Abstract:
An apparatus for refractive ophthalmic surgery by laser radiation including a source of radiation which emits a processing beam a beam path for focusing and scanning. The beam path focuses the processing beam into a cornea of an eye and shifts a position of a focus therein. A beam splitting device generates several foci in the cornea and divides the processing beam into a primary beam and at least one secondary beam. The primary and secondary beams have substantially the same cross section as the processing beam which is incident on the beam splitting device and the beam-splitting device introduces a separation between the primary and secondary beams. The primary and secondary beams expand in the beam path. A contact glass induces a pre-defined geometric boundary surface at the cornea.

Description:
PRIORITY CLAIM 
       [0001]    This application is a Division of application Ser. No. 12/597,720, filed Jan. 13, 2010, which is a National Phase Entry of PCT Application No. PCT/EP2008/003221, filed Apr. 22, 2008, which claims priority to U.S. Provisional Application No. 60/914,182, filed Apr. 26, 2007, and German Application Number 102007019812.6, filed Apr. 26, 2007, the disclosures of all of which are hereby incorporated by reference herein in their entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The invention relates to an apparatus for refractive ophthalmic surgery by laser radiation, said apparatus comprising a laser source which emits a processing beam, and a beam path for focusing and scanning, said beam path focusing the processing beam into the cornea of an eye and shifting the position of the focus therein, a beam splitting device being provided to generate several foci in the cornea. 
       BACKGROUND 
       [0003]    The processing of material by laser radiation is known. A particular application for processing transparent materials, where a processing effect is obtained by a non-linear interaction of the laser radiation with the per se transparent material, is refractive ophthalmic surgery. For surgery, the laser radiation is focused into the eye&#39;s cornea, and the focus is shifted along a cut surface to be generated. 
         [0004]    Of course, the processing time depends on how long the interaction in the focus lasts. An acceleration can be achieved by working with several focus spots at a time. 
         [0005]    Therefore, EP 1279386 A1, which discloses an apparatus of the above type, describes how to shorten the treatment time by multiplying the spots, allowing the simultaneous processing of larger partial areas. The presented solution has several disadvantages. According to  FIG. 4  of this publication, a beam  38  is split into partial beams  44   a . . . c  by lenses  42   a . . . c . The diameter the beams  44   a . . . c  have directly at the lenses  42   a . . . c  is smaller than the diameter of the beam  38 . This is a disadvantage, because a smaller beam cross section at the lenses  42   a . . . c  causes the beams  44   a . . . c  to be have an inferior focusing ability as compared to the beam  38 . That is, either greater larger spots result or the cross sections have to be adapted. After interaction of the near-parallel beam  38  with the lenses  42   a . . . c , convergent beams  44   a . . . c  form so that foci are located within the optical system. This is disadvantageous because it may cause high field strengths with undesired effects within the optical system, for example an energy-consuming optical breakthrough at a position in the optical beam path other than the target position in the material to be treated. Moreover, any focusing element always generates a need for adaptation to the subsequent optics, e.g. by collimation. This accordingly results in additional complexity. 
         [0006]    Also, in the state of the art, a scanning element is positioned directly in the intermediate image, i.e. conjugated to the actual processing plane. Although the beams would be deflected when using a galvanometer scanner, there would be no change of location. Therefore, the spots would rest in the processing volume despite any deflections of the galvanometer scanner. Further, the design according to DE 60208968 additionally uses an active mirror having 40,000 active facets, which is complex and expensive. 
         [0007]    A further problem of the known arrangement is that a fixed offset between the individual spots is generated anterior to the scanner. A spiral scan will then result in points of intersection between the spot paths in the processing volume. This leads to a non-concentric course of the paths, especially for a small number of spots. 
       SUMMARY OF THE INVENTION 
       [0008]    Therefore, it is an object of the invention to provide an apparatus for refractive ophthalmic surgery by laser radiation of the above-mentioned type such that several focus spots can be used without the above-described disadvantages. 
         [0009]    According to the invention, this object is achieved by an apparatus for refractive ophthalmic surgery by laser radiation, said apparatus comprising a laser source, which emits a processing beam, and a beam path for focusing and scanning, which beam path focuses the processing beam into the cornea of an eye and shifts the position of the focus therein, a beam splitting device being provided to generate a plurality of foci in the processing volume, which beam splitting device divides the processing beam into primary and secondary beams and leaves the cross section of the beam unchanged during dividing, so that the primary and secondary beams have the same cross section as the processing beam which is incident on the beam splitting device, wherein said beam splitting device introduces an angle of separation between the primary and secondary beams, so that the primary and secondary beams extend in the beam path in directions which differ by the angle of separation, and wherein a contact glass is provided, which induces a predefined geometric interface at the cornea. 
