eye for treatment and wherein a processor determines the position and the angle of the distorted first image on the display in response to user input to adjust the locations of the plurality of laser beam pulses.

10. The method of claim 1, further comprising:

modifying the second image to provide a corrected second image comprising less distortion similar to the first image.

11. The method of claim 1, wherein the patient interface comprises a light transmissive optic disposed along an optical path with one or more of a liquid or a viscoelastic material disposed between the cornea and the light transmissive optic and wherein the optic and the one or more of the liquid or the viscoelastic distort the image of the eye.

12. The method of claim 1, wherein the first image comprises a plurality of image structures corresponding to a plurality of tissue structures of the eye and wherein the plurality of image structures is moved from a first plurality of locations of the first image to a second plurality of locations of the distorted first image in response to distortion of the patient interface.

13. The method of claim 1, wherein the first image and the second image correspond to a coordinate reference of a laser treatment system and wherein a plurality of locations of the first image are mapped from first locations of the coordinate reference of the laser system to second locations of the coordinate reference of the laser system to provide distortion of the first distorted image corresponding to distortion of the second image in order to position the first distorted image in alignment with the second image.

14. The method of claim 1, wherein the first image and the second image correspond to a first coordinate reference of an ancillary diagnostic device and a second coordinate reference of a laser treatment system, respectively, and wherein a plurality of locations of the first image are mapped from first locations of the first coordinate reference to second locations of the second coordinate reference of the laser system in order to determine of the position and the orientation of the eye with the patient interface over the cornea.

15. The method of claim 1, wherein first image of the eye and the second image of the eye comprise images of an iris of the eye from a camera and wherein one or more structures of the first image and the second image correspond to one or more structures of the iris.

16. An apparatus for treating an eye having a cornea, the apparatus comprising:

a topography measurement system for measuring a topography of the cornea of the eye;

an image capture device for capturing an image of the eye, the image capture device configured to capture the first image of the eye when the cornea is exposed to a gas and a second image of the eye with the patient interface over the cornea;

a patient interface for coupling to and retaining the eye; and

a processor comprising a tangible medium configured to determine a position of the eye, wherein the processor comprising the tangible medium is configured to determine one or more of a position or an orientation of the eye in response to the first image and the second image when the patient interface has been paced over the cornea.

17. The apparatus of claim 16, wherein the topography measurement system comprises one or more of a keratometry system, an optical coherence tomography system, a Placido disc topography system, a Hartmann-Shack topography system, a Scheimpflug image topography system, a confocal tomography system, or a low coherence reflectometry system.

18. The apparatus of claim 16, wherein the topography measurement system is configured to measure a shape profile of the cornea of the eye when at least the eye of the patient is supported with a patient support of a laser surgery system,

wherein the shape profile is measured and the first image is generated before a suction ring of a patient interface is placed on the eye;

wherein the second image is generated when the patient is supported with the patient support of the laser surgery system.

19. The apparatus of claim 18, wherein the shape profile is used to determine an axis of treatment of an astigmatism of the eye, the shape profile comprising one or more of a keratometry reading of the eye, a corneal topography of the eye, an optical coherence tomography of the eye, a Placido disc topography of the eye, a reflection of a plurality of points from the cornea topography of the eye, a grid reflected from the cornea of the eye topography, a Hartmann-Shack topography of the eye, a Scheimpflug image topography of the eye, a confocal tomography of the eye, or a low coherence reflectometry of the eye.

20. The apparatus of claim 19, wherein the shape profile is used to determine an axis of treatment of a plurality of arcuate incisions, the plurality of arcuate incisions extending along an arc transverse to the axis of treatment.

21. The apparatus of claim 20, wherein locations of the plurality of arcuate incisions are displayed on the second image of the eye distorted with the patient interface and wherein locations of the plurality of arcuate incisions are mapped from first locations of the first image to second locations of the second image, the second locations corresponding to distortion of the eye with the patient interface and wherein the first image and the second image are generated with a camera of the laser surgery system.

22. The apparatus of claim 16, further comprising a display visible to a user, wherein the processor comprising the tangible medium is configured to modify the first image to provide a distorted first image comprising distortion similar to the second image and provide the distorted first image on the display.

