Patent Publication Number: US-2021186755-A1

Title: Paralimbal laser probe

Description:
TECHNICAL FIELD 
     The present disclosure relates to ophthalmological treatments generally and more specifically to laser probes for trabeculoplasty. 
     BACKGROUND 
     Higher-than-normal levels of intraocular pressure (TOP) is considered to be a significant factor in the development or worsening of various ocular conditions, such as glaucoma. Higher-than-normal IOP can be mitigated or avoided by increasing the aqueous humor outflow from the eye. The aqueous humor outflow path carries aqueous humor from the anterior chamber of the eye, through the trabecular meshwork (TM), and into the Schlemm&#39;s canal (SC) before flowing into the blood system. 
     Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are two techniques for treating various ocular conditions by increasing the acqueous humor outflow from the eye. Generally, ALT and SLT operate by focusing electromagnetic energy (e.g., laser light) onto the TM, which results in changes to the tissue (e.g., mechanical, chemical, biological, or otherwise) that result in increased outflow of aqueous humor, with subsequent reduction in IOP. ALT involves the use of an argon laser capable of heating the tissue upon which it is focused. SLT involves the use of a Q-switched frequency-doubled Nd:YAG laser that selectively targets and heats only the melanin granules in pigmented cells of the TM. 
     In operation, ALT and SLT systems generally involve focusing the laser light through a goniolens, with a skilled doctor using a slit lamp to align the laser targets at each shot location. The goniolens focuses the laser light onto TM through the anterior chamber, in a planar uveal manner. One or multiple pulses of laser light are emitted to each of these shot locations, which often include numerous spots along the TM, often covering 180° or a full 360° of the TM tissue surrounding the iris. However, shooting the laser at each of these spots along the TM can cause numerous cases of cell death along these tissues. Further, operator error can result in various complications. 
     SUMMARY 
     The term embodiment and like terms are intended to refer broadly to all of the subject matter of this disclosure and the claims below. Statements containing these terms should be understood not to limit the subject matter described herein or to limit the meaning or scope of the claims below. Embodiments of the present disclosure covered herein are defined by the claims below, not this summary. This summary is a high-level overview of various aspects of the disclosure and introduces some of the concepts that are further described in the Detailed Description section below. This summary is not intended to identify key or essential features of the claimed subject matter, nor is it intended to be used in isolation to determine the scope of the claimed subject matter. The subject matter should be understood by reference to appropriate portions of the entire specification of this disclosure, any or all drawings and each claim. 
     Embodiments of the present disclosure include a paralimbal probe, comprising: a probe tip shaped to mate with a surface of an eye at or near a corneal limbus of the eye, the eye having a Schlemm&#39;s canal and trabecular meshwork; and a waveguide positioned within the probe tip to convey electromagnetic radiation from a source of electromagnetic radiation into the eye, wherein the waveguide is oriented to direct the electromagnetic radiation along a treatment path intersecting the Schlemm&#39;s canal and the trabecular meshwork. 
     In some cases, the waveguide is further positioned within the probe tip such that the treatment path further intersects paralimbal tissue of the eye. In some cases, the waveguide is further positioned within the probe tip such that the treatment path further intersects corneal tissue of the eye. In some cases, the waveguide is further positioned within the probe tip such that the treatment path further intersects scleral tissue of the eye. In some cases, the waveguide is an optical waveguide and the source of electromagnetic radiation is a light source. In some cases, the source of electromagnetic radiation is a laser. In some cases, the probe tip includes a distal end shaped to mate with a curvature of the eye. In some cases, the distal end of the probe tip includes a corneal portion having a curvature that mates with a curvature of a cornea of the eye. In some cases, the distal end of the probe tip includes a scleral portion having a curvature that mates with a curvature of a sclera of the eye. In some cases, the probe further comprises one or more actuators coupled to the waveguide for adjusting the orientation of the treatment path with respect to the probe tip. In some cases, the source of electromagnetic radiation is housed within a probe body coupled to the probe tip. In some cases, the probe tip is shaped to mate with a second surface of the eye located anteriorly form the surface of the eye, and wherein the waveguide is oriented within the probe tip to direct additional electromagnetic radiation along an additional treatment path intersecting a pars plicata and an iris root site of the eye. 
     Embodiments of the present disclosure include an assembly, comprising: a source of electromagnetic radiation; a waveguide coupled to the source of electromagnetic radiation for conveying the electromagnetic radiation from a proximal end of the waveguide to a distal end of the waveguide; and a probe having a probe body supporting a portion of the waveguide and a probe tip supporting the distal end of the waveguide, wherein the probe tip is shaped to mate with a surface of an eye at or near a corneal limbus of the eye, and wherein the distal end of the waveguide is oriented within the probe tip to direct the electromagnetic radiation along a treatment path intersecting a Schlemm&#39;s canal and trabecular meshwork of the eye. 
     In some cases, the waveguide is positioned within the probe tip such that the treatment path further intersects paralimbal tissue of the eye. In some cases, the waveguide is positioned within the probe tip such that the treatment path further intersects corneal tissue of the eye. In some cases, the waveguide is positioned within the probe tip such that the treatment path further intersects scleral tissue of the eye. In some cases, the waveguide is an optical waveguide and the source of electromagnetic radiation is a light source. In some cases, the source of electromagnetic radiation is a laser. In some cases, the probe tip includes a distal end shaped to mate with a curvature of the eye. In some cases, the distal end of the probe tip includes a corneal portion having a curvature that mates with a curvature of a cornea of the eye. In some cases, the distal end of the probe tip includes a scleral portion having a curvature that mates with a curvature of a sclera of the eye. In some cases, the probe further comprises one or more actuators coupled to the waveguide for adjusting the orientation of the treatment path with respect to the probe tip. 
     Embodiments of the present disclosure include a scleral limbal probe, comprising: a probe tip shaped to mate with a surface of an eye at or near a scleral limbal area of the eye, the eye having a pars plicata and an iris root site; and a waveguide positioned within the probe tip to convey electromagnetic radiation from a source of electromagnetic radiation into the eye, wherein the waveguide is oriented to direct the electromagnetic radiation along a treatment path intersecting the pars plicata and the iris root site. 
