Abstract:
The present invention relates to a device for treating the eye, including a body portion configured to be positioned adjacent the exterior surface of the cornea and a heating means for heating the body portion to a predetermined temperature to affect at least one of the following: facilitation of the escape of aqueous humor from the eye and substantially preventing coagulation of the corneal tissue, while substantially destroying tumor cells.

Description:
[0001]     This application is a continuation-in-part of U.S. patent application Ser. No. 09/986,141, filed Nov. 7, 2001, entitled “Method of Reshaping the Cornea by Controlled Thermal Delivery”, and U.S. patent application Ser. No. 11/070,659 filed Mar. 2, 2005, entitled “Device and Method for Reshaping the Cornea”, the entire contents of both of which are incorporated herein by reference.  
         [0002]     This application is related to U.S. patent application Ser. No. 11/446,065, filed Jun. 1, 2006 and entitled “Device and Method for Reshaping the Cornea”, the entire contents of which are incorporated herein by reference. 
     
    
     DESCRIPTION OF THE RELATED PRIOR ART  
       [0003]     The most common type of glaucoma is primary open angle glaucoma (POAG). One factor in the cause of glaucoma is obstruction of the outflow of aqueous humour from the eye. Aqueous humour is produced by the epithelium lining the eye&#39;s ciliary body which then flows through the pupil and into the anterior chamber. The trabecular meshwork then drains the humour to Schlem&#39;s canal, and ultimately to the venous system. All eyes have some intraocular pressure, which is caused by some resistance to the flow of aqueous through the trabeculum and Schlem&#39;s canal. Pressures of anywhere between 7 and 21 mm Hg are considered normal. If the intraocular pressure is too high, (&gt;21.5 mm Hg), the pressure exerted on the walls of the eye results in compression of the ocular structures. The portions of the trabecular meshwork can become blocked or plugged, thus causing an increase in intraocular pressure.  
         [0004]     To treat these blockages, Glaucoma drainage devices, also known as tube shunts, are implanted that are designed to maintain an artificial drainage pathway. A small incision is made in the conjunctiva, usually towards the top of the eye. The surgeon will then make a tiny incision in the sclera of the eye and will fashion an opening for the drainage implant device. The drainage tube will be placed such that the opening of the tiny tube is inside the anterior chamber of the eye where it is bathed in aqueous fluid. The tube is sutured in place with the drainage device attached to the sclera of the eye. Most surgeons will place an absorbable suture around the tube at the time of surgery to prevent filtration through the device until a fibrous capsule has formed. As such, the device is not expected to function until about 3 to 8 weeks following the procedure.  
         [0005]     Other types of ailments of the eye are choroidal tumors, melanoma and retinoblastoma. To treat these ailments, radiation can be used. Radiation, at the appropriate dose rates and in the proper physical forms, is intended to eliminate growing tumor cells without causing damage to normal tissue sufficient to require removal of the eye. As the cells die, the tumor shrinks.  
         [0006]     Another way to treat tumors is using high energy particles (helium ion or proton beam radiation) from a cyclotron to irradiate the tumors. Surgery is performed first to sew small metal clips to the sclera so that the particle beam can be aimed accurately. Treatment is given over several successive days.  
         [0007]     Other treatments have been used for a small number of patients. Photocoagulation using white light or laser light has been used to bum small tumors, and cryo-therapy has been used to kill the tumors by freezing them. A few patients have had eye wall resection or a related procedure to remove tumors from their eyes.  
         [0008]     Age-related macular degeneration (ARMD) is the leading cause of blindness among persons over fifty in the United States and other countries. Two forms of age-related macular degeneration are known: (1) neovascular, also known as exudative, age-related macular degeneration (E-ARMD) and (2) nonneovascular, also known as nonexudative, age-related macular degeneration (NE-ARMD). NE-ARMD is characterized by the presence of drusen, yellow-white lesions of the retinal pigment epithelium within the macula, and by other abnormalities of the retinal pigment epithelium, including retinal cell death.  
         [0009]     Although the exact etiology of ARMD is not known, several risk factors seem to be important for the manifestation of this disease. For example, ARMD may be caused by chronic exposure of the retina to light. The presence or absence of certain nutrients in the diet, such as the antioxidant vitamins E and C, also may affect one&#39;s predisposition for ARMD. Other conditions, such as hypertension and smoking, are also considered to be important risk factors for the development of this disease.  
         [0010]     Several therapeutic methods have been tried. For example, vitamins and dietary supplements have been used for the purpose of delaying the onset of disease. Thalidomide is being investigated to determine if it will slow down or arrest new vessel formation. Laser or radiation has been used to destroy new vessels. However, none of these methods has led to successful results and no definitive treatment for ARMD has been developed to date.  
       SUMMARY OF THE INVENTION  
       [0011]     The present invention relates to a method of treating the eye, including the steps of positioning a device adjacent the exterior surface of the cornea in proximity to the Schlem&#39;s canal, and heating the device, such that the cornea is heated to a predetermined temperature, thereby facilitating the escape of excess aqueous humor from the eye.  
