Patent ID: 12226348

DETAILED DESCRIPTION

In the following description, details are set forth by way of example to facilitate discussion of the disclosed subject matter. It should be apparent to a person of ordinary skill in the field, however, that the disclosed embodiments are examples and not exhaustive of all possible embodiments.

As used herein, a reference numeral refers to a class or type of entity, and any letter following such reference numeral refers to a specific instance of a particular entity of that class or type. Thus, for example, a hypothetical entity referenced by ‘12A’ may refer to a particular instance of a particular class/type, and the reference ‘12’ may refer to a collection of instances belonging to that particular class/type or any one instance of that class/type in general.

Medical systems may be utilized in performing medical procedures with patients. In one example, a first medical system may be utilized, at a first time, in identifying one or more portions of a patient before a medical procedure. In a second example, a second medical system may be utilized, at a second time, in performing the medical procedure. In another example, the second medical system may utilize, at the second time, one or more identifications respectively associated with the one or more portions of the patient. The second time may be a later time than the first time. In one example, the first medical system may be utilized at an office of a doctor. In a second example, the second medical system may be utilized at a surgical facility. In another example, the second medical system may be utilized at the office of the doctor.

Medical systems may include optics. For example, a medical system may include one or more optical systems that may include optics. An optical system may include one or more optical devices. For example, an optical device may be or may include a device that controls light (e.g., reflects light, refracts light, filters light, transmits light, polarizes light, etc.). An optical device may be made of any material that controls the light as designed. For example, the material may include one or more of glass, crystal, metal, and semiconductor, among others. Examples of optical devices may include one or more of lenses, mirrors, prisms, optical filters, waveguides, waveplates, beam expanders, beam collimators, beam splitters, gratings, and polarizers, among others.

A medical procedure may include corneal cross-linking (CXL). CXL may be utilized in treating a condition and/or an issue of a cornea of an eye. The condition and/or the issue may cause the cornea to become weakened and/or thinned over time. For example, the condition and/or the issue may be keratoconus. CXL may be achieved via utilization of an ultraviolet (UV) laser. A laser may be or include a device that generates a beam of coherent monochromatic light by stimulated emission of photons from excited atoms and/or molecules. The UV laser may be pulsed. For example, pulses of a laser beam may have a pulse duration in any suitable range, e.g., the microsecond, nanosecond, picosecond, femtosecond, or attosecond range, among others. An UV laser beam may be directed to one or more locations associated with the cornea. For example, directing the UV laser beam to the one or more locations associated with the cornea may include adjusting at least one mirror to direct the UV laser beam to the one or more locations associated with the cornea. One or more locations associated with the cornea may be utilized in treating the cornea. A diameter of the UV laser beam may be adjustable. For example, a beam expander may be utilized to adjust a diameter of the UV laser beam.

Each of at least two of multiple locations associated with the cornea may be associated with an intensity profile. In one example, a first location associated with the cornea may be associated with a first intensity profile. The first intensity profile may be associated with a first optical intensity of a laser beam. In another example, a second location, different from the first location, associated with the cornea may be associated with a second intensity profile, different from the first intensity profile. The second intensity profile may be associated with a second optical intensity of the laser beam, different from the first optical intensity of the laser beam. An optical intensity of a laser beam may be an optical power per unit area. For example, the optical power per unit area may be watts per centimeters squared (W/cm2). The optical intensity of the laser beam may be a product of photon energy and photon flux.

Different intensity profiles may be utilized to compensate for intensity losses in certain areas (e.g., at a border of an area). For example, an intensity profile associated with a border of an area may be associated with an optical intensity that is greater than an optical intensity that is with a location that is closer to a center of the area. Different intensity profiles may be utilized to provide increased optical intensities in one or more areas. For example, the increased optical intensities in the one or more areas may enhance one or more CXL effects. Different intensity profiles may be utilized to achieve different effects. For example, the different effects may include one or more refractive change in the cornea. The one or more refractive change in the cornea may be achieved without additional beam shaping apertures and/or without additional optics.

Each of at least two of multiple locations associated with the cornea may be associated with a laser beam diameter. In one example, a first location associated with the cornea may be associated with a first laser beam diameter. In another example, a second location associated with the cornea may be associated with a second laser beam diameter, different from the first laser beam diameter. For example, a beam expander may be utilized to set and/or to configure a laser beam diameter. An angle of a laser beam expansion may be determined based at least on one or more laser beams parameters. For example, an area of irradiation (e.g., a laser beam diameter) may be determined based at least on a distance between a laser output aperture and an eye of a patient.

Multiple locations associated with the cornea may be associated with a shape and/or a pattern. For example, the multiple locations associated with the cornea may be similar to elements of a shape and/or a pattern. An element of the shape and/or the pattern may be associated with a diameter of a laser beam. An element of the shape and/or the pattern may be associated with a location of a laser beam on the cornea. An element of the shape and/or the pattern may be associated with an amount of photonic irradiation. Two or more elements of the shape and/or the pattern may at least partially overlap. Two or more elements of the shape and/or the pattern may not overlap.

Before and/or during a medical procedure, an eye may change positions and/or may rotate. In one example, if the eye changes positions and/or rotates, a medical system may compensate for position changes and/or for rotation. The medical system may compensate for the position changes and/or for the rotation to direct a laser beam to multiple locations associated with the cornea. In another example, the medical system may alert one or more medical personnel, may cease the medical procedure, and/or may prevent the medical procedure from starting. The medical system may utilize one or more iris structures in determining if the eye changes positions and/or rotates.

A first medical system may determine structures of an iris of an eye of a patient. For example, determining the structures of the iris of the eye of the patient may include identifying the structures of the iris of the eye of the patient. A second medical system may utilize the structures of the iris of the eye of the patient to determine if the eye changes positions and/or rotates. The second medical system may utilize a pupil of the eye of the patient to determine if the eye changes positions.

The second medical system may include an UV laser that may be utilized in one or more CXL medical procedures. The second medical system may include a laser (e.g., an UV laser, a visible spectrum laser, an infrared laser, etc.) that may cut a pocket in the eye. The position of an incision for the pocket may be associated with a location on the eye. As an example, the second medical system and the first medical system may be combined into a single medical system. As another example, the second medical system and the first medical system may be different medical systems.

