Abstract:
An automated eye corneal striae detection system for use with a refractive laser system includes a cornea illuminator, a video camera interface, a computer, and a video display for showing possible eye corneal striae to the surgeon. The computer includes an interface to control the corneal illuminator, a video frame grabber that extracts images of the eye cornea from the video camera, and is programmed to detect and recognize eye corneal striae. The striae detection algorithm finds possible cornea striae, determines their location, or position, on the cornea and analyzes their shape. After all possible eye corneal striae are detected and analyzed, they are displayed for the surgeon on an external video display. The surgeon can then make a determination as to whether the corneal LASIK flap should be refloated, adjusted or smoothed again.

Description:
[0001] The U.S. Government has a paid-up, non-exclusive license in this invention as provided for by Grant No. 1R43 EY13349-01 awarded by the National Eye Institute of the National Institutes of Health.  
         [0002] This application is a continuation-in-part of U.S. Ser. No. 09/842,539, filed Apr. 26, 2001, U.S. Ser. No. 10/008,883, filed Nov. 8, 2001, and U.S. Ser. No. 10/008,884, filed Nov. 8, 2001, which are hereby incorporated by reference herein in their entireties. 
     
    
     
       BACKGROUND  
         [0003]    1. Field of the Invention  
           [0004]    The present invention relates to ophthalmic surgical procedures for the correction of refractive error. More particularly, the present invention relates to an ophthalmic refractive correction procedure known as LASIK, wherein a corneal flap is produced. Still more particularly, the present invention relates to an ophthalmic instrument and method, which automates the detection of eye corneal striae, or corneal wrinkles, following the LASIK procedure.  
           [0005]    2. State of the Art  
           [0006]    Laser refractive surgery has become a very popular method for providing patients with better vision. The majority of laser refractive surgery patients will have the procedure termed LASIK (Laser In-Situ Keratomileusis) performed. There are some very important advantages that have caused LASIK to be used over the original Photo-Refractive Keratectomy (PRK) technique. For example, the healing process is usually shorter and more comfortable for the patient and larger refractive corrections can be performed.  
           [0007]    In the LASIK procedure a microkeratome device is used to create a thin “flap”, typically 120 to 160-microns in depth and typically 7 to 11-millimeters in diameter, in order to expose the corneal stroma below. The flap is not cut completely across the cornea, thus leaving a hinge. The flap is gently lifted off the cornea and held to the side while the laser system delivers the treatment profile into the cornea stroma (tissue directly underneath the flap). After the laser delivery is completed, the flap is put back in place and smoothed by the surgeon. Within about 2 minutes, the flap is reattached enough such that the lid speculum, which is used to hold the eye open, may be removed, thus allowing the patient to blink. At this point the laser refractive procedure is completed.  
           [0008]    Although this procedure does possess many advantages over PRK, it has one drawback that can cause postoperative refractive problems for the patient. The drawback is termed corneal flap striae, which is basically a wrinkle in the corneal flap, created when the flap is not uniformly reattached to the cornea. This striae, or wrinkle, can cause vision problems in the patient ranging from glare to acuity problems due to irregular astigmatism.  
           [0009]    Presently, there are two approaches to reducing or eliminating eye corneal striae. The first approach is a preventative method. Here, in one technique, methods and tools have been developed to visibly mark the cornea before the LASIK flap is made. These markings are then used to realign the flap when it is put back in place. U.S. Pat. No. 5,934,285 (1999) and U.S. Pat. No. 5,697,945 (1997) both to Kritzinger, et. al. describe tools that provide various visible markings to aid in realignment. However, even this technique does not guarantee that there will be no striae present nor does it automate the detection of striae. In another technique described in U.S. Pat. No. 6,019,754 to Kawesch, filtered compressed air is applied to the corneal flap to improve flap adherence. Again, it only addresses flap adherence; it does not address the detection of eye corneal striae.  
           [0010]    The second current approach attempts to detect striae after the flap has been put back in place. Currently, there are two dominant methods for attempting to detect striae after the LASIK procedure. Both methods are manual, as opposed to automated, techniques performed by the surgeon. In the most popular method, the refractive surgeon checks the “smoothness” of the cornea, with just the operating microscope and the diffuse, broadband, white light source present with the operating surgical microscope. Here, the surgeon is just making a broad visual determination if striae are present. In a second less popular, but more effective method, the surgeon uses a handheld slit lamp, which projects a thin line of visible broadband, white light onto the cornea. The surgeon scans this line across the cornea and looks for aberrations, or edges, on what otherwise should be a smooth surface. Usually, only two to three scans are made at different angles on the cornea and thus striae can be, and often are, missed at the other angles that are not addressed.  
           [0011]    Neither of these two present approaches for reducing or eliminating eye corneal striae addresses the automatic detection of eye corneal striae following LASIK refractive surgery.  
           [0012]    Outside the ophthalmic field, U.S. Pat. No. 5,764,345 to Fladd, et al., presents a method for detecting inhomogeneities, specifically striae, in infused silica glasses. This technique was developed for cases where a sample, such as a glass optical lens, can have a beam of light passed through it such that an instrument on the other side of the lens can detect it. This detector is part of an expensive interferometer system used to measure the striae present in the glass. This approach would not work for eye corneal striae detection, as one cannot place a detector on the other side of the cornea. Additionally, the interferometer requires precise alignment and would be too expensive for this application.  
           [0013]    Thus, there is no present method for automatically detecting eye corneal striae following LASIK refractive surgery.  
         SUMMARY OF THE INVENTION  
         [0014]    It is therefore an object of the invention to provide an automated technique for detecting eye corneal striae after LASIK refractive surgery, which is more precise and more complete than existing manual techniques.  
           [0015]    It is another object of the invention to provide an automated technique for detecting eye corneal striae after LASIK refractive surgery, which is faster than existing manual techniques.  
           [0016]    It is a further object of the invention to provide an automated technique for detecting eye corneal striae after LASIK refractive surgery which will aid in the reduction of patient revisits to correct eye corneal striae problems.  