         [0010]    It is particularly easy to make the beam splitting device leave the cross section unchanged, preferably in the pupil, if the device itself is located in or near the pupil of the beam path. Further, the beam splitting device preferably does not have a focusing effect. It is also convenient to arrange the beam splitting device anterior to scanning elements in the beam direction. 
         [0011]      FIG. 15  shows how the term “closeness to the pupil” is understood in connection with the present invention. It shows an axial beam  40  which is characterized by its peripheral rays  41  and a main ray  42 . The aperture of the axial beam  40  is defined by its peripheral rays  41 . Further, a field beam  43  is depicted by way of example. A reference plane  44  is located near a pupil plane  45 , as long as, for all field beams  43 , the intersection point  47  of a main ray  46  and the reference plane  44  is located within the aperture of the axial beam. Thus, a plane&#39;s closeness to the pupil is characterized in that the points of intersection where all the field beam main rays pass through the plane are located within the axial beam&#39;s aperture which is defined by the peripheral rays. 
         [0012]    In order to enable switching between single-spot and multiple-spot processing, it is convenient to provide the effect of the beam splitting device such that it can be switched on and off, for example by a mechanical system which disengages the beam splitting device from the beam path or bypasses it in the beam path. 
         [0013]    For splitting, the beam splitting device may comprise a diffractively effective element, which may be provided as a phase grating, for example. Said phase grating preferably also comprises means for distributing the radiation intensity of the incident processing beam as uniformly as possible to a limited number of main maxima. 
         [0014]    Particularly uniform distribution of the radiation intensity with the possibility of generating a very great number of secondary beams is possible by the use of a beam splitting device which comprises elements consisting of wedges and planar plates, e.g. in the form of a segmented plate, whose segments alternate between different wedges and planar plate elements. 
         [0015]    In the case of circular deflection of the position of the focus in the processing volume, the multiplicity of generated spots may cause intersecting of the respective, e.g. circular, paths on which the foci are shifted. In order to avoid this, it is convenient to control the angle of separation as a function of the target position of the primary spot. A particularly simple realization of this further embodiment is a beam splitting device which rotates the at least one secondary beam about the primary beam in an adjustable manner. For control, an additional further embodiment may then provide a control unit which controls the rotation synchronously with the shifting of the focus position. This prevents intersecting of paths of the spots of the primary and secondary beams. For example, the spots move on concentric circular paths. 
         [0016]    It will be appreciated that the features mentioned above and those yet to be explained below can be employed not only in the indicated combinations, but also in other combinations, or alone, without departing from the scope of the present invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]    The invention will be explained in more detail below, by way of example and with reference to the enclosed drawings, which also disclose features of the invention and wherein: 
           [0018]      FIG. 1  depicts the beam path for a treatment apparatus using several processing spots; 
           [0019]      FIG. 2  depicts a further embodiment of the apparatus of  FIG. 1 ; 
           [0020]      FIG. 3  depicts a further embodiment of the apparatus of  FIG. 1 ; 
           [0021]      FIG. 4  depicts a representation similar to  FIG. 1  of a particular construction of the beam splitting element; 
           [0022]      FIGS. 5   a - d  depict representations explaining the construction and function of the beam splitting element of  FIG. 4 ; 
           [0023]      FIG. 6  depicts paths of the multiple-spot foci generated in the processing volume by the treatment apparatus of  FIG. 4 ; 
           [0024]      FIG. 7  depicts a representation similar to  FIG. 6  for seven spots; 
           [0025]      FIG. 8  depicts a representation similar to  FIG. 4 , but with a differently designed beam splitting element; 
           [0026]      FIGS. 9   a - c  depict representations explaining the construction of the beam splitting elements of  FIG. 8 ; 
           [0027]      FIG. 10  depicts a treatment apparatus similar to that of  FIG. 1 , but with a controllable beam splitting element; 
           [0028]      FIG. 11  depicts a representation similar to that of  FIG. 6  for the treatment apparatus of  FIG. 8 ; 
           [0029]      FIGS. 12   a - b  depict drawings relating to the construction and function of the beam splitting element of  FIG. 10 ; 
           [0030]      FIG. 13  depicts a representation similar to that of  FIG. 6  for a modification of the treatment apparatus of  FIG. 10 ; 
           [0031]      FIG. 14  depicts a schematic drawing of a further beam splitting element for a treatment apparatus with analogy to  FIG. 1 , and 
           [0032]      FIG. 15  depicts a schematic drawing explaining the term “proximity to the pupil”. 
       