A CXL medical procedure may be performed after another medical procedure. For example, as a preventative medical procedure, the CXL medical procedure may be performed after a corneal procedure. A laser device may be utilized to perform the corneal procedure and to perform the CXL medical procedure, as an example. The corneal procedure and the CXL medical procedure may be different medical procedures. Utilizing the laser device for the corneal procedure and the CXL medical procedure may reduce an amount of time for the corneal procedure and the CXL medical procedure. Utilizing the laser device for the corneal procedure and the CXL medical procedure may reduce a number of pieces of medical equipment for the corneal procedure and the CXL medical procedure.

Turning now toFIG.1A, an example of a medical system is illustrated. As shown, a medical system110may be utilized with a patient120. As illustrated, medical system110may include a computer system112. Computer system112may be communicatively coupled to displays116A and116B. Computer system112may be communicatively coupled to a biometry device114. In one example, biometry device114may include one or more cameras. In another example, biometry device114may include a three-dimensional scanner. Biometry device114may be utilized in biometry of an eye122of patient120. As shown, display116A may display an image130A associated with eye122of patient120. As illustrated, display116B may display an image130B associated with eye122of patient120.

A user interface may be associated with one or more of computer system112, display116A, and display116B, among others. In one example, a user interface may include one or more of a keyboard, a mouse, a joystick, a touchscreen, an eye tracking device, a speech recognition device, a gesture control module, dials, and/or buttons, among other input devices. In another example, a user interface may include a graphical user interface (GUI). A user (e.g., medical personnel) may enter desired instructions and/or parameters via the user interface.

Computer system112may determine eye recognition information. For example, the eye recognition information may include biometry information associated with eye122of patient120. The biometry information associated with eye122may include one or more of a pattern of blood vessels of a sclera of eye122, a structure of an iris of eye122, a position of a structure of an iris of eye122, a distance measurement of a cornea of eye122to a lens of eye122, a distance measurement of a lens of eye122to a retina of eye122, a corneal topography of eye122, a retinal pattern of eye122, and a wavefront measurement, among others.

As shown, display116B may display structures134A-134C of an iris of eye122. As illustrated, display116B may display display areas136A-136D. In one example, a display area136may display a distance measurement of a cornea of eye122to a lens of eye122, a distance measurement of a lens of eye122to a retina of eye122, a position of an iris structure134, corneal topography information, or wavefront measurement information, among other biometry information associated with eye122. In another example, a display area136may display any information associated with patient120.

A person150may operate medical system110. For example, person150may be medical personnel.112. Person150may enter identification information associated with patient120into computer system112. The identification information associated with patient120may include one or more of a name of patient120, an address of patient120, a telephone number of patient120, a government issued identification number of patient120, a government issued identification string of patient120, and a date of birth of patient120, among others.

Person150may provide medical procedure information, associated with patient120, to computer system112. The medical procedure information may be associated with a medical procedure. The medical procedure information may be associated identification information associate with patient120. Computer system112may store the medical procedure information. For example, computer system112may store the medical procedure information for later utilization. The medical procedure information may be associated with a surgery. For example, the medical procedure information may be retrieved before the surgery. The medical procedure information may be utilized during a medical procedure. For example, the medical procedure may include a surgery.

Turning now toFIG.1B, an example of a biometry device is illustrated. As shown, biometry device114may include image sensors160A-160C. For example, an image sensor160may include a camera. A camera may include a one or more digital image sensors. In one example, a digital image sensor may include a charge-coupled device (CCD). In another example, a digital image sensor may include a complementary metal-oxide-semiconductor (CMOS). The camera may transform light into digital data. The camera may utilize a Bayer filter mosaic. For example, the camera may utilize a Bayer filter mosaic in combination with an optical anti-aliasing filter. A combination of the Bayer filter mosaic in combination with the optical anti-aliasing filter may reduce aliasing due to reduced sampling of different primary-color images. The camera may utilize a demosaicing process. For example, the demosaicing process may be utilized to interpolate color information to create a full array of red, green, and blue (RGB) image data.

As illustrated, biometry device114may include light projectors162A-162C. In one example, a light projector162may project visible light. In another example, a light projector162may project infrared light. A light projector162may project circles and/or dots onto an eye of a patient. An image sensor160may receive reflections of the circles and/or the dots that were projected onto the eye of the patient. A computer system may determine one or more locations and/or one or more templates associated with the eye of the patient based at least on the reflections of the circles and/or the dots that were projected onto the eye of the patient. As shown, biometry device114may include depth sensors164A-164C. A depth sensor164may include a light projector162. A depth sensor164may include an optical sensor. As illustrated, biometry device114may include an optical low coherence reflectometer (OLCR) device166. As shown, biometry device114may include a wavefront device168.

Wavefront device168may include one or more of a light source and a wavefront sensor, among others. A light source may provide a first light wave to eye122. A wavefront sensor may receive a first perturbed light wave, based at least on the first light wave, from eye122. In one example, wavefront device168may determine first optical corrections based at least on the first perturbed light. In another example, a computer system may determine first optical corrections based at least on the first perturbed light. Wavefront device168may provide data, based at least on the first perturbed light wave, to a computer system. For example, the computer system may determine first optical corrections based at least on the data from wavefront device168.

Any two or more of an image sensor160, a light projector162, a depth sensor164, an OLCR device166, and a wavefront device168may be combined. One or more of image sensors160A-160C, one or more of light projectors162A-162C, one or more of depth sensors164A-164C, OLCR device166, and/or wavefront device168, among others, may produce data that may be utilized by a computer system.

Turning now toFIG.2, an example of a laser system is illustrated. A laser system210may be utilized to irradiate one or more portions of eye122. For example, laser system210may be utilized to irradiate one or more portions of eye122with UV light from a UV laser device. Laser system210may be utilized in a medical procedure. For example, a medical system may include laser system210. The medical procedure may include an ophthalmic procedure on at least a portion part of eye122. Although optical system210may be utilized in a medical system, laser system210may be utilized in any system.