         [0012]     The present invention also relates to a method of treating the eye, including the steps of positioning a device adjacent the exterior surface of the cornea in proximity to tumor cells, and heating the device, such the cornea is heated to a predetermined temperature, thereby substantially preventing coagulation of the corneal tissue, while substantially destroying the tumor cells.  
         [0013]     The present invention also relates to a method of treating the eye, including the steps of heating the cornea, monitoring the temperature of the cornea, and controlling the heating of the cornea such that the cornea is heated to less than about 60 degrees C.  
         [0014]     The present invention also relates to a device for treating the eye, including a body portion configured to be positioned adjacent the exterior surface of the cornea, and a heating means for heating the body portion to a predetermined temperature to affect at least one of the following: facilitation of the escape of excess aqueous humor from the eye; and substantially preventing coagulation of the corneal tissue, while substantially destroying tumor cells.  
         [0015]     Other objects, advantages, and salient features of the present invention will become apparent to those skilled in the art from the following detailed description, which, taken in conjunction with the annexed drawings, discloses preferred embodiments of the invention.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0016]     Referring to the drawings which form a part of this disclosure:  
         [0017]      FIG. 1  is a side elevational view in cross section taken through the center of an eye showing the cornea, pupil and lens;  
         [0018]      FIG. 2  is a side elevational view in cross section of the eye of  FIG. 1  with a flap formed in the surface of the cornea;  
         [0019]      FIG. 3  is a side elevational view in cross section of the eye of  FIG. 2  with a reshaping device having a predetermined shape for correcting myopia proximate to the exposed surface of the cornea;  
         [0020]      FIG. 4  is a side elevational view in cross section of the eye of  FIG. 3  with the reshaping device immediately adjacent and overlying the exposed surface of the cornea;  
         [0021]      FIG. 5  is a side elevational view in cross section of the eye of  FIG. 4  with a laser irradiating the reshaping device to soften the cornea with the softened portion of the cornea conforming to the internal shape of the reshaping device;  
         [0022]      FIG. 6  is a side elevational view in cross section of the eye of  FIG. 5  with the reshaping device removed and the cornea maintaining its reformed shape;  
         [0023]      FIG. 7  is a side elevational view in cross section of the eye of  FIG. 6  with the flap repositioned over the reformed exposed surface of the cornea;  
         [0024]      FIG. 8  is a side elevational view in cross section of the eye of  FIG. 2  with a reshaping device having a predetermined shape for correcting hyperopia proximate to the exposed surface of the cornea;  
         [0025]      FIG. 9  is a side elevational view in cross section of the eye of  FIG. 8  with the reshaping device immediately adjacent and overlying the exposed surface of the cornea;  
         [0026]      FIG. 10  is a side elevational view in cross section of the eye of  FIG. 9  with a laser irradiating the surface of the cornea to soften the cornea with the softened portion of the cornea conforming to the internal shape of the reshaping device;  
         [0027]      FIG. 11  is a side elevational view in cross section of the eye of  FIG. 10  with the reshaping device removed and the cornea maintaining its reformed shape;  
         [0028]      FIG. 12  is a side elevational view in cross section of the eye of  FIG. 11  with the flap repositioned over the reformed exposed surface of the cornea;  
         [0029]      FIG. 13  is a side elevational view in cross section of the eye of  FIG. 2  with a thermally conductive reshaping device having a predetermined shape immediately adjacent the exposed surface of the cornea;  
         [0030]      FIG. 14  is a side elevational view in cross section of the eye of  FIG. 13  with the thermally conductive reshaping device administering controlled heat to the exposed surface of the cornea to soften the cornea with the softened portion of the cornea conforming to the internal shape of the reshaping device;  
         [0031]      FIG. 15  is a side elevational view in cross section of the eye of  FIG. 2  with a reshaping device having two passageways for irrigation and aspiration of a liquid with a predetermined temperature and having a predetermined shape immediately adjacent the exposed surface of the cornea;  
         [0032]      FIG. 16  is a side elevational view in cross section of the eye of  FIG. 15  with the aspiration and irrigation tubes extending through the reshaping device for administering and removing liquid with a predetermined temperature to the exposed surface of the cornea to soften the cornea with the softened portion of the cornea conforming to the internal shape of the reshaping device;  
         [0033]      FIG. 17  is a side elevational view in cross section of the eye of  FIG. 2  with a inlay positioned on the exposed surface of the cornea and with a reshaping device having a predetermined shape for correcting myopia proximate to the inlay;  
         [0034]      FIG. 18  is a side elevational view in cross section of the eye of  FIG. 17  with the reshaping device immediately adjacent the inlay;  
         [0035]      FIG. 19  is a side elevational view in cross section of the eye of  FIG. 18  with a laser irradiating the lens to soften the inlay with the softened portion of the inlay conforming to the internal shape of the lens;  
         [0036]      FIG. 20  is a side elevational view in cross section of the eye of  FIG. 19  with the lens removed and the flap repositioned over the reformed inlay;  
         [0037]      FIG. 21  is a side elevational view in cross section of the eye of  FIG. 1  with multiple cavities formed in the cornea via an ultra short pulse laser;  
         [0038]      FIG. 22  is a front view of the eye of  FIG. 21  showing the multiple cavities forming a substantially circular pattern;  
