JP2018538046A - Method and system for ophthalmic measurement and cataract surgery planning using vector functions derived from previous surgery - Google Patents

Abstract

An improved device, system and method for planning cataract surgery in a patient's eye identifies the results of previous corrective surgery by deriving valid surgical vector functions based on data from previous corrective surgery Incorporated into the planned cataract surgery of patients. An exemplary effective surgical vector uses an impact matrix, which determines the overall effectiveness of cataract surgery by identifying one or more parameters of an intraocular lens (IOL) that is implanted during cataract surgery. As a result, an improved refractive correction can be generated.

Description

(Cross-reference of related applications)
This application is a continuation-in-part of US patent application Ser. No. 13 / 341,385 filed on Dec. 30, 2011, and is provisional application No. 61/428, filed Dec. 30, 2010. The benefit of 644 is claimed under 35 USC 119 (e). The entire disclosure of the above-mentioned application is incorporated herein in its entirety as if fully set forth. The full Paris Convention priority is expressly retained by this document.

  The present invention relates generally to ophthalmic surgery and ophthalmic measurements, and more particularly to ophthalmic surgery and ophthalmic measurements for the identification and / or correction of visual failure. In an exemplary embodiment, the present invention provides a system and method for planning and performing cataract surgery, including selection and / or placement of an intraocular lens (IOL) in the eye.

  Laser corneal shaping or refractive surgery is commonly used to treat myopia, hyperopia, astigmatism, and the like. Laser refraction correction treatments include LASIK and (laser-assisted In-Situ corneal curvature surgery), photorefractive keratoplasty (PPK), epithelial corneal curvature surgery (LASEK or Epi-LASEK), and laser thermal keratoplasty. Skills are listed. Alternative refractive change procedures that do not depend on the laser and / or do not change the shape of the cornea are also described.

  During LASIK, the surgeon makes a cut through the anterior surface of the cornea, optionally using a vibrating steel blade or microkeratome. The microkeratome automatically advances the blade through the cornea, producing a thin flap of transparent tissue in the central front of the eye. The flaps can be folded to expose the interstitial tissue for selective ablation with an excimer laser. More recently, femtosecond laser systems have been developed to form laser incisions in corneal tissue so as to cut corneal flaps without the use of mechanical blades. Regardless of how the flap is prepared, the excimer laser corrects visual impairment by directing a beam of pulsed laser energy to the exposed corneal substrate. Each laser pulse from the excimer laser changes and corrects the refractive index of the entire eye by removing a very small and accurate amount of corneal tissue and removing all interstitial tissue from within the cornea. After removal of the desired interstitial tissue (and more specifically after laser ablation), the flap can be folded over the ablated surface. The protective epithelial flap flaps quickly and spontaneously reattaches on the recut stromal tissue and retains effective changes in the shape of many eyes after the cornea heals.

  A number of alternative laser refractive procedures have been used and / or developed. In some variations, rather than incising the corneal tissue for temporary displacement of the epithelial flap, the epithelium is ablated (typically using an excimer laser) or ablated with PPK treatment. Also good. As an alternative to re-cutting the stroma using an excimer laser, it has also been proposed to make an incision in the cornea or other refractive tissue of the eye using a femtosecond laser. . These femtosecond laser treatments include taking out a corneal lens and making an incision in the cornea to correct the refractive properties of the eye. Still further alternatives have been described, and new procedures have been developed to further enhance refractive correction capabilities using lasers and other refractive tissue deformation tools.

  Known corneal corrective treatments are generally quite successful in correcting standard visual impairments such as myopia, hyperopia and astigmatism. However, as with any success, further improvements are desired. To that end, wavefront measurement systems are currently available for measuring the refractive properties of a particular patient's eyes. These wavefront measurement systems allow accurate measurement of aberrations throughout the eye's optics, and make the patient's visual clarity even after standard refractive errors have been corrected (eg, with glasses, contact lenses, etc.) Extremely detailed information is provided about higher order visual aberrations that can limit performance. Additional additional measuring tools can provide useful information for such individualized ablation procedures. For example, corneal topographers are commercially available that can provide very accurate information regarding the shape of the anterior surface of the cornea. This surface can have a major role in the optical properties of the entire eye. An optical coherence tomograph (OCT) can provide information about both the front and inner surfaces of the eye. Combining these precision measuring instruments with the flexibility of modern scanning excimer lasers not only corrects the standard refractive error of the eye with individualized refractive correction, but also the specific higher-order aberrations of a specific patient Should also support.

  Individualized lasers and other refractive treatments have had a significant effect on many patients, but the overall improvement in the refractive properties of patients treated using these new technologies is theoretically The full potential above has not yet been reached. A number of theories or factors have been presented to help explain why some individually ablated procedures do not remove all of the higher order aberrations of the eye. Even when laser refractive correction is limited to standard refractive errors in myopia, hyperopia and astigmatism, empirical responses from previous treatments allow physicians to calculate prescriptions before treating the patient's eyes. Individual regulators or “nomograms” were applied to regulate Significant efforts have been directed at increasing the effects of both standard and individualized refractive correction by identifying similar nomogram adjustments for correction of higher order aberrations. Unfortunately, work related to the present invention has shown that it is difficult to identify nomogram adjustments suitable for individual refraction correction for a particular patient in a particular treatment setting, Subsequently, the effects of individualized corneal ablation may be limited to those that are significantly less than possible ideal outcomes. In fact, a significant number of higher-order refractive treatments may actually increase other higher-order aberrations of the eye (even if overall vision benefits from treatment).

  Cataract extraction surgery is another frequently performed surgical procedure. Cataracts are formed by the opacity of the eye lens. Cataracts can scatter light passing through the lens and worsen vision so that it can be perceived. Cataracts can vary in degree from slight opacity to complete opacity. In the early stages of age-related cataract progression, the lens power may increase, causing myopia (myopia). As the lens gradually turns yellow and turbid, blue recognition may be reduced. This is because these short wavelengths are more strongly absorbed and scattered within the cataractous lens. Cataract formation often progresses slowly, leading to progressive blindness.

  Cataract treatment may involve replacing the opaque lens with an artificial intraocular lens (IOL). Cataract surgery can be performed using a technique called ultrasonic phacoemulsification. This technique uses an ultrasonic tip with associated perfusion and suction ports to emulsify or cut the relatively hard core of the lens and facilitate removal through an opening created in the anterior lens capsule To. The nucleus of the lens is contained in the outer membrane of the lens called the lens capsule. Access to the lens nucleus can be provided by performing an anterior capsulotomy, which uses a femtosecond laser beam from a laser cataract surgery system and a small circular anterior to the lens capsule. Holes can be formed. Access to the lens nucleus can also be provided by performing manual continuous curvilinear capsulorhexis (CCC) using a microkeratome. A femtosecond laser can also be used to soften and disassemble the cataractous lens, which reduces the energy required for lens extraction by ultrasonic lens emulsification. An alternative to ultrasonic phacoemulsification is manual small incision cataract surgery (MSICS), where the entire lens passes through a self-sealing scleral tunnel wound and is placed outside the eye. Is a treatment that appears in

  Regardless of how the lens nucleus is removed, after this procedure is completed, an artificial intraocular lens (IOL) is inserted into the remaining lens capsule of the eye to replace the cataractous lens.

  Cataract treatment planning can be a challenging problem. Prior to performing a cataract surgery, the surgeon selects the appropriate parameter of the IOL to be implanted (eg, the refractive power of the IOL) to provide the patient with the desired refractive outcome (approximately the same as the glasses prescription). There will be a need.

  In many important eye biometric parameters, there is significant diversity from patient to patient (or by eye), each of which can affect surgical planning, treatment, and outcomes. In addition, many patients may have an impact on surgical planning, treatment and outcomes such as corneal low and high order aberrations, axial length of the tip, and / or previous corneal flexure treatments such as LASIK. A biometric composition may be included. For example, with regard to eye aberrations, some patients have myopia (myopia), hyperopia (hyperopia), or astigmatism. Myopia occurs when light is focused in front of the retina, while hyperopia occurs when light refracts into a focus behind the retina. Astigmatism occurs when the corneal curvature is unequal in more than one direction. Various surgical methods have been developed and used to treat these types of aberrations.

  Ideally, for best results and outcomes, to plan for cataract treatment prior to surgery and / or to evaluate the postoperative refractive status of the patient's eyes and the implanted IOL. The surgeon has access to not only the biometric information of the eye but also information about the anterior corneal surface, posterior corneal surface, anterior lens surface, posterior lens surface, lens tilt, lens thickness, and lens position. Yes.

  Traditionally, doctors use pre-operative measurements, including corneal curvature, axial length, and horizontal corneal (white to white) measurements, to estimate the required frequency of the IOL, and to measure For example, the appropriate frequency of the embedded IOL is selected by applying to expressions such as Hagis, Hoffer Q, Holladay 1, Holladay 2, and SRK / T.

  Various vision measurement systems have been developed, each providing a limited subset of the desired measurements. Thus, cataract patients may now need to take multiple measurements performed on various devices when the measurements are made. Multiple measurement devices in cataract planning because the patient's eyes may be in different positions, the position of the eyes may change from measurement to measurement, or because measurements are made under different conditions There are significant drawbacks to using. Furthermore, there can be no way to combine or fuse a collection of data from different devices to obtain a single three-dimensional model of the patient's eye.

  In the study, patients with refraction results using traditional eye measurement techniques and conventional IOL power formulas met the target of 0.5D or higher (targeted to distance) in 55% of cases. And correlates to 20/25), and in 85% of cases, 1D or more is shown (corresponding to 20/40 when targeted to distance). Furthermore, this means that in a significant proportion of cases, significantly less than optimal results are obtained, and there is substantial room for improvement in techniques using cataract surgery plans.

  In view of the above, it would be beneficial to provide improved devices, systems and methods for measuring, diagnosing and / or treating eye defects in cataract patients. These improved techniques still preferably allow the physician to enter nomogram adjustments for a particular patient. These improvements ideally increase overall accuracy while allowing higher order aberrations of the eye to be treated without significantly increasing the cost or complexity of the measurement and / or treatment system. If it is possible, it is considered to be particularly beneficial.

  In view of the above, it would also be beneficial to provide improved devices, systems and methods for performing ophthalmic measurements to diagnose and / or treat cataracts. These improvements would ideally specify, select and place an intraocular lens for cataract surgery without significantly increasing the cost or complexity of the measurement, diagnosis and / or treatment system. It would be particularly beneficial if the overall accuracy could be increased while making it possible.

  The present invention generally provides improved devices, systems and methods for, inter alia, ophthalmic measurements and diagnosing cataracts, planning cataract treatments and / or treating cataracts. The present invention derives an effective treatment vector function based on previous eye treatment and / or refractive surgery data, thereby enabling a prior patient's planned cataract surgery to include the previous refractive correction and / or surgery. Provides a holistic approach to incorporating results. This effective treatment vector function represents a multivariate feedback approach that can be adapted to a number of factors that contribute to the accuracy of selection and placement of intraocular lenses in cataract surgery. An exemplary effective treatment vector function uses an impact matrix analysis approach. In many cases, complex factors between factors and individual optical error modes can be used to contribute many factors to the induced error (along with a relatively large number of previous eye treatments). By using an influence matrix, it may be possible to produce improved refractive correction from currently available aberration measurement techniques. By appropriately using an impact matrix, or other effective treatment vector function, the overall effectiveness of cataract surgery, including improved resolution of a suitable intraocular lens (IOL) implanted in the patient's eye Can be increased.

  In a first aspect, the present invention provides a method for planning cataract surgery in a patient's eye. The method includes determining an effective treatment vector function based on a plurality of previous eye treatments. An effective treatment vector function can be determined by defining a pre-treatment vector that characterizes the measured pre-treatment higher order aberrations of the eye for each previous eye treatment of the associated eye. A post-treatment vector characterizing post-treatment high-order aberrations of the eye is also defined. An effective treatment vector function can then be determined by deriving a correlation between the pre-treatment vector and the associated post-treatment vector. An input vector for a particular patient can be defined based on the patient's eye pre-treatment higher-order aberrations, and the patient's eye treatment can be derived by applying a valid treatment vector function to the input vector Can do.

  The input vector can be defined by specifying the target refraction of the patient's eye that is induced by the refractive treatment. In many cases, the target refraction of the patient's eye can be normal, and after treating the patient's eye, the aberration is substantially removed. It should be noted that this is not always the case because treatment can intentionally cause certain desired aberrations in the eye to relieve presbyopia and the like. Regardless, once the target refraction is identified, a target refractive correction vector (IRC) that characterizes the difference between the measured pre-treatment aberrations of the patient's eye and the target can be subsequently measured.

  Deriving an effective treatment vector function can be done by determining a target refractive vector (IRC) for each relevant eye. Surgery-induced refractive correction (SIRC) can be defined as the actual change in aberration for each eye, for example, each SIRC is between the associated pre-treatment and post-treatment aberrations of the eye. Characterize the difference.

  In an exemplary embodiment, an effective treatment vector function is an influence matrix that relates SIRC to IRC.

を判定することによって導出することができる。例えば、

Can be derived by determining. For example,

は、関連する目の群に関して、

For the group of related eyes

となるように、ＳＩＲＣをＩＲＣに関連付け得、式中、

The SIRC can be related to the IRC so that

は（ｆを導出するようにゼロに向けて推移することができる）誤差ベクトルである。有効な治療ベクトル関数は、医師の調節及び／又はノモグラム調節ごとに、ＩＲＣを調整することによって（結果的に）任意選択的に定義することができる患者の目に対するベクトルＩＲＣから、調節した目的の屈折矯正ベクトル（ＡＩＲＣ）を算出することにより入力ベクトルに適用することができる。ＩＲＣ’（すなわちＩＲＣから導出したベクトル）を、ＡＩＲＣを導出するための、かつ／又は患者の目の治療を導出するための、入力ベクトルとして使用することができ、これによって、所望する場合に医師の調節及びノモグラム調節が可能になる。

Is an error vector (which can transition towards zero to derive f). The effective treatment vector function is determined from the vector IRC for the patient's eye, which can be (optionally) defined by adjusting the IRC for each physician adjustment and / or nomogram adjustment. It can be applied to the input vector by calculating the refractive correction vector (AIRC). IRC ′ (ie, a vector derived from IRC) can be used as an input vector for deriving AIRC and / or for deriving a treatment for the patient's eye, thereby allowing the physician if desired And nomogram adjustment are possible.

  It is preferable to derive an effective treatment vector function using an impact matrix approach. More specifically, the planned treatment of the patient's eyes can be characterized by a planned treatment matrix, where multiple components of the input vector each affect multiple components of the planned treatment vector A matrix can be derived. Similarly, the components of the plurality of planned treatment vectors can each vary with the components of the input vector. In fact, each component of the input vector (at least the component that characterizes the refractive shape of the patient's eye) can change each component of the planned treatment matrix (or the component that characterizes the change in the refractive shape of the patient's eye), And / or the influence matrix can be derived to vary.

  Pre-treatment aberration measurements for input vectors typically include eye refraction (such as spherical error, astigmatism power, and standard refraction characteristics of astigmatism angle), and higher order aberrations (such as Zernike coefficients) This characterizes the refraction aspect of the eye. The input vector may also include patient characteristics (patient age, gender, race, etc.) and / or treatment settings (e.g., physician or other system user identification, measurement and / or type used for treatment and / or treatment Non-refractive cofactors can be characterized, including system, humidity during measurement and / or treatment, temperature during measurement and / or treatment, geographic location of measurement and / or treatment, and the like. The pre-treatment and post-treatment vectors for the previous eye treatment (from which the influence matrix is derived) may include similar components.

  An exemplary method for deriving a patient's eye treatment may be to multiply the influence matrix of the effective treatment vector function by the input vector to define a conditional input vector. Refractive treatment can be planned using the matrix component of the conditional input vector.

  In another aspect, the present invention provides a method for planning refractive treatment of a patient's eye. The method includes deriving an impact matrix from a plurality of previous eye treatments. For a particular eye and associated particular treatment, it is possible to determine a target refractive correction vector (IRC), which characterizes the difference between the measured pre-treatment higher order aberrations and the target refraction. Similar IRC vectors can be prepared for each of the previous eye treatments. The surgically induced refractive vector (SIRC) can also be determined for each of the previously treated eyes, and each SIRC is between the measured pre-treatment aberration and the measured post-treatment aberration of the eye. Characterize the difference. The impact matrix can then be derived to provide a correlation between the IRC and SIRC. A patient's IRC vector can be defined that characterizes the difference between the pre-treatment higher order aberrations of the patient's eye and the target refraction of the patient's eye. The patient's IRC vector can then be adjusted based on the influence matrix to generate an adjusted IRC. In many embodiments, the patient will be treated based on a regulatory IRC.

  In another aspect, the present invention provides a method for planning treatment of a patient's eye. The impact matrix will preferably be derived from multiple previous eye treatments. The influence matrix can be derived by determining the target refraction of each eye along with the target refractive correction vector (IRC) that characterizes the difference between the pre-treatment higher order aberrations and the target. A surgically induced refractive correction vector (SIRC) is also determined for each eye, and the SIRC characterizes the difference between the measured pre-treatment and post-treatment aberrations. The impact matrix will be derived to provide a correlation between IRC and SIRC. The method includes receiving a patient's IRC vector that characterizes the difference between the measured pre-treatment higher aberrations of the patient's eye and the target refraction of the patient's eye. The IRC vector is adjusted based on the influence matrix. In many embodiments, the patient will then be treated based on the regulatory IRC.

  In another aspect, the present invention provides a system for planning treatment of a patient's eye. The system includes an input for receiving pre-treatment high order aberrations of the patient's eye. The processor is coupled to the input unit. The processor derives a treatment for the patient's eye in response to the higher order aberrations of the patient's eye by applying an effective treatment vector function. An effective treatment vector function is derived from the correlation between the pre-treatment vector characterizing higher order aberrations and the post-treatment vector characterizing post-treatment higher order aberrations for each of a plurality of previously treated eyes. The output is coupled to the processor to transmit a treatment to facilitate improving the patient's eye refraction.

