CA2391325A1 - Hydration and topography tissue measurements for laser sculpting - Google Patents

Hydration and topography tissue measurements for laser sculpting Download PDF

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Publication number
CA2391325A1
CA2391325A1 CA002391325A CA2391325A CA2391325A1 CA 2391325 A1 CA2391325 A1 CA 2391325A1 CA 002391325 A CA002391325 A CA 002391325A CA 2391325 A CA2391325 A CA 2391325A CA 2391325 A1 CA2391325 A1 CA 2391325A1
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Canada
Prior art keywords
tissue
light energy
fluorescent light
hydration
intensity
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Granted
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CA002391325A
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French (fr)
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CA2391325C (en
Inventor
John Karl Shimmick
Charles R. Munnerlyn
George Caudle
Terrance N. Clapham
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AMO Manufacturing USA LLC
Original Assignee
Visx, Inc.
John Karl Shimmick
Charles R. Munnerlyn
George Caudle
Terrance N. Clapham
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Application filed by Visx, Inc., John Karl Shimmick, Charles R. Munnerlyn, George Caudle, Terrance N. Clapham filed Critical Visx, Inc.
Priority to CA002684415A priority Critical patent/CA2684415A1/en
Publication of CA2391325A1 publication Critical patent/CA2391325A1/en
Application granted granted Critical
Publication of CA2391325C publication Critical patent/CA2391325C/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/107—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions for determining the shape or measuring the curvature of the cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • A61F9/00806—Correction of higher orders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00855—Calibration of the laser system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00878—Planning
    • A61F2009/0088—Planning based on wavefront
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00878—Planning
    • A61F2009/00882—Planning based on topography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00817—Beam shaping with masks

Abstract

Improved systems, devices, and methods measure and/or change the shape of a tissue surface, particularly for use in laser eye surgery. The invention generally takes advantage of fluorescence of the tissue at and immediately underlying the tissue surface. The excitation energy can be readily absorbed by the tissue within a small tissue depth, and may be provided from the same source used for photodecomposition of the tissue. The invention can also tak e advantage of changes in the fluorescence spectrum of a tissue in correlation with changes in the tissue's hydration.

Claims (56)

1. A method for measuring a surface topography of a surface of a tissue, the method comprising:
exposing the tissue to an excitation light energy so that the tissue produces a fluorescent light energy;
sensing the fluorescent light energy from the fluorescent tissue; and determining the surface topography of the surface using the sensed fluorescent light energy.
2. The method of claim 1 further comprising imaging the fluorescent tissue onto a detector responsive to the fluorescent light energy.
3. The method of claim 2 further comprising absorbing from about 50 to 100% of the excitation light energy with the tissue within a tissue depth corresponding to a resolution of the surface topography.
4. The method of claim 2 further comprising projecting the excitation light energy onto the tissue in a controlled irradiance pattern.
5. The method of claim 2 further comprising calculating the surface topography from an intensity of the fluorescent light energy acquired during the step of measuring.
6. The method of claim 2 wherein the excitation light energy has an ultraviolet wavelength in a range of about 150 to 400 nm.
7. The method of claim 6, wherein the excitation light energy has an ultraviolet wavelength in a range of about 190 to 220 nm.
8. The method of claim 2, wherein the fluorescent light energy has a wavelength in a range of about 250 to 500 nm.
9. The method of claim 8 wherein the fluorescent light energy has a wavelength in a range of about 300 to 450 nm.
10. A method for measuring a surface topography of an exposed surface of a corneal tissue, the method comprising:
making an excitation light energy with a wavelength in a range of about 190 to 220 nm;
exposing the tissue to the excitation light energy to induce a fluorescent light energy from the tissue, the fluorescent light energy having a wavelength in a range of about 300 to 450 nm;
projecting the excitation light energy onto the tissue in a controlled irradiance pattern;
absorbing from about 50 to 100% of the excitation light energy by the tissue within a 3 µm tissue depth from the exposed surface;
imaging the fluorescent light energy onto a detector responsive to the fluorescent light energy;
measuring an intensity of the fluorescent light energy with the detector;
and, calculating the surface topography from the measured intensity of the fluorescent light energy.
11. A method for laser sculpting a region of a surface of a tissue, the method comprising:
directing an ablative light energy toward the surface;
inducing a fluorescent light energy from the tissue with the ablative light energy;
measuring an intensity of the fluorescent light energy;
determining the shape of the exposed surface using the measured intensity;
and ablating the tissue with a pulsed beam of the ablative light energy.
12. The method of claim 11 wherein the tissue is a stromal corneal tissue, wherein the ablative light energy has a wavelength in a range of about 190 to 220 nm, wherein the fluorescent light energy is emitted by the tissue and has a wavelength from about 300 to 450 nm, the method further comprising:

projecting the ablative light energy onto the tissue in a controlled irradiance pattern;
absorbing from about 50 to 100% of the ablative light energy with the tissue within a 3 µm tissue depth so as to provide no more than a 3 µm resolution of the surface topography;
imaging the emitted fluorescent energy onto a spatially resolved detector responsive to the fluorescent light energy;
calculating the surface topography from the intensity of the fluorescent light energy; and, adjusting the ablating step by the shape of the exposed surface obtained during the measuring step to sculpt the surface to the predetermined shape.
13. The method of claims 11 or 12 further comprising adjusting the ablative light energy to be below the threshold of ablation prior to the measuring step.
14. A system for measuring a surface topography of an exposed surface of a tissue, the system comprising:
a light source directing an excitation light energy, at the surface the excitating light energy inducing a fluorescent light energy from the tissue;
an imaging system aligned with the surface for imaging the fluorescent light energy;
a detector for measuring an intensity of the fluorescent light energy; and a processor coupled to the detector, the processor determining the shape of the exposed tissue from the intensity.
15. The system of claim 14 wherein 50 to 100% of the excitation light energy is absorbed by the tissue within a tissue depth corresponding to a desired resolution of the surface topography.
16. The system of claim 14 further comprising a projection system for projecting the excitation light energy onto the tissue in a controlled irradiance pattern.
17. The system of claim 14 further comprising a processor for calculating the surface topography from the intensity of the fluorescent light energy measured by the detector.
18. The system of claim 14 wherein the excitation light energy has an ultraviolet wavelength in a range of about 150 to 400 nm.
19. The system of claim 18 wherein the excitation light energy has an ultraviolet wavelength in a range of about 190 to 220 nm.
20. The system of claim 14 wherein the fluorescent light energy has a wavelength in a range of about 250 to 500 nm.
21. The system of claim 20 wherein the fluorescent light energy has a wavelength in a range of about 300 to 450 nm.
22. A system for measuring a surface topography of an exposed surface of a corneal tissue, the system comprising:
a light source generating an excitation light energy to induce a fluorescent light energy from the tissue, the excitation light energy having a wavelength in a range of about 190 to 220 nm, wherein about 50 to 100% of the excitation light energy is absorbed within a 3 µm tissue depth so as to provide no less than a 3 µm resolution of the surface topography;
a projection system for projecting the excitation light energy onto the tissue in a controlled irradiance pattern;
an imaging system for imaging the fluorescent light energy emitted by the tissue; and, a spatially resolved detector measuring an intensity of the fluorescent light energy emitted by the tissue in a wavelength range of about 300 to 450 nm;
and, a processor calculating the surface topography from the intensity of the fluorescent light energy measured by the detector.
23. A laser system for sculpting a region on an exposed tissue surface to a desired surface topography, the tissue having a threshold of ablation, the system comprising:
a laser making a pulsed beam of an excitation light energy having an ablative wavelength that induces a fluorescent light energy from the tissue;