         [0039]      FIG. 23  is a front view of an eye having multiple cavities formed using an ultra short pulse laser as shown in  FIG. 21 , the cavities forming a substantially ring-shaped configuration;  
         [0040]      FIG. 24  is a front view of an eye having multiple cavities formed using an ultra short pulse laser as shown in  FIG. 21 , the cavities formed in an area offset from the main optical axis;  
         [0041]      FIG. 25  is a side elevational view in cross section of the eye of  FIG. 21  with a device applying a photosensitizer to the surface of the cornea;  
         [0042]      FIG. 26  is a side elevational view in cross section of the eye of  FIG. 25  with a reshaping device proximate to the external surface of the cornea;  
         [0043]      FIG. 27  is a side elevational view in cross section of the eye of  FIG. 26  with the reshaping device immediately adjacent the external corneal surface and a laser heating the cornea;  
         [0044]      FIG. 28  is a side elevational view in cross section of the eye of  FIG. 27  showing the cornea reshaped to conform to the predetermined shape of the reshaping device;  
         [0045]      FIG. 29  is a side elevational view in cross section of the eye of  FIG. 28  after the reshaping device has been removed; and  
         [0046]      FIG. 30  is a side elevational view in cross section of a device according to another embodiment of the present invention. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0047]      FIG. 1  is a side elevational view in cross section taken through the center of an eye  10 , which includes a cornea  12 , a pupil  14  and a lens  16 . If the cornea  12  and lens  16  do not cooperatively focus light correctly on the retina (not shown) of the eye to thus provide adequate vision, the curvature of the cornea can be modified to correct the refractive power of the cornea and thus correct the manner in which the light is focused with respect to the retina.  
         [0048]     As seen in  FIGS. 1-7 , the refractive properties of the eye can be modified or altered by forming a flap  18  in the surface  12  of the cornea, preferably by placing a reshaping device  20  having a predetermined shape on the surface  12  of the cornea, heating the reshaping device and in turn heating the surface of the cornea. However, it is noted that the cornea can be heated by any means suitable, such as directly by a laser or chemically or any other method that would allow heating the cornea to the proper temperature. Heating the cornea to the predetermined temperature causes the corneal stroma to soften and have a gel-like or gelatinous consistency. The gelatinous corneal portion then can flow and reform to take the form of the interior surface  32  of the reshaping device, thus changing the refractive properties of the cornea and the eye.  
         [0049]     To begin, the refractive error in the eye is measured using wavefront technology, as is known to one of ordinary skill in the art. A more complete description of wavefront technology is disclosed in U.S. Pat. No. 6,086,204 to Magnate, the entire content of which is incorporated herein by reference. The refractive error measurements are used to determine the appropriate shape of lens or contact  20  to best correct the error in the patient&#39;s cornea. Preferably, the lens  20  is manufactured or shaped prior to the use of the wavefront technology and is stored in a sterilized manner until that specific lens shape or size is needed. However, the information received during the measurements from the wavefront technology can be used to form the lens using a cryolathe, or any other desired system or machine.  
         [0050]     Preferably, a flap or portion  18  can be formed in the surface  24  of the cornea  12 , as seen in  FIG. 2 . Preferably the flap is formed in the stromal layer of the cornea, but does not necessarily need to be formed in the stromal layer and can be formed in any desired portion of the cornea. The flap may be formed be any means desired, such as with a knife, microkeratome, or with a laser. Preferably an internal area of the cornea is separated into first and second substantially circular shaped internal surfaces  22  and  26 , respectively, to form the circular shaped corneal flap  18 . First internal surface  22  faces in a posterior direction of cornea  12  and the second internal surface  26  faces in anterior direction of the cornea  12 . The flap  18  preferably has a uniform thickness of about 10-250 microns, and more preferably about 80-100 microns, but can be any suitable thickness. A portion  28  of flap  18  preferably remains attached to the cornea by an area at the periphery of the flap. However, the flap can be any suitable configuration, such as a flap attached to the cornea at a location other than at the periphery or a flap that is not attached to the cornea at all. Additionally, the flap may be shaped or sized as desired and does not need to be circular.  
         [0051]     The flap is moved or pivoted about portion  28  using any device known in the art, such as a spatula or microforceps or any other device, to expose the first and second corneal surfaces  22  and  26 , respectively. The flap preferably exposes a portion of the corneal surface that intersects the main optical axis  30  and allows uninhibited access thereto.  
         [0052]     Lens or shield  20  can then be positioned adjacent and overlying the surface  22  of the cornea, as seen in  FIG. 4 . However, it is noted that the lens does not necessarily need to be positioned adjacent a surface exposed by a flap and may be positioned on the external surface  24  of the cornea  12  or the second internal surface  26 . The surface exposed by the flap is the preferred method, since the cornea will not develop tissue necrosis, which may be possible, if the lens is positioned adjacent the external surface of the cornea.  
         [0053]     Lens  20  is preferably any metal that can absorb heat and transmit and distribute heat throughout the lens in a uniform or substantially uniform manner. However, the lens does not necessarily need to be metal and can be any synthetic or semi-synthetic material, such as plastic or any polymer or any material that has pigmentation that would allow the lens to absorb the heat from the laser and transmit and distribute the heat uniformly throughout the lens.  