  The processor will often include software in the form of a tangible medium that embodies machine readable instructions for deriving the therapy. In an exemplary embodiment, the processor is configured to generate and / or store an input vector for the patient's eye as a function of the target refraction desired to be derived by treatment. The input vector can be generated by determining a target refractive correction vector (IRC) that characterizes the difference between the measured pre-treatment aberrations of the eye and the target. Exemplary embodiments can include one or more aberrometers (such as wavefront sensors) coupled to the input. The processor uses the associated eye-target refractive vector (IRC) to derive an effective treatment vector function from a plurality of previous treatments to produce an associated eye surgery-derived refractive vector (SIRC). ) And each SIRC characterizes the difference between the associated pre- and post-treatment aberrations of the eye. A particularly preferred embodiment is an influence matrix that relates SIRC to IRC.

を使用して、有効な治療ベクトル関数を導出する。関連する目に関して、

Is used to derive an effective treatment vector function. Regarding related eyes,

を導出することが可能であり、

It is possible to derive

式中、

Where

は誤差ベクトルである。調節した目的の屈折矯正ベクトル（ＡＩＲＣ）を、

Is an error vector. Adjusted target refractive vector (AIRC)

となるように算出することにより、有効な治療関数を入力ベクトルに適用することができ、
式中、

By calculating so that an effective treatment function can be applied to the input vector,
Where

の逆数であり、式中、ＩＲＣ’は、（任意選択的に、医師の入力、ノモグラムなどを組み込むように）患者の目のＩＲＣに基づく。

Where IRC ′ is based on the IRC of the patient's eye (optionally to incorporate physician input, nomogram, etc.).

  Advantageously, the processor may have an input for receiving physician adjustments to the IRC, nomogram adjustments to the IRC, and the like. The processor can define an IRC 'for the patient's eye by applying these adjustments to the patient's eye's IRC. The input vector can then be based on IRC '.

  Typically, the effective treatment vector function is based on an influence matrix. The planned eye treatment will typically include a planned treatment vector, and the components of the input vector may each change the components of the planned treatment vector. In another embodiment, the components of the plurality of planned treatment vectors can each vary with the components of the input vector. In fact, all refractive components of the input vector can affect all components of the planned treatment vector by using an exemplary influence matrix derivation approach.

  In another aspect, the present invention provides a system for planning refractive treatment of a patient's eye. The system comprises a processor having an input for receiving data relating to a plurality of previous eye treatments. The processor is configured to derive an impact matrix from previous eye treatment data. The influence matrix may be derived by determining a target refractive correction vector (IRC) that characterizes the difference between the measured pre-treatment higher order aberrations and the target refraction for each eye associated with the previous eye treatment. it can. The refractive correction vector (SIRC) induced by each eye surgery is measured by characterizing the difference between the measured pre-treatment and post-treatment aberrations, and the vector is determined for each associated eye. . The impact matrix will generally include a correlation between IRC and SIRC. The system has an input for receiving a patient's IRC vector characterizing the difference between the measured pre-treatment aberrations of the patient's eye and the target refraction of the patient's eye. The output is coupled to a processor for transmitting therapy. The processor is configured to derive a treatment by adjusting the patient's IRC vector based on the influence matrix.

  In yet another aspect, the present invention provides a system for refractive treatment of a patient's eye. The impact matrix will be derived from multiple previous eye treatments. The impact matrix shows the target refractive index of the associated eye, along with a target refractive correction vector that characterizes the difference between the pre-treatment higher order aberrations and the target of the associated eye for each previous eye treatment of the associated eye. It is derived by judging. A surgically induced refractive correction vector (SIRC) is also determined for each eye, and the SIRC characterizes the difference between the measured pre-treatment and post-treatment aberrations for that eye. The impact matrix is derived to provide a correlation between IRC and SIRC. The system comprises an input for receiving a patient's IRC vector that characterizes the difference between the measured pre-treatment aberrations of the patient's eye and the target refraction of the patient's eye. The processor is coupled to the input unit. The processor is configured to adjust the patient's IRC vector based on the influence matrix. Optionally, the adjusted IRC vector is an output to a higher order refraction corrector, such as a laser eye surgery system, a custom IOL lens fab, a refractive femtosecond laser system, etc. It's okay.

  In one aspect, embodiments of the invention include a method for planning refractive treatment of a patient's eye. The exemplary method defines, for each previous eye treatment of the associated eye, defining a pre-treatment vector that characterizes the relevant eye's measured pre-treatment optical properties and characterizes the relevant eye's measured post-treatment optical properties. Based on multiple previous eye treatments by defining a post-treatment vector and deriving an effective treatment vector function using the correlation between the pre-treatment vector and the post-treatment vector Determining an effective treatment vector function may be included. The method also defines an input vector based on the measured pre-treatment optical characteristics of the patient's eye, and derives a treatment for the patient's eye by applying an effective treatment vector function to the input vector; Can be included. In some cases, the pre-measurement optical characteristics include elements selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. In some cases, the refractive treatment includes an element selected from the group consisting of excimer laser treatment, femtosecond laser treatment, intraocular lens treatment, contact lens treatment, and eyeglass treatment. In some cases, the process of defining the input vector identifies the target refraction of the patient's eye that is induced by refractive treatment and the desired refraction that characterizes the difference between the measured pre-treatment aberration of the patient's eye and the target. Determining an correction vector (IRC). The process of deriving an effective treatment vector function from a previous treatment is to determine an associated eye target refractive vector (IRC) and an associated eye surgery-derived refractive vector (SIRC). Each SIRC characterizes the difference between the associated pre- and post-treatment aberrations of the eye. In some cases, the process of deriving an effective treatment vector function includes determining an influence matrix that associates SIRC with IRC. In some cases, the method defines IRC ′ for the patient's eye by applying to the IRC of the patient's eye at least one adjustment selected from the group consisting of a physician's adjustment for IRC and a nomogram adjustment for IRC. May include. The input vector can be based on IRC '. In some cases, an influence matrix can be used to derive an effective treatment vector function. In some cases, the planned treatment of the patient's eyes is characterized by the planned treatment vector, and the influence matrix is derived such that multiple components of the input vector each change multiple components of the planned treatment vector. The In some cases, the planned treatment of the patient's eyes is characterized by a planned treatment vector, and the influence matrix is derived such that multiple planned treatment vector components each vary with multiple components of the input vector. . In some cases, the planned treatment of the patient's eye is characterized by the planned treatment vector, and the influence matrix is such that all components of the input vector that characterize the refractive shape of the patient's eye are used to account for changes in the refractive shape of the patient's eye. Derived in such a way that all components of the planned treatment vector to be characterized can be varied. In some cases, pre-treatment vectors and input vectors characterize refraction, non-refractive cofactors that characterize patient and / or treatment settings, and optical properties of the eye. In some cases, treatment of the patient's eye is derived by multiplying the input matrix by the effect matrix of the effective treatment vector function and defining the conditional input vector, and planning refractive treatment by the matrix component of the conditional input vector To be derived.

  In another aspect, embodiments of the invention include a method for planning treatment of a patient's eye. An exemplary method is a target refractive correction vector (IRC) that characterizes the difference between the associated pre-treatment higher-order aberrations and the associated target eye refraction for each previous eye treatment of the associated eye. ) And determining the refraction correction vector (SIRC) induced by the associated eye surgery that characterizes the difference between the measured pre-treatment aberration and the associated post-treatment aberration of the eye. Deriving an impact matrix from previous eye treatments. The impact matrix may be derived to provide a correlation between IRC and SIRC. The method also defines a patient IRC vector that characterizes the difference between the pre-treatment higher order aberrations of the patient's eye and the target refraction of the patient's eye, and adjusts the patient's IRC vector based on the influence matrix Can be included. In some cases, for each previous eye treatment of the relevant eye, characterize the difference between the measured pre-treatment low-order aberration and the target low-order aberration between the measured pre-treatment corneal topography and the target corneal topography. IRC can be further determined to characterize the difference between the pre-measurement corneal topography and the pre-treatment corneal topography SIRC may be further determined to characterize the difference. The patient's IRC vector may be further defined to characterize the difference between the measured pre-treatment lower order aberrations and the target refraction and to characterize the difference between the measured pre-treatment topography of the eye and the target topography. In some cases, the method may include treating the patient based on the adjusted IRC.

  In another aspect, embodiments of the invention include a method for planning refractive treatment of a patient's eye. The impact matrix determines the relevant eye target refraction for each previous eye treatment of the relevant eye and the target refraction characterizing the difference between the relevant eye's measured pre-treatment optical properties and the goal. An associated eye surgery-derived refractive correction vector (SIRC) characterizing the difference between determining the correction vector (IRC) and the measured pre-treatment optical characteristic and the associated post-measurement optical characteristic of the eye. Can be derived from a plurality of previous eye treatments. The impact matrix may be derived to provide a correlation between IRC and SIRC. The method receives a patient's IRC vector characterizing a difference between the measured pre-treatment optical properties of the patient's eye and the target refraction of the patient's eye, and adjusting the patient's IRC vector based on an influence matrix , May be included.

  In yet another aspect, embodiments of the present invention include a system for planning refractive treatment of a patient's eye. An exemplary system includes an input for receiving pre-treatment optical characteristics of a patient's eye and a processor coupled to the input, wherein the optical characteristic of the patient's eye is applied by applying an effective treatment vector function. And a processor for deriving a treatment for the patient's eye. An effective treatment vector function is, for each of a plurality of previous eye treatments, between a pre-treatment vector characterizing an associated pre-treatment optical characteristic of the eye and a post-treatment vector characterizing an associated post-treatment optical characteristic of the eye. It can be derived from the correlation. The system can also include an output coupled to the processor to transmit the treatment to facilitate improved refraction of the patient's eyes. In some cases, the pre-treatment optical characteristics of the patient's eye include at least one selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. List elements. In some cases, for each of a plurality of previous eye treatments, the pre-treatment vector can characterize the associated optical properties of the eye prior to treatment, including low-order aberrations, high-order aberrations, corneal topography. There may be one or more elements selected from the group consisting of measured values, optical coherence tomography measured values, and corneal curvature measured values. In some cases, the post-treatment vector can characterize the associated optical properties of the eye prior to treatment, including low-order aberrations, high-order aberrations, corneal topography measurements, optical coherence tomography measurements, and There may be one or more elements selected from the group consisting of corneal curvature measurements. In some cases, the output is configured to facilitate refractive treatment including an element selected from the group consisting of excimer laser treatment, femtosecond laser treatment, intraocular lens treatment, contact lens treatment, and eyeglass treatment. . In some cases, the processor includes a tangible medium that embodies machine-readable instructions for performing therapy derivation. In some cases, the processor determines a target refraction correction (IRC) that characterizes the difference between the measured pre-treatment aberrations of the patient's eye and the target to determine the target refraction of the patient's eye induced by the refractive treatment. In response, an input vector for the patient's eye is generated. In some cases, the system may further comprise an aberrometer coupled to the input, wherein the aberrometer senses lower order aberrations and higher order aberrations of the eye and processes the lower order aberrations and higher order aberrations. Send to. In some cases, the aberrometer is configured to sense the corneal topography and send the corneal topography to the processor. In some cases, the system may include an optical coherence tomography measurement device that is coupled to the input, sends the optical properties of the eye, and transmits the optical properties to the processor. In some cases, the system may include a corneal curvature measurement device that is coupled to the input, senses optical characteristics of the eye, and transmits the optical characteristics to the processor. In some cases, the processor derives an effective treatment vector function from a previous treatment in response to an associated eye objective refraction vector (IRC), and a refraction correction vector (SIRC) derived from the associated eye surgery. ) And each SIRC characterizes the difference between the measured pre-treatment aberrations and post-treatment aberrations of the associated eye. In some cases, the effective treatment vector function can be based on an influence matrix that associates SIRC with IRC. In some cases, the system may comprise an additional input coupled to the processor for receiving at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC. The processor may be configured to define an IRC 'for the patient's eye by applying at least one adjustment to the patient's eye's IRC, the input vector being based on the IRC'. In some cases, the effective treatment vector function can be based on an influence matrix. In some cases, the planned treatment of the patient's eye may include a planned treatment vector, each of the plurality of components of the input vector may change the plurality of components of the planned treatment matrix, and / or Each of the planned treatment vector components can vary with multiple components of the input vector. In some cases, the input vector includes a refractive component that characterizes the patient's eye refraction, a non-refractive cofactor that characterizes the patient and / or treatment settings, and a component that characterizes the optical properties of the eye. In some cases, the components that characterize the optical properties of the eye include higher order components that characterize higher eye aberrations, lower order components that characterize lower eye aberrations, corneal topography measurement components that characterize corneal topography measurements, An element selected from the group consisting of an optical coherence tomography measurement component characterizing the optical interference topography measurement value and a corneal curvature measurement value component characterizing the corneal curvature measurement value of the eye can be included. In some cases, the processor can be configured to derive a treatment for the patient's eye by multiplying the input matrix by the effect matrix of the effective treatment vector function.

  In yet another aspect, embodiments of the present invention include a system for planning refractive treatment of a patient's eye. An exemplary system is for receiving data relating to a plurality of previous eye treatments and for each previous eye treatment of the associated eye, an eye associated with a measured pre-treatment higher order aberration of the associated eye. Determining the target refractive correction vector (IRC) that characterizes the difference between the target refraction of the eye and the associated eye surgery characterizing the difference between the measured pre-treatment aberration and the post-treatment aberration of the eye And a processor having an input for deriving an influence matrix from the data by determining a refractive correction vector (SIRC) derived by. In some cases, the impact matrix can include a correlation between IRC and SIRC. In some cases, the system may also include another input for receiving a patient's IRC vector that characterizes the difference between the pre-treatment higher order aberrations of the patient's eye and the target refraction of the patient's eye. it can. In some cases, the system can also include an output for transmitting the therapy coupled to a processor configured to derive the therapy by adjusting the patient's IRC vector based on the impact matrix. . In some cases, the pre-treatment optical characteristics of the patient's eye include at least one selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. List elements. In some cases, for each of a plurality of previous eye treatments, the pre-treatment vector can characterize the associated optical properties of the eye prior to treatment, including low-order aberrations, high-order aberrations, corneal topography. There may be one or more elements selected from the group consisting of measured values, optical coherence tomography measured values, and corneal curvature measured values. In some cases, the post-treatment vector can characterize the associated optical properties of the eye prior to treatment. The optical characteristics can include one or more elements selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. In some cases, the pre-treatment optical properties of the patient's eye include an element selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. You may mention. In some cases, refractive treatment can include an element selected from the group consisting of excimer laser treatment, femtosecond laser treatment, intraocular lens treatment, contact lens treatment, and eyeglass treatment. In some cases, the system can also include a laser ophthalmic surgical device coupled to the output, where the surgical device generates a laser beam for treating the patient based on the adjusted IRC.

  In another aspect, embodiments of the present invention include a system for planning treatment of a patient's eye. The impact matrix determines the relevant eye target refraction for each previous eye treatment of the relevant eye and the target refraction characterizing the difference between the relevant eye's measured pre-treatment optical properties and the goal. Determining an correction vector (IRC) and an associated eye surgery-induced refractive correction vector (SIRC) that characterizes the difference between the associated eye's measured pre-treatment and post-treatment aberrations And can be derived from multiple previous eye treatments. An impact matrix can also be derived to provide a correlation between IRC and SIRC. The system may comprise an input for receiving a patient's IRC vector characterizing the difference between the measured pre-treatment optical properties of the patient's eye and the target refraction of the patient's eye. In some cases, the system may comprise a processor coupled to the input, the processor being configured to adjust the patient's IRC vector based on the influence matrix. In some cases, the associated pre-measurement optical properties of the eye include an element selected from the group consisting of low-order aberrations, high-order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. Can be mentioned. In some cases, the pre-treatment optical properties of the patient's eye include an element selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. Can be mentioned. In some cases, refractive treatment can include an element selected from the group consisting of excimer laser treatment, femtosecond laser treatment, intraocular lens treatment, contact lens treatment, and eyeglass treatment. In some cases, the influence matrix can be based on a correlation between the associated pre-treatment cylinder values of the eye, post-treatment sphere values, and pre-treatment corneal curvature measurements. In some cases, the influence matrix can be based on a correlation between associated pre-treatment corneal curvature measurements of the eye and associated eye higher-order aberrations, such as pre-treatment higher-order aberrations or post-treatment aberrations.

  In yet another aspect, embodiments of the present invention include a system for planning treatment of an eye of a patient having a natural lens eye. An exemplary system may include an input for receiving pre-treatment optical characteristics of a patient's eye with a natural lens and a processor coupled to the input, the processor applying a valid treatment vector function By deriving a treatment for the patient's eye according to the optical properties of the patient's eye, an effective treatment vector function is associated with each of a plurality of previous eye treatments with an associated lens therein Derived from the correlation between the pre-treatment vector characterizing the optical properties of the eye and the post-treatment vector characterizing the relevant post-treatment optical properties of the eye after extracting the natural lens and implanting the associated intraocular lens. The The system can also include an output coupled to the processor to transmit the treatment to facilitate improved refraction of the patient's eyes.

  In one aspect, embodiments of the present invention include a system for treating a patient's eye, the eye having a front surface. An exemplary system can include an input for receiving pre-treatment optical characteristics of a patient's eye and a processor coupled to the input. The processor can be configured to derive a treatment for the patient's eye according to the optical characteristics of the patient's eye by applying an effective treatment vector function, wherein the effective treatment vector function is For each of the eye treatments, it is derived from the correlation between the pre-treatment vector characterizing the relevant pre-treatment optical properties of the eye and the post-treatment vector characterizing the relevant post-treatment optical properties of the eye. The system also includes a femtosecond laser system coupled to the processor for focusing the femtosecond laser energy pattern through the front of the patient's eye so that refractive treatment is performed in the patient's eye Can do.