     In some cases, the waveguide is an optical waveguide and the source of electromagnetic radiation is a light source. In some cases, the source of electromagnetic radiation is a laser. In some cases, the probe tip includes a distal end shaped to mate with a curvature of the eye. In some cases, the distal end of the probe tip includes a corneal portion having a curvature that mates with a curvature of a cornea of the eye. In some cases, the distal end of the probe tip includes a scleral portion having a curvature that mates with a curvature of a sclera of the eye. In some cases, the probe further comprises one or more actuators coupled to the waveguide for adjusting the orientation of the treatment path with respect to the probe tip. In some cases, the source of electromagnetic radiation is housed within a probe body coupled to the probe tip. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The specification makes reference to the following appended figures, in which use of like reference numerals in different figures is intended to illustrate like or analogous components. 
         FIG. 1  is a schematic diagram depicting a trans-scleral laser probe system according to certain aspects of the present disclosure. 
         FIG. 2  is a cut-away schematic diagram depicting a paralimbal treatment path on an eye according to certain aspects of the present disclosure. 
         FIG. 3  is a schematic diagram depicting a laser probe according to certain aspects of the present disclosure. 
         FIG. 4  is a partial cut-away schematic diagram depicting a laser probe in position on an eye according to certain aspects of the present disclosure. 
         FIG. 5  is a close up, partial cut-away schematic diagram depicting a laser probe treating an eye according to certain aspects of the present disclosure. 
         FIG. 6  is close up, cut-away schematic diagram depicting a paralimbal treatment path on an eye according to certain aspects of the present disclosure. 
         FIG. 7  is a schematic diagram depicting a laser probe treating the Schlemm&#39;s canal and trabecular meshwork of an eye according to certain aspects of the present disclosure. 
         FIG. 8  is a close up side view of a distal end of a waveguide according to certain aspects of the present disclosure. 
         FIG. 9  is a bottom view of a circular probe tip according to certain aspects of the present disclosure. 
         FIG. 10  is a bottom view of an annular sector probe tip according to certain aspects of the present disclosure. 
         FIG. 11  is a projection view depicting a probe tip with a waveguide in a first position according to certain aspects of the present disclosure. 
         FIG. 12  is a projection view depicting a probe tip with a waveguide in a second position according to certain aspects of the present disclosure. 
         FIG. 13  is a projection view depicting a probe tip with a waveguide in a third position according to certain aspects of the present disclosure. 
         FIG. 14  is a close up, partial cut-away schematic diagram depicting a laser probe performing iridoplasty on an eye according to certain aspects of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Certain aspects and features of the present disclosure relate to a laser probe capable of treating both the Schlemm&#39;s canal (SC) and the trabecular meshwork (TM) of the eye with electromagnetic radiation (e.g., laser light) to improve aqueous humor outflow and thus decrease intraocular pressure (IOP). The laser probe can include a tip capable of being placed on an eye, such as on a corneal limbus of the eye. The tip can include an optical waveguide angled to direct laser light through both the Schlemm&#39;s canal and trabecular meshwork of the eye. The laser light can be continuous or pulsed, and can be configured to provide appropriate therapy to both the Schlemm&#39;s canal and trabecular network. The laser probe can facilitate performing trans-scleral trabeculoplasty treatment, especially trans-scleral Schlemm trabeculoplasty. 
     Certain aspects and features of the present disclosure relate to a probe capable of outputting electromagnetic radiation along an output path (e.g., in an output direction). The probe can include an internal source of electromagnetic radiation (e.g., light source) or can be coupled to an external source of electromagnetic radiation (e.g., an external control box containing its own light source), such as using an optical cable. 
     The probe can include a probe tip. In some cases, the probe tip can be removable and can be sanitizable and/or disposable. In some cases, the entire probe can be sanitizable and/or disposable. The probe tip can be shaped to rest against an eye. In some cases, the probe tip can rest against a distinctly shaped and/or distinctly identifiable portion of the eye, such as the corneal limbus. In some cases, the probe tip can include indicators or other features to facilitate proper placement on the eye. The probe tip can be made of any suitable material for continued contact with an eye. 
     A waveguide (e.g., optical waveguide) can direct the electromagnetic radiation (e.g., laser light) through the probe tip and out of a distal end of the probe tip at an output angle. The output angle can be an angle other than perpendicular to the surface of the distal end of the probe tip. In some cases, the output angle can be at or approximately more than 5°, 10°, 15°, 20°, 25°, 30°, 35°, 40°, 45°, 50°, 55°, 60°, 65°, 70°, 75°, and/or 80° away from a line perpendicular to the distal end of the probe tip. Described another way, the electromagnetic radiation can exit the probe tip at an acute angle with the surface of the distal end of the probe tip. 
     In some cases, the waveguide or at least a portion of the waveguide can be part of a sterilizable and/or replaceable probe tip. In such cases, the waveguide or the portion of the waveguide can be insertable into a waveguide receptacle of the probe. For example, placing a sterilized or new probe tip on the probe can include inserting the waveguide or portion of the waveguide into the waveguide receptacle. The waveguide receptacle can form a continuous electromagnetic (e.g., optical) path from within the probe to the waveguide or portion of the waveguide. In some cases, however, the waveguide can be non-removable and the probe tip can be removable for sterilization and/or replacement. In some cases, the waveguide can be removable from the remainder of the probe separate from the probe tip&#39;s removability from the remainder of the probe. 
     While any suitable type of electromagnetic radiation can be used, the probe will be described herein as a laser probe used to deliver laser light. Therefore, as applicable, any descriptions herein attributable to laser light or optical elements can be replaced with other electromagnetic radiation and other relative elements. In some cases, the laser probe can include lenses, mirrors, or other optical elements as necessary to achieve a desired output path. 
     The laser probe as described herein can be used for various purposes. In at least some cases, the laser probe described herein can be especially suitable for trans-scleral trabeculoplasty treatment, such as trans-scleral Schlemm trabeculoplasty. In trans-scleral trabeculoplasty, laser light passes through the sclera of the eye to reach the trabecular meshwork. In trans-scleral Schlemm trabeculoplasty, laser light passes through the sclera of the eye along an axis that intercepts both the trabecular meshwork and the Schlemm&#39;s canal of the eye. In some cases, the probe tip as disclosed herein can have an optical waveguide oriented with respect to the distal end of the probe tip to achieve an output path of laser light that intercepts both the trabecular meshwork and the Schlemm&#39;s canal when the distal end of the probe tip is positioned against the sclera of the eye. In some cases, the probe tip as disclosed herein can have an optical waveguide oriented with respect to the distal end of the probe tip to achieve an output path of laser light that intercepts both the trabecular meshwork and the Schlemm&#39;s canal when the distal end of the probe tip is positioned against the limbus of the eye. 