Laser system210may include multiple optical devices. For example, an optical device may be or may include a device that controls light (e.g., reflects light, refracts light, filters light, transmits light, polarizes light, etc.). An optical device may be made of any material that controls the light as designed. For example, the material may include one or more of glass, crystal, metal, and semiconductor, among others. Examples of optical devices may include one or more of lenses, mirrors, prisms, optical filters, waveguides, waveplates, beam expanders, beam collimators, beam splitters, gratings, and polarizers, among others.

As shown, laser system210may include a laser220(e.g., a laser device). Laser220may generate a laser beam221. In one example, laser220may be a device that generates a beam of coherent monochromatic light by stimulated emission of photons from excited atoms and/or molecules. In another example, laser220may be a device that generates a laser beam that includes photons associated with multiple frequencies. Laser beam221may have any suitable wavelength, e.g., a wavelength in an infrared (IR) range, in a visible range, or in an UV range. Pulses of laser beam221may have a pulse duration in any suitable range, e.g., the microsecond, nanosecond, picosecond, femtosecond, or attosecond range, among others. Laser beam221may deliver consecutive pulses, having a pulse duration, for a period of time. The focus of laser beam221may be a focal point of laser beam221. Laser beam221may represent one or more laser beams. For example, laser220may be configured to produce one or more laser beams221.

As illustrated, laser system may include focusing optics240. As shown, focusing optics240may include a beam expander241, a scanner244, and an objective lens248. Objective lens248may include multiple lenses. In one example, objective lens248may be or include a compound lens. In another example, objective lens248may be or include a F-theta lens. As illustrated, beam expander241may include lenses242A and242B. Although beam expander241is shown with two lenses, beam expander241may include any number of lenses.

Focusing optics240may direct and/or may focus laser beam221towards eye122. Focusing optics240may direct and/or may focus laser beam221towards a cornea310, illustrated inFIG.3, of eye122. Focusing optics240may direct a focal point of laser beam221parallel to or along a Z-axis towards eye122.

An optical device, such as a lens242A and/or a mirror, may control a Z-position of a focal point of laser beam221. Another optical device, such as a lens242B (e.g., in combination with lens242A), may expand a diameter of laser beam221. For example, beam expander241may be configured to control a focal point of laser beam221.

Scanner244may include one or more optical devices that may control a direction of laser beam221to control a XY-position of the focal point. For example, to transversely deflect laser beam221, scanner244may include a pair of galvanometric actuated mirrors that may tilt about mutually perpendicular axes. Scanner244may receive laser beam221from beam expander241. Scanner244may manipulate laser beam221to control the XY-position of the focal point of laser221. Objective lens248may receive laser beam221from the scanner244. Objective lens248may direct laser beam221to eye122.

As illustrated, laser system210may include a computer system250. Computer system250may execute instructions in implementing at least a portion of one or more systems, one or more flow charts, one or more processes, and/or one or more methods described herein. Although laser system210is illustrated as including computer system250, laser system210may not include computer system250. For example, computer system250may be external to laser system210. Computer system250may be communicatively coupled to laser system210.

As shown, computer system250may be communicatively coupled to laser220. As illustrated, computer system250may be communicatively coupled to beam expander241. As shown, computer system250may be communicatively coupled to scanner244. In one example, computer system250may receive information from one or more of laser220, beam expander241, and scanner244, among others. In another example, computer system250may provide information to one or more of laser220, beam expander241, and scanner244, among others. Computer system250may provide control information to one or more of laser220, beam expander241, and scanner244, among others.

A medical system may include laser system210. Laser system210may be utilized in one or more medical procedures. As one example, laser system210may be utilized with a Dresden protocol. As a second example, laser system210may be utilized with a derivation of a Dresden protocol (e.g., higher/lower energy settings, different irradiation times, on/off “pulsed” irradiation, different riboflavin application strategies, etc.). As a third example, laser system210may be utilized with created pockets (e.g. corneal pockets, interface after refractive lenticule extraction, LASIK (laser-assisted in situ keratomileusis) flaps, etc.) to apply riboflavin. As another example, laser system210may be utilized in a CXL medical procedure.

Turning now toFIG.3, an example of layers of a cornea of an eye is illustrated. As shown, a cornea310may include layers320-360. In one example, layer320may be an epithelium. In a second example, layer330may be a Bowman's membrane. In a third example, layer340may be a stroma. In a fourth example, layer350may be a Descemet's membrane. In another example, layer360may be an endothelim.

Turning now toFIG.4A, a second example of a medical system is illustrated. As shown, a surgeon410may utilize surgical tooling equipment420. In one example, surgeon410may utilize surgical tooling equipment420in a surgery and/or a medical procedure involving eye122of patient120. A medical system400A may include an ophthalmic surgical tool tracking system. As illustrated, medical system400A may include a computer system430, a display440, and a microscope integrated display (MID)450.

Computer system430may receive image frames captured by one or more image sensors. For example, computer system430may perform various image processing on the one or more image frames. Computer system430may perform image analysis on the one or more image frames to identify and/or extract one or more images of surgical tooling equipment420from the one or more image frames. Computer system430may generate a GUI, which may overlay the one or more image frames. For example, the GUI may include one or more indicators and/or one or more icons, among others. The one or more indicators may include medical data, such as one or more positions and/or one or more orientations. The one or more indicators may include one or more warnings. The GUI may be displayed by display440and/or MID450to surgeon410and/or other medical personnel.

Computer system430, display440, and MID450may be implemented in separate housings communicatively coupled to one another or within a common console or housing. A user interface may be associated with one or more of computer system430, display440, and MID450, among others. For example, a user interface may include one or more of a keyboard, a mouse, a joystick, a touchscreen, an eye tracking device, a speech recognition device, a gesture control module, dials, and/or buttons, among other input devices. A user (e.g., surgeon410and/or other medical personnel) may enter desired instructions and/or parameters via the user interface. For example, the user interface may be utilized in controlling one or more of computer system430, display440, and MID450, among others. As illustrated, medical system400A may include a laser system210. For example, surgeon410may utilize laser system210in performing a CXL procedure on eye122. As an example, MID450may include a laser system210.