           [0017]    It is an additional object of the invention to provide an automated technique for detecting eye corneal striae after LASIK refractive surgery, which is capable of being retrofit to existing refractive laser systems without modifying any hardware in the existing laser system.  
           [0018]    In accord with these objects an automated eye corneal striae detection system is provided for use with a refractive laser system, which produces a laser for surgically reshaping the eye. In one embodiment of the invention, the automated eye corneal striae detection system includes a means (a corneal illuminator) for illuminating the cornea of the eye with one or more shapes, e.g., lines, circles, squares, triangles, etc., and a means for moving a patient and the illumination shapes relative to each other.  
           [0019]    The means for moving the patient is preferably a surgical bed, surgical chair or headrest, which is motorized to move the patient, and consequently the patient&#39;s cornea, relative to the projected illumination lines. Alternatively, the illumination lines may be moved relative to the cornea of the patient.  
           [0020]    According to another embodiment of the invention, the automated eye corneal striae detection system includes a means (a corneal illuminator) for illuminating the cornea of the eye with one or more illumination shapes, e.g., lines, triangles, stars, crosshairs, squares, etc., and a means for rotating (or otherwise moving) the illumination shapes relative to the eye of a patient.  
           [0021]    In each embodiment, the system also includes a means for capturing images of the eye, a computer, and a video display to present possible corneal striae to the surgeon.  
           [0022]    The computer preferably includes an opto-isolated, digital input-output printed circuit board, which controls the illuminating apparatus, although any digital input-output printed circuit board will suffice; and a video frame grabber, which captures images of the illumination shapes projected on the eye from a camera on the laser system. The computer is programmed to perform an automated eye corneal striae detection algorithm with respect to the images. The automated eye corneal striae detection algorithm finds possible striae in the images and calculates their position and shape characteristics. The possible striae are then displayed on the video display so that the surgeon can make a determination as to whether the corneal flap should be refloated, adjusted or smoothed again.  
           [0023]    The present invention overcomes many of the problems associated with existing manual methods and tools used to prevent and detect eye corneal striae, or corneal wrinkles, after LASIK refractive surgery, by automating the eye corneal striae detection process with a computer-based analysis system.  
           [0024]    The automated eye corneal striae detection system may be retrofit to existing refractive laser systems. Additionally, the automated eye corneal striae detection system may be provided as an integral part of new refractive laser surgery systems.  
           [0025]    Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the accompanying drawings. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0026]    [0026]FIG. 1 is a schematic view of a refractive surgery system microscope provided with a corneal illuminator, an automated eye corneal striae detection computer system, a patient positioning interface, and a surgeon&#39;s video display according to the invention;  
         [0027]    [0027]FIG. 2A is a perspective view of a corneal illuminator according to the invention shown attached to a refractive surgery system microscope disposed above an eye being analyzed;  
         [0028]    [0028]FIG. 2B is a schematic elevation view showing the corneal illuminator juxtaposed with a microsurgery microscope and the surface of the eye and additionally showing a cross section of the linear light beams directed to the cornea;  
         [0029]    [0029]FIG. 2C is a schematic, upwardly-directed, view taken on line  2 C- 2 C in FIG. 2B and showing the circular openings as well as alternate positions of the openings shown by dashed circles;  
         [0030]    [0030]FIG. 2D shows a printed circuit board with illumination light sources installed and interface cable connector port along with dashed circles describing alternate positions for the illumination light sources;  
         [0031]    [0031]FIG. 3A is a schematic view of the corneal illuminator electronics interface subsystem according to the invention;  
         [0032]    [0032]FIG. 3B is a schematic view of the patient positioning electronics interface subsystem of the invention;  
         [0033]    [0033]FIG. 4A and 4B comprise a flow chart describing the method of corneal striae detection according to the invention;  
         [0034]    [0034]FIG. 5 shows all lines illuminated on the cornea at one static position (e.g., not being scanned) during the analysis portion of the invention;  
         [0035]    [0035]FIG. 6 shows the processed, detected inner and outer edges of all static illuminated lines on the cornea within a region-of-interest shown in FIG. 5, as seen through a camera coupled to a microscope; i.e., inverted from FIG. 5;  
         [0036]    [0036]FIG. 7A describes the scanning of an illumination line across a cornea within a region-of-interest during the analysis according to the invention, in an inverted orientation relative to FIG. 5;  
         [0037]    [0037]FIG. 7B shows the processed, detected inner and outer edges of the illumination line described in FIG. 7A, along with the detection of one possible striae object;  
         [0038]    [0038]FIG. 7C shows one possible detected striae object after all processing has been completed on the scanned positions of the illumination line described in FIG. 7A;  
         [0039]    [0039]FIG. 8 is an alternate video camera position and attachment method along with a cross section of the linear light beams directed to the cornea;  
         [0040]    [0040]FIGS. 9A and 9B describe an alternate striae recognition algorithm according to the invention;  
         [0041]    [0041]FIG. 10 shows a schematic view of an alternative corneal illuminator electronics interface subsystem using fiber optic illumination;  
         [0042]    [0042]FIG. 11 shows a digitally captured image of an eye with possible striae highlighted;  
         [0043]    [0043]FIG. 12 shows a line illuminated on the cornea at one position during rotation of the line on the cornea according to another embodiment of the invention;  
         [0044]    [0044]FIG. 13 shows a first assembly by which to rotate a projected illuminated shape, such as a line, on the cornea;  
         [0045]    [0045]FIG. 14 a  shows a binary representation of an image of the line of FIG. 12 on the cornea;  
         [0046]    [0046]FIG. 14 b  shows several binary representations of the line of FIG. 12 at different rotational positions;  
         [0047]    [0047]FIG. 14 c  shows detected edges of the line at the different rotational positions of FIG. 14 b,  which permit identification of potential striae;  
         [0048]    [0048]FIG. 15 shows a second assembly by which to rotate a projected illuminated shape, such as a line, on the cornea;  
         [0049]    [0049]FIGS. 16 and 17 show masks which, when used in conjunction with an illumination source, are adapted to project non-linear shapes onto the cornea; and  
         [0050]    [0050]FIG. 18 shows crosshairs illuminated on the cornea at one position during rotation of the crosshairs on the cornea according to an embodiment of the invention. 