     As used herein, the laser probe can be referred to as a paralimbal probe. The term paralimbal can refer to at or near the limbus (e.g., corneal limbus) of the eye. The treatment paths of a paralimbal probe can pass through tissue (e.g., scleral tissue and/or corneal tissue) at or adjacent the limbus before reaching the Schlemm&#39;s canal and/or trabecular meshwork. 
     In some cases, the laser probe is capable of providing laser light to the trabecular meshwork and/or Schlemm&#39;s canal without first sending laser light through the cornea. In some cases, the laser probe is capable of providing laser light to the trabecular meshwork and/or Schlemm&#39;s canal without sending laser light through the cornea at all. In some cases, the laser probe is capable of providing laser light to both the trabecular meshwork and the Schlemm&#39;s canal at the same time. In some cases, the laser probe is capable of providing laser light to both the trabecular meshwork and the Schlemm&#39;s canal sequentially without repositioning the laser probe. In some cases, the laser probe is capable of directing laser light along a treatment path that intersects the sclera, the Schlemm&#39;s canal, and then the trabecular meshwork. 
     In some cases, actuators in the probe can induce movement of the output path of the laser light. In some cases, actuators can manipulate the waveguide to change the output path of the laser light. In some cases, actuators can manipulate other elements of the probe to adjust the output path of the laser light. The output path of the laser light can be thus adjusted without needing to move and/or reposition the probe tip on the eye. Thus, different locations of the eye can be treated without needing to move and/or reposition the probe tip on the eye. 
     Certain aspects and features of the present disclosure may be especially suitable for treating not only the Schlemm&#39;s canal and the trabecular meshwork, but also simultaneously treating more of the trabecular outflow pathway than possible with ALT or SLT systems. For example, a laser directed through the Schlemm&#39;s canal and the trabecular meshwork along a paralimbal treatment path, such as described herein, can also impinge upon the intertrabecular tissue and permit treatment of the whole trabecular apparatus, which can lead to improved (e.g., increased) aqueous outflow. 
     Certain aspects and features of the present disclosure may be especially suitable for iridoplasty, such as to treat plateau iris syndrome or angle closure glaucoma (ACG). Certain aspects and features of the present disclosure can enable a treatment path that directs laser light through the limbal scleral area towards the pars plicata and iris root site to cause an iridoplasty effect as well as a therapeutic laser contracture to the anteriorly positioned ciliary process or pars plicata area, thereby causing a posterior movement of the ciliary process away from the iris root and opening the trabecular angle. For example, the same laser probe used for treatment of the Schlemm&#39;s canal and trabecular meshwork can be shifted posteriorly by approximately 1-3 mm to redirect the laser light to the anterior portion of the ciliary body (e.g., pars plicata) and iris root. The laser light can induce mild contracture burns to these ocular structures to widen the anterior chamber angles. In some cases, a laser power of approximately 1-1.6 Watts with a duty cycle of approximately 30-45% and a duration of approximately 50-80 seconds can be used, although other settings can be used. 
     In some cases, certain aspects of the present disclosure enable treatment of plateau iris syndrome caused by anteriorly positioned ciliary process, for which other iridoplasty techniques are incapable of treating. 
     These illustrative examples are given to introduce the reader to the general subject matter discussed here and are not intended to limit the scope of the disclosed concepts. The following sections describe various additional features and examples with reference to the drawings in which like numerals indicate like elements, and directional descriptions are used to describe the illustrative embodiments but, like the illustrative embodiments, should not be used to limit the present disclosure. The elements included in the illustrations herein may not be drawn to scale. 
       FIG. 1  is a schematic diagram depicting a trans-scleral laser probe system  100  according to certain aspects of the present disclosure. The laser probe system  100  can include a control box  102  coupled to a probe  106  via a probe cable  104 . The control box  102  can include a processor  110  and light source  112 , as well as other suitable equipment not shown for illustrative purposes (e.g., power supply, memory, interfaces, and the like). The light source  112  can be a laser light source. The probe cable  104  can be an optical cable capable of conveying the light from the light source  112  to the probe  106 . In some cases, the probe cable  104  can include electrical connections to convey power and/or data signals between the control box  102  and the probe  106 . In some cases, the probe  106  can contain its own light source, in which case the probe cable  104  may carry power to power the light source and may not carry any optical signals. 
     The probe  106  can be positioned on an eye  108  to treat the eye as described herein. The probe  106  depicted in  FIG. 1  can be of any suitable shape or size, and not necessarily as depicted. 
     In some cases, processor  110  can enable automation of the treatment process. Automation can include automatically adjusting laser settings (e.g., power, duty cycle, frequency, duration, or others), automatically adjusting the laser treatment path during or between treatments (e.g., using actuators or paths with reference to  FIGS. 7 and 11-13 ), and/or automatically triggering laser light output, such as in response to sensor input indicating desired positioning of the probe  106 . 
       FIG. 2  is a cut-away schematic diagram depicting a paralimbal treatment path  216  on an eye  208  according to certain aspects of the present disclosure. The eye  208  can be eye  108  of  FIG. 1 . The eye  208  can include an anterior chamber  218  containing aqueous humor. The eye includes an iris  220  and lens  226 . The corneal limbus  228  can be located at the border between the cornea  248  and sclera  250 . Near the base of the cornea  248 , the trabecular meshwork  222  can be found between cornea  248  and the iris  220  to facilitate drainage of aqueous humor from the anterior chamber  218  into the Schlemm&#39;s canal  224 . The approximate optical axis  214  of the eye  208  is shown. 