Turning now toFIG.4B, a third example of a medical system is illustrated. As shown, a surgeon410may utilize a system400B. For example, surgeon410may utilize system400B in a surgery involving eye122of patient120. System400B may include multiple systems. System400B may include a cutting system. For example, surgeon410may utilize system400B in cutting eye122. Surgeon410may utilize system400B in cutting a flap in cornea310of eye122of patient120or in cutting a pocket in cornea310of eye122of patient120. In one example, system400B may cut a flap in cornea310of eye122with a blade. In a second example, system400B may cut a pocket in cornea310of eye122with a blade. In a third example, system400B may cut a flap in cornea310of eye122with a laser beam produced by a laser device and/or a laser system. In a fourth example, system400B may cut a flap in cornea310of eye122with a laser beam produced by a laser device and/or a laser system. In another example, system400B may cut any femto-cut in cornea310of eye122with a laser beam produced by a laser device and/or a laser system. A fluid may be applied to one or more interior portions of cornea310of eye122via the flap or via the pocket. For example, the fluid may include riboflavin. Surgeon410may utilize system400B in removing a layer from cornea310of eye122. For example, surgeon410may utilize system400B in removing layer320from cornea310of eye122. As an example, removing layer320may include scraping layer320from cornea310. After layer320of cornea310of eye122is removed, a fluid may be applied to one or more interior portions of the cornea of eye122. For example, the fluid may include riboflavin.

As illustrated, system400B may include a laser system210. For example, surgeon410may utilize laser system210in performing a CXL procedure on eye122. As shown, system400B may include a display440. As illustrated, system400B may include a MID450. System400B may include one or more of image sensors160A-160C, one or more of light projectors162A-162C, one or more of depth sensors164A-164C, an OLCR device166, and/or a wavefront device168, among others.

System400B may include a laser, such as a femtosecond laser, which may use short laser pulses to ablate or cut a series of small portions of corneal tissue to form a flap that may be lifted up to expose an interior part of cornea310of eye122. The flap may be planned and cut using one or both of display440and MID450, along with control devices and a computer system430. Fluid may be dispensed under the flap. For example, the fluid may be dispensed to the interior part of cornea310of eye122. The fluid may include riboflavin.

System400B may include a laser, such as a femtosecond laser, which may use short laser pulses to ablate or cut a series of small portions of corneal tissue to form a pocket that may expose an interior part of cornea310of eye122. The pocket may be planned and cut using one or both of display440and MID450, along with control devices and a computer system430. Fluid may be dispensed under in the pocket. For example, the fluid may be dispensed to the interior part of cornea310of eye122. The fluid may include riboflavin.

As shown, system400B may include computer system430. For example, computer system430may be communicatively coupled to one or more of image sensors160A-160C, one or more of light projectors162A-162C, one or more of depth sensors164A-164C, an OLCR device166, a wavefront device168, display440, MID450, a laser, and/or laser system210, among others, of system400B.

System400B may include one or more control devices. For example, the one or more control devices may include one or more of an interactive display, such as a touchscreen display, a keyboard, a mouse, a touchpad, buttons, a joystick, a foot pedal, a heads-up display, and virtual-reality glasses, or other devices able to interact with a user, such as medical personnel.

System400B may include at least one computer system configured to generate an image presented on at least one of display440and MID450, among others. For example, the at least one computer system may include computer system430. Computer systems430may be communicatively coupled to observational devices, such as a microscope, a camera, an optical coherence tomography (OCT) device or display, or another device able to measure the position of the eye undergoing surgery. Computer systems430may be communicatively coupled to one or more of the control devices.

In one example, computer system430: i) may be communicatively coupled to observational devices that observe eye122when patient120is positioned with system400B, ii) may provide graphical information regarding the planned flap location and the planned area of ablation to one or more of display440and MID450, and iii) may be communicatively coupled to one or more control devices of system400B. In a second example, computer system430: i) may be communicatively coupled to observational devices that observe eye122when patient120is positioned with system400B, ii) may provide graphical information regarding the planned pocket location and the planned area of ablation to one or more of display440and MID450, and iii) may be communicatively coupled to one or more control devices of system400B. In another example, a computer system may include the properties and/or the attributes described above with respect to computer system430, among others.

A computer system of a system400may be communicatively coupled to another part of system400in a wired fashion or in a wireless fashion. One of more of computer systems of system400may be communicatively coupled to a database, stored locally, on a remote computer system or a remote data center, or both, that store patient data, treatments plans, and/or other information associated with medical treatments and/or system400. In one example, the database may include a relational database. In a second example, the database may include a graph database. In another example, the database may include a “Not Only SQL” (NoSQL) database.

System400may enter information regarding patient120and the treatment to be performed on patient120or actually performed on patient120. System400may allow a user to enter and view information regarding patient120and the treatment to be performed on patient120. Such data may include information about patient120, such as identifying information, a medical history of patient120, and/or information about eye122being treated, among others. Such data may include information about the treatment plans, such as the shape and location of a corneal cut, a shape and location of ablation, and/or multiple locations associated with a CXL procedure, among others.

Turning now toFIG.4C, an example of a microscope integrated display and examples of surgical tooling equipment are illustrated. Medical personnel may utilize surgical tooling equipment420. As shown, surgical tooling equipment420A may be or include a scalpel. As illustrated, surgical tooling equipment420B may be or include a Q-tip. As shown, surgical tooling equipment420C may be or include tweezers. As illustrated, surgical tooling equipment420D may be or include an eyedropper. For example, an eyedropper may be utilized to dispense a fluid to eye122. The fluid may include riboflavin. Other surgical tooling equipment that is not specifically illustrated may be utilized with one or more systems, one or more processes, and/or one or more methods described herein.