  In a further aspect, embodiments of the invention include a method for planning cataract surgery for a patient's eye. An exemplary method is effective based on multiple previous corrective operations by defining a pre-operative vector that characterizes the relevant pre-measurement pre-operative higher order aberrations for each related corrective operation of the eye. Using the correlation between the preoperative vector and the postoperative vector to determine the treatment vector function, defining the postoperative vector that characterizes the relevant eye measurement postoperative high order aberrations, and By deriving a surgical vector function, defining an input vector based on the pre-operative higher order aberrations of the patient's eye, and applying a valid surgical vector function to the input vector, Deriving one or more parameters of an intraocular lens (IOL) to be implanted in the device.

  In yet another aspect, embodiments of the present invention include a method for planning cataract surgery in a patient's eye. An exemplary method is a refractive correction vector (IRC) for purposes of characterizing the difference between the associated eye's measured pre-operative high-order aberrations and the associated target eye refraction for each previous corrective surgery of the associated eye. Determining a refraction correction vector (SIRC) induced by an associated eye surgery that characterizes the difference between the associated pre- and post-operative aberrations of the eye, The influence matrix is derived to provide a correlation between IRC and SIRC, thereby deriving the influence matrix from a plurality of previous surgeries, and measuring preoperative higher order aberrations of the patient's eye Defining a patient's IRC vector that characterizes the difference between the patient's eye and the target refraction of the patient's eye, and adjusting the patient's IRC vector based on an influence matrix.

  In yet a further aspect, embodiments of the present invention include a method for planning a cataract surgery for a patient's eye, wherein the impact matrix relates to the associated eye goal for each previous corrective surgery for the associated eye. Determining refraction, determining a target refractive correction vector (IRC) that characterizes the difference between the associated pre-measurement pre-operative higher order aberrations and the target, and associated ocular measurement pre-operative aberrations and measurements Determining an associated eye surgery-derived refractive correction vector (SIRC) that characterizes the difference between post-operative aberrations, and has been derived from a plurality of previous surgeries, and the influence matrix is IRC And is derived to provide a correlation between SIRC and SIRC. An exemplary method is to receive a patient's IRC vector characterizing a difference between the patient's eye pre-measurement high-order aberrations and the target refraction of the patient's eye, and based on the influence matrix, the patient's IRC vector Adjusting.

  In yet a further aspect, embodiments of the present invention include a system for planning cataract surgery for a patient's eye. An exemplary system is an input for receiving pre-operative high order aberrations of a patient's eye and a processor coupled to the input, the processor applying a valid surgical vector function to Deriving one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in response to higher order aberrations of the eye, and an effective surgical vector function for each of a plurality of previous corrective operations A processor, in a patient's eye, derived from a correlation between a pre-operative vector characterizing the higher order aberrations of the previous associated eye and a post-operative vector characterizing the related post-operative higher order aberrations; And an output unit coupled to the processor to transmit one or more parameters of the embedded IOL.

  In a further aspect, embodiments of the present invention include a system for planning cataract surgery for a patient's eye. An exemplary system for refractive correction for receiving data relating to a plurality of previous corrective surgeries and for characterizing a difference between associated pre-measurement pre-operative higher order aberrations and associated target eye refractions Determining a vector (IRC) and an associated eye surgery-derived refractive correction vector (SIRC) that characterizes the difference between the associated eye pre- and post-operative aberrations And an input unit for deriving an influence matrix from the data, the influence matrix including a correlation between IRC and SIRC, and pre-measurement pre-order aberrations of the patient's eye A processor having another input for receiving a patient's IRC vector characterizing a difference between the target refraction of the patient's eye and embedded in the patient's eye in a cataract surgery of the patient's eye An output coupled to a processor for transmitting one or more parameters of an intraocular lens (IOL), wherein the processor adjusts the patient's IRC vector based on an influence matrix; And an output configured to derive one or more parameters of the IOL embedded in the eye.

  In yet a further aspect, embodiments of the present invention include a system for planning cataract surgery for a patient's eye, wherein the impact matrix relates to the associated eye goal for each previous corrective surgery for the associated eye. Determining refraction, determining a target refractive correction vector (IRC) that characterizes the difference between the associated pre-measurement pre-operative higher order aberrations and the target, and associated ocular measurement pre-operative aberrations and measurements Determining an associated eye surgery-induced refractive correction vector (SIRC) that characterizes the difference between post-operative aberrations, and has been derived from a plurality of previous corrective surgeries, and the influence matrix is IRC And is derived to provide a correlation between SIRC and SIRC. An exemplary system includes an input for receiving a patient's IRC vector characterizing a difference between a patient's eye measurement pre-operative higher order aberrations and a target refraction of the patient's eye, and a processor coupled to the input The processor may comprise a processor configured to adjust the patient's IRC vector based on the influence matrix.

  In yet another further aspect, embodiments of the invention include a method for planning cataract surgery in a patient's eye. The exemplary method defines, for each previous eye treatment of the associated eye, a pre-operative vector that characterizes the relevant eye's measured pre-operative optical properties and characterizes the relevant eye's measured post-operative optical properties Based on multiple previous eye treatments by defining a postoperative vector and deriving a valid surgical vector function using the correlation between preoperative and postoperative vectors Determine the effective surgical vector function, define the input vector based on the pre-operative optical properties of the patient's eye, and apply the effective surgical vector function to the input vector to treat the patient's eye Deriving.

  In yet another aspect, embodiments of the present invention include a method for planning cataract surgery for a patient's eye. An exemplary method is to calculate a refractive index vector (IRC) of interest for characterizing the difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction for each previous operation of the associated eye. Determining an associated eye surgery-induced refractive correction vector (SIRC) that characterizes the difference between the associated eye pre- and post-operative aberrations, and the effects The matrix is derived to provide a correlation between IRC and SIRC, thereby deriving an influence matrix from a plurality of previous corrective operations, and measuring preoperative higher order aberrations of the patient's eye Defining a patient's IRC vector that characterizes the difference between the patient's eye and the target refraction of the patient's eye, and adjusting the patient's IRC vector based on an influence matrix.

  In another further aspect, embodiments of the present invention include a method for planning cataract surgery for a patient's eye, wherein the impact matrix is related to the associated eye for each previous corrective surgery. Determining a target refraction, determining a target refractive correction vector (IRC) that characterizes the difference between the relevant pre-measurement optical properties of the eye and the target, and associated pre-measurement optical properties of the eye Determining the refraction correction vector (SIRC) induced by the relevant eye surgery that characterizes the difference between the measured post-operative optical properties, and the influence matrix is derived from a plurality of previous corrective surgery, , Derived to provide a correlation between IRC and SIRC. An exemplary method is to receive a patient's IRC vector characterizing a difference between a patient's eye's measured pre-operative optical properties and the patient's eye target refraction, and based on an influence matrix, calculate the patient's IRC vector. Adjusting. Can be included.

  In yet another additional aspect, embodiments of the present invention include a system for planning cataract surgery for a patient's eye. An exemplary system is an input for receiving preoperative optical properties of a patient's eye and a processor coupled to the input, the processor applying a valid surgical vector function to Depending on the optical properties of the eye, one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in a patient's eye cataract surgery are derived, and an effective surgical vector function is a plurality of previous For each corrective operation, a processor and a cataract derived from a correlation between a pre-operative vector characterizing the relevant optical characteristics of the eye before surgery and a post-operative vector characterizing the relevant post-operative optical characteristics of the eye And an output coupled to the processor to transmit one or more parameters of the IOL that is surgically implanted in the patient's eye.

  In yet another further aspect, embodiments of the invention include a system for planning cataract surgery for a patient's eye. An exemplary system is a processor for receiving data relating to a plurality of previous corrective surgeries and for measuring associated pre-operative higher order aberrations for each previous corrective surgery of the eye. Determining a target refractive correction vector (IRC) that characterizes the difference between the target eye target refraction and characterizing the difference between the associated pre- and post-operative aberrations of the eye An input for deriving an influence matrix from the data by determining a refractive correction vector (SIRC) induced by eye surgery, the influence matrix being a correlation between IRC and SIRC A separate input for receiving a patient's IRC vector characterizing the difference between the patient's eye pre-measurement high-order aberrations and the target refraction of the patient's eye; An output connected to a processor for transmitting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye during surgery, the processor based on the influence matrix An output configured to derive one or more parameters of the IOL by adjusting the IRC vector.

  In an additional further aspect, an embodiment of the present invention is a system for planning a cataract surgery for a patient's eye, wherein the impact matrix is related to each previous corrective surgery for the associated eye. Determining a target refraction, determining a target refractive correction vector (IRC) that characterizes the difference between the relevant pre-measurement optical properties of the eye and the target, and measuring the relevant pre-op aberration and measurement of the eye Determining an associated eye surgery-derived refractive vector (SIRC) that characterizes the difference between post-operative aberrations, and derived from a plurality of previous corrective surgeries, and the impact matrix is IRC Includes a system that is derived to provide a correlation between the SIRC and the SIRC. An exemplary system includes an input for receiving a patient's IRC vector characterizing a difference between the pre-operative optical properties of the patient's eye and the target refraction of the patient's eye, coupled to the input, and an influence matrix And a processor configured to adjust the patient's IRC vector based on

1 is a schematic diagram of a system and method for measuring and treating refractive errors in a patient's eye. FIG. FIG. 2 is a perspective view schematically illustrating refractive treatment of a patient's eye using a laser eye surgery system as may be included in the system of FIG. 2 is a schematic diagram of components of a simplified computer system for use with the measurement and / or treatment components of the system of FIG. FIG. 2 is a diagram of another wavefront measurement system for use in the system of FIG. FIG. 2 is a diagram of another wavefront measurement system for use in the system of FIG. It is a graph which shows the statistical range of the high-order aberration (HOA) measurement value before a treatment, and shows the precision of these measurement values. It is a graph which shows the statistical range of the high-order aberration (HOA) measurement value before a treatment, and shows the precision of these measurement values. FIG. 6 is a data plot of post-treatment higher order aberrations versus total pre-treatment aberrations. FIG. 5 is a data plot showing a strong correlation between an effective spherical defocus treatment and a spherical defocus measured before treatment, indicating an effective treatment of low order errors. FIG. 6B is a data plot similar to FIG. 6B, but showing the correlation between pre-treatment and post-treatment high-order aberrations showing potential induction of some high-order aberrations. FIG. 6B is a data plot similar to FIG. 6B, but showing the correlation between pre-treatment and post-treatment high-order aberrations showing potential induction of some high-order aberrations. It is a graph which shows the correlation between the effective high-order aberration of treatment of the right eye, and the high-order aberration before measurement treatment. It is a graph which shows the correlation between the effective high-order aberration of treatment of the left eye, and the high-order aberration before measurement treatment. FIG. 10 is a graph identifying a selected small number of exemplary linkages between induced higher order aberrations and pre-treatment measured higher order aberrations. It is the schematic of the selected linkage. FIG. 2 is a functional block diagram schematically illustrating processing components and methods for eye treatment, including a relationship between measurements and treatment parameters. FIG. 2 is a functional block diagram schematically illustrating processing components and methods for eye treatment, including a relationship between measurements and treatment parameters. FIG. 5 is an improved functional block diagram schematically illustrating the development of treatment planning parameters to improve clinical outcome. To iteratively improve outcomes for a range of patients by adjusting treatments based on effective treatments generated from previous treatments to relieve induced eye higher order aberrations FIG. 3 is an improved functional block diagram illustrating an exemplary treatment plan solution. 6 is a graph illustrating the surprising benefits of optical accuracy that can be provided by the systems and methods described herein. 2 is an exemplary aspect of a system and method according to embodiments of the present invention. 2 is an exemplary aspect of a system and method according to embodiments of the present invention. 2 is an exemplary aspect of a system and method according to embodiments of the present invention. 2 is an exemplary aspect of a system and method according to embodiments of the present invention. 2 is an exemplary aspect of a system and method according to embodiments of the present invention. 1 is a front perspective view illustrating a vision measurement system according to some embodiments. FIG. 1 is a rear perspective view of a vision measurement system according to some embodiments. FIG. 1 is a side perspective view illustrating a vision measurement system according to some embodiments. FIG. 1 is a block diagram of eye positions for a system comprising a vision measurement device and for a system according to one or more embodiments described herein that may be used by vision measurement. FIG. Preferred configuration and integration of optical coherence tomography instrument subsystem, wavefront aberrometer subsystem, corneal topographer subsystem, iris imaging subsystem, fixation target subsystem, both according to non-limiting embodiments of the present invention The assembly of is shown. Preferred configuration and integration of optical coherence tomography instrument subsystem, wavefront aberrometer subsystem, corneal topographer subsystem, iris imaging subsystem, fixation target subsystem, both according to non-limiting embodiments of the present invention The assembly of is shown. 1 is a block diagram of an OCT assembly according to many embodiments of the present invention. FIG. 1 is a schematic diagram of a human eye. FIG. 4 is a diagram of a preferred scan area for an OCT subsystem in accordance with many embodiments of the present invention. FIG. 6 is an exemplary graph of OCT signal strength of the OCT subsystem 190, as a function of depth along an axis defining the eye axis length of the eye, according to many embodiments. FIG. 3 is a cross-sectional view of an eye obtained with the vision measurement system of the present invention using an OCT subsystem according to the present invention. 3 is a three-dimensional view of the anterior portion of an eye obtained using a vision measurement system according to many embodiments. FIG. Using an eyesight measuring instrument according to one embodiment described herein, including a wavefront aberrometer, corneal topography and OCT meter at various positions with respect to the eye along the axial length of the eye 2 is a flowchart of an exemplary embodiment of a method for performing a cataract diagnosis. 4 is a flowchart of another exemplary embodiment of a method for performing eye cataract diagnosis using a vision measuring device. 6 is a flowchart of another exemplary embodiment of a method for performing an eye cataract diagnosis using a vision measuring device capable of performing OCT measurement and iris imaging simultaneously. 6 is a flowchart of yet another exemplary embodiment of a method for performing an eye cataract diagnosis using a vision measuring device capable of performing OCT measurement and iris imaging simultaneously.

  The present invention generally provides improved devices, systems and methods for diagnosing refractive structures in a patient's eye and planning and / or treating treatment of refractive structures. In exemplary embodiments of the present invention, current trends (and / or currently developed) that identify and characterize recent trends in eye refractive index measurements and, in particular, higher order aberrations in human patients' eyes Use tools). In addition to the currently widely used Hartmann Shack wavefront sensor and other wavefront sensors used to measure aberrations throughout the optical system of the eye, measurement data and systems used in embodiments of the present invention include topography, It may include pachymetry, pupil measurement values, corneal curvature measurement values, refractive index measurement values, biometric measurement values, and the like. The type of visual tissue treatment used by the methods and systems described herein often includes laser treatment by ablation (typically using an excimer laser or solid state laser), but instead of corneal Intra-organ light change techniques, such as intramaternal femtosecond laser treatment, that make incisions to change shape can also be used. Still further alternative therapies may be aimed at changing the effective shape or function of the visual tissue other than the cornea, eg, by changing or replacing the lens, or by changing the structure of the lens capsule. Accordingly, various measurement and / or treatment types can be used in various embodiments of the present invention.

  The embodiments of the invention described herein will overcome previous attempts to identify and characterize the specific link between the shape of the visual refraction treatment and the potential induction of the associated higher order aberrations. . Exemplary embodiments can identify and accurately characterize complex interrelationships between pre-treatment refractive error modes of the eye and associated post-prescription shape modifications that improve the patient's overall visibility . The relationship between these aberrations / treated eye modes is at least partly specific to the type of eye treatment (eg, re-cutting the eye by ablation with a laser eye surgery system), To a specific treatment execution hardware structure (eg, to a specific excimer laser shape and assembly design, visual training, scanning mechanism, etc.) or even to a software package that controls a specific treatment (eg, desired It can be specific (such as to a short pattern generation software package that identifies excimer laser shots) to approximate the overall recurring refractive treatment shape. Since the association may also be related to the healing effect of the eye, the price for aberration / treated eye association occurs several hours, weeks, and / or ideally months after treatment is complete May benefit from previous experience with slow changes in organization.

  In order to more effectively measure and characterize the actual effects of the overall formulation, embodiments of the present invention will often use measurements from a number of different previous treatments. Previous treatments preferably use measurement and / or treatment systems that share common components, techniques, etc. for refractive treatments planned for a particular patient's eye. Often, at least some of the previous treatments for which information is to be derived will be of a refractive treatment that uses and / or uses different treatment components, techniques than those of the planned refractive treatment. It may be diagnosed and / or treated under different circumstances. Nevertheless, collecting accurate data from previous treatments can improve the accuracy of planned treatments. More specifically, in addition to obtaining accurate pre-treatment data characterizing the eye, embodiments of the methods and systems described herein can be obtained from higher order aberration measurements obtained after treatment of multiple eyes. Many benefits have been received and post-treatment data is ideally sufficient time after the treatment has been performed, the eye has become substantially stable and the healing response of the refractive change of the treated tissue has been substantially terminated. It is obtained by. Ideally, the vector analysis of pre-treatment and post-treatment high-order aberration measurements using an impact matrix approach would result in complexity between the desired refractive treatment and the overall effective refractive treatment. Specific associations can be identified and used for future planned treatments of a particular patient's eye.

  In addition to pre-treatment measurements and post-treatment measurements, various cofactors may be included in the vector analysis and calculations used in many embodiments of the present invention. Tissue response and healing effects may be affected by biometric cofactors such as patient age, gender, race, and / or the like. Specific identification of the components of the measurement and / or treatment system, the treatment laser system model, measurement system type identifier, specific measurement system identification, diagnosis and / or treatment physician identification, treatment and / or measurement surroundings It may be included in specific cofactors such as room temperature and humidity, daytime measurement or treatment time, patient understanding level, etc. The exemplary embodiment may further allow the physician to make input modifiers and nomogram adjustments to change the overall refractive prescription for each physician experience. Advantageously, the removal-based ablation shot tissue and data used in the calculation of shot number and location to approximate the overall desired refractive prescription shape is provided by the invention described herein. There is no need to change to take advantage of improvements. Furthermore, the overall vector function approach described herein is more of a factor that affects the specific link between the change in the refractive objective of the patient's eye and the resulting higher order change. Because it is compatible with the specific analysis, analysis of the components of the influence function (or other matrix analysis components) can be performed, and further values can be pre-changed to determine the overall measurement and / or treatment component New changes can be reflected.