         [0054]     Additionally, lens  20  is substantially circular and has a first or inner side or surface  32  and a second or outer side or surface  34  and preferably has a substantially concave shape. The lens preferably has a predetermined shaped, or more specifically, the first surface  32  preferably has a predetermined shape that would be the proper shape of the surface  26  of the cornea plus the flap  18  to focus light onto the retina. In other words, if the interior of the cornea were the shape of the interior surface of the lens the patient would be able to have 20/20 vision or better.  
         [0055]      FIGS. 1-7  show the correction of myopic error using a concave lens  20 . However, the lens can be formed such as lens  120 , shown in  FIGS. 8-12  and discussed below, for correction of hyperopic error or any other shape desired for the correction of astigmatic error or any other error.  
         [0056]     Once the reshaping device is positioned immediately adjacent the exposed surface  26  of the cornea  12 , a heating device is applied or administered to the reshaping device  20 , which in turn transfers the heat to the surface of the cornea. Preferably as seen in  FIG. 5 , a laser  36  is aimed and fired or directed, so that the light emitted form the laser or the laser beam L is absorbed by the reshaping device  20  and then absorbed by or transferred to the cornea. Preferably, the laser beam is in the infrared portion of the electromagnetic spectrum, such as light supplied by a Nd-Yag laser at 1.32 μm, a Holmium laser at 2.2 μm or a Erb-Yag laser at 2.9 μm, or any other laser light wave length that is absorbed by water. For example, the laser light can be from a CO 2  laser or a visible light laser, such as an argon laser. Additionally, the reshaping device can be heated by any means suitable, such as microwaves.  
         [0057]     The laser beam preferably heats the lens so that the inner surface of the reshaping device is about or below 60° Celsius (140° F.), which in turn heats the corneal surface  26  (preferably the stroma) to about the same temperature, thereby softening the cornea. The reshaping device inner surface temperature is constantly controlled or measured, preferably using multiple thermocouples  40  on the inner surface of the reshaping device. The thermocouples are linked to a computer control system (not shown) using any method known in the art, such as direct electrical connection or wires or a wireless system. The computer control system monitors the temperature and controls the laser to change the temperature of the reshaping device. The computer can maintain a precise constant temperature, increase temperature or decrease temperature as desired, and at any rate desired. This computer control system, along with the thermocouples ensure an adequate and precise temperature, since heating the cornea above 60° Celsius can cause coagulation of the cornea.  
         [0058]     By heating the corneal stroma to about or below 60° C., the molecules of the cornea are loosened, and the cornea changes from a substantially solid substance to a gelatinous substance or gel-like substance. However, the corneal temperature is maintained at or below 60° C., and therefore, protein denaturization does not occur as with conventional thermal coagulation. Since the heated portion of the cornea is now flowable, the cornea reforms and is molded to take the shape of the inner surface  32  of the reshaping device, thereby forming the cornea into the reformed, corrected shape in an effort to provide the patient with 20/20 vision. The cornea is then cooled by applying cool or cold water, by applying air or by simply removing the heated reshaping device or the heat from the reshaping device and using the ambient air temperature. As the cornea cools, it is held by the reshaping device  20  to the preferred shape, which becomes its new permanent shape once the cornea is completely cooled and changes from its gel-like consistency to its original substantially solid consistency, as shown in  FIG. 6 .  
         [0059]     The flap  18  is then replaced so that it covers or lies over the first surface  26  of the cornea  12  in a relaxed state, as seen in  FIG. 7 . This new permanent shape allows the cornea to properly focus light entering the eye on the retina. The refractive power of the eye is then measured to determine the extent of the correction. If necessary the method can be repeated.  
         [0060]     A reshaping lens can be applied to the external surface of the cornea, if necessary, after the flap has been replaced to maintain the proper corneal curvature or the eye can be left to heal with no additional reshaping lens being used.  
         [0061]     Furthermore, at the end of the method, if desired, topical agents, such as an anti-inflammatory, antibiotics and/or an antiprolifrative agent, such as mitomycin or thiotepa, at very low concentrations can be used over the ablated area to prevent subsequent haze formation. The mitomycin concentration is preferably about 0.005-0.05% and more preferably about 0.02%. A short-term bandage contact lens may also be used to protect the cornea.  
         [0062]     By reforming the cornea into the desired shape in this manner, a highly effective surgical method is formed that allows perfect or near perfect vision correction without the need to ablate any of the cornea or causing a gray to white response in the cornea of the eye.  
         [0000]    
       FIGS. 8-12 
     
         [0063]     As shown in  FIGS. 8-12 , the same general method as shown in  FIGS. 1-7  can be used to correct hyperopic error in the cornea. In this method, a substantially circular convex reshaping device  120 , rather than concave reshaping device  20 , having a first or inner surface  122  and a second or outer surface  124 , is used and placed immediately adjacent and overlying the surface  26  of the cornea. A heating element, preferably a laser  36 , is used to heat the reshaping device, which in turn increases the temperature of the cornea to about or below 60° Celsius, as described above. This heating causes the cornea to soften and turn into a gel-like material, thereby becoming flowable to conform to the inner surface  122 . Once the corneal surface  26  is cooled and permanently reformed to the inner surface of the reshaping device, the device is removed and the flap replaced. The hyperopic error is corrected and the cornea can now effectively focus light on the retina, as described above.  