As an example, surgical tooling equipment420may be marked with one or more patterns. The one or more patterns may be utilized in identifying surgical tooling equipment420. The one or more patterns may include one or more of a hash pattern, a stripe pattern, and a fractal pattern, among others. As another example, surgical tooling equipment420may be marked with a dye and/or a paint. The dye and/or the paint may reflect one or more of visible light, infrared light, and ultraviolet light, among others. In one example, an illuminator478may provide ultraviolet light, and image sensor472may receive the ultraviolet light reflected from surgical tooling equipment420. Computer system430may receive image data, based at least on the ultraviolet light reflected from surgical tooling equipment420, from image sensor472and may utilize the image data, based at least on the ultraviolet light reflected from surgical tooling equipment420, to identify surgical tooling equipment420from other image data provided by image sensor472. In another example, an illuminator478may provide infrared light, and image sensor472may receive the infrared light reflected from surgical tooling equipment420. Computer system430may receive image data, based at least on the infrared light reflected from surgical tooling equipment420, from image sensor472and may utilize the image data, based at least on the infrared light reflected from surgical tooling equipment420, to identify surgical tooling equipment420from other image data provided by image sensor472.

As illustrated, MID450may include eye pieces452A and452B. As shown, MID450may include displays462A and462B. Surgeon410may look into eye pieces452A and452B. In one example, display462A may display one or more images via eye piece452A. A left eye of surgeon410may utilize eye piece452A. In another example, display462B may display one or more images via eye piece452B. A right eye of surgeon410may utilize eye piece452B. Although MID450is shown with multiple displays, MID450may include a single display462. For example, the single display462may display one or more images via one or more of eye pieces452A and452B. MID450may be implemented with one or more displays462.

As shown, MID450may include image sensors472A and472B. In one example, image sensors472A and472B may acquire images. In a second example, image sensors472A and472B may include cameras. In another example, an image sensor472may acquire images via one or more of visible light, infrared light, and ultraviolet light, among others. One or more image sensors472A and472B may provide data of images to computer system430. Although MID450is shown with multiple image sensors, MID450may include a single image sensor472. MID450may be implemented with one or more image sensors472.

As illustrated, MID450may include distance sensors474A and474. For example, a distance sensor474may determine a distance to surgical tooling equipment420. Distance sensor474may determine a distance associated with a Z-axis. Although MID450is shown with multiple image sensors, MID450may include a single distance sensor474. In one example, MID450may be implemented with one or more distance sensors474. In another example, MID450may be implemented with no distance sensor.

As shown, MID450may include lenses476A and476B. Although MID450is shown with multiple lenses476A and476B, MID450may include a single lens476. MID450may be implemented with one or more lenses476. As illustrated, MID450may include illuminators478A and478B. For example, an illuminator478may provide and/or produce one or more of visible light, infrared light, and ultraviolet light, among others. Although MID450is shown with multiple illuminators, MID450may include a single illuminator478. MID450may be implemented with one or more illuminators478. MID450may include one or more devices, one or more structures, and/or one or more functionalities as those described with reference to biometry device114. In one example, MID450may include OLCR device166. In another example, MID450may include wavefront device168. MID450may include a biometry device114. As shown, MID450may include biometry device114.

Turning now toFIG.5, an example of a computer system is illustrated. As shown, a computer system500may include a processor510, a volatile memory medium520, a non-volatile memory medium530, and an input/output (I/O) device540. As illustrated, volatile memory medium520, non-volatile memory medium530, and I/O device540may be communicatively coupled to processor510.

The term “memory medium” may mean a “memory”, a “storage device”, a “memory device”, a “computer-readable medium”, and/or a “tangible computer readable storage medium”. For example, a memory medium may include, without limitation, storage media such as a direct access storage device, including a hard disk drive, a sequential access storage device, such as a tape disk drive, compact disk (CD), random access memory (RAM), read-only memory (ROM), CD-ROM, digital versatile disc (DVD), electrically erasable programmable read-only memory (EEPROM), flash memory, non-transitory media, and/or one or more combinations of the foregoing. As shown, non-volatile memory medium530may include processor instructions532. Processor instructions532may be executed by processor510. In one example, one or more portions of processor instructions532may be executed via non-volatile memory medium530. In another example, one or more portions of processor instructions532may be executed via volatile memory medium520. One or more portions of processor instructions532may be transferred to volatile memory medium520.

Processor510may execute processor instructions532in implementing at least a portion of one or more systems, one or more flow charts, one or more processes, and/or one or more methods described herein. For example, processor instructions532may be configured, coded, and/or encoded with instructions in accordance with at least a portion of one or more systems, one or more flowcharts, one or more methods, and/or one or more processes described herein. Although processor510is illustrated as a single processor, processor510may be or include multiple processors. A processor may include one or more processor cores. One or more of a storage medium and a memory medium may be a software product, a program product, and/or an article of manufacture. For example, the software product, the program product, and/or the article of manufacture may be configured, coded, and/or encoded with instructions, executable by a processor, in accordance with at least a portion of one or more systems, one or more flowcharts, one or more methods, and/or one or more processes described herein.

Processor510may include any suitable system, device, or apparatus operable to interpret and execute program instructions, process data, or both stored in a memory medium and/or received via a network. Processor510further may include one or more microprocessors, microcontrollers, digital signal processors (DSPs), application specific integrated circuits (ASICs), or other circuitry configured to interpret and execute program instructions, process data, or both.

I/O device540may include any instrumentality or instrumentalities, which allow, permit, and/or enable a user to interact with computer system500and its associated components by facilitating input from a user and output to a user. Facilitating input from a user may allow the user to manipulate and/or control computer system500, and facilitating output to a user may allow computer system500to indicate effects of the user's manipulation and/or control. For example, I/O device540may allow a user to input data, instructions, or both into computer system500, and otherwise manipulate and/or control computer system500and its associated components. I/O devices may include user interface devices, such as a keyboard, a mouse, a touch screen, a joystick, a handheld lens, a tool tracking device, a coordinate input device, or any other I/O device suitable to be used with a system.