  FIG. 1 schematically illustrates a simplified system 0 according to an embodiment of the present invention. The system 0 comprises a measuring device 1 used during the measuring procedure and a laser surgical system 5 used during the therapeutic procedure. Measurement and diagnostic treatments for a particular eye may precede the therapeutic treatment for that eye for minutes, hours, days, or weeks. A series of measurements can be taken, and the time between measurements is optionally very short, but in some cases may be several days or weeks away, confirming the stability of the measurement can do. Measurements are also often made after the treatment is complete, and at least some of the measurements take a considerable amount of time after the treatment so that healing and any other tissue response to the treatment is fully progressed and treated It is possible to return to a substantially stable refractive system.

  The exemplary measurement system 1 includes a wavefront measuring device 2, such as a Hartmann Shack wavefront aberrometer. An imaging assembly for capturing the image of the eye substantially simultaneously while the wavefront measuring device 2 directs the beam 3 to the patient's eye 15 in the measurement procedure (so that the eye does not move between imaging and measurement). 25 is also included. Directing the laser beam 3, obtaining measurement data, capturing images and other measurement parameters are performed under the direction of the entire computer system 35 of the system 0. Since the wavefront measurement and the image exist substantially simultaneously, and the structure of the imaging assembly in the measurement device is optically and / or mechanically coupled, the positional information contained in the image and measurement Can be associated.

  In some embodiments, the computer system 35 of the image capture device 1 can also generate and store additional treatment information, such as a planned ablation profile or a desired recut with a laser. Such treatment information can be generated from data obtained by the wavefront measurement device 2 and can be downloaded from the measurement system 1 to the processor 22 of the laser treatment device 5. Suitable measurement systems include Abbott Medical Optics, Inc. Structures such as (or based on) WaveScan Wavefront® commercially available from (AMO) (Santa Ana, Calif.); Zyooptix® measurements commercially available from Bosch and Lomb (Rochester, NY) Examples include workstations. Exemplary measurement systems include those developed for commercial and clinical use by TopCon Corporation (Japan), such as the integrated wavefront and topography, such as the iDesign System developed by Abbott Medical Optics (California). Name the system. Thus, in addition to the overall measurement of aberrations throughout the optical system of the eye, the aberration data more specifically includes, for example, topographic measurements of the anterior surface of the cornea, posterior surface measurements of the cornea (by optical coherence tomography, OCT), lens The source of aberration can be identified by measuring the size, shape, and aberration of the lens.

  The laser system 5 includes a laser 55 such as an excimer laser or a femtosecond laser. Since the imaging assembly 6 obtains an image of the eye and the image can be obtained substantially simultaneously with the refractive treatment of the eye using the laser 55, the treatment image from the imaging assembly 6 and the measurement from the imaging assembly 25. By registering the image, the therapeutic laser beam 65 can be accurately directed to the eye 15. Registration of the image and directing the laser beam is performed by the processor 22. In an exemplary embodiment, the processor 22 directs excimer laser energy to the corneal stromal tissue to provide a corneal volumetric readjustment. In an alternative refractive laser system, femtosecond pulses can be used to make the incision, and in some embodiments, another laser is used to first cut the corneal flap under the epithelial tissue. A stroma can be exposed, and then the exposed stroma can be volumetrically cut again to change the refractive characteristics of the eye 15. In some embodiments, the ablation profile is generated by other components of the processor 22 for calculation of the desired refractive correction within the components of the treatment system 5. Thus, the combined computer system of the combined device can generally be referred to as a single computer system 35, and the processor 22 is a component of the computer system 35. Specific processing tasks may be performed by any of a variety of processors and / or by software organized in a variety of subroutines.

  Referring now to FIG. 1A, a laser eye surgery system 10 can be used as the treatment system 5 in the schematic of FIG. The laser eye surgery system 10 includes a laser 12 that generates a laser beam 14. The laser 12 is optically coupled to a laser delivery optics system 16 that directs the laser beam 14 to the patient's P eye. The delivery optic support structure (not explicitly shown here) extends from a frame 18 that supports the laser 12. The microscope 20 is fixed to the delivery optics support structure, and the microscope is often used to image the cornea of the eye.

  The processor 22 of the laser system 10 can include a conventional PC system including standard user interface devices such as a keyboard, display monitor, etc. (or it can be interfaced). The processor 22 typically includes an input device such as a magnetic disk drive or optical disk drive, an internet connection, and the like. In many cases, such an input device will be used to download computer-executable code from a tangible storage medium 29 that embodies any of the methods of the present invention. The tangible storage medium 29 can take the form of a floppy disk, optical disk, data tape, volatile or non-volatile memory, RAM, etc., and the processor 22 is a modern computer for storing and executing this code. Includes computer system memory boards and other standard components. The tangible storage medium 29 can also optionally implement wavefront sensor data, wavefront tilt, wavefront ridge maps, treatment maps, corneal ridge maps, and / or ablation tables. Although the tangible storage medium 9 is often used directly in conjunction with the input device of the processor 22, the storage medium can also be processed by a network connection such as the Internet and by wireless means such as infrared, Bluetooth, etc. It can also be connected so that it can be operated remotely. Many other hardware system structures can also be implemented.

  The laser 12 and delivery optics 16 typically direct the laser beam 14 to the patient P under the direction of the processor 22. The processor 22 often adjusts the laser beam 14 selectively to expose a portion of the cornea to a pulse of laser energy, resulting in a predetermined cut of the cornea and changing the refractive characteristics of the eye. In many embodiments, both the laser beam 14 and the laser delivery optics system 16 will result in the desired laser cutting process under computer control of the processor 22, which will affect the pattern of laser pulses ( And optionally modify the pattern). The pattern of pulses can be summarized in machine readable data on a tangible storage medium 29 in the form of a treatment table.

  Using various alternative mechanisms, the laser beam 14 can be adjusted to provide the desired cut. One or more variable apertures can be used to selectively limit the laser beam 14. The laser beam can also be adjusted as necessary by changing the size and offset of the laser spot from the eye axis. Scan the laser beam across the surface of the eye and control the number and / or dwell time of the pulses at each position, using a mask in the optical path of the laser beam 14 that changes the beam launch profile in the cornea by ablation A hybrid profile scanning system in which various sized beams are scanned across the cornea (typically controlled by slits of variable width and / or iris diaphragm of variable diameter), and so on. Alternatives are possible. Optical and electromechanical computer programs, hardware, and control methods for techniques for adjusting these laser patterns are fully described in the patent publication.

  Additional components and subsystems can be included with the laser system 10 as should be appreciated by those skilled in the art. For example, a space and / or time integrator may be included to control the energy distribution in the laser beam. Optical ablation effluent aspirators / filters, aspirators, and other ancillary components of laser surgical systems are known in the art. Suitable systems also include commercially available refractive lasers, which are also manufactured and / or sold by Abbott Medical Optics, Alcon, Bausch & Lomb, Nidek, WaveLight, LaserLight, Schwind, Carl Zeiss Meditec AG, etc. .

  FIG. 2 is a simplified block diagram of an exemplary integrated computer system 35 that can be used with system 0 of the present invention (see FIGS. 1 and 1A). Computer system 35 typically includes at least one processor 52 (and optionally processor 22) that can communicate with a number of peripheral devices via bus subsystem 54. These peripheral devices may include a storage subsystem 56 including a memory subsystem 58 and a file storage subsystem 60, a user interface input device 62, a user interface output device 64, and a network interface subsystem 66. Network interface subsystem 66 provides an interface to external network 68 and / or other devices, such as wavefront measurement system 30.

  The user interface input device 62 includes a keyboard, a pointing device (mouse, trackball, touch pad, or graphics terminal), a scanner, a foot pedal, a joystick, a touch screen incorporated in a display, and an audio input device (voice recognition system, Microphones, and other types of input devices). In many cases, the user input device 62 will be used to download computer-executable code from a tangible storage medium 29 that embodies any of the methods of the present invention. In general, use of the term “input device” is intended to include a variety of conventional, proprietary devices and methods for entering information into computer system 35.

  User interface output device 64 may include a non-display device such as a display subsystem, printer, fax machine, or audio output device. The display subsystem can be a flat panel device such as a cathode ray tube (CRT), a liquid crystal display (LCD), a projection device, or the like. The display subsystem can also provide a non-display device such as an audio output device. In general, use of the term “output device” is intended to include a variety of conventional, proprietary devices and methods for outputting information from computer system 35 to a user.

  The storage subsystem 56 can store basic programming and data constructs that provide the functionality of various embodiments of the present invention. For example, as described herein, databases and modules that implement the functionality of the method of the present invention can be stored in the storage subsystem 56. These software modules are generally executed by the processor 52 and / or by the processor 22 (see FIGS. 1 and 1A). In the deployed environment, the software modules can be stored separately on the plurality of computer systems 22, 35 and executed by the processors of the plurality of computer systems. Storage subsystem 56 typically includes a memory subsystem 58 and a file storage subsystem 60.

  The memory subsystem 58 typically includes a main random access memory (RAM) 70 for storing instructions and data during execution of the program, and a read only memory (ROM) 72 in which immutable instructions are stored. Includes a large number of memories. The file storage subsystem 60 provides persistent (non-volatile) storage for program and data files and can include a tangible storage medium 29 (FIG. 1A), optionally with wavefront sensor data, wavefront tilt, A wavefront uplift map, a treatment map, and / or an ablation table can be implemented. File storage subsystem 60 includes hard disk drive, floppy disk drive with associated removable media, compact digital read only memory (CD-ROM) drive, optical drive, DVD, CD-R, CD-RW, removal Possible SSDs and / or other removable media cartridges or disks may be mentioned. One or more drives may be located at a remote location of another connected computer at another location coupled to computer system 35. Modules that implement the functionality of the present invention can be stored by the file storage subsystem 60.

  Bus subsystem 54 provides a mechanism by which the various components and subsystems of computer system 35 can communicate with each other as intended. The various subsystems and components of computer system 35 need not be in the same physical location, but can be located in various locations within the deployed network. Although the bus subsystem 54 is shown schematically as a single bus, in an alternative embodiment of the bus subsystem, multiple buses may be used.

  The computer system 35 itself is of various types, such as a personal computer, portable computer, workstation, computer terminal, network computer, wavefront measurement system or control system for a laser surgical system, mainframe, or any other data processing system. be able to. Due to the ever-changing nature of computers and networks, the description of computer system 35 shown in FIG. 2 is intended as one example only for the purpose of illustrating one embodiment of the present invention. Many other configurations of computer system 35 having more or fewer components than the computer system shown in FIG. 2 are possible.

  Turning now to FIG. 3, one embodiment of a wavefront measurement system 30 is schematically shown in a simplified form. Very generally speaking, the wavefront measurement system 30 is configured to sense the local gradient of the tilt map emanating from the patient's eye. Devices based on the Hartmann Shack principle generally include a lenslet array that uniformly samples a tilt map across the aperture, which is usually the exit pupil of the eye. Thereafter, the local gradient of the slope map is analyzed to reconstruct the wavefront surface or map.

  More specifically, one wavefront measurement system 30 includes an image source 32, such as a laser, that projects the original image through visual tissue 34 of eye E, and causes image 44 to be retina R's. Form on the surface. The image from the retina R is transmitted by the optical system of the eyes (for example, the visual tissue 34), and the image is formed on the wavefront sensor 36 by the system optical element 37. The wavefront sensor 36 communicates a signal to the process 22 'for measurement of visual error in the visual tissue 34 and / or measurement of the visual tissue ablation treatment program. The process 22 'can be incorporated into the overall computer system 35 and optionally uses the same or similar hardware as the processors 22 and / or 52 illustrated in FIGS. 1, 1A and 2. be able to. The processor 22 ′ can communicate with the processor 22 that sends commands to the laser surgical system 10, or some or all components of the computer system 35 of the wavefront measurement system 30 and the laser surgical system 10 are combined. Or may be separated. If desired, the data from the wavefront sensor 36 can be transmitted to the laser processor 22 via the tangible medium 29, via an I / O port, via a networking connection 66 such as an intranet or the Internet, or otherwise. Can tell.

  The wavefront sensor 36 generally includes a lenslet array 38 and an image sensor 40. When the image from the retina R travels through the visual tissue 34 and is imaged on the surface of the image sensor 40, and the image of the eye pupil P is similarly imaged on the surface of the lenslet array 38, the lenslet array is transmitted. The separated images are separated into an array of beamlets 42 and the separated beamlets are imaged on the surface of the sensor 40 (in combination with other optical components of the system). The sensor 40 typically includes a charge coupled device, or “CCD”, that can sense the characteristics of these individual beamlets and use these characteristics to measure the characteristics of the relevant region of the visual tissue 34. . In particular, if the image 44 contains a light spot or small spot of light, the transmitted spot position, as imaged by the beamlet, may directly indicate the local gradient of the relevant region of the visual tissue. it can.

  Eye E typically defines a forward ANT and a backward POS. As shown in FIG. 3, the image source 32 typically projects an image backward through the visual tissue 34 onto the retina R. The visual tissue 34 again transmits the image 44 forward from the retina toward the wavefront sensor 36. The image 44 actually formed on the retina R may be distorted by any defect in the optical system of the eye when the image source is first transmitted by the visual tissue 34. Optionally, the image source projection optics 46 can be configured or adapted to reduce any distortion of the image 44.

  In some embodiments, by correcting for spherical and / or cylindrical errors in the visual tissue 34, the image source optics 46 can reduce lower order optical errors. By using compatible optics, such as deformable mirrors (discussed below), higher order optical errors in the visual tissue can also be corrected. Using the image source 32 selected to define a point or plaque in the image 44 on the retina R can facilitate analysis of the data provided by the wavefront sensor 36. Because the central portion of the pupil may be less susceptible to optical errors than the peripheral portion, distortion of the image 44 is limited by transmitting the original image through the central region 48 of the visual tissue 34 that is smaller than the pupil 50. be able to. Regardless of the structure of a particular image source, it would generally be beneficial to have a well-defined and precisely formed image 44 on the retina R.

  In one embodiment, the x and y wavefront slopes obtained from the image spot analysis of the Hartmann Shack sensor image, as measured by the image of the pupil camera 51 (FIG. 3), and the nominal center of the Hartmann Shack lenslet array. The wavefront data containing the x and y pupil center offsets can be stored in two separate arrays in a computer readable medium 29, or in the memory of the wavefront sensor system 30. Such information may be sufficient to reconstruct the wavefront or any desired portion of the wavefront. The data space for storing the tilted array is not large. For example, an array of 20 × 20 size (ie 400 elements) is often sufficient to accept an image of a pupil having a diameter of 8 mm. As will be appreciated, in other embodiments, the wavefront data can be stored in the memory of the wavefront sensor system, in an array or multiple arrays.

  Although the method of the present invention has generally been described with reference to sensing the image 44, it may refer to a series of wavefront sensor data readings. For example, time-series wavefront data readings can help make a more accurate overall determination of visual tissue aberrations. Because visual tissue can change shape over time, relying on single instantaneous imaging of optical properties, the basis for refractive correction procedures, by measuring multiple wavefront sensors separated in time Can be avoided. Still further alternatives are also available, including taking eye wavefront sensor data using eyes that differ in structure, position, and / or orientation. For example, patients often help maintain eye aiming using the wavefront measurement system 30 by focusing on a fixation target. Accepting or adapting to the eye imaging the field of view at various distances by changing the position of the fixation target as described in that citation, and determining the optical properties of the eye Can do.

  The position of the optical axis of the eye can be verified by referring to the data provided from the pupil camera 52. In the exemplary embodiment, pupil camera 52 measures pupil position to image pupil 50 and register wavefront sensor data for visual tissue.

  An alternative embodiment of the wavefront measurement system is shown in FIG. The main components of the system of FIG. 4 are similar to those shown in FIG. Furthermore, FIG. 4 includes an adaptive optical element 53 in the form of a deformable mirror. The original image is reflected from the deformable mirror 98 during transmission to the retina R, and the deformable mirror is also the optical path used to form a transmitted image between the retina R and the imaging sensor 40. It is along. The deformable mirror 98 can be deformed in a controllable manner by the processor 22 to limit distortion of the image formed on the retina or after the image formed on the retina, and the wavefront obtained. The accuracy of the data can be increased. The structure and use of the system of FIG. 4 is described in more detail in US Pat. No. 6,095,651, the entire disclosure of which is incorporated herein by reference.

  Components in one embodiment of a wavefront measurement system for measuring eye and ablation can include components of a WaveScan® system available from Abbott Medical Optics (California). It should be understood that other wavefront aberrometers could be used with the present invention. Relatedly, embodiments of the present invention include WaveFront Sciences, Inc., including COAS wavefront aberrometers, ClearWave contact lens aberrometers, CrystalWave IOL aberrometers, iDesign Systems, and the like. Encompasses any implementation of the various optical instruments provided by.

  Referring now to FIGS. 5A and 5B, treatment with known laser eye surgery systems is not always effective in reducing or eliminating higher order optical aberrations of the eye as has been expected. The measurable accuracy of higher order optical aberrations can ultimately determine the accuracy with which a treatment plan can be derived. Fortunately, known wavefront aberration systems can measure the human eye with very good accuracy. FIG. 5A shows frequency and probability plots (along the horizontal axis) for different high-order root mean square (RMS) ranges for eye pre-treatment measurements in a series of studies. The average range of pretreatment measurements was approximately 93 micrometers. This relatively small measurement error, as represented by the cumulative distribution function plot of FIG. 5B, was fairly consistent throughout the hundreds of eyes in the study. Thus, if the accuracy of the overall treatment is limited only by the measurement accuracy, the treatment should be very effective in reducing or eliminating higher order aberrations.