         [0064]     This method for correcting hyperopic conditions is substantially similar to the method for correcting myopic conditions. Thus, the entire method described above for correcting myopic error of the cornea applies to the correction of hyperopic error, except for the exact configuration of the reshaping device.  
         [0000]    
       FIGS. 13 and 14 
     
         [0065]     As shown in  FIGS. 13 and 14 , the reshaping device can be a thermally conductive plate or reshaping device  220  that is electrically connected to a power source (not shown) using electrical wires  222 . The thermally conductive plate  220  is preferably any metal or conductive material that can conduct electricity supplied by a power source (not shown) and turn the electricity into heat. Furthermore, the plate preferably is formed from a material that would allow an equal or substantially uniform distribution of heat through the plate.  
         [0066]     This method is similar to those described above; however, the temperature of the cornea is increased using the thermocouple plate instead of a laser. As seen in  FIG. 13 , the plate  220  is heated to the desired temperature, preferably about or below 60° Celsius, as described above. This causes loosening of the corneal molecules or softening of the cornea, which allows the cornea to conform to surface  224  of plate  220 , thereby permanently changing the shape of the cornea. Once the corneal surface  26  has cooled and permanently reformed to the inner surface of the thermocouple plate, the plate is removed and the flap replaced. The cornea can now effectively focus light on the retina, as described above.  
         [0067]     Although, the method is shown in  FIGS. 13 and 14  using a thermally conductive plate to correct myopic error, a thermally conductive plate can be used to change the shape of the cornea in any manner desired, such to correct astigmatic or hyperopic error in the cornea.  
         [0068]     Furthermore, since this method is substantially similar to the methods described above, the description of those methods and references numerals used therein, excluding the specific lens and heating element, apply to this method.  
         [0000]    
       FIGS. 15 and 16 
     
         [0069]     As shown in  FIGS. 15 and 16 , reshaping device  320  can be a container, i.e., hollow, with an irrigation port  330  and an aspiration port  332  providing access to interior chamber  340 . Reshaping device  320  is preferably any metal or plastic that can be filled with a liquid and absorb heat and distribute the heat throughout the reshaping device in a uniform or substantially uniform manner. However, the reshaping device does not necessarily need to be metal and can be any synthetic or semi-synthetic material, such as plastic or any polymer of any material that would allow the lens to absorb the heat from the liquid and distribute the heat uniformly throughout the reshaping device.  
         [0070]     The method of  FIGS. 15-16  is similar to those described above; however, the temperature of the cornea is increased using a tube  334  that couples to the irrigation port and fills chamber  340  of the container with a liquid of a predetermined temperature, preferably about or below 60° Celsius (140° F.). Once filled with the liquid, the inner surface of the reshaping device would increase to the desired temperature, thereby loosening the molecules of the cornea or softening surface  26  of the cornea, which allows the cornea to conform to surface  324  of reshaping device  320  and results in the proper reformation of the cornea. The liquid can then be removed from the container via the aspiration tube  236 , allowing the cornea to cool and permanently reform to the desired shape, as described above. Once the corneal surface  26  has cooled and permanently reformed to the inner surface of the reshaping device, the reshaping device is removed and the flap replaced. The cornea can now effectively focus light on the retina, as described above.  
         [0071]     Although, the method shown in  FIGS. 15 and 16  uses a container to correct myopic error, this method can be used to change the shape of the cornea in any manner desired, such to correct astigmatic or hyperopic error in the cornea.  
         [0072]     Furthermore, since this method is substantially similar to the methods described above, the description of those methods along with the reference numerals used therein, excluding the specific reshaping device and heating element, apply to this method.  
         [0000]    
       FIGS. 17-20 
     
         [0073]     As seen in  FIGS. 17-20 , a modified method does not necessarily need to be performed on the cornea, but can be performed on a separate lens or inlay  430 . Inlay  430  is preferably a substantially circular polymeric or synthetic inlay or blank that has a predetermined thickness and a first side  432  and a second side  434  and is positioned under the flap adjacent second surface  26  to correct refractive error in the eye. For a more complete description of use of an inlay, see U.S. Pat. No. 6,197,019 to Peyman, the entire contents of which are herein incorporated by reference.  
         [0074]     As described above and seen in  FIGS. 18 and 19 , a reshaping device  420  having a first surface  422  and a second surface  424  is placed over the inlay  430  adjacent first second surface  434  and heated to the appropriate temperature using a laser  36 . Since the inlay is a polymer and is not formed from living cells, there is no need to keep the temperature at or about 60° Celsius (140° F.). The rise in temperature of the lens causes the inlay  430  to soften or become a gelatinous material and thereby flowable which allows the inlay to conform to the shape of the inner surface  422  of reshaping device  420 . In a similar manner to that described for the cornea above.  
         [0075]     As seen in  FIG. 20 , once the reshaping device  420  is removed, the flap  18  is placed over the inlay  430 . First internal surface  22  is positioned so that it overlies the second surface  434  of inlay  430  without substantial tension thereon. In other words, the flap is merely laid overtop of the inlay  430  so as to not cause undue stress or tension in the flap and possibly causing damage thereto.  