    
    
     DETAILED DESCRIPTION 
       [0033]      FIG. 1  shows a laser-surgical system for refraction-correcting treatment of the human eye. The system comprises a source  1  of radiation. which may be provided, for example, as a femtosecond laser, whose radiation is used to process a material, which is the cornea of an eye  2  in the example embodiment described herein. In order to obtain a defined geometrical boundary surface or interface at the cornea  3 , a known contact glass  4  is placed on the cornea  3 . 
         [0034]    The source  1  of radiation provides a processing beam  5 , optionally by the use of optics  6  arranged posterior to the source  1  of radiation. An aperture stop  7  defines the cross section of the beam and the pupil in the beam path that leads to the eye  2 . Near the aperture stop  7 , i.e. near the pupil, there is a beam splitter  8 . which divides the incident processing beam  5  such that a secondary beam  9  is split off, which extends in a slightly different direction to that of the primary beam  10  not being split off The cross section of the processing beam  5  is not changed thereby. The angle of divergence or angle of separation between the primary beam  10  and the secondary beam  9  is indicated by way of example and is referred to by the reference numeral  11 . Scanners  12 ,  13  arranged posterior to the beam splitter  8  deflect the processing radiation in the beam path. Thus, foci  15   a ,  15   b  are formed in the processing volume  2  by subsequently arranged focusing optics  14 . 
         [0035]    Accordingly, the laser-surgical system comprises: a source  1  of radiation (e.g. fs laser), which emits the beam  5 ; the beam splitter  8 , which divides the processing beam into the primary beam  10  and one or more secondary beams  9 ; one or more scanning elements  12 ,  13  (for example, scanning mirrors) for deflection of the beams  8 ,  10 ; and focusing optics  14 , which focus the beams  9 ,  10  into the cornea  3  of the eye  2 . 
         [0036]    The source  1  of radiation is preferably a femtosecond laser emitting fs pulses in the wavelength region of 700-1150 nm and over a spectral width of +/−5 nm. The pulse duration is 10-900 fs. Sources of this type are known and may also comprise pulse-shaping devices in addition to the actual laser. 
         [0037]    For a multiple focus to form, beam splitting is effected near a pupil. A pupil is an image of an aperture stop  7 , or the aperture stop  7  itself. The aperture stop  7  defines the aperture of the beams  5 ,  9 ,  10  which opening is used for imaging. The beam splitter  8  generates an angular offset of the secondary beams  9  relative to the primary beam  10 . This angle of separation  11  leads to separate foci  15   a ,  15   b  in the processing volume posterior to the scanning optics  12 ,  13 ,  14 . It should be noted here that a great number of alternative positions are possible to locate the beam splitter  8 , e. g. on the scanning mirrors  12 ,  13  themselves, posterior to the scanning mirrors  12 ,  13  or even as part of the focusing optics  14 . The decisive factor is the closeness to the pupil. 
         [0038]    The beam splitter  8  deflects portions of the beam  5  into the secondary beams  9 . Following the splitter the primary  10  and secondary beams  9  extend in slightly different directions; thus, the angle of separation  11  is formed between the beams  9 ,  10 . The beam splitter  8  further has the property that the beam&#39;s cross section remains unchanged. This leads to the particular advantage that the aperture in the foci  15   a,    15   b  remains unchanged and, thus, the size of the foci  15   a,    15   b  does not change. The complexity of an otherwise required adaptation of aperture is dispensed with completely. Also, no additional constructional space is needed apart from the space for the splitter  8 . 