     
    
     REFERENCE NUMERALS IN DRAWINGS  
       [0051]    [0051] 20  refractive surgery system operating microscope  
         [0052]    [0052] 21  annularly arranged circular openings  
         [0053]    [0053] 22  ring illuminator housing  
         [0054]    [0054] 23  line generator optic  
         [0055]    [0055] 24  illumination light sources  
         [0056]    [0056] 25  corneal illuminator interface cable  
         [0057]    [0057] 26  light emitter  
         [0058]    [0058] 28  cornea  
         [0059]    [0059] 29  eye  
         [0060]    [0060] 31  iris  
         [0061]    [0061] 32  illumination scan line one  
         [0062]    [0062] 33  illumination scan line two  
         [0063]    [0063] 34  illumination scan line three  
         [0064]    [0064] 35  illumination scan line four  
         [0065]    [0065] 36  illumination scan line five  
         [0066]    [0066] 39  illumination scan line six  
         [0067]    [0067] 40  microscope optics  
         [0068]    [0068] 41  pupil  
         [0069]    [0069] 42  video camera optical port  
         [0070]    [0070] 43  cross sectional view of an illumination scan line on the cornea  
         [0071]    [0071] 44  video camera  
         [0072]    [0072] 45  illumination scan line seven  
         [0073]    [0073] 46  automated eye corneal striae detection computer system  
         [0074]    [0074] 47  illumination scan line eight  
         [0075]    [0075] 48  opto-isolated corneal illuminator and patient positioning PC interface board  
         [0076]    [0076] 49  other possible locations for illumination sources  
         [0077]    [0077] 50  video camera interface  
         [0078]    [0078] 51  side view of an illumination scan line on the cornea  
         [0079]    [0079] 52  frame grabber  
         [0080]    [0080] 53  other possible locations for annularly arranged openings  
         [0081]    [0081] 54  eye corneal striae recognition processor  
         [0082]    [0082] 56  video display interface  
         [0083]    [0083] 57  surgical chair (or bed or headrest)  
         [0084]    [0084] 58  corneal illuminator electronics and patient positioning interface subsystem  
         [0085]    [0085] 60  corneal illuminator  
         [0086]    [0086] 62  surgeon&#39;s video display  
         [0087]    [0087] 70  interface cable  
         [0088]    [0088] 74  electrical current limiting resistors  
         [0089]    [0089] 80  Automated Eye Corneal Striae Detection Algorithm  
         [0090]    [0090] 82  Turn ON LEDs  
         [0091]    [0091] 84  Send ON Signal to Control Electronics  
         [0092]    [0092] 86  Receive Digitized Image  
         [0093]    [0093] 88  mask out striae area in image  
         [0094]    [0094] 90  apply nonlinear edge detection operator  
         [0095]    [0095] 92  apply thresholding technique  
         [0096]    [0096] 94  apply outer gradient operator  
         [0097]    [0097] 96  apply particle filter  
         [0098]    [0098] 98  get particle parameters from particle filter  
         [0099]    [0099] 99  create ideal lines from particle filter results and subtract from processed outer and inner edges  
         [0100]    [0100] 100  all line scans processed (decision activity)  
         [0101]    [0101] 102  outline possible corneal striae  
         [0102]    [0102] 104  show possible corneal striae on display  
         [0103]    [0103] 106  process for striae again (decision activity)  
         [0104]    [0104] 108  detection algorithm done  
         [0105]    [0105] 120  illumination light source printed circuit board  
         [0106]    [0106] 122  illuminator interface connector port  
         [0107]    [0107] 124  clearance space  
         [0108]    [0108] 126  mounting fasteners  
         [0109]    [0109] 128  ring illuminator housing mounting bracket  
         [0110]    [0110] 134  large clearance hole (in PCB)  
         [0111]    [0111] 136  region-of-interest (ROI)  
         [0112]    [0112] 138  eye optical axis  
         [0113]    [0113] 140  mounting bracket  
         [0114]    [0114] 142  video camera lens  
         [0115]    [0115] 144  alternative fiber optic corneal illuminator and patient positioning electronics interface subsystem  
         [0116]    [0116] 146  fiber optic corneal illuminator interface bundle  
         [0117]    [0117] 148  fiber optic illumination light sources  
         [0118]    [0118] 150  video camera cable  
         [0119]    [0119] 152  video display cable  
         [0120]    [0120] 160  pattern matching technique  
         [0121]    [0121] 162  get matched particle parameters  
         [0122]    [0122] 166  outer edge of illumination scan line one  
         [0123]    [0123] 167  inner edge of illumination scan line one  
         [0124]    [0124] 168  outer edge of illumination scan line two  
         [0125]    [0125] 169  inner edge of illumination scan line two  
         [0126]    [0126] 170  outer edge of illumination scan line three  
         [0127]    [0127] 171  inner edge of illumination scan line three  
         [0128]    [0128] 172  outer edge of illumination scan line four  
         [0129]    [0129] 173  inner edge of illumination scan line four  
         [0130]    [0130] 174  outer edge of illumination scan line five  
         [0131]    [0131] 175  inner edge of illumination scan line five  
         [0132]    [0132] 176  outer edge of illumination scan line six  
         [0133]    [0133] 177  inner edge of illumination scan line six  
         [0134]    [0134] 178  outer edge of illumination scan line seven  
         [0135]    [0135] 179  inner edge of illumination scan line seven  
         [0136]    [0136] 180  outer edge of illumination scan line eight  
         [0137]    [0137] 181  inner edge of illumination scan line eight  
         [0138]    [0138] 183  possible detected striae object  
         [0139]    [0139] 185  steering diode  
         [0140]    [0140] 187  double-pole, double-throw (DPDT) relay, X  
         [0141]    [0141] 188  double-pole, double-throw (DPDT) relay, Y  
         [0142]    [0142] 189  voltage supply for X-left motion, V XL    
         [0143]    [0143] 191  voltage supply for X-right motion, V XR    
         [0144]    [0144] 193  voltage supply for Y-forward motion, V YF    
         [0145]    [0145] 195  voltage supply for Y-back motion, V YB    
         [0146]    [0146] 197  surgical bed interface cable  
         [0147]    [0147] 199  position surgical chair  
         [0148]    [0148] 200  save possible detected striae objects for later display  