I/O device540may include one or more busses, one or more serial devices, and/or one or more network interfaces, among others, that may facilitate and/or permit processor510to implement at least a portions of one or more systems, processes, and/or methods described herein. In one example, I/O device540may include a storage interface that may facilitate and/or permit processor510to communicate with an external storage. The storage interface may include one or more of a universal serial bus (USB) interface, a SATA (Serial ATA) interface, a PATA (Parallel ATA) interface, and a small computer system interface (SCSI), among others. In a second example, I/O device540may include a network interface that may facilitate and/or permit processor510to communicate with a network. I/O device540may include one or more of a wireless network interface and a wired network interface. In a third example, I/O device540may include one or more of a peripheral component interconnect (PCI) interface, a PCI Express (PCIe) interface, a serial peripheral interconnect (SPI) interface, and an inter-integrated circuit (I2C) interface, among others. In a fourth example, I/O device540may include circuitry that may permit processor510to communicate data with one or more sensors. In a fifth example, I/O device540may facilitate and/or permit processor510to communicate data with one or more of a display550and a MID560, among others. In another example, I/O device540may facilitate and/or permit processor510to communicate data with an imaging device570. As illustrated, I/O device540may be coupled to a network580. For example, I/O device540may include a network interface.

Network580may include a wired network, a wireless network, an optical network, or a combination of the foregoing, among others. Network580may include and/or be coupled to various types of communications networks. For example, network580may include and/or be coupled to a local area network (LAN), a wide area network (WAN), an Internet, a public switched telephone network (PSTN), a cellular telephone network, a satellite telephone network, or a combination of the foregoing, among others. A WAN may include a private WAN, a corporate WAN, a public WAN, or a combination of the foregoing, among others.

A computer system described herein may include one or more structures and/or one or more functionalities as those described with reference to computer system500. In one example, computer system250may include one or more structures and/or one or more functionalities as those described with reference to computer system500. In a second example, computer system112may include one or more structures and/or one or more functionalities as those described with reference to computer system500. In a third example, computer system430may include one or more structures and/or one or more functionalities as those described with reference to computer system500. In another example, a computer system of MID450may include one or more structures and/or one or more functionalities as those described with reference to computer system500.

Turning now toFIGS.6A-6D, examples of an eye are illustrated. As shown inFIG.6A, eye122may be oriented upwards. In one example, eye122may be oriented upwards without being angled. In another example, eye122may be oriented upwards without being rotated. One or more of iris structures134A-134C may be utilized in determining that eye122is oriented upwards. For example, computer system430may determine respective positions of the one or more of iris structures134A-134C. Computer system430may determine that eye122is oriented upwards based at least on the respective positions of the one or more of iris structures134A-134C.

As illustrated inFIG.6B, eye122may be rotated. One or more of iris structures134A-134C may be utilized in determining that eye122is rotated. For example, computer system430may determine respective positions of the one or more of iris structures134A-134C. Computer system430may determine that eye122is rotated by an angle based at least on the respective positions of the one or more of iris structures134A-134C.

As shown inFIG.6C, eye122may be angled. As illustrated, eye122may be angled to the left. One or more of iris structures134A-134C may be utilized in determining that eye122is angled. For example, computer system430may determine respective positions of the one or more of iris structures134A-134C. Computer system430may determine that eye122is angled by an angle based at least on the respective positions of the one or more of iris structures134A-134C.

As illustrated inFIG.6D, eye122may be angled. As shown, eye122may be angled down. One or more of iris structures134A-134C may be utilized in determining that eye122is angled. For example, computer system430may determine respective positions of the one or more of iris structures134A-134C. Computer system430may determine that eye122is angled by an angle based at least on the respective positions of the one or more of iris structures134A-134C.

Turning now toFIGS.6E-6H, examples of an eye and a coordinate system are illustrated. As shown inFIG.6E, eye122may be at an angle θxfrom a Z-axis with respect to a X-axis. Angle θxmay be positive or negative. As illustrated inFIG.6F, eye122may be at an angle θyfrom the Z-axis with respect to a Y-axis. Angle θymay be positive or negative. As shown inFIG.6G, eye122may be rotated by an angle ϕ. For example, eye122may be rotated by angle ϕ about the Z-axis. Angle ϕ may be positive or negative. As illustrated inFIG.6H, eye122may be rotated by angle ϕ about an arbitrary axis610. For example, axis610may be a vector in a three-dimensional Cartesian coordinate system. Angle ϕ may be positive or negative. In one example, axis610may be based at least on angle θx. In a second example, axis610may be based at least on angle θy. In another example, axis610may be based at least on angle θxand based at least on angle θy. AlthoughFIGS.6E-6Hutilize a Cartesian coordinate system, any coordinate system may be utilized. Computer system430may determine one or more of angle θx, angle θy, angle ϕ, and axis610based at least on respective positions of one or more of iris structures134A-134C.

Turning now toFIG.7A, an example of a method of operating a medical system is illustrated. At710, data associated with multiple locations associated with a cornea of an eye of a patient may be received. For example, computer system430may receive data810(illustrated inFIG.8) associated with multiple locations910associated with cornea310of eye122of patient120. Data810may include one or more of data815A-815M, among others. In one example, data815A-815M may be respectively associated with multiple locations910A-910M. In a second example, data815A may be associated with location910, illustrated inFIG.9C. In another example, data815A may be associated with location910, illustrated inFIG.9C, and data815B and815C may be respectively associated with locations910A and910B, any of illustrated inFIGS.9D-9F. The data associated with the multiple locations, associated with the cornea of the eye of the patient, may include locations910of any ofFIGS.9C-9F. For example, multiple data815may be utilized in any order. Data associated with locations910A-910G, illustrated in any ofFIGS.9D-9F, may be utilized before data associated with location910, illustrated inFIG.9C. Data associated with location910, illustrated inFIG.9C, may be utilized before data associated with locations910A-910G, illustrated in any ofFIGS.9D-9F. For example, one or more locations of a FIG. ofFIGS.9C-9Fmay be irritated with a laser beam before another FIG. ofFIGS.9C-9Fmay be irritated with a laser beam. Data810may include information that may described, characterize, and/or indicate this performance.

As illustrated inFIG.9A, a plane905may be associated with multiple locations910A-910M. Plane905may be orthogonal to laser221after laser221is transmitted from objective lens248. Plane905may be associated with eye122as illustrated inFIG.9B. Multiple locations910A-910M may be associated with cornea310of eye122of patient120. Although only fourteen locations are illustrated inFIG.9A, any number of locations may be utilized.