         [0076]     It is noted that the method of  FIGS. 17-20  is not limited to the first herein described method using a reshaping device and a laser, but can be used with any heating means, such as the container method and the thermally conductive plate method also described herein and any other method that would heat a reshaping device overlying the inlay to the appropriate temperature.  
         [0077]     Additionally, this method of  FIGS. 17-20  can be preformed with a lens that has a predetermined refractive index, is a blank having no refractive index or a lens that has been modified by a laser, a cryolathe or any other method known in the art to have a predetermined refractive index. For example, with a blank, the inlay can have no refractive power, the entire corrective change in the lens coming from the conformation to the inner surface of reshaping device  420  or the inlay can have refractive power with the reshaping device  420  simply modifying the refractive properties.  
         [0078]     Although, the method shown in  FIGS. 17-20  uses a lens to correct myopic error, this method can be used to change the shape of the cornea in any manner desired, such to correct astigmatic or hyperopic error in the cornea.  
         [0079]     Furthermore, since this method is substantially similar to the methods described above, the description of those methods along with the reference numerals used therein applies to this method.  
         [0000]    
       FIGS. 21-29 
     
         [0080]      FIGS. 21-29  illustrate another embodiment of the present invention for correcting refractive error in the eye, wherein a laser  500 , such as a short pulse laser, is used to form cavities or three dimensional portions  502  in the cornea  12  of an eye  10 . A mold or lens  504  is then used to reshape the cornea to correct the refractive error in the eye.  
         [0081]     First, as described above the refractive error in the eye is measured using wavefront technology, as is known to one of ordinary skill in the art or any other suitable method. The refractive error measurements are used to determine the appropriate shape of lens or contact  504  to best correct the error in the patient&#39;s cornea  12 . Preferably, the lens or reshaping device  504  is manufactured or shaped prior to the use of the wavefront technology and is stored in a sterilized manner until that specific lens shape or size is needed. However, the information received during the measurements from the wavefront technology can be used to form the lens using a cryolathe, laser, or any other desired system, method or machine.  
         [0082]     Preferably lens  504  is preferably clear and formed any organic, synthetic or semi-synthetic material or combination thereof, such as plastic or any polymer or any material that has pigmentation that would allow laser light to pass therethough such that laser light could heat the cornea as described herein. Lens  504  has a first surface  520  and a second surface  522 . The second surface preferably is adapted to be positioned adjacent a surface of the cornea and has a predetermined curvature that will change the curvature of the cornea to correct refractive error. However, the lens does not necessarily need to be formed in this manner and can be opaque and/or formed in any manner described above or in any manner suitable for changing the curvature of the cornea.  
         [0083]     As shown in  FIG. 21 , the laser  500  is preferably fired at a portion  506  of the cornea beneath or under the exterior surface  24  of the cornea, forming a predetermined pattern of cavities, which have a predetermined size and shape. In other words, the laser  500  is preferably fired at the stromal layer of the cornea. The laser is programmed to form up to 10,000 small cavities or three dimensional aberrations  502  in the stroma of the eye. Each cavity has a diameter of about 10 microns or less to about 1 millimeter. It is noted that cavities  502  do not necessarily need to be formed in the stroma and can be formed in any portion of the cornea, such as in the Bowman&#39;s layer, the epithelial layer, or suitable portion of the eye or any combination thereof.  
         [0084]     Laser  500  is preferably an ultra short pulse laser, such as a femto, pico, or attosecond laser; but may be any light emitting device suitable for creating cavities  502 . The ultrashort pulse laser  500  is positioned in front of the eye and focuses the laser beam in the cornea  12  at the desired depth for creating multiple cavities. Ultra short pulse lasers are desired since they are capable of ablating or vaporizing corneal tissue beneath the surface of the cornea without disrupting, damaging or affecting the surface of the cornea. Additionally, ultra short pulse lasers are high precision lasers that require less energy than conventional lasers to cut tissue and do not create “shock waves” that can damage surrounding structures. Cuts or ablation performed using ultra short pulse lasers can have very high surface quality with accuracy better than 10 microns, resulting in more precise cuts than those made with mechanical devices or other lasers. This type of accuracy results in less risks and complications than the procedures using other lasers or mechanical devices. However, it is noted that the cavities  502  can be formed by any manner or device desired.  
         [0085]     As shown in  FIGS. 22-24 , cavities  502  can form various configurations or patterns. For example, the cavities can form a substantially circular pattern ( FIG. 22 ), a substantially ring-shaped pattern ( FIG. 23 ), or a pattern that is offset from the main optical axis ( FIG. 24 ). Each specific configuration is particularly useful for correcting a specific vision problem in the eye. For example, a substantially circular pattern facilitates correction of myopia and hyperopia, a substantially ringed shaped pattern facilitates correction of presbyopia and a pattern offset from the main optical axis facilitates correction of astigmatism. It is noted that these patterns and configurations are exemplary purposes only and the cavities can be formed in any suitable configuration for correcting myopia, hyperopia and/or astigmatism or any other refractive error in the eye.  