         [0149]    [0149] 202  all line positions recorded (decision activity)  
         [0150]    [0150] 204  example of display of possible striae highlighted  
         [0151]    [0151] 206  all scan positions of line processed (decision activity)  
         [0152]    [0152] 402  line generating laser diode  
         [0153]    [0153] 404  neutral density filter  
         [0154]    [0154] 406  iris  
         [0155]    [0155] 408  stepper motor  
         [0156]    [0156] 410  shaft and gear  
         [0157]    [0157] 412  gear  
         [0158]    [0158] 414  flange to connect to microscope optical camera port  
         [0159]    [0159] 420  a digitized line reflected from the cornea  
         [0160]    [0160] 420   a,    420   b,    420   c  independent rotated positions of line  420   
         [0161]    [0161] 422  region-of-interest  
         [0162]    [0162] 424  cornea  
         [0163]    [0163] 426   a,    426   b ,  426   c  edges of each reflected line position  
         [0164]    [0164] 500  a slit shaped mask  
         [0165]    [0165] 502  illumination source  
         [0166]    [0166] 504  diffuser plate  
         [0167]    [0167] 506  optic  
         [0168]    [0168] 508  motor  
         [0169]    [0169] 510  shaft and gear  
         [0170]    [0170] 512  gear ring  
         [0171]    [0171] 514  flange to connect to microscope optical camera port  
         [0172]    [0172] 602  mask  
         [0173]    [0173] 604  triangular shape slit  
         [0174]    [0174] 606  radiating spoke slits  
         [0175]    [0175] 610  mask  
         [0176]    [0176] 612  star shape slit  
         [0177]    [0177] 614  radiating spoke slits  
         [0178]    [0178] 620  crosshairs  
         [0179]    [0179] 622 ,  624  lines of crosshairs  
       DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0180]    Turning now to FIG. 1, a refractive surgery system operating microscope  20  is coupled to an automated eye corneal striae detection computer system  46  of the invention. The refractive surgery system operating microscope  20  includes a set of microscope optics  40  allowing the surgeon adequate view of the corneal surface and a video camera optical port  42  optically coupling the image the surgeon views to a video camera  44 , e.g., a Teli CS6460, that is used to capture a corneal image (FIG. 5).  
         [0181]    The automated eye corneal striae detection computer system  46 , e.g., a Compaq Deskpro EN, 450-MHz PC, generally includes a video camera interface  50  that is coupled to the video-out port of the video camera  44  through a video camera cable  150 , and a frame grabber  52 , e.g., a National Instruments PCI 1411. The computer system  46  also includes a video display interface  56  that is coupled to a surgeon&#39;s video display  62  through a video display cable  152 , and an opto-isolated corneal illuminator and patient positioning PC interface board  48 , e.g., a National Instruments PCI-6527. In addition, the computer system  46  includes an eye corneal striae recognition processor  54 , which implements a software algorithm  80  for striae detection as discussed below with respect to FIGS. 4A and 4B.  
         [0182]    Referring to FIG. 2A, a corneal illuminator  60 , attached to the refractive surgery system operating microscope  20 , is shown in relationship to a patient&#39;s cornea  28 . Referring to FIG. 2B, the corneal illuminator  60  includes a ring illuminator housing  22  and an illumination light source printed circuit board  120  (FIG. 2D). The ring illuminator housing  22  is constructed and arranged to be mounted on the base of the refractive surgery system operating microscope  20 . A ring illuminator housing mounting bracket  128  and a set of mounting fasteners  126  are used to mount the corneal illuminator  60  to the refractive surgery system operating microscope  20 , although other mounting methods may be used.  
         [0183]    Ring illuminator housing  22  is in the form of a preferably continuous ring having an inner diameter generally sufficient to ensure an adequate clearance space  124  so as not to interfere with the delivered laser beam or the optical view of the surgeon (FIG. 2C). In the preferred embodiment, the diameter of the clearance space  124  is approximately 50 mm. Ring illuminator housing  22  is also provided with a plurality of annularly arranged circular openings  21  that are preferably evenly spaced (though may be otherwise spaced) around the ring illuminator housing  22 . In a preferred embodiment, preferably eight circular openings are arranged as follows. Beginning on the left at the 0-degree axis, a hole exists for illumination scan line  36 , the scan lines being described below in greater detail. Counterclockwise (CCW) 22.5° from 0°, the next hole exists for another illumination scan line  35 . Counterclockwise (CCW) 45° from 0°, the next hole exists for another illumination scan line  34 . This arrangement repeats for all eight holes that are spaced at 22.5° intervals.  
         [0184]    Referring to FIGS. 2C and 2D, the illumination light source printed circuit board  120  includes illumination light sources  24  coupled to line generator optics  23 . The light sources are preferably white light emitters  26 , although any preferably monochromatic light source wavelength that is reflected by the cornea is applicable, which may be fiber bundles, light emitting diodes, incandescent bulbs, halogen bulbs, etc. The line generator optics  23  may be cylindrical lenses, micro rod lenses, Powell-glass lenses, etc. In the preferred embodiment, eight bright white light emitting diodes, e.g., Lumex SSL-LX3054UWC/A, serve as the light emitters  26 , and when coupled to the line generator optic  23 , e.g., an Edmund Industrial Optics L54-088, serve as the illumination light sources  24 . When spaced evenly around ring illuminator housing  22 , as shown in FIG. 2D, illumination light sources  24  provide scan lines  32 ,  33 ,  34 ,  35 ,  36 ,  39 ,  45  and  47 , which pass through the circular openings  21  to illuminate the cornea  28 . The scan lines are preferably directed through the openings  21  to the cornea at an angle of 16° from the optical axis  138 , although other angles may be implemented. A greater or fewer number of illumination light sources  24  may be employed. In addition, the printed circuit board has a large clearance hole  134  preferably coaxial with clearance space  124  so as not to interfere with the delivered laser beam or the optical view of the surgeon.  