         [0039]    The beam splitter preferably does not have a focusing effect and, thus, generates no intermediate foci. Thus, undesired effects, such as optical breakthroughs within the system, are avoided. 
         [0040]    The scanning elements are preferably galvanometer scanning mirrors  12 ,  13 , which deflect the beam(s)  9 ,  10  in adjustable directions. Arranged following the scanners  12 ,  13  are the focusing optics  14  through which the beams  9 ,  10  are focused into a therapy volume (cornea)  2 , where processing is effected. The multiple spots  15   a,    15   b  are guided through the therapy volume by the scanners  12 ,  13  according to a predetermined path. The predetermined paths are preferably spirals or lines. 
         [0041]    Due to the particularly preferable circular paths or circle-like paths (ellipses, spirals), fixed beam splitting produces intersecting of the spot paths, which intersecting can be avoided by closed-loop controlled or synchronized beam splitting, as will be described later. 
         [0042]    In order to selectively work without multiplication of the spots, the effect of the beam splitter  8  can be optionally switched off. The beam splitter  8  can be switched on and off in many ways. 
         [0043]    In  FIG. 2  (elements in this and further Figures which correspond to elements already explained are provided with the same reference numerals and shall not be described again), the beam splitter  8  itself is movable, for example. If its effect is desired, it is pushed or folded into the beam path by means of an apparatus. Moreover, it is also possible to bypass the beam splitter  8 . A stepped mirror arrangement  17  comprising mirrors  18 - 21  is provided for this purpose in the example of  FIG. 3 , said arrangement  17  being movable as a whole or in parts. The mirrors  18  and  21  can be folded in and out of the beam path, for example. When they are folded into the beam path, the stepped mirror arrangement  17  is active and the beam splitter  8  is bypassed. In order to achieve a constant power density per spot in both single-spot operation and multiple-spot operation, the power of the source  1  of radiation is preferably adapted to the status of the beam splitter  8  (active or deactivated). 
         [0044]    A diffractively working element (grating) is preferred for the beam splitter  8 . Referring to  FIG. 4 , a phase grating is explained as an example of a specific set of parameters, for ease of illustration. It is expressly pointed out that similar solutions can be embodied also using other gratings and other sets of parameters. In the construction of  FIG. 4 , the aperture stop has a diameter of 15 mm. The phase grating has a period of 4.16 mm. This leads to an angle of separation of 0.014°. The focal length of the focusing optics is 20 mm. A possible design of the phase grating of the beam splitter  8  and its function are explained hereinafter with reference to  FIGS. 5   a - c.    
         [0045]    The beam splitter  8  is a binary phase grating, which leads to beam splitting in different directions according to the grating formula: 
         [0000]    
       
         
           
             
               sin 
                
               
                   
               
                
               α 
             
             = 
             
               
                 ± 
                 k 
               
                
               