         [0086]     As shown in  FIG. 25 a  photosensitizer or an ultraviolet absorbing compound  508  can be applied to the surface of the cornea  24  using a device or applicator  510 . The photosensitizer can be applied to the entire cornea or merely to specific areas and can absorb ultraviolet or near ultraviolet red radiation to help facilitate or create cross-linking of collagen and hold the corneal structure into the new reformed shape. A suitable material for photosensitizing the cornea is riboflavin. Additionally, photosensitizer  508  is preferably a liquid or gel that is capable of initiating or catalyzing the energy from the laser  500 ; however, the photosensitizer can be any suitable substance. Furthermore, the initiator does not necessarily need to be a photosensitizer and can be any suitable substance that facilitates formation of the cavities or reduces the heat and/or energy required to form the cavities  502 .  
         [0087]     Once the photosensitizer is applied and allowed to spread through or penetrate to the corneal stroma, lens or reshaping device  504  is positioned immediately adjacent the external corneal surface, as shown in  FIGS. 26 and 27 . Reshaping device second surface  522  which has a predetermined curvature is preferably positioned immediately adjacent the external surface of the cornea, overlying all or substantially all of the cavities  502 ; however, it is noted that it is not necessary for the reshaping device to overlie all or substantially all of the cavities  502  and can overlie only a portion of the cavities  502  if desired. The reshaping device  504  is substantially similar to the embodiments described above and any description thereof is application to the present embodiment, including the use of thermocouples  505 .  
         [0088]     As shown in  FIG. 28 , laser or light emitting device  512  is aimed and fired at the corneal stroma, at or approximately at the portion of the cornea in which the cavities  502  are formed. Laser  512  can be the same laser, or a substantially similar laser, as laser  500 , it can be any device capable of emitting ultraviolet light or near ultraviolet red radiation or laser  512  can be any suitable laser or light emitter. The laser beam L (preferably combined with the reaction from photosensitizer  508 ) then heats the corneal stroma to above body temperature and below a temperature at which coagulation occurs, preferably at about 60° C., and preferably to between about 45° C.-50° C. The preferred temperatures allow or facilitate cross-linking of the collagen cells in the eye, so that the cornea can be reshaped more easily. As with the embodiments described above, the temperature can be controlled using the thermocouples and a suitable computer control system.  
         [0089]     Additionally, it is noted that the laser can heat the reshaping device, which in turn heats the cornea, or the cornea can be heated in any manner described herein.  
         [0090]     By heating the corneal stroma to about or below 60° C., the molecules of the cornea are loosened, and the cornea is softened, in a manner substantially similar to that described above. However, the corneal temperature is maintained at or below 60° C., and therefore, protein denaturization does not occur as with conventional thermal coagulation. Since the heated portion of the cornea is now softened, the cornea reforms and is molded to take the shape of the inner surface of reshaping device  504 , thereby forming the cornea into the reformed, corrected shape in an effort to provide the patient with 20/20 vision. The cornea is then cooled by applying cool or cold water, by applying air, by letting the reshaping device  504  cool through time or by simply removing the heated reshaping device or the heat from the reshaping device and using the ambient air temperature.  
         [0091]     Preferably, as the cornea cools, it is held by the reshaping device  504  to the preferred shape, which becomes its new permanent shape once the cornea is completely cooled and changes to its original substantially solid consistency, as shown in  FIG. 29 .  
         [0092]     Preferably, the reshaping device  504  is transparent as described above, thus allowing the patient to see while the reshaping device is still on the external surface of the eye. In other words, as the cornea cools, the reshaping device  504  acts as a contact lens.  
         [0093]     It is noted that reshaping device does not necessarily need to be applied to the external surface of the cornea and can the positioned directly on the Bowman&#39;s layer, directly on the corneal stroma or any other suitable portion of the cornea. This positioning can be achieved by forming a flap that would expose the desired portion of the internal structure of the cornea. As described herein the flap can be a Lasik type flap (i.e., attached to the cornea at the periphery—see.  FIG. 3 ), or it can be a flap that is attached at a central portion of the cornea (i.e., along the main optical axis), the flap can be completely removed, or the internal structure of the cornea can be exposed in any other suitable manner.  
         [0094]     In another embodiment, device  600  ( FIG. 30 ) can be used in Glaucoma therapy. Heat can be applied to the exterior of the cornea adjacent or in proximity to the Schlem&#39;s canal and trabecular meshwork. Preferably, the device is positioned on the external portion of the cornea adjacent the Schlem&#39;s canal and/or the trabecular meshwork, but can be positioned externally or internally in any suitable manner. This device generally requires no invasive procedures to be performed on the eye, thus reducing the risk of possible damage.  
         [0095]     Such application of the device  600  encourages absorption of deposits which plug the out flow of the aqueous fluid. The heat damages (or kills) certain cells and encourages regeneration of the cells (i.e., re-population), while simultaneously causing other cells to become more active, thereby facilitating removal of debris. The device prefereably heats the corneal stroma between about 20 degrees C. and about 60 degrees C. or any suitable range or temperature therein. For example, suitable ranges can be between about 35 degrees C. and 50 degrees C. and between about 42 degrees C. and about 47 degrees C.; however, the stroma can be heated to any suitable temperature. As with the embodiments described above, the temperature can be controlled using thermocouples and/or a suitable computer control system or in any other suitable manner.  