an optical delivery system delivering the light energy to the eye in a controlled manner to sculpt the surface;
an imaging system for imaging the fluorescent light energy; and, a detector measuring an intensity of the imaged fluorescent light energy to determine the shape of the exposed tissue.
24. The system of claim 23 wherein about 50 to 100% of the excitation light energy is absorbed by the tissue at a tissue depth corresponding to a desired resolution of the surface topography.
25. The system of claim 23 further comprising a projection system for projecting the light energy onto the tissue in a controlled irradiance pattern.
26. The system of claim 25 wherein the projection system comprises the optical delivery system.
27. The system of claims 23 or 26 wherein the light energy is adjustable to be below the threshold of ablation of the tissue.
28. The system of claim 23 further comprising a processor for calculating the surface topography from the intensity of the fluorescent light energy measured by the detector.
29. The system of claim 23 wherein the excitation light energy has a wavelength in the range of about 150 to 400 nm.
30. The system of claim 29 wherein the excitation light energy has a wavelength in the range of about 190 to 220 nm.
31. The system of claim 23 wherein the fluorescent light energy has a wavelength in the range of about 250 to 500 nm.
32. The system of claim 29 wherein the fluorescent light energy has a wavelength in the range of 300 to 450 nm.
33. A laser system for sculpting an ablated region on an exposed stromal tissue surface to a predetermined surface topography, the tissue having a threshold of ablation, the system comprising:
a laser for making a pulsed beam of an ablative light energy that makes a fluorescent light energy with the tissue wherein about 50 to 100% of the ablative light energy is absorbed by the tissue at a tissue depth corresponding to a desired resolution of the surface topography, the ablative light energy being adjustable to be below the threshold of ablation of the tissue and having a wavelength in the range of about 190 to 220 nm, the fluorescent light energy having a wavelength in the range of 300 to 450 nm;
an optical delivery system for delivering the light energy to the eye in a controlled manner to sculpt the surface;
a detector for measuring an intensity of the fluorescent light energy to determine the shape of the exposed tissue;
an imaging system for imaging the fluorescent light energy onto the detector;
a projection system for projecting the light energy onto the tissue in a controlled irradiance pattern wherein the projection system comprises the optical delivery system; and, a computer for calculating the surface topography from the intensity of the fluorescent light energy measured by the detector.
34. A system for measuring hydration of a tissue, the system comprising:
a light source directing an excitation light toward the tissue so that the tissue generates fluorescent light;
a fluorescent light sensor in an optical path of the fluorescent light from the tissue, the sensor generating a signal indicating the fluorescent light;
and a processor coupled to the sensor, the processor generating a hydration signal indicating the hydration of the tissue from the fluorescent light signal.
35. The system of claim 34, further comprising an ablation energy delivery system coupled to the processor, the delivery system directing an ablative energy toward the tissue, the ablative energy from the delivery system varying in response to the hydration signal.
36. The system of claim 35, wherein the tissue comprises a corneal tissue of an eye, the delivery system comprising an optical delivery system transmitting photoablative laser energy toward the corneal tissue so as to selectively alter an optical characteristic of the eye.
37. The system of claim 36, wherein the processor varies a quantity of change in the optical characteristic of the eye in response to the hydration signal.
38. The system of claim 34, further comprising an output device coupled to the processor, the output showing a display in response to the hydration signal.
39. The system of claim 34, wherein an intensity of the fluorescent spectrum of the tissue varies with the hydration, and wherein the signal indicates an intensity of the fluorescent light at a first frequency.
40. The system of claim 39 wherein the processor normalizes the signal using an intensity of the fluorescent light at a second frequency.
41. The system of claim 35, wherein the intensity of the fluorescent light at the second frequency is less sensitive to hydration than the intensity of the fluorescent light at the first frequency.
42. The system of claim 34, wherein the sensor comprises a spectrometer, and further comprising imaging optics directing the fluorescent light along the optical path from the tissue to the spectrometer, the imaging optics forming an image of a target area of the tissue adjacent a detector surface of the spectrometer.