23. The apparatus of claim 22, wherein the display is configured to allow a user to adjust one or more of a location or an angle of the first distorted image on the display and wherein locations of a plurality of laser beam pulses are adjusted in response to the location or the angle of the first distorted image on the display.

24. The apparatus of claim 22, wherein the distorted first image is overlaid on the second image on the display to determine the position and the angle of the eye for treatment and wherein the processor comprising the tangible medium determines the position and the angle of the distorted first image on the display in response to user input to adjust the locations of the plurality of laser beam pulses.

25. The apparatus of claim 16, wherein the processor comprising the tangible medium is configured to modify the second image to provide a corrected second image comprising less distortion similar to the first image.

26. The apparatus of claim 16, wherein the patient interface comprises a light transmissive optic disposed along an optical path with one or more of a liquid or a viscoelastic material disposed between the cornea and the light transmissive optic and wherein the optic and the one or more of the liquid or the viscoelastic distort the image of the eye.

27. The apparatus of claim 16, wherein the first image comprises a plurality of image structures corresponding to a plurality of tissue structures of the eye and wherein the plurality of image structures is moved from a first plurality of locations of the first image to a second plurality of locations of the distorted first image in response to distortion of the patient interface.

28. The apparatus of claim 16, wherein the first image and the second image correspond to a coordinate reference of a laser treatment system and wherein a plurality of locations of the first image are mapped from first locations of the coordinate reference of the laser system to second locations of the coordinate reference of the laser system to provide distortion of the first distorted image corresponding to distortion of the second image in order to position the first distorted image in alignment with the second image.

29. The apparatus of claim 16, wherein the first image and the second image correspond to a first coordinate reference of an ancillary diagnostic device and a second coordinate reference of a laser treatment system, respectively, and wherein a plurality of locations of the first image are mapped from first locations of the first coordinate reference to second locations of the second coordinate reference of the laser system in order to determine of the position and the orientation of the eye with the patient interface over the cornea.

30. The apparatus of claim 16, wherein first image of the eye and the second image of the eye comprises images of an iris of the eye from the image capture device and wherein one or more structures of the first image and the second image correspond to one or more structures of the iris.

31. The apparatus of claim 16, wherein the topography measurement system comprises a tomography system configured to measure an anterior surface topography of the cornea and a posterior surface topography of the cornea, and wherein the processor is configured to determine a thickness profile of the cornea comprising a thickness of the cornea extending between an anterior surface of the cornea and a posterior surface of the cornea.

32. The apparatus of claim 31, wherein the processor is configured to determine a thickness profile map of the cornea comprising a thickness of the cornea extending between the anterior surface topography of the cornea and the posterior surface topography of the cornea.

33. The apparatus of claim 31, wherein the processor is configured to determine a treatment axis of the cornea in response to the thickness profile map of the cornea.

34. The apparatus of claim 16, wherein the processor comprises instructions to fit profile data of the topography of the cornea with one or more of a Fourier transform, polynomials, a spherical harmonics, Taylor polynomials, a wavelet transform, or Zernike polynomials.

35. The apparatus of claim 34, wherein the processor comprises instructions to provide wavefront aberration data of the cornea relative to a reference surface in response to the one or more of the Fourier transform, the polynomials, the spherical harmonics, the Taylor polynomials, the wavelet transform, or the Zernike polynomials.

36. The apparatus of claim 16, wherein the processor comprises instructions to determine corneal incisions in response to an intraocular lens to be placed in the eye.

37. The apparatus of claim 36, wherein the processor comprises instructions to determine the corneal incisions in response to ray tracing simulating rays of light extending through the cornea and intraocular lens to correct residual optical error of the intraocular lens.

38. The apparatus of claim 16, wherein the processor comprises instructions to determine a visual axis of the eye in response to biometry of the eye and to position one or more of corneal incisions or a capsulotomy in relation to the visual axis.

39. The apparatus of claim 16, further comprising a fixation light to determine a visual axis of the eye when the eye is supported with a patient support and the patient views the fixation light.

40. The apparatus of claim 39, wherein the fixation light is coupled to the eye along a substantially fixed optical path of a video camera aligned with an optical axis of the patient interface to provide stable fixation when one or more of a pulsed laser beam or a measurement beam is scanned along the eye.

41. The apparatus of claim 40, wherein the fixation light is coupled to lenses along the optical path to provide a positive vergence to the eye when the eye is coupled to the patient interface.