         [0096]     The device  600  can be substantially circular, substantially semicircular, substantially ring shaped, arcuate or any other suitable configuration that would facilitate or achieve the desired outcome. Prefereably, the device has a first surface  602  and a second surface  604 . The first surface is generally arcuate and has a radius of curvature of about the same curvature as the external surface of the eye; however, the device can have any suitable configuration. The first surface is preferably positioned on the external surface of the cornea at or near the desired area. The device can be heated using any desired means, such as electrically, with lasers and/or water or any suitable means or any combination of the herein described means or any other suitable means.  
         [0097]     Once the device is heated, the eye can be monitored for any suitable duration to determine if any blockage in the Schlem&#39;s canal and/or the trabecular meshwork has been reduced or relieved. If desired, the procedure can be repeated one or multiple times or until the desired result is achieved.  
         [0098]     Furthermore, a laser can be used to heat the appropriate portion of the eye. For example, a laser can be used to ablate or heat the meshwork, thus enhancing the outflow of vitreous fluid. The laser can be used alone to heat/ablate portions of the eye (e.g. the meshwork) or in combination with any other device or method described herein. The addition of the laser to the system allows the light to penetrate deeper into the cornea (or other portion of the eye) while controlling the temperature at the application site. The laser can be applied simultaneously from outside (through the conjunctiva and or sclera) or in a non-coagulative form to the Schlem&#39;s canal (at the junction of the cornea and sclera) in treatment of glaucoma.  
         [0099]     The device  600  can also be used to treat small choroidal tumors, melanoma and/or Retinoblastoma, among other things. In this embodiment, the device is positioned adjacent (or in any suitable location) the choroidal tumors, melanoma and/or Retinoblastoma and heat is applied. The heat is preferably controlled to be below 60 degree Celsius to prevent coagulation of the tissue while achieving destruction of the tumor cells which are more sensitive to heat application than normal cells; however, the heat can be within any suitable range including any temperature above body temperature and at or below the temperature at which coagulation occurs. Prefereably the temperature to which the device (and thus the temperature of the specific area of the eye) is heated is closely controlled or monitored using computers and/or any other means, as described above, or by any suitable means or device.  
         [0100]     The heat to treat small choroidal tumors, melanoma and/or Retinoblastoma, among other things, is applied alone through device  600  or in conjunction with a laser. The laser can be any suitable laser, including a laser within the visible spectrum or any other suitable wavelength. Furthermore, the device can be used with an ultrasonic device or radio frequency probe or any other suitable device.  
         [0101]     Additionally, the device  600  can have any suitable diameter to eliminate or treat any size tumor. For example, the device can be substantially circular with a diameter of about 2-3 mm to treat smaller tumors or the device can be 3-7 mm to eliminate or treat larger tumors. However, it is noted that the device can be any configuration and/or size disclosed above or any other suitable size and/or configuration.  
         [0102]     Furthermore, the device  600  can be used alone or in a combined system for treatment of Age Related Macular Degeneration (ARMD). As with several of the embodiments described above, it is preferable not to increase the corneal tissue temperature above 59 degrees Celsius (or more preferably to above 50 degrees Celsius); however, the cornea can be heated to any suitable temperature between about body temperature and about 60 degrees Celsius. Prefereably the temperature that the macula is heated to is closely controlled or monitored using computers and/or any other means, as described above or by any suitable device or means.  
         [0103]     Additionally, device  600  can be used simultaneously or substantially simultaneously with a device that also applies heat through electricity, ultrasound, radio frequency wave or a laser in visible or infrared light or heated water. The application time of the heat is generally between about 5 seconds to about 600 seconds, but can be 1000 seconds or more. The spot size is preferably between about 0.1 to about 10 mm or larger, but can be any suitable spot size. The diameter of device  6 —when treating ARMD is preferably between about 10 to about 15 mm and is preferably substantially ring shaped; however, the instrument can have any suitable shape or configuration and be any suitable size.  
         [0104]     Furthermore, if desired the above method can be used to heat the macular simply using a device that applies heat through electricity, ultrasound, radio frequency wave or a laser in visible or infrared light or heated water without device  600  to treat ARMD.  
         [0105]     Additionally, any of the above described methods and/or devices can be used to encouraging the penetration of a drug applied to an adjacent tissue. For example, the drug (or any other substance) can be applied topically to the cornea of the eye or in any suitable or desired area of the body. Examples of substances that can be applied are photosensetizers, antimetabolites, anti-cancer, ant-inflammatory, antibiotics, macrolides, antiprostoglandins etc. It is noted that the present method is not limited to these substances and any suitable substance can be used to treat the appropriate portion of the body or to benefit the human body or facilitate healing thereof.  
         [0106]     Preferably, the heat application is controlled in any of the suitable manners described above, which facilitates penetration of topically applied medication (or other substance) in the eye (or other suitable location), including the surrounding tissue.  
         [0107]     While various advantageous embodiments have been chosen to illustrate the invention, it will be understood by those skilled in the art that various changes and modifications can be made therein without departing from the scope of the invention as defined in the appended claims.