                 λ 
                 g 
               
             
           
         
       
     
         [0046]    with α being the direction of the maxima, k being orders, λ being the wavelength and g being the grating constant. 
         [0047]    The separation between the foci is obtained approximatively according to 
         [0000]        y′=f′· tan α≈ f ′·sin α
 
         [0048]    with y′ being the focus position for the 0 th  order, α being the direction of the maxima and f′ being the focal length of the focusing optics. 
         [0049]    For a wavelength of, for example, 1040 nm, the +/−1 th  orders are at +/−0.014 degrees relative to the 0 th  order. Thus, posterior to the focusing optics, which have a focal length of 20 mm, a deviation of 5 μm results between the foci. Due to a preferably provided groove shape of the grating, the major part of the energy is diffracted into the 0 th , the −1 th  and the +1 th  order. The differences in intensity between the three main maxima are minimal. Of course, other means are also possible for this purpose. If the threshold for the optical breakthrough is, for example, at 30% of the maximum intensity, only the 3 main maxima will produce an optical breakthrough. Thus, the beam has been tripled.  FIGS. 5   a - c  show the pupil function and the intensity distribution of a binary phase grating having a period of 4.16 mm, a bar-space-ratio of 1:1, a phase amplitude of 2.015 rad and a symmetric arrangement. 
         [0050]      FIG. 5   a  shows the pupil function for the grating in the form of an amplitude image  22  as well as a phase image  23 . The diffraction characteristics of this grating are illustrated in  FIGS. 5   b  and  5   c . As can be seen, the main energy flows into the 0 th  order  24  as well as the +1 th  order  25  and as the −1 th  order  26 .  FIG. 5   b  shows the intensity values as the peak intensity for each order, normalized to the peak intensity of the 0 th  order. The plotting of the intensity I in  FIG. 5   c  also illustrates that only the first three main maxima carry radiation sufficient for an optical breakthrough. Integral evaluation of the peaks shows that a mere 16.35% of the radiation energy passes into still higher orders of diffraction (2 nd  orders and above) and is, thus, not available. Accordingly, the phase grating effectively achieves splitting of the processing beam  5  into a primary beam  24  (corresponding to the 0 th  order) as well as two secondary beams  25 ,  26  (corresponding to the +/−1 th  orders). 
         [0051]    In the described embodiments, the beam splitter anterior to the scanning mirrors  12 ,  13  causes a fixed offset, e. g. in the y direction. If the scanners  12 ,  13  are controlled according to a circular path for the 0 th  order, the image of  FIG. 6  will result in the target volume. The foci  15   a ,  15   b  move along circular paths  27   a, b, c  whose centers are mutually offset. 
         [0052]    In the case of such a fixed offset, a grating design is of advantage which two-dimensionally generates more than 3 foci. This can be achieved, for example, in that the primary beam is divided by the beam splitter  8  in two spatial directions. Said splitting may be effected by sequential splitting in two directions, which are preferably orthogonal to one another, as achieved, for example, by an arrangement of two diffraction gratings, which are rotated relative to each other at 90° about the beam axis. Since these two diffractive elements are to be arranged at least approximately in a position in the beam path that is optimal for splitting (pupil or near the pupil), an arrangement of the two in immediate spatial proximity to one another is preferred. 
         [0053]    The focus image of an arrangement comprising 7 spots is schematically shown as an example in  FIG. 7 . The individual spot paths  27  intersect several times, forming a ring-like pattern. The Figure shows the spot paths  27 , with the intersection of the spot paths  27  resulting from the fixed splitting being clearly visible. The unfavorable effects of an intersection can be reduced by greater distances between the individual spots  25 , bearing in mind, however, that all spots are located in one plane perpendicular to the optical axis. This prerequisite has to be taken into account when defining the separation distance. If two-dimensionally curved cut surfaces (e.g. spheres) are to be cut, this