     According to certain aspects of the present disclosure, laser treatment can be provided through the sclera  250  along a treatment path  216  that intersects both the Schlemm&#39;s canal  224  and the trabecular meshwork  222 . Due to the size and position of the Schlemm&#39;s canal  224  and trabecular meshwork  222 , it can be difficult or impossible to treat both locations simultaneously using a goniolens, which would rest on the cornea  248  and be generally centered on the optical axis  214 . However, a laser probe positioned at the limbus  228  can direct laser light through both the Schlemm&#39;s canal  224  and trabecular meshwork  222 , such as along treatment path  216 . It will be understood that various treatment paths may exist other than the treatment path  216  depicted in  FIG. 2 , as long as the treatment paths intersect both the Schlemm&#39;s canal  224  and trabecular meshwork  222 . 
     Generally, as disclosed herein, treatment can be provided from a laser probe positioned at the limbus  228  by transmitting laser light through the sclera  216 , through the Schlemm&#39;s canal  224 , then to the trabecular meshwork  222 , all at portions located adjacent the laser probe (e.g., without the laser light passing the optical axis  214  prior to contacting the Schlemm&#39;s canal  224  and trabecular meshwork  222 ). However, in some cases, the laser probe can be constructed to provide laser light to portions of the trabecular meshwork  222  and Schlemm&#39;s canal  224  located opposite optical axis  214  from where the laser probe is positioned. In such cases, the treatment path may extend first through the cornea  248  adjacent the limbus  228 , through the optical axis  214  of the eye  208 , then through a portion of the trabecular meshwork  222  at the opposite side of the anterior chamber  218 , then to the Schlemm&#39;s canal  224  adjacent that portion of trabecular meshwork  222 . 
       FIG. 3  is a schematic diagram depicting a laser probe  306  according to certain aspects of the present disclosure. The laser probe  306  can be the laser probe  106  of  FIG. 1 . The laser probe  306  can be any suitable shape or size any may not necessarily appear as depicted in  FIG. 3 . The laser probe  306  can include a probe body  330  and a probe tip  332 . Treatment radiation, such as laser light  340 , can exit the probe  306  via waveguide  336 . Waveguide  336  can be an optical waveguide for transmitting the laser light  340 . The laser light  340  can be generated by a light source that is internal to the probe  306  (e.g., housed within the probe body  330 ) or external to the probe  306  (e.g., housed in a control box and carried to the probe  306  via probe cable  304 ). Probe cable  304  can convey energy to the probe  306 , such as optical energy (e.g., in the case of the light source being housed in an external control box) or electrical energy (e.g., to power an internal light source of the probe  306 ). 
     The probe tip  332  can include a distal end  334 . The distal end  334  can be designed to be placed against an eye, such as against the limbus of an eye (e.g., limbus  228  of eye  208  of  FIG. 2 ). The distal end  334  of the probe tip  332  can be shaped to be placed against a surface. The distal end  334  of the probe tip  332  can have a diameter sized to facilitate easy placement of the probe tip  332  against the limbus of an eye, which can include a distal end  334  small enough to not act as an obstruction during placement and maneuvering against the limbus of the eye, while also being large enough to provide sufficient surface area to maintain steady and reliable contact with the eye during treatment. In some cases, the distal end  334  of the probe tip  332  can have a diameter of approximately 2 mm to 5 mm, approximately 3 mm to 4 mm, or approximately 3.5 mm. In some cases, however, the distal end  334  can have a diameter that is smaller than 2 mm or larger than 5 mm. 
     The probe tip  332  can have a length suitable to distance the probe body  330  from the eye during treatment to avoid contamination and contact between the probe body  330  and the patient (e.g., the eye, eyelids, mucus membranes, or other parts of the patient). In some cases, the probe tip  332  can advantageously have a length of between approximately 3 mm and 7 mm, between approximately 4 mm and 6 mm, or approximately 5 mm. In some cases, the probe tip  332  can have a length of at or at least approximately 3 mm, 4 mm, 5 mm, 6 mm, or 7 mm. 
     The entire laser probe  306 , from distal end  334  of the probe tip  332  to the proximal end of the probe body  330  can have any suitable length, such as to facilitate dexterous, manual handling by a treatment professional. In some cases, this length can be between approximately 70 mm and 90 mm, between approximately 75 mm and 85 mm, or approximately 80 mm. In some cases, however, this length can be less than 70 mm or greater than 90 mm. The probe body  330  can also have any suitable diameter, such as to facilitate dexterous, manual handling by a treatment professional. In some cases, this diameter can be between approximately 10 mm and 20 mm, approximately 12 mm and 18 mm, or approximately 15 mm. In some cases, however, the diameter can be smaller than 10 mm or greater than 20 mm. 
     A probe axis  342  can be an axis that is normal or substantially normal (e.g., within 0.5°, 1°, 1.5°, 2°, 2.5°, 3°, 3.5°, 4°, 4.5°, 5°, 6°, 7°, 8°, 9°, or 10° of normal or less) to the surface against which the distal end  334  is to be placed or to the surface of the distal end  334 . In some cases, the probe axis  342  can extend axially along the probe body  330 , although that need not always be the case. The probe axis  342  can also be referred to as a probe placement axis. 
     Laser light  340  can be transmitted through the waveguide  336  and output in a direction  352 . Laser light  340  can enter the waveguide  336  at a proximal end (not shown), such as at a light source, and can be conveyed by the waveguide  336  until it exits the waveguide  336  at a distal end (e.g., at or near the distal end  334  of the probe tip  332 ). The waveguide  336  can be shaped and/or oriented to direct laser light  340  in direction  352  such that an angle exists between the probe axis  342  and the direction  352 . The angle can be at or approximately more than 5°, 10°, 15°, 20°, 25°, 30°, 35°, 40°, 45°, 50°, 55°, 60°, 65°, 70°, 75°, and/or 80°, and less than 90°. Put another way, direction  352  can form an acute angle with the surface of the distal end  334  of the probe tip  332 . In some cases, the waveguide  336  can extend generally parallel to the probe axis  342  for an extent before angling towards direction  352  before reaching the distal end  334  of the probe tip  332 . 
     In some cases, the probe tip  332  is removable from the probe body  330 , such as for sterilization and/or replacement. In some cases, the waveguide  336  can be integrated with the probe tip  332  and be removable from the probe body  330  along with the probe tip  332 . In some cases, the waveguide  336  can be located within an opening of the probe tip  332  and the probe tip  332  can be removable from the probe body  330  without requiring removal of the waveguide  336  from the probe body  330 . In such cases, the waveguide  336  may be removable from the probe body  330  or not. The waveguide  336  can be secured to the probe body  336  at a waveguide receptacle  338 . In some cases, if the waveguide  336  is removable, the waveguide receptacle  338  can accept the waveguide  336  and establish an optical coupling to permit laser light  340  to be directed from within the probe body  330  to the waveguide  336  and out the waveguide  336 . 