43. In an apparatus for resculpting a corneal tissue of an eye, the apparatus directing a pattern of light energy from a laser under direction of a processor to effect a desired change in an optical characteristic of the eye, a system comprising:
a sensor coupled to the processor, the sensor generating a signal indicating hydration of the corneal tissue; and an adjustment module of the processor, the module varying the pattern in response to the hydration signal from the sensor.
44. The apparatus of claim 43, wherein the signal varies in response to a thickness of a film of fluid covering a surface of the corneal tissue, the sensor comprising an ellipsometer.
45. A method for measuring hydration of a tissue, the method comprising:
directing an excitation light toward the tissue so that the tissue generates fluorescent light;
sensing the fluorescent light; and calculating the hydration of the tissue using the sensed fluorescent light.
46. In a procedure for resculpting a corneal tissue of an eye by selectively directing a pattern of laser energy toward the eye to effect a predetermined change in an optical characteristic of the eye, a compensation method comprising:
sensing a hydration of the tissue; and adjusting the pattern of laser energy in response to the sensed hydration.
47. The compensation method of claim 46, wherein the hydration sensing step comprises:
directing an excitation light toward the tissue so that the tissue generates fluorescent light;
measuring an intensity of the fluorescent light at a first frequency relative to a second frequency;
calculating hydration of the tissue using the measured relative intensity.
48. The compensation method of claim 46, further comprising estimating ablation rate for the calculated hydration, wherein the pattern adjusting step varies the pattern in response to the estimated ablation rate.
49. The compensation method of claim 45, wherein the excitation light comprises the laser energy.
50. The compensation method of claim 45 wherein the sensing step comprises measuring a thickness of a fluid film on a surface of the eye by ellipsometry.
51. A method for sculpting of a corneal tissue of an eye to effect a desired change in an optical property of the eye, the method comprising:
sensing hydration of the corneal tissue;
determining a desired change in shape of the eye in response to the hydration and the desired change in optical property; and planning a pattern of laser energy to direct toward the corneal tissue to effect the determined change in shape.
52. The method of claim 51, the desired change in optical quality determined while the eye has a first hydration, wherein the eye swells and the hydration increases from the first hydration to a second hydration, and wherein the desired change in shape is determined using the second hydration.
53. The method of claim 52, wherein the hydration increases and the corneal tissue swells in response to at least one member selected from the group consisting of a therapeutic compound applied to the eye and incising of the eye to expose a tissue for ablation.
54. The method of claim 52, further comprising increasing a total depth of corneal tissue removed from the eye to compensate for swelling of the corneal tissue.
55. The method of claim 54, wherein the corneal tissue increases in thickness in by up to about 50 % with the increase from the first hydration to the second hydration.
56. The method of claim 55, wherein the corneal tissue increases in thickness in a range from about 10 % to about 50 % with the increase in hydration, wherein a first tissue removal depth will effect the desired change in optical property when the eye has the first hydration, and wherein the increased tissue removal depth is between about 10 % and about 50 % greater than the first tissue removal depth.
CA002391325A 1999-07-28 2000-07-27 Hydration and topography tissue measurements for laser sculpting Expired - Fee Related CA2391325C (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CA002684415A CA2684415A1 (en) 1999-07-28 2000-07-27 Hydration and topography tissue measurements for laser sculpting

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US14623199P 1999-07-28 1999-07-28
US60/146,231 1999-07-28
PCT/US2000/020764 WO2001008547A2 (en) 1999-07-28 2000-07-27 Hydration and topography measurements for laser sculpting

Related Child Applications (1)

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CA002684415A Division CA2684415A1 (en) 1999-07-28 2000-07-27 Hydration and topography tissue measurements for laser sculpting

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CA2391325A1 true CA2391325A1 (en) 2001-02-08
CA2391325C CA2391325C (en) 2009-12-15

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CA002391325A Expired - Fee Related CA2391325C (en) 1999-07-28 2000-07-27 Hydration and topography tissue measurements for laser sculpting

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US (1) US6592574B1 (en)
EP (1) EP1210011B1 (en)
JP (1) JP4651253B2 (en)
AT (1) ATE388664T1 (en)
AU (1) AU765519B2 (en)
CA (2) CA2684415A1 (en)
DE (1) DE60038303T2 (en)
MX (1) MXPA02000876A (en)
WO (1) WO2001008547A2 (en)

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