Furthermore, locations910may be arranged at any locations. In one example, a single location910is illustrated inFIG.9C. In a second example, multiple locations910may be associated with plane905as illustrated inFIG.9D. In a third example, multiple locations910may be associated with plane905as illustrated inFIG.9E. In another example, multiple locations910may be associated with plane905as illustrated inFIG.9F. As illustrated inFIG.9G, multiple locations910may be associated with cornea310of eye122. As shown inFIG.9F, a first portion of cornea310is associated with locations910. As illustrated inFIG.9F, a second portion of cornea310, different from first portion, is not associated with locations910. For example, one or more portions of cornea310may be treated while one or more other one or more portions of cornea310may not be treated.

As illustrated inFIG.8, data810may include data815A-815M. For example, data815A-815M may be respectively associated with locations910A-910M. Data815may include coordinate information820. For example, coordinate information820may include XY coordinates. The XY coordinates may be associated with a X-axis and a Y-axis. Data815may include diameter information825. For example, diameter information825may include a diameter measurement of a laser beam associated with location910. Data815may include period of time information830. For example, period of time information830may include a period of time to apply a laser beam at location910. Data815may include pulse duration information835. For example, pulse duration information835may include a pulse duration. As an example, a pulse duration may include a microsecond duration, a nanosecond duration, a picosecond duration, a femtosecond duration, or an attosecond duration, among others. For example, laser220may be configured with a pulse duration based at least on pulse duration information835.

At715, at least one lens may be adjusted based at least on diameter information of the data associated with at least one of the multiple locations, to set a diameter of a laser beam. For example, at least one of lenses242A and242B may be adjusted based at least on diameter information of the data associated with at least one of the multiple locations, to set a diameter of laser beam221. A computer system may provide control information to beam expander241to adjust at least one of lenses242A and242B to set a diameter of laser beam221. In one example, computer system250may provide control information to beam expander241to adjust at least one of lenses242A and242B to set a diameter of laser beam221. In a second example, computer system430may provide control information to beam expander241to adjust at least one of lenses242A and242B to set a diameter of laser beam221. In a third example, computer system430may provide control information to computer system250. Computer system250may provide the control information to beam expander241to adjust at least one of lenses242A and242B to set a diameter of laser beam221. In another example, computer system430may be or include computer system250. The control information may be based at least on the diameter information of the data associated with the at least one of the multiple locations.

Method elements720-740may be performed for each of the multiple locations associated with the cornea of the eye of the patient. For example, Method elements720-740may be performed for each of multiple locations910.

At720, it may be determined if the eye has changed from a first position of the eye to a second position of the eye, different from the first position of the eye. For example, computer system430may determine if eye122has changed from a first position of the eye to a second position of the eye, different from the first position of the eye. As one example, eye122may change from a first position of eye122, illustrated inFIG.6A, to a second position of eye122, illustrated inFIG.6B. Eye122may have changed from the first position of eye122, illustrated inFIG.6A, to the second position of eye122, illustrated inFIG.6B, via one or more rotations. As a second example, eye122may change from a first position of eye122, illustrated inFIG.6A, to a second position of eye122, illustrated inFIG.6C. As a third example, eye122may change from a first position of eye122, illustrated inFIG.6A, to a second position of eye122, illustrated inFIG.6D. As another example, eye122may change from a first position of eye122, illustrated inFIG.6C, to a second position of eye122, illustrated inFIG.6D. Determining if the eye has changed from the first position of the eye to the second position of the eye, different from the first position of the eye, may include determining if a pupil of the eye has changed from a first position of the pupil to a second position of the pupil. Determining if the eye has changed from the first position of the eye to the second position of the eye, different from the first position of the eye, may include determining if a center of a pupil of the eye has changed from a first position of the center of the pupil to a second position of the center of the pupil.

Determining if the eye has changed from the first position of the eye to the second position of the eye, different from the first position of the eye, may include determining if at least one iris structure has changed from a first position of the at least one iris structure to a second position of the at least one iris structure. In one example, iris structure134A may be at a first position of iris structure134A, illustrated inFIG.6A, and iris structure134A may be at a second position of iris structure134A, illustrated inFIG.6B. In a second example, iris structure134A may be at a first position of iris structure134A, illustrated inFIG.6A, and iris structure134A may be at a second position of iris structure134A, illustrated inFIG.6C. In a third example, iris structure134A may be at a first position of iris structure134A, illustrated inFIG.6A, and iris structure134A may be at a second position of iris structure134A, illustrated inFIG.6D. In another example, iris structure134A may be at a first position of iris structure134A, illustrated inFIG.6C, and iris structure134A may be at a second position of iris structure134A, illustrated inFIG.6D. In these examples, one or more of iris structures134B and134C may be utilized in place of or in addition to iris structure134A in a fashion as iris structure134A has been described. As one example, one or more of iris structures134A-134C may be determined via medical system110. As another example, one or more of iris structures134A-134C may be determined via medical system400.

If the eye has not changed from a first position of the eye to a second position of the eye, at least one mirror may be adjusted based at least on the location, at725. For example, if eye122has not changed from a first position of eye122to a second position of eye122, at least one mirror of scanner244may be adjusted based at least on location910. For example, scanner244may include one or more mirrors that may be adjusted based at least on location910.

If the eye has changed from the first position of the eye to the second position of the eye, the at least one mirror may be adjusted based at least on the location and based at least on the second position of the eye, at730. For example, if eye122has changed from the first position of eye122to the second position of eye122at least one mirror of scanner244may be adjusted based at least on location910and based at least on the second position of eye122. As an example, scanner244may include one or more mirrors that may be adjusted based at least on location910and based at least on the second position of eye122.

If eye122has changed from the first position of the eye to the second position of the eye, location910may be translated based at least on the second position of the eye.

Adjusting the at least one mirror based at least on the location and based at least on the second position of the eye may include adjusting the at least one mirror based at least on the location and based at least on a translation of the location. The translation may be based at least on the second position of the eye. In one example, translating based at least on the second position may include translating based at least on a second position of a center of a pupil of eye122. In a second example, translating based at least on the second position of the eye may include translating based at least on a second position of an iris structure. The second position of the iris structure may be a second position of iris structure134A, a second position of iris structure134B, or a second position of iris structure134C, among others. In another example, translating based at least on the second position of the eye may include translating based at least on second positions of respective multiple iris structures. The second positions of the respective multiple iris structures may include two or more of a second position of iris structure134A, a second position of iris structure134B, and a second position of iris structure134C, among others.