     The probe  306  can additionally contain additional elements, such as actuators, switches, cameras, sensors, or the like. In some cases, these additional elements can facilitate probe placement (e.g., appropriate placement at the limbus) or use (e.g., actuation of the control box to initiate outputting of the laser light  340 ). In some cases, probe  306  can include additional actuators capable of manipulating the direction  352  of the laser light  340 , at least with respect to the probe axis  342 . In such cases, the direction  352  of the laser light  340  can be manipulated without needing to remove the probe tip  332  from the eye or otherwise move the probe tip  332 . In some cases, such additional actuators can rotate the waveguide  336  to adjust the direction  352  around the probe axis  342 . In some cases, additional actuators can further adjust the angle between the direction  352  and probe axis  342 , such as by manipulating the orientation of the waveguide  336  within the probe tip  332 . 
       FIG. 4  is a partial cut-away schematic diagram depicting a laser probe  406  in position on an eye  408  according to certain aspects of the present disclosure. The laser probe  406  and eye  408  can be laser probe  106  and eye  108  of  FIG. 1 , respectively. The laser probe  406  can be placed such that the distal end  434  of the probe tip  432  rests against the limbus  428  of the eye  408 . The distal end  434  of the probe tip  432  can be shaped to facilitate proper placement of the probe tip  432  at the limbus  428  of the eye  408 . The waveguide  436  of the probe  406  can be oriented to deliver laser light through the Schlemm&#39;s canal  424  and the trabecular meshwork  422 . In some cases, the waveguide  436  of the probe  406  can be oriented to deliver laser light through the Schlemm&#39;s canal  424  and the trabecular meshwork  422  without first passing the optical axis  414  of the eye  408 . In some cases, the waveguide  436  of the probe  406  can be oriented to deliver laser light through the Schlemm&#39;s canal  424  and the trabecular meshwork  422  after first passing through paralimbal tissue of the eye  408 . In some cases, the paralimbal tissue can include tissue of the cornea  448 . In some cases, the paralimbal tissue can include tissue of the sclera  450 . 
       FIG. 5  is a close up, partial cut-away schematic diagram depicting a laser probe  506  treating an eye  508  according to certain aspects of the present disclosure. The laser probe  506  and eye  508  can be laser probe  106  and eye  108  of  FIG. 1 , respectively. The lens  526  and anterior chamber  518  are identified for illustrative purposes. 
     The laser probe  506  can be placed such that the distal end  534  of the probe tip  532  rests against the limbus  528  of the eye  508 . The distal end  534  of the probe tip  532  can be shaped to facilitate proper placement of the probe tip  532  at the limbus  528  of the eye  508 . The waveguide  536  of the probe  506  can be oriented to deliver laser light  540  through the Schlemm&#39;s canal  524  and the trabecular meshwork  522 . In some cases, the waveguide  536  of the probe  506  can be oriented to deliver laser light through the Schlemm&#39;s canal  524  and the trabecular meshwork  522  without first passing the optical axis  514  of the eye  508 . In some cases, the waveguide  536  of the probe  506  can be oriented to deliver laser light through the Schlemm&#39;s canal  524  and the trabecular meshwork  522  after first passing through paralimbal tissue of the eye  508 . In some cases, the paralimbal tissue can include tissue of the cornea  548 . In some cases, the paralimbal tissue can include tissue of the sclera  550 . 
       FIG. 6  is close up, cut-away schematic diagram depicting a paralimbal treatment path  616  on an eye  608  according to certain aspects of the present disclosure. The eye  608  can be eye  108  of  FIG. 1 . The lens  626  and anterior chamber  618  are identified for illustrative purposes. The paralimbal treatment path  616  extends through both the Schlemm&#39;s canal  624  and trabecular meshwork  622  of the eye  608 . The paralimbal treatment path  616  also passes through tissue at or near the corneal limbus  628 , such as corneal tissue or scleral tissue. In some cases, the paralimbal treatment path  616  passes through scleral tissue at or near the corneal limbus  628  and does not pass through corneal tissue. 
     Line  644  represents an axis normal or substantially normal (e.g., within 0.5°, 1°, 1.5°, 2°, 2.5°, 3°, 3.5°, 4°, 4.5°, 5°, 6°, 7°, 8°, 9°, or 10° of normal or less) to the limbus  628  of the eye  608  (e.g., the surface of the eye  608  at the limbus  628 ). Line  644  can be referred to as a limbal-normal axis. The paralimbal treatment path  616  can form an angle  646  with line  644 . The angle  646  can be an acute angle. The angle  646  can be less than 90° and at or greater than approximately 1°, 2°, 3°, 4°, 5°, 6°, 7°, 8°, 9°, 10°, 11°, 12°, 13°, 14°, 15°, 16°, 17°, 18°, 19°, 20°, 21°, 22°, 23°, 24°, 25°, 26°, 27°, 28°, 29°, 30°, 31°, 32°, 33°, 34°, 35°, 36°, 37°, 38°, 39°, 40°, 41°, 42°, 43°, 44°, 45°, 46°, 47°, 48°, 49°, 50°, 51°, 52°, 53°, 54°, 55°, 56°, 57°, 58°, 59°, 60°, 61°, 62°, 63°, 64°, 65°, 66°, 67°, 68°, 69°, 70°, 71°, 72°, 73°, 74°, 75°, 76°, 77°, 78°, 79°, 80°, 81°, 82°, 83°, 84°, 85°, 86°, 87°, 88°, and/or 89°. In some cases, angle  646  can have other values. 
     As described herein, a laser probe (e.g., laser probe  106  of  FIG. 1 ) can be configured to emit laser light along the paralimbal treatment path  616  when the laser probe is positioned on or near the limbus  628  of the eye  608 . 