To more fully analyze the interaction of eye measurements, planned treatments, treatments actually performed on the eyes, and post-healing effects (such as epithelial regrowth, fluid-induced swelling or hydration effects) It is beneficial to measure all effective treatments applied to the eye. Effective treatment can be defined as follows.
Treatment = Post Op-Pre Op
In the formula, treatment refers to a vector that characterizes an effective treatment or change in refraction (including higher order aberrations), and “Post Op” means after refraction treatment of the eye and after the eye has stabilized ( Means higher-order vector characterization (typically involving wavefront measurements) and “Pre Op” means higher-order vector characterization (typically including wavefront measurements) prior to refractive treatment of the eye .

  Ideally, the treatment should not correlate to the Pre Op measurement, since the Post Op aberration is ideally zero. Unfortunately, known laser eye surgery measurement and treatment systems do not provide this ideal outcome uniformly.

  Referring now to FIG. 6A, for each of a plurality of previously treated eyes, a plot of post-treatment higher order optical aberrations (along the vertical axis) versus total measured pre-treatment aberrations (along the horizontal axis) is superior. A good correlation. Since the overall aberration is determined by the standard low-order refraction term, there is a significant undesired link between the pre-treatment eye refraction or low-order aberration term and the post-treatment eye high-order aberration. Seems to exist. Data Note that FIG. 6A shows data from the eyes measured prior to treatment using a wavefront measurement system such as those described above. These eyes are then treated using a refractive laser ophthalmic surgery system and for each eye based on measured aberrations (including both standard refractive errors and higher order aberrations) for that eye. Individual refraction was derived. Since post-eye measurement was performed for a considerable time after treatment (eg 6 months), healing was almost complete and the refractive properties of the eye were substantially stable.

  Referring now to FIG. 6B, the existing laser ophthalmic surgical system functions very well for standard refractive error correction. Individual components of eye aberrations can be referenced using their standard Zernike coefficients, as confirmed in the table below. The effective treatment defocus term Z (2,0) was plotted along the vertical axis and the same coefficient for Pre Op was plotted along the horizontal axis. A slope of approximately -1 indicates that for each defocus unit of the eye prior to treatment, an effective treatment has substantially removed the same amount of error from the eye. Thus, this data allows existing laser eye surgery systems (including associated measurement systems) to work well for correcting the standard refractive error of the eye.

  Referring to FIGS. 7A and 7B, the overall response of the eye to measurement and treatment can be more complex when analyzing individual higher order aberrations. For example, as shown in FIG. 7A, the Post Op aberration measured in the Z (4,0) term (plotted on the vertical axis) is the pre-treatment defocus measured in Z (2,0) (plotted on the horizontal axis). Positive correlation. In other words, the positive slope in the graph of FIG. 7A indicates that the higher order spherical ablation term of Z (4,0) can be induced in proportion to the amount of defocus being corrected. This individual relationship can optionally be used to develop specific adjustments or nomograms for future eyes, thereby seeking to avoid inducing such errors. Unfortunately, the total number of such correlations between higher order aberrations is complex enough that it can be difficult to attempt to adjust treatment using such individual nomograms for each identified correlation, and Ultimately, it cannot be ideally effective. For example, as shown in FIG. 7B, a significant pre-treatment error in the higher order aberration term of Z (2,2) can be associated with a significant treatment Z (4,2) term. If these individual correlations exist well, especially when knowledge about all of the individual associations is not perfect, the nomogram adjustment approach resolves some errors while inducing other errors. It can be done throughout.

  Referring now to FIGS. 8A and 8B, a graphical representation of the correlation matrix between treatment and pre-op wavefront measurements shows a number of correlations between different Zernike whole Zernike-Zernike terms, and strong correlations. It shows. The numbers on each axis shown in FIGS. 8A and 8B correspond to specific Zernike coefficients starting with Z (−2, 2) (Zernike number 3) up to Z (6, 6). Extends from 3,3 to 28,28 if the planned treatment changes the target aberration by the desired amount (and does not result in other induced aberrations, i.e. not associated with other aberration modes) All values along the diagonal are −1, and all values other than the values along the diagonal are considered to be 0. As shown in FIGS. 8A and 8C, existing measurement and treatment systems do not provide this idealized result. Instead, there is a significant correlation for many of the Zernike terms between effective treatment and off-diagonal pre-treatment aberration measurements.

  The correlation between pre-operative measurements and effective therapeutic index is relatively high for the number of refraction terms 3-5. Unfortunately, many of the diagonal components are significantly different from the ideal value 1 and many of the off-diagonal components are significantly different from the ideal value 0. Note that the difference in the sign and value of the correlation may be associated with a different eye, and the right eye has a clearly different value than the left eye. For example, the horizontal aberration terms for Zernike 7 and 8 are different.

  Referring now to FIG. 8C, the selected terms are highlighted with a relatively small angle or even with a radial coefficient. Specifically, as indicated by the sign of the correlation, the pre-operative measurement that identifies defocus (Zernike number 4) induces spherical aberration in therapy (Zernike number 12). Similarly, secondary astigmatism is induced with effective treatment in correcting measured preoperative astigmatism. In the secondary radial order, some cross-linking between astigmatism terms is also evident (between Zernike number 3 and Zernike number 5). Since refraction terms are generally the largest pre-treatment aberrations measured by the eye, they can be present in the most important terms of the association matrix. Nevertheless, most or even all other off-diagonal components contribute to aberrations to some extent (typically not so much) (in other words, induce at least some aberrations after treatment). ) Some of the more important associations identified in the correlation matrix are illustrated graphically in FIG.

  Referring now to FIG. 10, an overview of improved treatment and treatment improvement method 310 begins with a pre-treatment refraction measurement 312 for a particular patient. A refractive treatment plan is created (314) and the patient is treated (316) to correct the refractive failure identified in measurement 312. After treatment, a post-treatment refraction measurement is performed for the treated eye (318).

  Post-treatment measurement 318 has at least two different advantages. First, the patient's eyes are confirmed to have made the desired refraction change, which gives information about that particular patient. Further, post-treatment measurements 318 provide feedback information that can be used to create a refractive treatment plan 314 to treat other eyes in the future. In an exemplary embodiment of the method described herein, feedback from previous treatments is affected by deriving and / or updating 320 effective treatment vector functions.

  With respect to the use of post-treatment measurements 318 for treated patients, these measurements can provide an indication as to whether re-treatment is appropriate (322). For example, if the post-treatment measurement differs by more than a threshold amount compared to the expected eye characterization, an eye re-treatment (eg, a new repeated LASIK treatment, etc.) can be planned (314) It can then be performed (316). Target refraction measurements and associated variation thresholds can be established for one or more specific time intervals after treatment 316. For example, a post-treatment refraction measurement 318 on the day of treatment 316 can have one expected set of acceptable diversity of refraction characteristics and ranges, while 2 weeks or 6 months post-treatment refraction. Each measurement 318 may have a different value. Accordingly, post-treatment measurement 318 can include a series of measurements. The re-treatment decision 322 may also be repeated over days, weeks, months, or even years after treatment 316.

  The information displayed in FIGS. 8A-9 can be understood in more detail by defining some of the terms and analyzing them more closely. Surgery-induced refractive correction (SIRC) can be defined as the actual change in the measured wavefront induced by surgery. Therefore, the vector SIRC can be defined mathematically as follows:

  Here, the vector component can include Zernike coefficients of the numbers described. Another vector, target refractive correction (IRC), is the refractive change that is the goal of the treatment. If the target outcome of treatment is a normal eye, the IRC can be calculated as practically equal to the negative number of the pre-treatment aberration measurement Pre Op as follows:

  Note that sight is not necessarily the goal of many treatments. For example, it may be desirable to leave (or include) a slight myopia in one eye of the patient while the other eye is orthographic to provide sufficient monovision for the transition to presbyopia. Alternatively, various multifocal or aspheric presbyopia shapes may be desirable in a patient's eye that will have or lose some or all of the ability to adjust vision. If normal vision is not the target, the IRC vector can be calculated as follows based on the measured pre-treatment aberrations and the vector characterizing the final desired eye shape (target).

  In order to provide the desired outcome, it is beneficial for SIRC to approach or be equal to the IRC within physical visual restriction and clinical tolerance.

  By applying the vector definition to the overall treatment plan 310, the pre-treatment refraction measurement 312 typically provides a definition of the Pre Op vector that characterizes the higher order aberrations of a particular patient's eye prior to receiving any treatment. The refractive treatment plan 314 defines an IRC (target refractive correction vector), and if the normal vision is not the target, the IRC reflects the target vector. Alternatively, if normal vision is the goal, the goal can be defined as a normal vision target vector.

  After treatment 316, post-treatment refractive treatment 318 results in a Post Op vector characterizing the higher order aberrations of the eye for each previously treated eye. For each previous treatment, surgically guided refractive correction (SIRC) can be defined as the difference between the Post Op and Pre Op vectors for the relevant eye. The set of SIRC vectors can then be used to derive an effective treatment vector function 320. If an effective treatment vector function 320 has been previously defined, the new eye treatment (and associated pre- and post-treatment measurements) can be used to update the effective treatment vector function. Thus, based on previous measurements and treatments for multiple eyes, the effective treatment vector function 320 provides a feedback loop for the planning of a new patient's refractive treatment 314.

  Referring now to FIG. 10A, a simplified block diagram schematically illustrates input and output vectors for a particular patient, and a description of the software modules associated with the vector components described above is also provided schematically. Yes. The goal module 332 defines a goal vector or desired higher order characterization of the eye after treatment. Note that the goal module 332 allows the physician and / or patient to select from a variety of goal treatments or a range of goal treatments. For example, a relatively young patient who seeks the best possible distance vision may desire binocular stereopsis, but a patient of sufficient age to become presbyopia may have a desired degree of near vision for reading etc. To obtain visual acuity, a desired degree of myopia with one eye, or an aspherical or multifocal refractive shape is selected. The Pre Op input module 334 accepts wavefronts or other measurements that characterize the higher order refractive properties of the eye. Accordingly, the Pre Op measurement input 334 is often coupled to a wavefront aberrometer, topographer and / or others. The target refractive correction IRC vector module 336 will calculate and store the target refractive correction vector. Similar to the target module 332 and the Pre Op measurement module 334, the IRC module 336 is typically implemented by software and / or hardware of the computer system 35 (see FIG. 1).

  Continuing from the simplified functional block diagram 330 of FIG. 10A, the treatment planning module 338 derives a series of commands corresponding to treatment vectors for the refractive laser or other treatment structure used, and the treatment commands 340. Will be stored for use. Treatment orders will typically include shot locations and numbers in a table, which is often ordered to minimize thermal damage and speed up the procedure. Surgical ablation is performed using a laser control module 342 (typically including many of the components described above with respect to the processor 22 of FIGS. 1 and 1A). Surgical ablation itself changes the final shape of the eye with healing after treatment. The post-treatment measurement can then be used in conjunction with the pre-treatment measurement to define an overall effective treatment SIRC in the surgically guided refractive correction treatment module 344.

  The treatment planner 338 will often use basic data defining the ablation depth for the target laser fluence and spot size. This basic data is often measured in the eyes of pigs and / or carcasses, and the use of this data can be tightly controlled by a regulatory agency such as the Food and Drug Administration. Note that the basic data need not closely match the ablation rate in the in-vivo human eye. For example, healing may not be included during the measurement of basic data. Nevertheless, basic data can form an important basis for regulatory approval, especially for LASIK and other refractive correction procedures, especially for previously approved refractive laser therapy systems. Advantageously, the basic data need not be changed to take advantage of the feedback methods and system improvements described herein.

  The improved functional block diagram 350 and associated methods include many of the components described above with respect to FIG. 10A. However, instead of using the IRC vector directly, an adjusted target refractive correction vector AIRC can be defined for adjusting and storing the IRC in the adjusted correction module 352.

  Various individual and / or global adjustments can be made to the IRC. For example, a physician using an existing refractive laser treatment system has experience entering physician adjustments into the physician adjustment module 354 based on experience, practice, and the like. Similarly, multiple nomogram adjustments are inputs 356 for changing treatment based on qualitative or quantitative factors for a particular patient. These inputs effectively complete the loop between the clinical outcome and the desired correction for a particular patient's eye for an aspect of treatment, but in particular, multiple modes of higher-order optical aberration errors in certain modes. If the linkage of changes is combined with a large number of higher order optical aberrations potentially induced in the treated eye, it does not necessarily change the treatment comprehensively. Still further IRC adjustments can also be incorporated, including planned treatment adjustments to compensate for the reduction in ablation depth as the angle of incidence of the laser on the corneal tissue surface is increased. So-called co-sign correction and other adjustments (including color adjustments) can be included in the color and co-sign correction module 358. In addition, adjustment may be possible based on other factors. For example, apparent refraction or low order aberration measurements can be input to the pre-treatment K input module 368.

  In order to better utilize the feedback from previous treatments, the functional block diagram 360 of FIG. 10C is more general, which improves outcomes with intermittent, regular, or continuous process improvements. A simple solution. Many of the method steps and associated modules are similar to those described above. However, the relationship between IRC and AIRC can be substantially more complex. More specifically, rather than simply adjusting the low order aberrations between IRC and AIRC, the method of FIG. 10C will result in a significant change in the high order aberrations of the treatment being performed. Treatment improvement is achieved by feeding back the results of previous treatments to an effective treatment vector function derivation module 362 based on SIRC data from higher order aberration measurements, and using an effective treatment vector function or adjustment function.

３６４を生成することにより実施することができる。医師は、図１０Ｂに関して上述したとおりに、個別ベースで治療を調節する能力を保持していることに注意されたい。概ね上述したように、有効な治療ベクトル関数

Can be implemented by generating 364. Note that the physician retains the ability to adjust treatment on an individual basis, as described above with respect to FIG. 10B. Effective treatment vector function, generally as described above

は、補助因子（例えば患者の年齢、性別、人種、測定及び／又は治療時の湿度、測定及び／又は治療時の医師が同一であること、測定及び／又は治療システムの型番又は同一性など）もまた利用することができる。補助因子モジュール３６６を使用して、有効な治療ベクトル関数３６４を実行しているプロセッサモジュールにこれらの補助因子を入力することができる。

Are cofactors (eg, patient age, sex, race, humidity during measurement and / or treatment, measurement and / or treatment physicians are the same, measurement and / or treatment system model number or identity, etc. ) Can also be used. The cofactor module 366 can be used to input these cofactors to a processor module that is executing an effective therapy vector function 364.

  The determination of an appropriate effective treatment vector function module 362 can optionally be described as an optimization. The derivation of the appropriate function need not be an absolute optimization, but the resulting vector function has a significantly better vision after treatment and after healing than would be expected to result without adjustment. Note that this will preferably change the IRC vector to provide.

  A number of mathematical approaches are applied by module 362 to provide appropriate adjustment vector functions

及び関連する関数ｆを導出することができる。以下の例において、ｆを定義する影響マトリクスを導出するために、比較的簡単な線形代数学及び多変量回帰アプローチを適用する。より複雑な非線形アプローチもまた使用可能であることに注意されたい。

And the associated function f can be derived. In the following example, a relatively simple linear algebra and multivariate regression approach is applied to derive an influence matrix that defines f. Note that more complex non-linear approaches can also be used.

  As described above, SIRC and IRC are represented as vectors containing components having values that are induced by surgery and that represent the target refractive wavefront surface. The SIRC vector also incorporates a Pre Op wavefront measurement surface prior to treatment in this exemplary embodiment. The vector component can include Zernike coefficients that best represent SIRC and IRC wavefront aberrations. The SIRC and IRC vectors can further include corneal curvature measurements. Optional components of these vectors include cofactor parameters that are known or appear to affect SIRC, such as age, gender, humidity, corneal water content, etc. it can. The total number of components in each of these vectors can be represented as N.

  It is generally desirable to predict the SIRC produced by a system given an IRC. Toward this goal, the SIRC and IRC vectors can be assumed to be related by the influence matrix f and the error vector E as follows:

  Advantageously, this mathematical model allows each component of the IRC to potentially contribute linearly to each component of the SIRC in the exemplary embodiment.

  As described above, the component of f can be specified or adapted by clinically measuring the optical aberration components of SIRC and IRC. In SIRC and IRC, there are assumed to be m pairs of measurements, each represented by the subscript k, and the global merit function Ψ can be defined as follows:

In the merit function Ψ, each unknown component f has an associated symbol f _ij . For each unknown component of f, Ψ can be minimized by generating an equation for m ² for each unknown component (if m is greater than or equal to n). For example,

The solution of f can be obtained by the following linear algebra. The resulting collection of equations for M ² can be described and solved in a more concise matrix form as follows.

式中、Ａ及びＢは成分を含むマトリクスであり、

Where A and B are matrices containing components;

  Once the best fit value for f is determined, the matrix can be used to evaluate model quality and generate an AIRC as follows:

  In the above, E represents an error vector for f. A basic model evaluation can be applied to additional paired measurements to confirm the solution of f. E can be determined for each additional measurement and the quality of the model can be assessed by comparing the desired physical optical properties and clinical resistance of the entire system.

  To adjust the IRC to yield the desired SIRC,

を使用してＡＩＲＣを生成することができる。したがって、治療プランナに入力する際に、ＡＩＲＣは、システムに対する所望の治療を生成することとなる。

Can be used to generate AIRC. Thus, when entering the treatment planner, AIRC will generate the desired treatment for the system.

  The adjustment in this embodiment generates an AIRC based on a linear combination of the IRC and the cofactor. The combination of wavefront IRC components is typically a cross-linkage that can have physical causes for a number of factors, including potentially low spatial frequency filtering effects of flaps, biomechanics and healing effects, tissue migration zone offsets, etc. . Cofactors may represent variables that do not enter treatment planner module 338 (see FIG. 10A) directly, but may still have an impact on outcome. Exemplary cofactors are described above. Modulation can have a tendency to be very specific. For example, accommodation can be related to individual physicians or subpopulations (eg, intense myopia).