         [0185]    A corneal illuminator interface cable  25  connects to the illumination light source printed circuit board  120  at an illuminator interface connector port  122 , shown as an edge card connector arrangement although other connector arrangements may be used, and to a corneal illuminator electronics and patient positioning interface subsystem  58 . Alternatively, the light emitters  26  may be individually wired to the corneal illuminator interface cable  25  that connects to the corneal illuminator electronics and patient positioning interface subsystem  58 . Even further, light emitters  26  may be individual fiber optic cables connected to an alternative fiber optic corneal illuminator electronics and patient positioning interface subsystem  144  through a fiber optic corneal illuminator interface bundle  146 , as described below with respect to FIG. 10.  
         [0186]    A patient positioning system, such as a surgical chair  57  (or bed or headrest) provided with motors, is capable of relatively rapidly positioning the chair such that an eye of a patient in this chair is moved relative to illumination scan lines  32 ,  33 ,  34 ,  35 ,  36 ,  39 ,  45  and  47  to thereby scan the lines across the cornea.  
         [0187]    Referring to FIG. 3, the corneal illuminator electronics and patient positioning interface subsystem  58  is connected by corneal illuminator interface cable  25  to the corneal illuminator  60  and by an interface cable  70  to the opto-isolated corneal illuminator PC interface board  48 . The corneal illuminator electronics and patient positioning interface subsystem  58  also provides appropriate control signals to move the surgical chair  57  through a surgical bed interface cable  197 . To that effect, control signals from the opto-isolated corneal illuminator PC interface board  48  are coupled to double-pole, double-throw (DPDT) relays  187  and  188 , e.g., Aromat Corp. TQ2-5V relays. When activated, DPDT relays  187  and  188  couple appropriate control voltages V XL , V XR , V YF , or V YB , to surgical chair  57  “X” and “Y” motor control circuitry through surgical chair interface cable  197 . DPDT relays  187  and  188  operate in such a way as to couple only one voltage (V XL  or V XR ) to the “X” motor control circuitry and only one voltage (V YF  or V YB ) to the “Y” motor control circuitry. Steering diodes  185  protect voltage supply for X-left motion, V XL    189 , voltage supply for X-right motion, V XR    191 , voltage supply for Y-forward motion, V YF    193 , and voltage supply for Y-back motion, V YB    195  from errant feedback voltages.  
         [0188]    Referring to FIG. 5, eight illumination scan lines  32 ,  33 ,  34 ,  35 ,  36 ,  39 ,  45  and  47  are shown in a static centered position (e.g., not being scanned) on the cornea. The scan lines are preferably each one millimeter wide and arranged at 22.5° intervals about a center and clockwise relative to a 0° axis; i.e., at 0°, 22.5°, 45°, 67.5°, 90°, 112.5°, 135°, and 157.5°. The lines are positioned on a corneal surface within a region-of-interest (ROI)  136  slightly larger than the largest LASIK incision. In a preferred embodiment, the region-of-interest (ROI)  136  is approximately 12-mm in diameter and is centered on a pupil  41 , although other ROI sizes can be used. Eye  29 , an iris  31  and pupil  41  are shown in relationship to the illumination light sources&#39; coverage areas. As the scan lines are preferably one millimeter wide, the scan lines are scanned across the cornea at one millimeter intervals, using the patient positioning system, such that a scan line is subsequently positioned with an inner edge of the scan line at the location of the outer edge of the scan line in the previous position.  
         [0189]    The apparatus of the invention is placed into operation after the LASIK surgery procedure is completed and the flap has been manipulated back to its original place by the surgeon and allowed to seal. According to FIG. 4A, in accord with the preferred algorithm  80 , the automated eye corneal striae detection computer system  46  turns on appropriate LEDs at  82  by sending out a control signal at  84  through the opto-isolated corneal illuminator and patient positioning PC interface board  48  to the corneal illuminator electronics and patient positioning interface subsystem  58 . The cornea  28  is thereby illuminated with a first illumination scan line  32  (FIG. 5).  
         [0190]    Next, at  199 , the computer system  46  sends out a control signal at  84  through opto-isolated corneal illuminator and patient positioning PC interface board  48  to corneal illuminator electronics and patient positioning interface subsystem  58  to position surgical chair  57  to orient illumination scan line  32  in the correct position. For example, the beginning position of illumination scan line  32  is achieved by energizing DPDT relay  188  such that voltage supply for Y-forward forward motion, V YF    193  is applied to surgical chair  57  until the correct position is obtained. In another example, illumination scan line  34  is placed in its original position (FIG. 7A, lower left position) by energizing DPDT relays  187  and  188  simultaneously such that voltage supply for Y-forward motion, V YF    193  and voltage supply for X-right motion, V XR    191  are applied to surgical chair  57  until the correct position is obtained. Once the current illumination scan line is in position, control is passed to  86 .  