       FIG. 7  is a schematic diagram depicting a laser probe  706  treating the Schlemm&#39;s canal  724  and trabecular meshwork  722  of an eye according to certain aspects of the present disclosure. The laser probe  706  can include a probe body  730 , a probe tip  738 , and a waveguide  736 . A light source  712  can generate laser light  740  that is fed into the waveguide  736  and output at the probe tip  738  along a treatment path  716  that intersects both the Schlemm&#39;s canal  724  and the trabecular meshwork  722  of an eye  708 . 
     The probe tip  738  can be shaped to mate with the contours of the limbus  728  of the eye  708 . For example, as depicted in  FIG. 7 , the surface of the eye  708  at the limbus  728  can have a slight bend or groove formed where the curvature of the corneal tissue  748  meets the different curvature of the scleral tissue  750 . The distal end of the probe tip  738  can be shaped to mate with the surface of the eye  708  at the limbus  728 , such as by including a corneal portion  754  having a curvature that mates with (e.g., matches) the curvature of the corneal tissue  748  at or near the limbus  728 ; as well as a scleral portion  756  having a curvature that mates with (e.g., matches) the curvature of the scleral tissue  750 . Thus, the probe tip  738  can be shaped to facilitate placement of the probe tip  738  in a proper position at the limbus  728  of the eye  708 . 
     The waveguide  736  of the laser probe  706  can be shaped to output light along the treatment path  716  when the probe tip  738  is in proper position. For example, the waveguide  736  of the laser probe  706  can direct laser light in a direction that intersects both the Schlemm&#39;s canal  724  and the trabecular meshwork  722  when the corneal portion  754  of the distal end of the probe tip  738  mates with the corneal tissue  748  at or near the limbus  728  and when the scleral portion  756  of the distal end of the probe tip  738  mates with the scleral tissue  750  at or near the limbus  728 . While depicted as centered within the probe body  730  of the laser probe  706  in  FIG. 7 , the waveguide  736  can be positioned anywhere within or on the laser probe  706 . In some cases, the waveguide is centered at the limbus  728  (e.g., centered on an axis intersecting the limbus  728 ) for at least a portion of the length of the laser probe  706  before being tilted towards an axis collinear with the treatment path  716 . 
     In some cases, the light source  712  can be part of the laser probe  706 . In some cases, the light source  712  can be separate from the laser probe  706  and can be coupled to the laser probe  706  via a probe cable  704 . 
     In some cases, an optional actuator  758  can be coupled to the waveguide  736  and/or the probe tip  738  to manipulate the waveguide  736  to facilitate adjusting the treatment path  716  without needing to otherwise move the probe tip  738  with respect to the eye  708 . The actuator  758  may extend into both the probe body  730  and the probe tip  738 , may exist solely within the probe body  738 , or may exist solely within the probe tip  738 . The actuator  758  can induce any suitable motion in the waveguide  736  to direct the laser light  740  in the desired direction, such as a bending motion or a rotary motion. Any suitable type of actuator  758  can be used to impart force on the waveguide  736  to adjust the output path of the laser light  740 , such as a rotary actuator (e.g., a motorized collar attached to the waveguide  736  to turn the waveguide  736 ), a linear actuator (e.g., a screw-type actuator to push and/or pull the waveguide  736 ), a non-contacting actuator (e.g., an electromagnet magnetically coupled to a corresponding magnetic structure coupled to the waveguide  736  to pull the waveguide  736  in response to an applied magnetic field), a bending actuator (e.g., a piezoelectric bending actuator to bend the waveguide  736  in response to an applied electrical signal), or any other suitable actuators. In some optional cases, the output path of the laser light  740  can be steered using other techniques, such as lenses or optical phase arrays. 
       FIG. 8  is a close up side view of a distal end  862  of a waveguide  836  according to certain aspects of the present disclosure. Waveguide  836  can be waveguide  336  of  FIG. 3 . The waveguide  836  is shown without the surrounding probe tip and with exaggerated dimensions for illustrative purposes. The distal end  862  of the waveguide  836  can have a curvature shaped to match the limbus of an eye (e.g., limbus  228  of eye  208 ). In some cases, the curvature of the distal end  862  of the waveguide  836  can have a curvature height  860  that is at or approximately between 0.5 mm and 1.5 mm, between 0.75 mm and 1.25 mm, or at or approximately 1 mm, In some cases, other curvature heights  860  can be used. 
       FIG. 9  is a bottom view of a circular probe tip  932  according to certain aspects of the present disclosure. The probe tip  932  can have a generally circular shape or cross section at least at the distal end  934  of the probe tip  932 . The waveguide  936  can exit from the center of the distal end  934  of the probe tip  932 , although that need not always by the case. 
       FIG. 10  is a bottom view of an annular sector probe tip  1032  according to certain aspects of the present disclosure. The probe tip  1032  can have a slim, curved shape or cross section that generally takes the form of an annular sector (e.g., a sector or section of an annulus) at least at the distal end  1034  of the probe tip  1032 . As depicted in  FIG. 10 , the sides of the annular sector can shape can be rounded or otherwise shaped to facilitate manufacturing and/or reduce risk of injury when used near the eye. In some cases, the curvature of the top and bottom edges (e.g., as oriented in  FIG. 10 ) of the annular shape can have approximately the same curvature (e.g., as seen in  FIG. 10 ), or can have largely different curvatures. In some cases, the curvature of the annular sector shape can match or approximate the general curvature of the limbus of an eye (e.g., limbus  228  of eye  208 ). The waveguide  1036  can exit from the center of the distal end  1034  of the probe tip  1032 , although that need not always by the case. 
     In some cases, the cross section or distal end of a probe tip can have shapes other than circular or similar to an annular sector. 
       FIG. 11  is a projection view depicting a probe tip  1132  with a waveguide  1136  in a first position according to certain aspects of the present disclosure. The probe tip  1132  can be probe tip  332  of  FIG. 3  or any other suitable probe tip. The probe tip  1132  can be used with any suitable probe body or can be incorporated into a probe body. The probe tip  1132  can contain a waveguide  1136  therein. 
     The waveguide  1136  can be movable through multiple positions without needing to move the placement of the probe tip  1132  on an eye, thus permitting multiple locations to be treated without needing to reposition the probe tip  1132  on the eye. In some cases, the probe tip  1132  can rotate or include rotatable portions to facilitate movement of the waveguide  1136  between different positions. In some cases, the probe tip  1132  can remain stationary as the waveguide  1136  is moved within the probe tip  1132 . Movement can be achieved using manual mechanical controls (e.g., manipulation of rotatable parts to rotate a portion of the waveguide  1136 ), user-activated electronic controls (e.g., pressing of a button to cause an actuator to move the waveguide  1136 ), automated electronic controls (e.g., a computer program that causes an actuator to automatically move the waveguide  1136 ), or otherwise. 