  Referring now to FIG. 11, modeling based on previous eye treatment studies shows that a surprisingly significant reduction can be effected by the methods and systems described herein. Most, almost all (> 95%) and / or substantially all (> 90%) eyes are projected, representing a significant reduction in higher order aberrations (HOA).

  FIG. 12 illustrates aspects of a method 1200 for planning refractive treatment of a patient's eye according to an embodiment of the present invention. As shown herein, method 1200 includes determining a valid treatment vector function based on a plurality of previous eye treatments 1210. As shown here, with respect to individual previous eye treatments 1212a, 1212b of related eyes (of a plurality of previous eye treatments 1210), the exemplary method would be represented by steps 1214a, 1214b, respectively. Measuring the pre-treatment vector and characterizing the associated pre-treatment optical properties 1216a, 1216b of the eye. Relatedly, with respect to related eye individual previous eye treatments 1212a, 1212b (of a plurality of previous eye treatments 1210), the exemplary methods are as illustrated by steps 1224a, 1224b, respectively. It involves defining a post-vector and characterizing the associated post-treatment optical properties 1226a, 1226b of the eye. Further, for a plurality of previous eye treatments 1210, the method derives an effective treatment vector function using the correlation between the pre-treatment vector and the post-treatment vector, as represented by step 1230. Including that. The method 1200 also includes defining an input vector based on the measured pre-treatment optical characteristics 1242 of the patient's eye 1240 as represented by step 1244. Further, the method 1200 includes deriving a treatment for the patient's eye by applying a valid treatment vector function to the input vector, as represented by step 1250. In some cases, pre-treatment vectors, post-treatment vectors, effective treatment vectors, and / or input vectors characterize refraction, non-refractive cofactors that characterize patient and / or treatment settings, and / or optical properties of the eye. be able to.

  In some cases, pre-measurement optical properties (eg, 1216a, 1216b, and / or 1242) include low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, corneal curvature measurements, and the like. be able to. In some cases, the refractive treatment as derived at step 1250 can be for excimer laser treatment, femtosecond laser treatment, intraocular lens treatment, contact lens treatment, or eyeglass treatment. In some cases, the method further comprises performing a treatment on the patient's eye.

  In some cases, previous eye treatments 1212a, 1212b may correspond to a first patient and a second patient, respectively. In some cases, previous eye treatments 1212a, 1212b may correspond to a right eye (OD) and a left eye (OS), respectively. Therefore, the right eye (or right eye group) and the left eye (or left eye group) can be analyzed separately. Relatedly, data for the right eye (or group of right eyes) and left eye (or group of left eyes) can be transformed and analyzed simultaneously. In some cases, previous eye treatments 1212a, 1212b may correspond to only the right eye or only the left eye. Thus, an effective treatment vector function can be derived from multiple treatments (or information from them). In some cases, each previous eye treatment in the plurality of previous eye treatments corresponds to an individual individual. In some cases, each previous eye treatment in the plurality of previous eye treatments corresponds to a previously treated right eye. In some cases, each previous eye treatment in the plurality of previous eye treatments corresponds to a previously treated left eye. Relatedly, in evaluating the patient's eye 1240, the selected eye (eg, OD or OS) can correspond to the analyzed eye (eg, OD or OS) from which a valid treatment vector function is derived. Similarly, the derived treatment can also correspond to the patient's appropriate eye (eg, OD or OS).

  FIG. 13 illustrates additional aspects of a process 1310 for defining (1320) an input vector and a process 1330 for deriving (1340) a valid treatment vector function. As shown here, the procedure for defining the input vector is represented by identifying the target refraction of the patient's eye induced by refractive treatment, as represented by step 1322, and by step 1326. Determining a target refractive correction vector (IRC) that characterizes the difference between the measured pre-treatment optical characteristic 1324 of the patient's eye and the target. Further, as shown here, the procedure 1330 for deriving an effective treatment vector function from the previous treatment is the purpose of the related eye (eg, multiple related eyes), as represented by step 1342. Determining the refraction correction vector (IRC) of the subject and determining the refraction correction vector (SIRC) induced by the associated eye surgery, as represented by step 1346. According to some embodiments, each SIRC can characterize a difference between the associated pre-measurement optical properties 1344 and post-treatment optical properties 1345 of the eye. In some cases, the optical properties, SIRC, and / or IRC may be corneal curvature measurements, K values, optical tomography measurements, corneal topography values, anterior chamber length or depth values, posterior corneal curvature values, axial length values. The lens thickness value, the radius of curvature value, the inclination value, etc. can be contained.

  FIG. 14 illustrates aspects of a method 1400 for planning refractive treatment of a patient's eye according to an embodiment of the present invention. As shown herein, the method 1400 includes deriving an influence matrix from a previously treated eye, or a plurality of previous eye treatments 1410. For each previous eye treatment 1412a, 1412b of each associated eye, it is possible to determine the target refractive vector (IRC) and the surgically induced refractive vector (SIRC) as follows. As shown here, method 1400 includes associated pre-measurement pre-treatment higher-order aberrations (or optical properties) 1414a, 1414b and associated eye target refraction, as represented by steps 1418a, 1418b, respectively. Including determining a refractive correction vector (IRC) for purposes of characterizing the difference between 1416a and 1416b. Further, method 1400 includes measured pre-treatment aberrations (or optical properties) 1414a, 1414b and associated post-measurement aberrations (or optical properties) 1420a, 1420b, respectively, as represented by steps 1440a, 1440b, respectively. Determining an associated eye surgery-induced refractive correction vector (SIRC) that characterizes the difference between. The method may also include deriving an impact matrix to represent the correlation between the IRC and SIRC, as represented by step 1450. Further, the method may include measuring pre-treatment higher order aberrations (or optical properties) 1460 of the patient's eye and target refraction 1470 of the patient's eye (eg, surgically induced target correction, as represented by step 1480). Or defining an IRC vector for the patient that characterizes the difference between In some cases, the target refraction 1470 can correspond to a normal vision target. In some cases, the target refraction can correspond to a non-eyesight target. Further, as represented by step 1490, the method may include adjusting the patient's IRC vector based on the influence matrix. In some cases, the optical properties (eg, 1414a, 1414b, 1420a, 1420b, 1460) include low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and / or corneal curvature measurements. be able to. In some cases, the method may further include treating the patient's eye based on the patient's IRC vector. In some cases, for each previous eye treatment of the associated eye, the IRC is further determined to characterize the difference between the measured pretreatment corneal topography and the target corneal topography, and the measured pretreatment low The difference between the second order aberration and the target lower order aberration can be characterized. In some cases, for each previous eye treatment of the relevant eye, SIRC is further determined to characterize the difference between the measured pre-treatment lower order aberrations and the measured post-treatment aberrations, and the measured pre-treatment The difference between the corneal topography and the measured post-treatment corneal topography can be characterized. In some cases, further defining the patient's IRC vector to characterize the difference between the measured pre-treatment lower order aberrations and the target refraction, and to characterize the difference between the measured pre-treatment topography of the eye and the target topography Can do.

  In some cases, previous eye treatments 1412a, 1412b may correspond to a first patient and a second patient, respectively. In some cases, previous eye treatments 1412a, 1412b may correspond to a right eye (OD) and a left eye (OS), respectively. Therefore, the right eye (or right eye group) and the left eye (or left eye group) can be analyzed separately. Relatedly, data for the right eye (or group of right eyes) and left eye (or group of left eyes) can be transformed and analyzed simultaneously. In some cases, previous eye treatments 1412a, 1412b may correspond to only the right eye or only the left eye. Thus, an impact matrix (or SIRC) can be derived from multiple treatments (or information from them). In some cases, each previous eye treatment in the plurality of previous eye treatments corresponds to an individual individual. In some cases, each previous eye treatment in the plurality of previous eye treatments corresponds to a previously treated right eye. In some cases, each previous eye treatment in the plurality of previous eye treatments corresponds to a previously treated left eye. Relatedly, in evaluating a patient's eye 1460, the selected eye (eg, OD or OS) can correspond to the analyzed eye (eg, OD or OS) from which the impact matrix (or SIRC) is derived. . Similarly, the adjusted patient IRC vector can also correspond to the patient's appropriate eye (eg, OD or OS).

  FIG. 15 illustrates aspects of a system 1500 for planning or guiding refractive treatment of a patient's eye according to an embodiment of the present invention. As shown herein, system 1500 includes an input 1510 for receiving pre-treatment optical properties of a patient's eye, a processor 1520 coupled to the input, and an output 1530 coupled to the processor. In some cases, depending on the optical properties of the patient's eye by applying an effective treatment vector function, the processor 1520 is configured to derive a treatment for the patient's eye. In some cases, an effective treatment vector function is a pre-treatment vector that characterizes an associated pre-treatment optical characteristic for each of a plurality of previous eye treatments and a post-treatment optical characteristic that characterizes an associated post-treatment optical characteristic. It can be derived from the correlation between the vectors. In some cases, the output 1530 can be configured to transmit a treatment to facilitate improving the refraction of the patient's eyes.

  According to some embodiments, the system 1500 can include an input 1540 for receiving a target refraction of the patient's eye. In some embodiments, the system 1500 can include or be coupled to an apparatus 1550, such as a laser delivery system, for treating a patient. As shown here, system 1500 can comprise or be coupled to an aberrometer 1560. In some cases, the aberrometer 1560 can be configured to sense low order aberrations of the eye and high order aberrations of the eye. Such low and high order aberrations can be transmitted to or received by processor 1520. In some cases, the aberrometer 1560 can be configured to sense corneal topography of the eye. Such corneal topography can be transmitted to or received by processor 1520. System 1500 can also include or be coupled to an optical tomography instrument 1570. In some cases, the optical tomography measurement device 1570 can be configured to detect optical characteristics of the eye. Such optical characteristics can be transmitted to processor 1520 or received by processor 1520. System 1500 can also include or be coupled to a corneal curvature measurement device 1580. In some cases, corneal curvature measurement device 1580 can be configured to detect optical characteristics of the eye. Such optical characteristics can be transmitted to processor 1520 or received by processor 1520.

  Typically, a corneal curvature measurement device 1580 can be used to measure or evaluate the radius of curvature of the cornea. The corneal curvature measuring device 1580 can be, for example, a keratometer or a corneal curvature meter that measures the curvature of the front corneal surface. In the corneal curvature measurement technique, the front corneal surface can be considered as a specular reflector. A ring can be placed in front of the eye, and a virtual image of the ring can be formed in the lower part of the surface so that the virtual image becomes the first Purkinje image of the ring by reflecting off the cornea. According to the equation R = 2dy / h, where h is the radius of the object ring, y is the image radius of the object, and d is the distance between the object and the image. The size can be related to the radius of curvature (R) of the cornea. The corneal refraction index can be used to convert corneal radius to corneal force. Thus, corneal curvature measurements can be used to evaluate corneal forces and anterior corneal surface measurements. In some cases (eg, when corneal astigmatism is present) the ring is elliptical with a major axis and a minor axis. Corneal curvature measurements can be made along two orthogonal vertical lines to obtain maximum and minimum corneal forces, and such extreme values can be expressed as corneal K's or K values. In some aspects, the K value can be used to quantify the central slope of the cornea. Thus, the system can optionally include or use information obtained from a corneal curvature measurement device (eg, curvature value) and / or information obtained from a topography device (eg, uplift value). In some cases, topographic information can be used to determine or approximate the K value.

  FIG. 16 illustrates aspects of a system or apparatus 1600 for use in refractive treatment of a patient's eye according to an embodiment of the present invention. As shown here, the system 1600 combines aberration measurements and corneal topography measurements. The system 1600 includes a wavefront sensor component 1610, which can be a Hartman Shack (HS WFS) type aberrometer. In some cases, the wavefront sensor component 1610 includes a high-resolution wavefront aberrometer, such as the COAS-HD ™ Model 2800. System 1600 also includes a fixation target 1620, which can be created by a microdisplay. As shown here, the system 1600 also includes a corneal topography device 1630. In some cases, the topography device 1630 can be used to obtain a K value. The operation of the corneal topography device 1630 may involve measuring the position of the first Purkinje reflection on an array of light sources appropriately spaced on the conical surface 1632. The optical arrangement can create a rectangular and evenly spaced grid of first Purkinje reflections, which can be used, for example, when measuring a calibration surface with an average corneal dimension, such as a CCD detector 1634 (eg, Topographic channel). The conical surface 1632 can be illuminated from behind by a Lambertian reflective screen using 780 nm LEDs. This uniform light field may then be masked by an optically thick screen having a daylighting aperture with an appropriate spacing and vacant angle. This creates a light source with a narrow forward light emission that is mainly directed to the focal plane of the anterior cornea and improves the luminous efficacy of the device. By analyzing the change in plaque position in two directions (x and y), the corneal slope at each sample point can be measured. Movement of the position of the plaque allows calculation of the ray angle for a vertical surface at the same position. Since the incident ray angle is known from the shape of the device, the inclination of the corneal surface is measured. Integration (based on Fermat's principle) and iterative search algorithms allow reconstruction of uplift data. The distance between the eye being measured and the first optical element in the system can be measured to determine the radius of curvature. With this instrument, it is possible to measure the distance by noting that the radius of curvature calculated from the Helmholtz spot (HHS) is independent of the eye position (because the light is projected through the condenser lens). it can. For corneal topography (CT) cone spots, the pattern can depend on both the radius of curvature and the position of the eye. The correct distance can be obtained where the HHS pattern matches the CT pattern. Measurement of corneal tilt can be in two directions. Corneal topography measurement data can be mapped to the same axis used for aberration measurement (eg, field of view, ie LOS), and after this mapping process the results can be presented to the operator . Sampling at the cornea can be 215 micro square meters (eg, for a corneal radius of curvature of 8 mm), and the sampling pattern can be slightly less dense than the central corneal region. Aberration and corneal topography measurements may not be exactly the same. In some cases, the time gap between these measurements is a tenth of a second. Each measurement can include multiple images, including, for example, a wavefront spot image, a corneal topography spot image, a dark spot iris (SI), and a bright spot iris (PI). The last three images (CT, SI, and PI) can be recorded with different illumination with the same camera. Both aberration and topography systems can use a pre-recorded reference to subtract out any small errors remaining in the optical system. These can be recorded optically using the ideal wavefront and corneal surface reference. The instrument software can map a collection of aberrations and topography data to the mutual coordinate system, and export raw corneal uplift data to center the CT data along the VK axis. Can be maintained in a deployed format.

  In patients with high cylinder values, standard surgery can improve cylinder values without improving the spherical surface. Relatedly, standard surgery may increase the amount of high-order aberrations in the patient. However, it has been determined that various associations exist between certain low order aberrations, high order aberrations, and other optical properties. Such an association can be used to improve the final visual clarity and other optical performance specifications. For example, association has been observed between a cylinder (before surgery) and a net sphere (after surgery). Thus, in some cases, both spherical and cylindrical terms can be included in the analysis. For example, the multivariate techniques disclosed herein can be used to generate a treatment vector and / or influence matrix that corrects or compensates for this association and the association for higher order terms. In some cases, this may involve a treatment vector that corrects or compensates for the association by adjusting the cylinder values to produce the desired effect on the sphere. Thus, according to embodiments of the present invention, it is possible to identify and / or compensate for the association between a cylinder and a sphere using an influence matrix or other effective treatment vector function, and hence treatment It is possible to provide solutions that increase the overall accuracy of the. In another example, when optical data from a patient is analyzed and corneal curvature measurement data (eg, pre-treatment K values) is also considered, the correlation between a cylinder (eg, before treatment) and a spherical surface (after treatment) Increased. For example, when corneal curvature measurement data is not used, a correlation coefficient of about 19% is observed between the cylinder and the spherical surface, and when corneal curvature measurement data is used, a correlation coefficient of about 59% is observed. It was done. In many cases, treatment was applied using the same treatment equipment, and pre- and post-operative data were obtained using the same measurement equipment. According to embodiments of the present invention, a number of optical properties such as low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, corneal curvature measurements, and related components such as anterior and / or Posterior chamber length or depth value, anterior and / or posterior corneal curvature value, axial length value, lens thickness value, radius of curvature value, inclination value (eg natural lens), lens eccentricity value (eg natural lens value) Lens), induced astigmatism (or associated corneal incision parameters, such as incision direction), pupil centering or eccentricity (eg, pupil center location), eye condition (eg, magnification), degree of illumination (eg, Twilight or light), physician specific factors (eg, surgical procedure, previous treatment history), planned treatment data (eg, planned induced astigmatism), resulting treatment data (eg, outcomes or changes observed after treatment), Rukin'e image, the size of the corneal flap data (e.g., diameter or area of the flap), when considering the corneal hydration data, it is possible to obtain an improved correlation. Such techniques include laser-assisted in situ corneal curvature formation (LASIK), photorefractive corneal ablation (PPK), laser-assisted subepithelial keratotomy (LASEK), radial corneal curvature measurement, arc-shaped corneal curvature measurement, and others It can be applied in the context of laser refraction and / or corneal surgery, as well as in intraocular lens therapy, contact lenses, glasses and the like.

  In another example, a similar correlation was observed when optical parameter measurements were obtained directly from the measuring instrument without any physician adjustment. In some cases, for each cylindrical diopter, a corresponding spherical 1/8 diopter was observed. Therefore, in patients with high cylinder values (eg -3D, -4D), a corresponding difference in the sphere of about 3 / 8D or 4 / 8D was observed.

  In some cases, a strong association was observed between the K value and one or more higher order aberrations. Thus, for example, a correction or adjustment of a K value that is believed to produce a desired result for spherical aberration can be determined. Thus, the results can be more predictable when considering both K values and aberrations. For example, the multivariate techniques disclosed herein can be used to generate treatment vectors and / or influence matrices that correct or compensate for this association. In some cases this may involve a treatment vector that corrects or compensates for the association by adjusting the K value to produce the desired effect on spherical aberration.