         [0191]    Referring back to FIG. 1, the video camera optical port  42  to which video camera  44  is coupled is typically a microscope beam splitter optical port which permits users to attach cameras thereto for recording the surgery and audience viewing of the surgery. The automated eye corneal striae detection computer system  46  takes advantage of one of these microscope beam splitter optical ports in order to monitor the eye via a provided video camera. For example, in the VISX™ laser system, an electronic output signal port connector is provided which is attached to an internal color CCD camera. On other systems an electronic signal splitter can be attached at the output of the camera so that the video camera interface  50  and the frame grabber  52  may capture the signal. Alternatively, a separate camera may be provided with the automated eye corneal striae detection system of the invention and added to the microscope beam splitter optical port in order to capture the illuminated corneal images. That is, a number of methods and systems may be utilized to capture the image of the eye from the refractive surgery system operating microscope  20  used in performing the refractive laser surgery. The frame grabber  52  takes the signal from the video camera interface  50  and converts it to a digital signal. Alternatively, a digital camera and associated digital frame grabber, e.g., a Pulnix TMC-1000 and National Instruments PCI-1424, respectively, can be used to capture the corneal image directly in digital format.  
         [0192]    Referring back to FIG. 4A, the automated eye corneal striae detection computer system  46  receives the digitized image signal for each scan position at  86  and converts the digitized image signal to a digital matrix, which is save (stored in memory) for individual later processing. Referring to FIG. 4B, a decision is made at  202  as to whether all of the current illumination scan line positions for a particular scan line have been recorded. If not, control is returned to  199  where surgical chair  57  is moved to the next position. For example, the second position of illumination scan line  32  is achieved by energizing DPDT relay  188  such that voltage supply for Y-back motion, V YB    195  is applied to surgical chair  57  until the correct position is obtained. In the second example, illumination scan line  34  is placed in its next position (FIG. 7A) by energizing DPDT relays  187  and  188  simultaneously such that voltage supply for Y-back motion, V YB    195  and voltage supply for X-left motion, V XL    189  are applied to surgical chair  57  until the correct position is obtained. If all current illumination scan line positions have been recorded, control is sent to  88 .  
         [0193]    Generally, the automated eye corneal striae detection computer system  46  (1) processes the digitized corneal image for eye corneal striae recognition, (2) determines a position and a shape characteristic profile for each detected eye corneal striae object, and (3) displays the detected eye corneal striae object to surgeon&#39;s video display  62 . Each of the functions of the automated eye corneal striae detection computer system  46  are preferably performed by the algorithm  80 , which is now described in detail.  
         [0194]    Once all of the current illumination scan line positions have been recorded at  86 , there are several image processing methods that can be used to find eye corneal striae. One preferred method implemented by the eye corneal striae recognition processor  54  uses the contrast between the reflected illumination scan lines of light and the non-reflected surface of cornea  28 . Each captured, digitized illumination scan line of light is compared against a calculated, digitized line object (or ideal line objects) to detect the striae, which distorts the reflected illumination scan line of light where present, and determines the striae&#39;s positions and shape characteristic profile, preferably by the following ten steps.  
         [0195]    First, a small area of the captured image is masked out at  88  so as to limit the region-of-interest (ROI)  136  (FIG. 5) for detecting the eye corneal striae. This region of interest is slightly larger than the LASIK incision, and in the present embodiment consists of a 12 mm diameter circular area centered on the pupil  41 .  
         [0196]    Second, image data from the region-of-interest (ROI)  136  is then processed at 90 by an edge detection operator, preferably a Prewitt or Sobel, although other edge detection approaches can be used, to highlight edges within the ROI image. Once this operation has been performed, a bimodal image is produced.  
         [0197]    Third, a threshold function is preferably applied to the bimodal image at  92  to create a binary representation of the image, which permits faster image processing. The threshold function replaces the image intensity values below some threshold value to black (a value of zero) while placing the intensity values above the threshold value to all white (a value of 256 in an 8-bit image representation); i.e., a binary representation of the image is created. At this step the edges of the captured, digitized illumination scan lines within the ROI image are now totally white against a black background.  
         [0198]    Fourth, the binary representation is preferably further processed at  94  by an outer gradient operator. In this operation an external edge algorithm subtracts the source ROI image from a dilated image of the source ROI image. The remaining image pixels correspond to the pixels added by the dilation. This yields a more pronounced image of the inner edge  167  and outer edge  166  of the captured, digitized illumination scan line  32  (FIGS. 5 and 6). The inner and outer edges  168 - 181  of the other scan lines (scan lines two through eight  33 ,  34 ,  35 ,  36 ,  39 ,  45  and  47 ) may similarly be detected.  
         [0199]    Fifth, at  96 , the processed binary ROI image undergoes a characterization process, termed a particle filter, to determine a set of parametric values from the image. Since all captured, digitized current positions of illumination scan line  32  will be linear (or nearly linear), processed inner edge  167  and outer edge  166  will be linear (or nearly linear) in shape and within a known length (greater than 2 mm and less than 12 mm, in the preferred embodiment). Thus, the search of the binary objects can be limited to a range defined by the dimensions and shape characteristics of illumination scan line  32 . A search is then performed on the binary image for objects matching the criterion. Those objects found in this range are returned with several pieces of shape characteristic information, termed a shape characteristic profile.  
         [0200]    Sixth, at  98 , the shape characteristic information (particle parameters) is extracted from the particle filter and saved for future processing. Such pieces of shape information include, but are not limited to, object position, center of mass, bounding box coordinates, perimeter length, etc.  
         [0201]    Seventh, referring to FIG. 4B, at  99 , the shape information found at  98 , in particular the bounding box coordinates and the object position coordinates, is used to create ideal line objects with lengths and positions based on processed outer and inner edges  167 ,  166  of scan line  32 . The created ideal line objects are then subtracted from the processed inner edge  167  and outer edge  166 , yielding possible striae objects. An example of one possible striae object is shown in FIGS. 7B and 7C as object  183 . Any possible striae objects are saved at  200  for later display at  104 .  