     The waveguide  1136  can be manipulated in any suitable fashion, such as described herein. In some cases, the various positions of the waveguide  1136  can follow a path  1170 . In some cases, features of the probe tip  1132  or other aspects of the probe can restrict movement of the waveguide  1136  to positions along the path  1170 . In an example, the waveguide  1136  can be positioned in a cutout portion of the probe tip  1132  that restricts movement of waveguide  1136  to only positions along the path  1170 . In another example, a rail or track can be coupled to or positioned adjacent the waveguide  1136  to restrict movement of waveguide  1136  to only positions along the path  1170 . In some cases, an actuator controlling movement of the waveguide  1136  can use mechanical linkages to restrict movement of the waveguide  1136  to only positions along the path  1170 . In some cases, software controls can be used with an actuator to ensure the waveguide  1136  is only moved to positions along the path  1170 . Other techniques can be used to control positioning of the waveguide  1136 . 
     As depicted in  FIG. 11 , the waveguide  1136  can have a bent shape that permits rotation of the waveguide  1136  around the center axis of the probe tip  1132  to move the output end of the waveguide  1136  along path  1170 . In some cases, the waveguide  1136  can maintain a consistent angle of output laser light  1140  from different positions along the path  1170 . 
     In the first position, as depicted in  FIG. 11 , the waveguide  1136  can be oriented in a fashion that directs laser light  1140  into a first treatment area  1172 . A second treatment area  1174  and third treatment area  1176  may remain untreated by the laser light  1140  when the waveguide  1136  is in the first position, although that need not always be the case. 
     As used herein, a treatment area can include any suitable tissue for treatment, such as portions of a Schlemm&#39;s canal and/or portions of trabecular meshwork. In some cases, multiple treatment areas associated with different positions of the waveguide can be distinct (e.g., not overlapping). However, in some cases, multiple treatment areas associated with different positions of the waveguide can be partially overlapping. In some cases, the waveguide  1136  and path  1170  can be configured such that different positions can treat multiple treatment areas that are associated with the same portion of trabecular network but different portions of the Schlemm&#39;s canal. In other cases, the waveguide  1136  and path  1170  can be configured such that different positions can treat multiple treatment areas that are associated with different portions of trabecular network and different portions of the Schlemm&#39;s canal 
     After treatment of first treatment area  1172  by the laser light  1140 , the laser light  1140  can be optionally stopped and the waveguide  1136  can be moved to another position, such as position two, as depicted in  FIG. 12 . 
       FIG. 12  is a projection view depicting a probe tip  1232  with a waveguide  1236  in a second position according to certain aspects of the present disclosure. The probe tip  1232  can be probe tip  1132  of  FIG. 11  after being moved into a second position, or can be any other suitable probe tip. The probe tip  1232  can be used with any suitable probe body or can be incorporated into a probe body. The probe tip  1232  can contain a waveguide  1236  therein. 
     In the second position, as depicted in  FIG. 12 , the waveguide  1236  can be oriented in a fashion that directs laser light  1240  into a second treatment area  1274 . A first treatment area  1272  and third treatment area  1276  may remain untreated by the laser light  1240  when the waveguide  1236  is in the second position, although that need not always be the case. 
     After treatment of second treatment area  1274  by the laser light  1240 , the laser light  1240  can be optionally stopped and the waveguide  1236  can be moved to another position, such as position three, as depicted in  FIG. 13 . 
       FIG. 13  is a projection view depicting a probe tip  1332  with a waveguide  1336  in a third position according to certain aspects of the present disclosure. The probe tip  1332  can be probe tip  1232  of  FIG. 12  after being moved into a third position, or can be any other suitable probe tip. The probe tip  1332  can be used with any suitable probe body or can be incorporated into a probe body. The probe tip  1332  can contain a waveguide  1336  therein. 
     In the third position, as depicted in  FIG. 13 , the waveguide  1336  can be oriented in a fashion that directs laser light  1340  into a third treatment area  1376 . A first treatment area  1372  and second treatment area  1374  may remain untreated by the laser light  1340  when the waveguide  1336  is in the third position, although that need not always be the case. 
     After treatment of third treatment area  1376  by the laser light  1340 , the laser light  1340  can be stopped and the probe tip  1132  can be repositioned on the eye to treat additional treatment areas. 
     While  FIGS. 11-13  describe three positions, it will be understood that any number of positions can be used and in any desirable order or combination to treat a desired set of treatment areas. In some cases, the same position can be used more than once to provide continued treatment to the same treatment area without repositioning the probe tip. In such cases, multiple instances of treatment of the same treatment area can be separated by treatment of another treatment area to permit the first treatment area to heal or cool down between treatments, all without repositioning the probe tip. 
       FIG. 14  is a close up, partial cut-away schematic diagram depicting a laser probe  1406  performing iridoplasty on an eye  1408  according to certain aspects of the present disclosure. In some cases, the iridoplasty depicted in  FIG. 14  can be considered iridoparsplicataplasty due to the simultaneous treatment of the pars plicata and iris root. The laser probe  1406  and eye  1408  can be laser probe  106  and eye  108  of  FIG. 1 , respectively. The lens  1426  and anterior chamber  1418  are identified for illustrative purposes. 
     The laser probe  1406  can be placed such that the distal end  1434  of the probe tip  1432  rests against the scleral  1450  at or near the limbus  1428  of the eye  1408  (e.g., a scleral limbal area). The distal end  1434  of the probe tip  1432  can be shaped to facilitate proper placement of the probe tip  1432  at the scleral limbal area. In some cases, the probe tip  1432  can be shaped to facilitate placement of the probe tip  143  at both the scleral limbal area and the limbus  1428  of the eye  1408  (e.g., to facilitate both treatment of the Schlemm&#39;s canal and trabecular meshwork and treatment of the pars plicata and iris root. The waveguide  1436  of the probe  1406  can be oriented to deliver laser light  1440  to the pars plicata  1482  and the iris root  1480 . In some cases, the waveguide  1436  of the probe  1406  can be oriented to deliver laser light through the pars plicata  1482  and the iris root  1480  without first passing the optical axis  1414  of the eye  1408 . In some cases, the waveguide  1436  of the probe  1406  can be oriented to deliver laser light through the pars plicata  1482  and the iris root  1480  after first passing through scleral tissue of the eye  1408 . 