  In some cases, another method may be able to reduce higher order aberrations that may be induced as a result of surgery. For example, if a particular corneal incision or relaxation cut can induce a certain amount of cylinder value or astigmatism, plan an ophthalmic treatment that incorporates the formation of such an incision before or in addition to performing the surgery It may be possible. Thus, using the techniques described herein, it may be possible to compensate for the effects of surgery in advance.

  The principles described above for an improved treatment plan for laser refractive surgery can also be applied to cataract surgery, resulting in an improved treatment plan for laser refractive surgery. Also applied to devices, systems and methods for diagnosing and / or treating cataracts to increase the overall accuracy with which intraocular lenses for cataract surgery are identified, selected and placed in the eye be able to.

  Illustrative embodiments of a vision measurement system and method for cataract diagnosis to illustrate various aspects and advantages of these devices and methods are described below. However, the principles associated with these devices and methods can be used in a variety of other contexts, and therefore the novel devices and methods disclosed and claimed herein are illustrative examples described below. It should be understood that it should not be construed as limited to the embodiments.

  As shown in FIGS. 17A-17C, a vision measurement system 1701 according to many embodiments is operable to make multiple measurements of the human eye, including measurements of the cornea, lens capsule, lens and retina. is there. The main unit 1702 includes a foundation 1703 and includes many main subsystems of many embodiments of the system 1701. For example, externally visible subsystems include a touch screen display control panel 1707, a patient interface assembly 1704, and a joystick 1708.

  The patient interface assembly 1704 is beneficially configured to secure the patient's head in a stable, stationary and preferably comfortable position during measurement measurements and using the measurement system to the patient's eye. It includes one or more structures that maintain suitable aiming. In a particularly preferred embodiment, for all measurements and imaging measurements performed by the system 1701, the patient's eye remains substantially in the same position relative to the measurement system.

  In one embodiment, the patient interface includes a chin support 1706 configured to hold the patient's head in a single, uniform position, preferably aimed at the system 1701 throughout the measurement. Including a frontal platform 1704. As shown in FIG. 18C, the vision measurement system 1701 is preferably arranged so that the patient can sit in the patient chair 1709. The patient chair 1709 can be configured to be adjusted and positioned on three axes (x, y, and z) so that the patient's head is suitable for placement on the patient interface. Height and horizontal position.

  In many embodiments, the system 1701 can include an external communication connection. For example, system 1701 can include a network connection (eg, an RJ45 network connection) for connecting system 1701 to a network. Using a network connection may allow network printing of measurement reports, remote access to confirm patient measurement reports, and remote access to perform system analysis. The system 1701 can include a video output port (eg, HDMI) that can be used to output video of measurements performed by the system 1702. For example, the output video can be displayed on an external monitor for confirmation by a physician or user. The output video can also be recorded for archival purposes, for example. The system 1702 can be used to store patient measurement reports, eg, data storage devices or computer readable media, eg, non-volatile, coupled to a laser cataract surgery device for use in measurements in performing laser cataract surgery. One or more data output ports (eg, USB) that can be exported to any computer-readable medium. The measurement report stored on the data storage device or computer readable medium may then be used for any suitable purpose, such as printing from an external computer in the case of a user who does not have access to network-based printing, or It can be accessed after some time for use during cataract surgery, including laser cataract surgery.

  FIG. 18 is a block diagram of a system that includes a vision measurement device 1801 in accordance with one or more embodiments described herein. The vision measuring instrument 1801 includes an optical interferometer (OCT) subsystem 1810, a wavefront aberrometer subsystem 1820, and a corneal topographer subsystem 1830 for measuring one or more characteristics of the subject's eye. The vision measurement device 1801 may further include an iris imaging subsystem 1840, a fixation target subsystem 1850, a controller 1860 including one or more processors 1861 and a memory 1862, a display 1870, and an operator interface 1880. The visual acuity measuring device 1801 further includes a patient interface 1804 for the subject to present an eye for measurement by the visual acuity measuring device 1801.

  The optical coherence tomography measurement subsystem 1810 is configured to measure the spatial arrangement of the eye structure in three dimensions (eg, three-dimensional coordinates of points on the boundary, eg, X, Y, and Z). Such target structures include, for example, the anterior surface of the cornea, the posterior surface of the cornea, the anterior portion of the capsular bag, the posterior portion of the capsular bag, the anterior surface of the lens, the posterior surface of the lens, the iris, the pupil, and the limbus , Implanted intraocular lenses, and / or retina. The spatial arrangement of the structure of interest and / or the structure of the geometric modeling that is suitably matched, such as surfaces and curves, in some embodiments, programs and controls subsequent laser assisted surgical procedures. Or can be generated and / or used by the controller 1860 for a number of purposes, including clarification of the intraocular lens and its placement in the eye. Various parameters can be measured using the spatial arrangement of the structure of interest and / or suitably matched geometrically modeled structure.

  As a non-limiting example, the system 1801 can be configured to use a swept wavelength OCT imaging system that uses a wavelength of approximately 1060 nm with a scan depth of 8 mm. The spatial arrangement of the eye structure, using optical coherence tomography measurements, usually must be measured while the patient is at the patient interface 1804. To obtain a sufficient ophthalmic scan depth, the OCT scan depth is preferably 8-50 mm, and the scan depth is preferably greater than about 24 mm, or even greater than 30 mm. The wavelength-swept wavelength can be centered at a wavelength between 840 nm and 1310 nm.

  The optical coherence tomography subsystem 1810 is just one example of an eye structure imaging subsystem that can be used with the vision measuring device 1801. In another embodiment, different eye structure imaging subsystems can be used, such as Scheinproof imagers, fluorescence imagers, stereoscopic illumination imagers, wavefront tomometers, ultrasound imagers, and integrated imagers.

  The wavefront aberrometer subsystem 1820 is configured to measure the aberrations of the eye, preferably including low and high order aberrations, by measuring the wavefront appearing from the eye, for example with a Hartmann Shack wavefront sensor.

  Corneal topographer subsystem 1830 reads eye corneal curvature measurements, eye corneal topography, eye optical coherence tomography measurements, eye platid disc topography, reflection of multiple points from eye corneal topography, eye Any number of methods including one or more of grid reflecting from corneal topography, eye Hartmann shack measurement, eye shine proof image topography, eye confocal tomography, Helmholtz light source topographer, or eye low interference reflected light measurement Can be applied to measure the shape of the cornea. The shape of the cornea typically must be measured while the patient is at the patient interface 1804.

  Since it is often desirable to measure refraction and wavefront aberrations when the eye 1901 (see FIG. 19A) is focused at a far point, the fixation target system 1850 provides for patient accommodation. Configured to control.

  An image taken by the corneal topographer subsystem 1810, the wavefront aberrometer 1820, the optical coherence tomography measuring instrument subsystem 1830, or the camera 1840, respectively, is displayed on the operator interface 1880 of the visual acuity measuring system 1801 or on the visual acuity measuring system. 1870 can be displayed. It is also possible to modify, transform, or transform any of the displayed images using the operator interface.

  Shared optical element 1855 includes patient interface 1804, optical coherence tomography (OCT) subsystem 1810, wavefront aberrometer subsystem 1820, corneal topographer subsystem 1830, and in some embodiments a camera 1840, And a common propagation path disposed between each of the fixation targets 1850. In many embodiments, the shared optical element 1855 receives light emitted from the respective subsystems to the patient's eye, and in some cases, the light emitted from the patient's eye is appropriate along a common transmission path. Multiple optical elements can be included, including mirrors, lenses, and beam combiners that redirect the director.

  The controller 1860 controls the direction of the visual acuity measuring device 1801 and passes through the communication path 1858 to the optical coherence tomography measurement (OCT) subsystem 1810, the wavefront aberrometer subsystem 1820, one or more of the subject's eyes. Input from any of the corneal topographer subsystem 1830, camera 1840, fixation target 1850, display 1870, and operator interface 1880 for measuring features may be received. The controller 1860 can include any suitable component, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In many embodiments, the controller 1860 controls the display 1870 to provide user control in the laser eye surgery procedure, a pre-cataract treatment plan according to the user's specific treatment parameters, and in the laser eye surgery procedure. Provides user control of The communication path 1858 can be implemented in any suitable configuration including any suitable shared or dedicated communication path between the controller 1860 and the respective system components.

  The operator interface 1880 can include any suitable user input device suitable for providing user input to the controller 1860. For example, user interface device 1880 may include devices such as joystick 1808, keyboard, or touch screen display 1870.

  19A and 19B are simplified block diagrams illustrating an assembly 1900 according to many embodiments and can be included in the system 1801. The assembly 1900 includes an optical coherence tomography (OCT) subsystem 1890, a wavefront aberrometer subsystem 1850, a corneal topographer subsystem 1810 for measuring one or more characteristics of the subject's eye, a camera 1840, a fixed A non-limiting example of a suitable configuration and integration of the optotype subsystem 1950 and the shared optical element 1855.

  The shared optical element generally includes one or more components of the first optical system 1970 disposed along a central axis 1902 that passes through an opening or aperture 1914 in the structure 1910. The first optical system 1970 directs light from various light sources along the central axis 1902 and establishes a shared or common optical path through which light from the various light sources travels to the eye 1901. In one embodiment, the optical system 1970 includes a quarter wave plate 1971, a first beam splitter 1972, a second beam splitter 1973, an optical element (eg, lens) 1974, a second lens 1975, a third beam. A structure including a splitter 1976 and an aperture 1978 is included. Additional optics can be used in assembly 1900 to direct light from one or more light sources to first optics 1970. For example, the second optical system 1960 directs light from the wavefront aberrometer subsystem 1950 to the first optical system 1970 and includes a mirror 1953, a beam splitter 1962 and a beam splitter 1983, and a lens 1985.

  Other configurations of the assembly 1900 may be possible and will be apparent to those skilled in the art.

  The corneal topographer subsystem 1940 includes a structure 1910 having a major surface 1912 having an opening or aperture 1914 therein, a plurality of first (or peripheral) light sources 1920 provided on the major surface 1912 of the structure 1910, Helmholtz. A light source 1930 and a detector, photodetector, or detector array 1941 are included.

  In one embodiment, the structure 1910 has an elongated ellipse or “Zeppelin” shape with an opening or aperture at either end. Examples of such structures are described in Yobani Meji'a-Barbosa et al. , “Object surface for applying a modified Hartmann test to measure cone topography”, APPLIED OPTICS, Vol. 40, no. 31 (Nov. 1, 2001) ("Meji'a-Barbosa"). In some embodiments, as shown in FIG. 19A, the major surface 1912 of the structure 1910 is concave when viewed from the cornea of the eye 1901.

  In one embodiment where the major surface 1912 is concave, the major surface 1912 has a truncated cone shape. Alternatively, the major surface 1912 can have a hemispherical shape or the shape of some other portion of a sphere with an opening or aperture therein. Alternatively, the major surface 1912 can have a deformed sphere or frustoconical shape with the side portions removed. Beneficially, such an arrangement improves the ergonomics of assembly 1900 by allowing the structure 1910 to be more easily placed closer to the subject's eye 1901 without disturbing the subject's nose. be able to. Of course, various other configurations and shapes for the major surface 1912 are possible.

  In the embodiment of FIG. 19A, a plurality of first light sources 1920 are provided on the major surface 1912 of the structure 1910 to illuminate the cornea of the eye 1901. In one embodiment, the light source 1922 can include individual light generating components or lamps, such as fiber bundles, individual optical fiber light emitting diodes (LEDs) and / or chips. Alternatively, the major surface 1912 of the structure 1910 can have a plurality of holes or apertures therein and one or more backlight lamps, which can include reflectors and / or diffusers, Through which light passes and can be provided to form a plurality of first light sources 1920 that project light onto the cornea of the eye 1901. Other arrangements are possible.

  In another embodiment, the structure 1910 is omitted from the assembly 1900 and the first light source 1920 is hung independently (eg, as a separate optical fiber) and placed around the central axis. 1920 groups can be formed, and the groups are separated from the axis by a radial distance that defines an aperture in the group (usually corresponding to the aperture 1914 in the structure 1910 shown in FIG. 19A). .

  In operation, light rays (solid lines) from one of the first light sources 1920 are reflected by the cornea and pass through the optical system 1970 (including the aperture 1978) and appear as light spots on the detector array 1941. It is understood that these rays represent a small bundle of rays that pass through the optical system 1970 to reach the detector array 1941, all of which are substantially focused on the same location on the detector array 1941. Let's do it. Other rays from that first light source 1920 are blocked by aperture 1978 or otherwise scattered and do not pass through optical system 1970. In a similar manner, light from other first light sources 1920 is imaged on detector array 1941, each one of the first light sources 1920 having a specific reflection location on the cornea of eye 1901, and Imaged or mapped to a location on the detector array 1941 that may be correlated with the shape of the cornea. Accordingly, detector array 1941 detects the light spot projected thereon and provides a corresponding output signal to the processor of controller 1860 (FIG. 18). The processor determines the position and / or shape of the light spots on the detector array 1941 and compares these positions and / or shapes to those expected for a standard cornea or model cornea, thereby controlling the controller 1860. Allows the processor to determine the corneal topography. Alternatively, other methods of processing point images on the detector array 1941 can be used to determine corneal topography of the eye 1901 or other information related to the characterization of the eye 1901.

  Detector array 1941 includes a plurality of light detection components arranged in a two-dimensional array. In one embodiment, detector array 1941 includes such a charge coupled device (CCD), such as that found in a video camera. However, other devices such as a CMOS array or another electro-sensitive device may be used instead. Beneficially, the video output signals of detector array 1941 are provided to a processor 1861 that processes these output signals, described in more detail below.

  The assembly 1900 also includes a Helmholtz light source 1930 constructed according to Helmholtz principles. As used herein, the term “Helmholtz source” or “Helmholtz light source” means that light from each individual light source passes through a refractive optical element. Reflecting the reference or test object, passing through the optical element and arranged to be received by the detector, and using light from a Helmholtz light source, the geometry of at least part of the surface of the reference or test object and Means one or more individual light sources that measure optical information. In general, it is a feature of a Helmholtz light source that the detector signal is independent of the relative position of the test or reference object relative to the Helmholtz light source. As used herein, the term “optical element” refers to a component that refracts, reflects and / or diffracts light and has either positive or negative refractive power.

  In such an embodiment, the Helmholtz light source 1930 is located at optical infinity with respect to the eye 1901. The Helmholtz principle includes a telecentric detector system, i.e. optically infinite, relative to the surface at the time of measurement, in addition to ensuring that the main measured beam leaving the surface is parallel to the optical axis of the instrument. Use of such an infinite light source in combination with a system that places the detector array at a distance is included. Since Helmholtz's corneal measurement principle includes a Helmholtz light source at optical infinity and a telecentric observation system, detector array 1941 is also optically located at infinity from the image of the light source formed by the cornea. Such a measurement system is not sensitive to misalignment of the corneal surface axis with respect to the instrument.

  In one embodiment, Helmholtz light source 1930 includes a second light source 1932 that may include a plurality of lamps, eg, LEDs or fiber optic chips. In one embodiment, the second light source 1932 includes an LED and plate 1933 having a plurality of holes or apertures on a surface illuminated by one or more backlight lamps with optical elements 1931 and includes a diffuser. be able to.

  In one embodiment, the second light source 1932 is located off the central optical axis 1902 of the assembly 1900 and the light from the second light source 1932 is directed to the optical element 1971 by the third beam splitter 1976.

  Manipulation of the topographer portion of assembly 1900 can be performed by using a combination of first light source 1920 and Helmholtz light source 1930. In operation, the detector array 1941 moves from both the Helmholtz light source 1930 (detected at the central portion of the detector array 1941) and the first light source 1920 (detected at the peripheral portion of the detector array 1941) to the array 1941. The projected light spot is detected and an output signal corresponding to the processor is provided. In general, the image of the first light source 1920 appearing on the detector array 1940 extends from the outer region of the corneal surface, and the image of the Helmholtz light source 1930 appearing on the detector array 1941 is from the central region or the axial region of the cornea surface. Extend. Thus, although information about the central region of the corneal surface (eg, surface curvature) cannot be measured from the image of the first light source 1920 on the detector array 1941, such information can be obtained from the detector array 1941. It can be measured from the image of the Helmholtz light source 1930 above. The processor of the controller 1860 measures the position and / or shape of the light spot on the detector array 1941 and compares these position and / or shape to those expected based on a standard cornea or model cornea. This allows the processor to measure the corneal topography of the eye 1901. Thus, the topography of the entire corneal surface can be characterized by the assembly 1900 without “holes” or without losing data from the central corneal region.

  A fourth light source 19201 deviated from the central axis 1902 is arranged on the optical axis 1902 by mirrors 1977 and 1979 arranged on or near an aperture 1978 perpendicular to the optical axis 1902, which is configured as a pupil retroreflected light irradiator. Can be directed along. The pupil retro-reflected light illuminator is configured to direct the disc-shaped light to the patient's eyes, so that the disc-shaped light can be reflected from the reflective surface in the eye, and the reflected light is in the optical path The signal is transmitted to the detector 1941 by 1970. The pupil retro-reflected light irradiator is optional so that when the patient's pupil is enlarged, the disc-shaped light from the light source 19201 is reflected from the embedded IOL and forms an IOL image including an arbitrary reference mark. If the IOL is imperfectly placed, the detector 1941 can be used to measure that the end of the IOL is eccentric. In addition, in the image from the detector 1941 using the pupil retroreflected light irradiator, when the IOL is not properly folded, a fold, for example, an unfolded edge may be seen.

  The wavefront aberrometer subsystem 1950 of the assembly 1900 includes a third light source 1952 that provides a probe beam and a wavefront sensor 1955. The wavefront aberrometer subsystem 1950 includes an adjustable telescope including a collimating lens 1954, a polarizing beam splitter 1956, a first optical element, a lens 1963, and a second optical element, a lens 1964, a movable stage. Alternatively, it may further include a platform 1966 and a dynamic range limiting aperture 1965 for limiting the dynamic range of the light provided in the wavefront sensor 1955 to eliminate data ambiguity. Light from the wavefront aberrometer subsystem passes through an opening or aperture 1914 in the structure 1910 and is directed to one of the constituent optical elements of the optical system 1970 disposed along the central axis 1902. Those skilled in the art will appreciate that any of the lenses 1963, 1964, or other lenses discussed herein, can be replaced or supplemented by another type of conversion or branching optical element, eg, a diffractive optical element. Let's be done.