         [0202]    Eighth, the algorithm  80  decides at  100  whether all illumination scan lines have been processed for each position. This is based on whether all illumination scan lines are projected individually as disclosed in the preferred embodiment; projected at the same time (as suggested by FIG. 5); or projected in any other combination. In the preferred embodiment, scan lines at each position are individually recorded at  202 , and then for each position processed at  88 ,  90 ,  92 ,  94 ,  96 ,  98  and  99 . If all illumination scan lines have been processed at  206  (scans for each individual line) and then at  100  (all lines), the algorithm then continues on to display the results at  102  discussed below. If not, the algorithm continues at  82  (FIG. 4A) where the next illumination scan line is illuminated on the cornea. Algorithm control then continues as previously described.  
         [0203]    Ninth, at  102  (FIG. 4B), possible striae found at  99  are highlighted with a high-contrast color, such as red, yellow or green, although other high-contrast colors would suffice, and integrated with a digitally captured image of the eye  29  so that the possible corneal striae are obvious to the surgeon. This new generated image (FIG. 11) is sent at  104  to the surgeon&#39;s video display  62  for viewing by the surgeon or other medical practitioner, with the possible corneal striae  204  highlighted. (It is noted that the striae  204  displayed in FIG. 11 do not correspond in location to the possible striae identified in FIGS. 7B and 7C.)  
         [0204]    Tenth, at  106 , the surgeon is given the option to repeat the process. This may occur after the surgeon has smoothed a striae or wrinkle, or when the surgery procedure is complete. If the surgeon requires another process, algorithm control is sent back to  82  and the procedure repeats. If the surgeon indicates the procedure is complete, the algorithm is finished at  108 .  
         [0205]    It is recognized that there may be variations on the first embodiment system and method that are within the scope of the invention. By way of example, shapes other than lines may be projected on the cornea and scanned thereacross. For example, circles, squares, triangles, and any other shape (preferably which is easily definable in mathematical terms) may be scanned across the eye. The non-linear shapes may be projected by an illumination source and a mask. Then, if such non-linear shapes are utilized, the processing may be substantially similar to that described with respect to the lines. That is, (1) a limited region-of-interest is defined in the image for detecting the corneal striae objects; (2) the image data from the limited region-of-interest is processed by shape characteristic information such that a bimodal image is produced; (3) a threshold function is applied to the bimodal image such that a binary representation of the image is created; (4) the binary representation image is searched for shapes having dimensions substantially similar to a predetermined shape; (5) an ideal shape is created having predefined dimensions; and (6) the ideal shape is subtracted from shapes located in the binary representation image such that possible corneal striae objects are identified.  
         [0206]    By way of another example of a modification to the system, the video camera  44  may be otherwise positioned. Referring to FIG. 8, the video camera  44  is shown mounted to the refractive surgery system operating microscope  20  by a mounting bracket  140  at an appropriate angle to capture an image of the cornea and at a proper position so as not to interfere with the surgeon or surgeon&#39;s assistants. A video camera lens  142  is used to provide the automated eye corneal striae detection computer system  46  (FIG. 1) with an appropriate sized image to perform striae detection. The addition of the video camera lens  142  ensures that eye corneal striae recognition processor  54  receives a similar image as is delivered in the previous embodiment. In this embodiment the output port of the video camera  44  is connected to the video camera interface  50  in the automated eye corneal striae detection computer system  46  through the video camera cable  150  as before.  
         [0207]    In addition, another eye corneal striae recognition approach can be used. For example, referring to FIGS. 9A and 9B, an eye corneal striae recognition technique involving pattern matching can be implemented at  160 . As in the preferred embodiment, the cornea is illuminated with illumination scan line  32  at  82  and  84 ; surgical chair  57  moves the patient, and this the patient&#39;s eye, to the correct position and the illuminated cornea image is captured and saved for later processing at  86 ; a decision is made at  202  (FIG. 9B) as to whether all positions of the current illumination scan line have been captured and saved; possible corneal area (ROI) for striae is masked out at  88 ; and a pattern matching technique is applied at  160 . This alternative pattern matching technique uses a grayscale pattern matching method based on correlation. Known, defined illumination line objects (e.g., known lengths and widths) are scanned through each ROI image searching for a pattern match. The technique is shift-invariant, stretch or size-invariant, and rotation-invariant, and is highly immune to adverse lighting conditions, focus variations, or noise. Once an illumination line object is found, its shape characteristic information (particle parameters), such as object position, center of mass, and bounding ox coordinates, are saved at  162  as in the main embodiment algorithm, and processing then occurs as before at  99 . Algorithm control continues from here as described in the main embodiment.  
         [0208]    Turning now to FIG. 10, an alternative illumination means is shown. A fiber optic corneal illuminator electronics interface subsystem  144  includes fiber optic illumination light sources  148 . The interface subsystem  144  is connected by a fiber optic corneal illuminator interface bundle  146  to the corneal illuminator  60  and by an interface cable  70  to the opto-isolated corneal illuminator and patient positioning PC interface board  48 . Electrical current limiting resistors  74  couple the control signal from the opto-isolated corneal illuminator patient positioning PC interface board  48  to fiber optic illumination light sources  148 , e.g., an Industrial Fiber Optics IF-E97, preferably white light sources, although any monochromatic wavelength that is reflected by the cornea will suffice. Moreover, when any color monochromatic light is used (e.g., red, blue, green, etc.), either by fiber optics, LEDs, incandescent sources, etc., the lines may be processed using color techniques in which the objects are identified based on their color.  
         [0209]    Furthermore, rather than moving the patient relative to the corneal illuminator, the lines or other shapes may be scanned across the cornea while the patient is relatively immobilized. For example, the light emitters can be motorized or scanning mirrors can be utilized to scan the illumination lines across the cornea.  
         [0210]    According to a second embodiment of a corneal striae detection system, rather than scanning lines or other illumination shapes across the cornea, lines or other illumination shapes may be rotated on cornea. The image of the line or other shape can be projected onto the cornea with a beamsplitter optical port of the operating microscope, which all surgical microscopes offer to allow for additional surgeon viewing or for attaching a video camera. Referring to FIG. 12, for example, with the use of appropriate optical elements, a single line  420 , generated either preferably from a line generating laser diode, or alternatively from an illuminated mask, can be projected onto the region-of-interest  422  of the cornea  424 . This line  420  can then be rotated through 180-degrees to cover the entire cornea by a simple motorized mount, as hereinafter described. It is also appreciated that appropriate optical elements can be utilized to project and rotate shapes other than lines; e.g., triangles, stars, squares, eccentrically-rotated circles, etc.  