A computer system may compute one or more translations of one or more locations910. For example, the computer system may compute a translation of a location910based at least on one or more of angle θx, angle θy, angle ϕ, and axis610, among others. A computer system may determine one or more of angle θx, angle θy, angle ϕ, and axis610based at least on respective positions of one or more of iris structures134A-134C. In one example, the computer system may determine one or more of angle θx, angle θy, angle ϕ, and axis610based at least on a first position of iris structure134A and a second position of iris structure134A. In a second example, the computer system may determine one or more of angle θx, angle θy, angle ϕ, and axis610based at least on a first position of iris structure134B and a second position of iris structure134B. In another example, the computer system may determine one or more of angle θx, angle θy, angle ϕ, and axis610based at least on a first position of iris structure134C and a second position of iris structure134C.

At735, the laser beam may be produced. For example, laser220may produce laser beam221. Laser beam221may be an UV laser beam. For example, laser220may be or include a device that generates a beam of coherent monochromatic light, in an UV spectrum, by stimulated emission of photons from excited atoms and/or molecules. Producing the laser beam may include pulsing the laser beam at a pulse duration. For example, the pulse duration may be a microsecond duration, a nanosecond duration, a picosecond duration, a femtosecond duration, or an attosecond duration, among others. The pulse duration may be configured and/or set based at least on pulse duration information835associated with location910. In one example, the pulse duration may be configured and/or set based at least on pulse duration information835A associated with location910A. In another example, the pulse duration may be configured and/or set based at least on pulse duration information835B associated with location910B. A first pulse duration, associated with a first location, may be different from a second pulse duration, associated with a second location. The pulse duration associated with location910A may be different from the pulse duration associated with location910B. The pulse duration associated with location910A may be equal to the pulse duration associated with location910B.

Before the laser beam is produced, at least one of a flap and a pocket may be cut in the cornea of the eye. In one example, a blade may cut the cornea of the eye. In another example, another laser may cut the cornea of the eye. Before the laser beam is produced, riboflavin may be applied to an interior portion of the cornea. For example, riboflavin may be applied to an interior portion of the cornea via the flap that was cut or via the pocket that was cut. Before the laser beam is produced, a layer of the cornea may be removed to expose an interior portion of the cornea. Layer320, as illustrated inFIG.3, may be removed. Riboflavin may applied to the cornea after the layer of the cornea is removed and before the laser beam is produced.

At740, the laser beam may be directed to the location for a period of time associated with the location. For example, laser beam221may be directed to location910for a period of time associated with location910. Focusing optics240may direct laser beam221to location910for a period of time associated with location910. A first period of time associated with a first location may be different from a second period of time associated with a second location. For example, a period of time associated with location910A may be different from a period of time associated with location910B. The period of time associated with location910A may be indicated by period of time information830A. The period of time associated with location910B may be indicated by period of time information830B. A period of time associated with a first location may be equal a second period of time associated with a second location. For example, a period of time associated with location910A may be equal to a period of time associated with location910B.

Directing the laser beam to the location for the period of time associated with the location may add bonds between collagen fibers in the cornea. For example, directing laser beam221to location910for the period of time associated with location910may add bonds between collagen fibers in cornea310associated with location910.

The bonds between the collagen fibers may aid in stabilizing cornea310. For example, the bonds between the collagen fibers associated with each location of locations910may aid in stabilizing cornea310. Locations910may be determined based at least on a topography of cornea310. Locations910may be determined based at least on a thicknesses at respective multiple positions associated with cornea310. Locations910may be determined based at least on refractive information associated with one or more of cornea310and eye122, among others. For example, one or more of methods7A and7B, among others, may be utilized in correcting an astigmatism in cornea310. Locations910may be determined based at least on a medical plan that may mitigate or may stop an issue and/or a disease that may weaken and/or thin cornea310. For example, locations910may be determined based at least on a medical plan that may mitigate or may stop progressive keratoconus from becoming worse.

Turning now toFIG.7B, another example of a method of operating a medical system is illustrated. Method elements710and720-740may be performed as described with reference toFIG.7A. In the method associated withFIG.7B, method elements715-740may be performed for each of the multiple locations associated with the cornea of the eye of the patient. For example, method elements715-740may be performed for each of multiple locations910. At715, at least one lens may be adjusted, based at least on diameter information of the data associated with the location, to set a diameter of a laser beam.

At least a first diameter associated with a first location may be different from a second diameter associated with a second location. In one example, a diameter associated with location910A may be different from a diameter associated with location910B. Diameter information825A may indicate the diameter associated with location910A. Diameter information825B may indicate the diameter associated with location910B. In a second example, a diameter associated with location910A may be different from a diameter associated with location910C. Diameter information825A may indicate the diameter associated with location910A. Diameter information825C may indicate the diameter associated with location910C. In another example, a diameter associated with location910A may be equal to a diameter associated with location910D. Diameter information825A may indicate the diameter associated with location910A. Diameter information825D may indicate the diameter associated with location910D.

One or more of the method and/or process elements and/or one or more portions of a method and/or processor elements may be performed in varying orders, may be repeated, or may be omitted. Furthermore, additional, supplementary, and/or duplicated method and/or process elements may be implemented, instantiated, and/or performed as desired. Moreover, one or more of system elements may be omitted and/or additional system elements may be added as desired.

A memory medium may be and/or may include an article of manufacture. For example, the article of manufacture may include and/or may be a software product and/or a program product. The memory medium may be coded and/or encoded with processor-executable instructions in accordance with one or more flowcharts, systems, methods, and/or processes described herein to produce the article of manufacture.

The above disclosed subject matter is to be considered illustrative, and not restrictive, and the appended claims are intended to cover all such modifications, enhancements, and other implementations which fall within the true spirit and scope of the present disclosure. Thus, to the maximum extent allowed by law, the scope of the present disclosure is to be determined by the broadest permissible interpretation of the following claims and their equivalents, and shall not be restricted or limited by the foregoing detailed description.