42. The apparatus of claim 38, wherein an incision of the capsule location is defined in response to a natural pupil of the eye.

43. The apparatus of claim 16, wherein the processor comprises instructions to determine a visual axis of the eye in response to one or more of the topography of the cornea or the image of the eye.

44. The apparatus of claim 16, wherein the processor comprises instructions to determine a first optical node of the eye corresponding to a first principal plane of the eye and a second optical node of the eye corresponding to a second principal plane of the eye in response to the topography of the cornea and an anterior surface profile of a lens of the eye and a posterior surface profile of a posterior lens of the eye.

45. The apparatus of claim 16, wherein the processor comprises instructions to determine a visual axis of the eye extending from an anterior optical node of the eye in response to one or more measurements of the eye prior to coupling the patient interface to the eye and wherein the processor comprises instructions to measure structures of the eye and determine a location and an orientation of the visual axis extending from the anterior node of eye in response to structures of the eye measured when the eye has been coupled to the patient interface.

46. The apparatus of claim 45, wherein the visual axis is determined in response to measurements taken when the patient views a fixation target prior to coupling the eye to the patient interface, the one or more measurements comprising the topography measurement and measurements of an anterior surface profile of the lens and a posterior surface profile of the lens and wherein the processor comprises instructions to determine an optical axis of the eye in response to curvature centers of the topography, the anterior surface profile and the posterior surface profile and wherein the processor comprises instructions to determine an anterior optical node of the eye along the optical axis of the eye and a posterior optical node of the eye along the optical axis of the eye.

47. The apparatus of claim 16, wherein the processor comprises instructions to display a visual axis of the eye extending from an optical node of the eye on a display and receive a user input to determine one or more incision profiles of the eye in response to the visual axis extending from the optical node of the eye on the display.

48. The apparatus of claim 47, wherein the one or more incision profiles of the eye comprise one or more of a corneal incision or a lenticular incision and wherein the processor comprises instructions to display the lenticular incision around a lenticular center and the corneal incision around corneal center, and wherein the processor comprises instructions to display the corneal center offset from the lenticular center in response to the visual axis rotated away from an optical axis of the patient interface.

49. The apparatus of claim 16, wherein the processor comprises instructions to determine an optical power of an intraocular lens in response to one or more of, an axial length of the eye, the topography of the eye, an anterior surface location of a capsule of a lens of the eye, a posterior surface location of the capsule of the lens, or a location of the retina of the eye.

50. The apparatus of claim 49, wherein the processor comprises instructions to determine one or more a tilt angle or an equatorial plane of the lens of the eye in response to a profile of the anterior surface of the capsule and a posterior surface profile of the capsule.

51. The apparatus of claim 50, wherein the processor comprises instructions to determine one or more of a tilt angle or an equatorial plane of an intraocular lens placed in the capsule of the eye in response to the profile of the anterior surface of the capsule and the posterior surface profile of the capsule and wherein the processor comprises instructions to identify an intraocular lens from among a plurality of intraocular lenses for placement in the capsule in response to the tilt angle or the equatorial plane.

52. The apparatus of claim 16, wherein the topographer comprises an optical coherence tomography system configured to measure an anterior surface profile of the cornea, a posterior surface profile of the cornea, an anterior surface profile of the lens capsule, and a posterior surface profile of the lens capsule, and instructions to project a beam of light onto the retina of the eye to determine the axial length of the eye and locations of the anterior surface profile of the cornea along an axis of the eye, the posterior surface profile of the cornea along the axis of the eye, the anterior surface profile of the lens capsule along the axis of the eye, the posterior surface profile along the axis of the eye, and the retina along the axis of the eye.

53. The apparatus of claim 52, wherein the processor comprises instructions to focus a measurement beam of the OCT system to a location anterior to the retina in order to project a blurry spot on the retina to determine the location of the retina.

54. The apparatus of claim 52, wherein the processor comprises instructions to focus a measurement beam of the OCT system to near the retina to determine the location of the retina.

55. An apparatus for treating an eye having a cornea and a lens, the lens having an anterior surface and a posterior surface, the apparatus comprising:

a tomography system for measuring a tomography of the eye; and

a processor comprising a tangible medium configured to determine one or more axes of the eye in response to one or more of a curvature of the cornea, a curvature of the anterior lens surface, or a curvature of the posterior lens surface.