         [0211]    With respect to projecting and rotating a line, FIG. 13 shows a preferable configuration whereby a line generating laser diode assembly  402 , e.g., an Edmund Scientific L52-896, connected to a gear  412 , is rotated by a stepper motor  408  connected to a shaft and gear  410 , e.g. an Airpax/Thomson 26M048B1U, or a dc motor with appropriate gear reduction. Alternatively, rather than combining the stepper motor with the gear, off-the-shelf rotation positioning stages can be utilized, with the laser diode assembly attached thereto. As yet another alternative, external hardware including pulse generating circuitry for the stepper motor, or transistors and feedback sensor circuitry for the dc motor can be provided which drives the rotation motor with simple commands from the computer.  
         [0212]    In a preferred, though not required, part of the method, the optically generated line passes through a neutral density filter  404  in order to reduce the optical power delivered to the eye. Additionally, an iris  406  preferably truncates the line beam length, although a circular mask may be used, before being projected through the microscope optics onto the patient&#39;s cornea, as shown in FIG. 13. The system is connected to the microscope optical camera port at flange  414 . The motor is controlled by the system software through a motion control PC board, e.g., a National Instruments PCI 7344, although other stepper motor controller boards will suffice, to rotate the line generating device through 180°, thus yielding a full 360-degree coverage on the cornea.  
         [0213]    [0213]FIG. 14 a  shows one static, recorded digitized line  420  reflected from the cornea  424  within a region-of-interest (ROI)  422  large enough to include the largest diameter corneal flap (typically 12-mm in diameter). FIG. 14 b  shows three examples of static, independent rotated positions  420   a,    420   b,    420   c  after digitization of each captured image within the ROI. Each captured line position would undergo an analysis similar to that described above in detail with respect to the first embodiment of the invention. Briefly, the edges  426   a,    426   b,    426   c  of each line position would be detected, as shown in FIG. 14 c.  The projected line dimensions are known based on the characteristics of the line generating optics. In addition, the angular position of the line is known, as software controls the motor, and thus, the angular position. Thus, the algorithm can detect each projected line edge then subtract the ideal (known) line to leave only the striae distortion as before (See, e.g., FIG. 7 c ).  
         [0214]    Turning now to FIG. 15, an alternate configuration is shown. Here, a slit shaped mask  500  is illuminated from behind by an illumination source  502 , such as an incandescent bulb or an LED, that projects light through a diffuser plate  504 . An optic  506  ensures that the slit is imaged properly on the eye through the microscope optics; i.e., the optic  506  collimates the light for imaging on the cornea. A motor  508  with shaft and gear  510  engages with gear ring  512 , which is attached to mask  500 , in order to rotate the slit through at least 180-degrees. The entire system mounts to the microscope optical camera port at flange  514 .  
         [0215]    In addition, by using a mask, other more complex shapes can be projected onto the eye, and the eye imaged to detect striae as discussed. For example, referring to FIG. 16, a mask  602  substantially defining a triangular shape  604  with internally radiating spokes  606  is shown. Referring to FIG. 17, a mask  610  substantially defining a star shape  612  within internally radiating spokes  614  is shown. The use of more complex shapes may further limit the degree to which the shape must be rotated to effect complete coverage of the region of interest.  
         [0216]    Another alternate shape that can relatively easily be projected onto the cornea and rotated thereabout is a crosshairs. For example, referring to FIG. 18, a mask which projects and rotates crosshairs  620  (two lines  622 ,  624  oriented at approximately ninety degrees relative to each other) can be used. The Edmund Scientific L52-896 line generating laser diode  402  (FIG. 13), optionally used in the second embodiment, is adapted to project crosshairs as well as lines. Using crosshairs  620 , the shape need only be rotated about 90°, whereas a single line must be rotated about 180° to effect the same complete coverage of the region of interest of the cornea with a projected shape.  
         [0217]    From the embodiments of the invention described above it can be appreciated that the automated eye corneal striae detection system provides a very effective method for detecting eye corneal striae, or wrinkles, that may be present after LASIK refractive surgery. Since the automated eye corneal striae detection system actually detects and displays eye corneal striae, it offers several advantages over current methods aimed at only preventing striae. Additionally, the automated eye corneal striae detection system provides detection of striae from several different angles thereby offering superior corneal coverage over current manual techniques that use only two or three angles.  
         [0218]    While the invention has been described in accordance with what is presently considered to be the preferred embodiments, it is to be understood that the invention is not limited to the disclosed embodiments, but on the contrary, is intended to cover various modifications and equivalent arrangements. Thus, while particular functional systems have been disclosed, it will be appreciated that other functional systems may be used as well. That is, the striae recognition processor and corneal illuminator electronics interface subsystem may be combined in a single system or further divided to perform the required tasks of the invention. Furthermore, while a particular preferred method and alternative methods have been disclosed for striae detection, it will be appreciated that other algorithms may be used. For example, neural network processing techniques, which are very efficient at pattern matching, can be used. Additionally, as only one video camera has been shown, it will be appreciated that two or more video cameras could be implemented to offer an increase in processing speed as well as additional information about striae object parameters, such as height information, etc. Furthermore, while a video display is preferred for display of the striae objects to the medical practitioner, it will be appreciated that other display means, e.g., high resolution printed image or a printed schematic indicating striae location, can also be used. Moreover, while it is preferred that an illuminating shape be projected onto the cornea and moved relative thereto, e.g., by scanning or rotation, it is recognized that a relatively complex shape having a high resolution, e.g., an intricate lattice structure, may be projected onto the cornea and a single image thereof may provide an indication of all present striae objects without necessitating moving the complex shape relative to the cornea. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.