will result in an upper limit for the separation distance. In the case of a spherical cut having a radius of curvature of 20 mm, the strictest criterion occurs for points which are remote from the center. Depending on the definition of the depth tolerance, a specific distance from the center (e.g. 5 mm) will yield a maximum allowable separation distance (of the group of spots generated, i.e. a sort of diameter of the group of spots). This distance is, for example, 3 μm for a depth tolerance of 0.8 μm, approximately 5 μm for a depth tolerance of 1.3 μm, or 10 μm for a depth tolerance of 2.6 μm. A limitation to, for example, few μm in the diameter of the group of spots appears useful for applications. 
         [0054]    In a further embodiment according to  FIGS. 8 and 9   a - c , a segmented element whose segments consist of glass strips is used as the beam splitter  8 . The strips are provided as wedges A and C or as a planar plate B. An example is specifically dimensioned here. However, it is expressly pointed out that other sets of parameters also yield valuable solutions. Such sets can be found by a person skilled in the art by modifying the parameters explained below.  FIG. 8  shows only the beams of segments A and B. 
         [0055]    Each wedge A, C deflects a beam. For scanning optics having a focal length of 20 mm and a distance of 5 μm between the spots, an angle of separation of 0.014° results. This angle is formed by wedges having a refractive index of n=1.5 and a wedge angle of 1.72 angular minutes. In order to provide 3 beams (−0.014°/0°/+0.014°), the pupil can be divided. For this purpose, wedge segments and segments of planar plates are combined, as shown in  FIGS. 9   a, b, c,  which depict lateral views of the individual elements ( FIG. 9   a ) of the segmented element ( FIG. 9   b ) and a top view of the segmented element ( FIG. 9   c ). 
         [0056]    The above-explained variants with fixed beam splitting generate a deflection anterior to the scanners  12 ,  13 . This deflection is fixed and causes a fixed offset. In this case, each spot  15  for itself may move on a circular path, but the circular paths are not concentric. In order to avoid this, a manipulator unit realizes controlled beam splitting according to a further embodiment. In this case, beam splitting is effected depending on control signals from a control unit  28 . Said control unit  28  realizes a synchronization between the scanners  12 ,  13  and a manipulator unit  29  for the beam splitter  8 , as shown in  FIG. 10 . 
         [0057]    Offset control is effected as a function of the target position of the primary spot and enables, for example, a spiral scan without the paths intersecting. The primary and secondary spots  15   a.    15   b  move on concentric circular paths  27   a,    27   b  having a fixed path distance  30 . as shown in  FIG. 11 . 
         [0058]    The manipulator may preferably be provided as a rotary beam splitter  8  according to  FIGS. 12   a, b . As described above, the beam splitter  8  may be a phase grating or a segmented plate. The rotation of the beam splitter  8  is synchronized with the x and y control of the scanners by the control unit, so that, as a result, the secondary beams  9  rotate around the primary beam  10 . 
         [0059]    If the beam is split into three parts (e. g. by the phase grating or the element consisting of wedge segments) and appropriately synchronized, the spots will move concentrically ( FIG. 13 ). 
         [0060]    In a further embodiment for a manipulator unit  32  according to  FIG. 14 , manipulation of the secondary beam  9  is effected separately. The primary beam  10  passes through the beam splitter  8  without manipulation. A splitter  31  separates a part of the processing beam, said part forming the secondary beam  9  which is subjected to manipulation (offset) in unit  32 . The secondary beam  9  then gets the primary beam  10  superimposed by means of a further splitter  33 . Utilizing polarization allows to optimize separation and superimposing with negligible losses. 
         [0061]    Two foci are generated. This variant is realizable in a fixed manner and in a controlled or synchronized manner. 
         [0062]    The manipulator in unit  32  can be embodied in many ways, e.g. as a mirror (stationary or scanning), a rotary wedge and/or a pair of wedges which are rotated relative to each other for offset adjustment.