56. The apparatus of claim 55, wherein the processor comprises instructions to determine an anterior optical node and an optical axis of the eye in response to the curvature of the cornea, the curvature of the anterior lens surface, the curvature of the posterior lens surface and wherein the anterior optical node is located substantially along the optical axis.

57. The apparatus of claim 56, wherein the processor comprises instructions to determine a center of curvature of the cornea, a center of curvature of the anterior surface of the lens and a center of curvature of the posterior surface of the lens and wherein the processor comprises instructions to determine a position and an orientation of the optical axis to inhibit separation of the optical axis from the center of curvature of the cornea, the center of curvature of the anterior surface of the lens and the center of curvature of the posterior surface of the lens.

58. The apparatus of claim 57, wherein the optical axis extends through the center of curvature of the cornea, the center of curvature of the anterior surface of the lens and the center of curvature of the posterior surface of the lens when determined with the processor.

59. The apparatus of claim 56, wherein the processor comprises instructions to determine a posterior optical node along the optical axis of the eye in response to the curvature of the cornea, the curvature of the anterior lens surface, the curvature of the posterior lens surface and one or more indices of refraction of the lens of the eye and wherein the posterior optical node is located substantially along the optical axis.

60. The apparatus of claim 55, wherein the processor comprises instructions to determine a visual axis of the eye when the patient views a fixation target, the visual axis extending away from an optical axis of the eye and wherein the processor comprises instructions to determine a position and an orientation of the visual axis and the optical axis in relation to locations of tissue structures of the eye prior to coupling a patient interface to the eye.

61. The apparatus of claim 60, wherein the tissue structure of eye comprises one or more of an iris of the eye, blood vessels of the eye, a limbus of the eye, or a corneal thickness profile of the eye and wherein the processor comprises instructions to measure the location of the tissue structure of the eye without the eye contacting the patient interface and to determine and display the visual axis and the optical axis to a user without the eye contacting the patient interface in response to the location of the tissue structure without the eye contacting the patient interface.

62. The apparatus of claim 60, wherein the processor comprises instructions to determine the visual axis of the eye and the optical axis of the eye in response to the locations of the tissue structures of the eye with the eye coupled to the patient interface.

63. The apparatus of claim 62, wherein the tissue structure of eye comprises one or more of an iris of the eye, blood vessels of the eye, a limbus of the eye, or a corneal thickness profile of the eye and wherein the processor comprises instructions to measure the location of the tissue structure of the eye with the eye coupled to the patient interface and to determine and display the visual axis and the optical axis to a user with the eye coupled to the patient interface in response to the location of the tissue structure with the eye coupled to the patient interface.

64. The apparatus of claim 55, wherein the processor comprises a first processor and a second processor, the first processor of a first tomography system for measuring a first tomography of the eye prior to contacting the eye with the patient interface, and a second processor of a second tomography system for measuring a second tomography of the eye when the eye has contacted the patient interface, the first tomography system physically separated from the second tomography system.

65. The apparatus of claim 55, wherein the processor comprises instructions to display one or more of a visual axis of the eye, an optical axis of the eye, a line of sight of the eye, a pupillary axis of the eye, a vertex of the cornea, a first Purkinje image of the eye, or cyclo torsional axis of the eye in response to measurements of the eye with the eye contacting the patient interface.

66. The apparatus of claim 55, wherein the processor comprises instructions to display one or more of a visual axis of the eye, an optical axis of the eye, a line of sight of the eye, a pupillary axis of the eye, a vertex of the cornea, a first Purkinje image of the eye, or a cyclo torsional axis of the eye with the eye contacting the patient interface in response to first measurements of the eye without the eye contacting the patient interface and second measurements of the eye with the eye contacting the patient interface.

67. A method of treating an eye, the method comprising centering a refractive procedure on a nodal point of an eye.

68. A method of measuring an eye, the method comprising:

coupling a corneal topography measurement structure to a patient interface structure to place the topography measurement structure in front of the eye;

measuring the eye with the topography measurement structure and the patient interface away from the eye;

decoupling the corneal topography measurement structure from the patient interface structure;

coupling the patient interface structure to a component of the patient interface in order to contact the eye; and

determining an astigmatism axis of the eye.