     As used below, any reference to a series of examples is to be understood as a reference to each of those examples disjunctively (e.g., “Examples 1-4” is to be understood as “Examples 1, 2, 3, or 4”). 
     Example 1 is a paralimbal probe, comprising: a probe tip shaped to mate with a surface of an eye at or near a corneal limbus of the eye, the eye having a Schlemm&#39;s canal and trabecular meshwork; and a waveguide positioned within the probe tip to convey electromagnetic radiation from a source of electromagnetic radiation into the eye, wherein the waveguide is oriented to direct the electromagnetic radiation along a treatment path intersecting the Schlemm&#39;s canal and the trabecular meshwork. 
     Example 2 is the probe of example(s) 1, wherein the waveguide is further positioned within the probe tip such that the treatment path further intersects paralimbal tissue of the eye. 
     Example 3 is the probe of example(s) 1 or 2, wherein the waveguide is further positioned within the probe tip such that the treatment path further intersects corneal tissue of the eye. 
     Example 4 is the probe of example(s) 1 or 2, wherein the waveguide is further positioned within the probe tip such that the treatment path further intersects scleral tissue of the eye. 
     Example 5 is the probe of example(s) 1-4, wherein the waveguide is an optical waveguide and the source of electromagnetic radiation is a light source. 
     Example 6 is the probe of example(s) 5, wherein the source of electromagnetic radiation is a laser. 
     Example 7 is the probe of example(s) 1-6, wherein the probe tip includes a distal end shaped to mate with a curvature of the eye. 
     Example 8 is the probe of example(s) 7, wherein the distal end of the probe tip includes a corneal portion having a curvature that mates with a curvature of a cornea of the eye. 
     Example 9 is the probe of example(s) 7 or 8, wherein the distal end of the probe tip includes a scleral portion having a curvature that mates with a curvature of a sclera of the eye. 
     Example 10 is the probe of example(s) 1-9, further comprising one or more actuators coupled to the waveguide for adjusting the orientation of the treatment path with respect to the probe tip. 
     Example 11 is the probe of example(s) 1-10, wherein the source of electromagnetic radiation is housed within a probe body coupled to the probe tip. 
     Example 12 is the probe of example(s) 1-11, wherein the probe tip is shaped to mate with a second surface of the eye located anteriorly form the surface of the eye, and wherein the waveguide is oriented within the probe tip to direct additional electromagnetic radiation along an additional treatment path intersecting a pars plicata and an iris root site of the eye. 
     Example 13 is an assembly, comprising: a source of electromagnetic radiation; a waveguide coupled to the source of electromagnetic radiation for conveying the electromagnetic radiation from a proximal end of the waveguide to a distal end of the waveguide; and a probe having a probe body supporting a portion of the waveguide and a probe tip supporting the distal end of the waveguide, wherein the probe tip is shaped to mate with a surface of an eye at or near a corneal limbus of the eye, and wherein the distal end of the waveguide is oriented within the probe tip to direct the electromagnetic radiation along a treatment path intersecting a Schlemm&#39;s canal and trabecular meshwork of the eye. 
     Example 14 is the assembly of example(s) 13, wherein the waveguide is positioned within the probe tip such that the treatment path further intersects paralimbal tissue of the eye. 
     Example 15 is the assembly of example(s) 13 or 14, wherein the waveguide is positioned within the probe tip such that the treatment path further intersects corneal tissue of the eye. 
     Example 16 is the assembly of example(s) 13 or 14, wherein the waveguide is positioned within the probe tip such that the treatment path further intersects scleral tissue of the eye. 
     Example 17 is the assembly of example(s) 13-16, wherein the waveguide is an optical waveguide and the source of electromagnetic radiation is a light source. 
     Example 18 is the assembly of example(s) 17, wherein the source of electromagnetic radiation is a laser. 
     Example 19 is the assembly of example(s) 13-18, wherein the probe tip includes a distal end shaped to mate with a curvature of the eye. 
     Example 20 is the assembly of example(s) 19, wherein the distal end of the probe tip includes a corneal portion having a curvature that mates with a curvature of a cornea of the eye. 
     Example 21 is the assembly of example(s) 19 or 20, wherein the distal end of the probe tip includes a scleral portion having a curvature that mates with a curvature of a sclera of the eye. 
     Example 22 is the assembly of example(s) 13-21, wherein the probe further comprises one or more actuators coupled to the waveguide for adjusting the orientation of the treatment path with respect to the probe tip. 
     Example 23 is a scleral limbal probe, comprising: a probe tip shaped to mate with a surface of an eye at or near a scleral limbal area of the eye, the eye having a pars plicata and an iris root site; and a waveguide positioned within the probe tip to convey electromagnetic radiation from a source of electromagnetic radiation into the eye, wherein the waveguide is oriented to direct the electromagnetic radiation along a treatment path intersecting the pars plicata and the iris root site. 
     Example 24 is the probe of example(s) 23, wherein the waveguide is an optical waveguide and the source of electromagnetic radiation is a light source. 
     Example 25 is the probe of example(s) 24, wherein the source of electromagnetic radiation is a laser. 
     Example 26 is the probe of example(s) 23-25, wherein the probe tip includes a distal end shaped to mate with a curvature of the eye. 
     Example 27 is the probe of example(s) 26, wherein the distal end of the probe tip includes a corneal portion having a curvature that mates with a curvature of a cornea of the eye. 
     Example 28 is the probe of example(s) 26 or 27, wherein the distal end of the probe tip includes a scleral portion having a curvature that mates with a curvature of a sclera of the eye. 
     Example 29 is the probe of example(s) 23-28, further comprising one or more actuators coupled to the waveguide for adjusting the orientation of the treatment path with respect to the probe tip. 
     Example 30 is the probe of example(s) 23-29, wherein the source of electromagnetic radiation is housed within a probe body coupled to the probe tip.