  The light source 1952 is preferably an 840 nm SLD (superluminescent semiconductor laser). SLDs are similar to lasers in that light originates from a very small emitter region. However, unlike a laser, the spectral width of an SLD is very large, about 40 nm. This tends to reduce the spectral effect and improve the image used for wavefront measurement.

  The wavefront sensor 1955 is preferably a Hartmann Shack wavefront sensor that includes a detector array and a plurality of lenslets for focusing the received light on the detector array. In this case, the detector array can be a CCD, a CMOS array, or another electrosensitive device. However, other wavefront sensors can be used instead. Embodiments of wavefront sensors that can be used in one or more systems described herein include US Pat. No. 6,550,917 (Neal et al.), Issued April 22, 2003, and No. 5,777,719 (Williams et al.), Issued July 7, 1998, both of which are incorporated herein by reference in their entirety. .

  With an aperture or opening in the center of the group of first light sources 1920 (eg, an aperture 1914 in the major surface 1912 of the structure 1910), the assembly 1900 provides a probe beam into the eye 1901 so that the overall Visual aberrations can be characterized. Accordingly, the third light source 1952 transmits the probe beam to the first beam splitter 1972 of the optical system 1970 through the light source polarizing beam splitter 1956 and the polarizing beam splitter 1962. The first beam splitter 1972 directs the probe beam through the aperture 1914 to the eye 1901. The light from the probe beam is preferably scattered from the retina of the eye 1901 and at least a portion of the scattered light returns through the first aperture 1914 to the first beam splitter 1972. The first beam splitter 1972 returns the backscattered light through the beam splitter 1972 to the polarizing beam splitter 1962 and through the mirror 1953 to the wavefront sensor 1955.

  The wavefront sensor 1955 outputs a signal to the processor 1861 of the controller 1860, which uses the signal to measure the visual aberration of the eye 1901. The processor 1861 is preferably able to better characterize the eye 1901 by taking into account the corneal topography of the eye 1901 measured by the corneal topography subsystem, and the corneal topography of the eye 1901 is also as described above. In addition, it can be measured by the processor 1861 based on the output of the detector array 1941.

  In operation of the wavefront aberrometer subsystem 1950, light from the light source 1952 is collimated by the lens 1954. The light passes through the light source polarizing beam splitter 1956. The light entering the light source polarization beam splitter 1956 is partially polarized. Since the light source polarization beam splitter 1956 reflects light having the first polarization (S) and transmits light having the second polarization (P), the existing light is 100% linearly polarized. In this case, S and P mean the direction of polarization with respect to the hypotenuse in the light source polarization beam splitter 1956.

  Light from the light source polarizing beam splitter 1956 enters the polarizing beam splitter 1962. Since the hypotenuse of the polarizing beam splitter 1962 is rotated 90 ° relative to the hypotenuse of the light source polarizing beam splitter 1956, the light is now S-polarized with respect to the hypotenuse of the polarizing beam splitter 1962, and therefore Light reflects upward. The light from the polarization beam splitter 1962 moves upward, passes through the beam splitter 1972 while maintaining S-polarized light, and then moves through the quarter-wave plate 1971. The quarter wave plate 1971 converts light into circularly polarized light. Next, the light travels through the aperture 1914 in the major surface 1912 of the structure 1910 to the eye 1901. The beam diameter on the cornea is preferably 1-2 mm. The light then travels through the cornea and forms an image on the retina of the eye 1901.

  The light spot that forms the image becomes the light source used to characterize the eye 1901 by the wavefront sensor 1955. The light from the probe beam that strikes the retina of the eye 1901 scatters in various directions. Some light reflects back as a semi-collimated beam and returns towards the assembly 1900. During scattering, about 90% of the light retains polarization. Thus, the light returning towards the assembly is still substantially circularly polarized. The light then travels through aperture 1914 in major surface 1912 of structure 1910, through quarter wave plate 1971, and is converted back to linearly polarized light. The quarter wave plate 1971 converts the polarization of light from the retina of the eye, so this light is P-polarized as opposed to the S-polarized probe beam received from the third light source 1950. This P-polarized light then reflects off the first beam splitter 1972 and then reaches the polarizing beam splitter 1962. Here, since the light is P-polarized with respect to the hypotenuse of the polarizing beam splitter 1962, the beam is transmitted and continues to the mirror 1953. After being reflected by the mirror 1953, the light is sent to an adjustable telescope that includes a first optical element 1964, a second optical element (eg, lens) 1963, and a movable stage or platform 1966. The beam is also directed through a dynamic range limiting aperture 1965 to limit the dynamic range of light directed to the wavefront sensor 1955 to eliminate data ambiguity.

  If the wavefront sensor 1955 is a Hartmann Shack sensor, light is collected by the lenslet array in the wavefront sensor 1955 and the image of the light spot appears on a detector array in the wavefront sensor 1955 (eg, a CCD). This image is then provided to the process of the controller 1860 and analyzed to calculate the refraction and aberrations of the eye 1901.

  The OCT subsystem 1990 of the assembly 1900 preferably includes an OCT assembly 1991 and a third optical path 1992 that directs the OCT beam of the OCT light source to the first optical path 1970. The third optical path 1992 operates under the control of the optical fiber line 1996 for guiding the OCT beam from the OCT light source and the controller 1860 to focus the beam in the z direction (ie, along the transmission direction of the OCT beam). A z-scan device 1993 that can be changed, and operating under the control of the controller 1860, respectively, to change the OCT beam in the x and y directions (ie, perpendicular to the direction of transmission of the OCT beam), x Preferably, a scanning device 1995 and a y-scanning device 1997 are included. The OCT light source and the reference arm can be incorporated into the main unit 4 of the visual acuity measuring device 1701 shown in FIG. 17A. Alternatively, the OCT assembly 1991 can be placed in the second unit 1920 and the OCT beam from the OCT light source can be directed from the second housing 1920 to the main unit by the optical path 1992.

  The OCT system and method of the present invention is an FD- comprising either an SD-OCT (spectral domain optical coherence tomography measurement) system or, more preferably, an SS-OCT (wavelength swept optical coherence tomography measurement) system. An OCT (Fourier domain optical coherence tomography measurement) system is preferred. In conventional FD-OCT systems, the interference signal spans multiple spectral wavelength intervals, is distributed and integrated, and is inverse Fourier transformed to obtain a depth dependent reflectivity profile of the sample. The profile of scattering as a function of depth is called A-scan (axial scan). The beam can be scanned laterally and combined together to produce a set of A scans that can form a tomographic image (B scan) of the sample.

  In the SD-OCT system, the various spectral wavelength intervals of the combined return light from the reference arm and sample arm are spatially encoded using, for example, a collimator, a diffraction grating, and a linear detector array. Resampling of the data obtained from the linear detector array is performed to correct the nonlinear spatial mapping of wave numbers. After resampling and subtraction of the dc background, the depth profile structure information is obtained by performing an inverse Fourier transform operation. In wavelength-swept OCT, a wide bandwidth light source is replaced with a fast scanning laser source. By quickly sweeping the source wavelength over a wide wavelength band and collecting all the scattered information at each wavelength and location, the composition of the collected signal is equal to the spectral domain OCT technique. Next, the collected spectral data is subjected to inverse Fourier transform to recover the depth dependency information of the space.

  FD-OCT is affected by an inherent sample-dependent limited depth range, typically 1-5 mm. One limitation arises from the fact that FD-OCT extracts depth information from the inverse Fourier transform of the spatial interferogram. Since the spatial interferogram can only be recorded as a true signal, its Fourier transform requires Hermitian symmetry about the zero path length difference (ZPD) position. As a result, the positive and negative displacements for ZPD cannot be unambiguously solved, resulting in mirror image artifacts, and the usable range is roughly halved. This is called complex conjugate ambiguity. Another limitation is a decrease in sensitivity that results in a decrease in sensitivity with increasing depth. Moreover, since the OCT signal is derived only from backscattered photons, optical attenuation from absorption and scattering typically results in a usable imaging depth of about 1-4 mm.

  Several “full range” OCT techniques have been developed that remove complex conjugate artifacts and effectively double the measurement range around the ZPD position. These full range OCT techniques result in usable imaging depths of up to about 5 mm and up to about 8 mm. Preferred full-range techniques are methods that use dithering reference lag to break phase ambiguity, methods that use phase distortion, and other suitable methods.

  As shown in FIG. 20, the OCT assembly 1991 of the OCT subsystem 1990 includes a broadband or swept light source 202 separated into a reference arm 206 and a sample arm 210 by a coupler 204. The reference arm 106 includes a module 108 that includes a reference reflection with suitable dispersion and path length compensation. The sample arm 110 of the OCT assembly 191 has an output connector 212 that functions as an interface to the rest of the remaining vision measuring equipment. The return signals from both the reference and sample arms 206, 210 are then directed by the coupler 204 to the detection device 220, which uses either time domain, frequency, or single point detection techniques. In FIG. 20, a wavelength sweep type technique is used with a laser wavelength of 1060 nm that is swept over a range of 8-50 nm depth.

  FIG. 21 is a schematic diagram of the human eye 2100. In many embodiments, light rays 2101 from the light source enter the eye from the left in FIG. . After refracting towards the lens, the light passes through the vitreous chamber 2112 and strikes the retina 2176. The retina 2176 detects light and converts it into an electrical signal that is transmitted to the brain through the optic nerve (not shown). The vitreous chamber 2112 contains a vitreous humor that is a transparent liquid disposed between the lens 2102 and the retina 2176. As shown in FIG. 21, the cornea 2110 has a corneal thickness (CT), here considered as the distance between the anterior and posterior surfaces of the cornea. The anterior chamber 2104 has an anterior chamber depth (ACD), which is the distance between the anterior surface of the cornea and the anterior surface of the lens. The lens 2102 has a lens thickness (LT) that is the distance between the front and back surfaces of the lens. The eye also has an axial length (AXL), which is the distance between the anterior surface of the cornea and the retina 2176. FIG. 21 also illustrates that in many subjects, the lens containing the lens capsule can be tilted at one or more angles relative to the optical axis, including the angle γ with respect to the optical axis of the eye.

  It is also possible to arrange the optical system so that the movement pattern of the scanning mirror provides lateral movement across the retina and the shape of the retina can be determined. It is of particular interest to measure the shape and location of the recessed area of the retina, called the fovea. When the patient is looking directly at the instrument, the fovea is at the center of the OCT left-right scan due to the viewing direction aimed at the fixation target. This information is useful in that it informs the operator of the instrument whether the patient was looking directly at the target at the time of measurement. Retinal scanning is also useful for detecting disease states. In some cases, there may be a foveal defect, which is also considered an indicator of corneal abnormalities.

  The average axial length of the adult human eye is about 24 mm. Since the full range imaging depth of the OCT measurement is only about 5 mm to 8 mm, the OCT scan of the present invention is preferably performed at different depths of the eye, and these are combined to form an integrated OCT OCT. An image can be formed. The OCT measurement of the present invention includes 1) at least part of the retina, 2) at least part of the anterior part of the eye, including at least part of the cornea (anterior and posterior), iris, and lens (anterior and posterior); And 3) In order to image the performance of the axial length measurement, it is preferable to include OCT imaging at various depths of the patient's eye.

  22A-22C illustrate various aspects of the OCT subsystem 1990 in accordance with various aspects of the present invention. FIG. 22A illustrates a preferred scan area for an OCT subsystem in accordance with many embodiments of the present invention. The scanning region can be defined from the start point 2201 to the end point 2202 in the front part of the eye, extends in a direction orthogonal to the transmission direction of the OCT beam, and the eye axis length is directed toward the back part 2204 of the eye. It also extends in a direction parallel to the axis defined. The left-right scan area typically must be large enough laterally to allow imaging of the central portion of the cornea, at least a portion of the iris, at least a portion of the lens, and at least a portion of the retina. Note that the region 303 between the posterior portion of the lens and the retinal surface may optionally be scanned by the OCT subsystem 1990 because portion 2230 does not include an anatomical structure for 3D analysis. .

  FIG. 22B shows an exemplary graph of the OCT signal strength of the OCT subsystem 1990, as a function of depth along an axis that defines the axial length of the eye, according to many embodiments. The graph generally has a complex structure: (1) a doublet-like structure, peak 2210 approximately corresponding to the position of the cornea, and (2) a doublet-like structure, generally of the anterior surface of the lens. It roughly represents a peak 2220 corresponding to the position, (3) a peak having a complex structure, generally corresponding to a position 2230 corresponding to the position of the posterior surface of the lens, and (4) a peak 2240 corresponding generally to the position of the retina. Using the distance between peak 310 and peak 2240, the eye axial length (AL) of the eye can be calculated. OCT scanning by the OCT subsystem 1990, including both A-scan and B-scan, can be performed using at least one position of the anterior portion of the eye (eg, the position of the cornea, the position of the anterior surface of the lens, and / or the position of the posterior surface of the lens) ) As well as at least one position in the posterior part of the eye (for example the position of the retina). In some embodiments, OCT scanning by the OCT subsystem 1990, including both A-scan and B-scan, is performed at a position corresponding to each of a corneal position, an anterior surface position of the lens, and a posterior surface position of the lens; And at a position corresponding to the retina.

  Since the OCT subsystem 1990 provides detection of various structures of the eye, including the position of the cornea, the OCT subsystem 1990 is used as a measurement system for accurately aiming the patient with respect to the vision measurement system 1 of the present invention. Note that you can. The use of OCT as a measurement system can significantly improve the accuracy of corneal topography measurements, including corneal curvature measurements, that are highly sensitive to poor aiming of the corneal structure.

  FIG. 22C shows a cross-sectional view of the eye obtained by the vision measurement system of the present invention using the OCT subsystem according to the present invention.

  FIG. 23 shows a three-dimensional view of an eye obtained by the vision measurement system of the present invention using an OCT subsystem according to the present invention. FIG. 23 shows that the OCT subsystem of the present invention has a central corneal thickness (CCT), anterior chamber depth (ACD), anterior corneal curvature radius (ROCAC), posterior corneal curvature radius (ROCPC), and eye axis. It is proved to be operable to obtain a manipulative measurement according to the present invention, including a long radius of curvature (ROCAL).

  The OCT subsystem 1990 preferably provides the user with well-understood structural information that provides a structural assessment that can indicate the suitability of a particular patient for laser cataract treatment. In one embodiment, an OCT scan (ie, retinal scan) performed by the OCT subsystem 1990 at or near the retina is well understood to identify the foveal location and depth. The absence of a dent indicates an unhealthy retina.

  In another embodiment, the vision measuring device 1801 of the present invention provides one or more measurements sufficient to perform an assessment of the patient's tear film. In one embodiment, tear film evaluation is performed between a wavefront aberration map of a patient's eye and a corneal topography map or OCT map, for example, by obtaining a distribution map of the difference by subtracting the corneal topography map from the wavefront aberration map. Includes comparison. Measurement of whether the tear film is broken (if not smooth), evaluation of the tear film (including tear film destruction) can be obtained by checking the shape of the plaque on the topographer . For example, the observation or indication that the tear film has been torn or destroyed is that if the plaque is not circular, e.g., has an oval or destroyed shape, the tear film has been destroyed. In terms of showing, it can be based on the shape of the plaque. The presence of such a broken tear film may indicate that the K value and other visual measurements may be unreliable.

  In operation, as shown in FIG. 20, after exiting the connector 2012, the OCT beam 2014 is preferably collimated using a collimating optical fiber 1996. After the collimating fiber 1996, the OCT beam 2014 scans the OCT beam in the x and y directions perpendicular to the z direction, as well as a z scanning device 1993 operable to change the focus of the OCT beam in the z direction. Are directed to x and y scanning devices 1995 and 1997 that are operable as described above.

  After the collimating optical fiber 1996, the OCT beam 2014 subsequently passes through the X scanning devices 1993, 1994. The z-scanning device is preferably a Z telescope 1993 operable to scan the focal position of the OCT beam 2014 into the patient's eye 1901 along the z-axis. For example, the Z telescope 1993 can be a Galileo telescope having two lens groups (each lens includes one or more lenses). One of the lens groups moves along the Z axis around the collimation position of the Z telescope 1993. Thus, the focal position in the patient's eye 1901 moves along the Z axis. In general, there is a relationship between the movement of the lens group and the movement of the focus. The exact relationship between the movement of the lens and the movement of the focal point in the z-axis of the eye coordinate system need not be a constant linear relationship. The motion can be non-linear and can be detected by a model or calibration from measurements or a combination thereof. Alternatively, the other lens group can move along the Z axis and adjust the position of the focal point along the Z axis. The Z telescope 1993 can function as a z-scanning device to change the focus of the OCT beam 2014 in the patient's eye 1901. The Z-scan device can be controlled automatically and dynamically by the controller 1860 and can be selected to be independent of or interacting with the X and Y scans described below. .

  After passing through the z-scan device, the OCT beam 2014 is incident on an x-scan device 1995 that is operable to scan the OCT beam 2014 in the X direction, and the beam 2014 is primarily transverse to the Z axis. The OCT beam 2014 is also transverse to the transmission direction. The X scanning device 1995 is controlled by the controller 60 and may include suitable components such as a lens, motor, galvanometer, or any other known optical movement device coupled to the MEMS device. The relationship of beam motion as a function of X actuator motion need not be fixed or linear. Relationship modeling or relationship measurement calibration or a combination thereof can be determined and used to derive the position of the beam.

  After being indicated by the X scanning device 1995, the OCT beam 2014 is incident on a Y scanning device 1997 that is operable to scan the OCT beam 2014 in the Y direction, and the beam 2014 is primarily directed to the X and Z axes. Horizontal direction. The Y scanning device 1997 is controlled by the controller 1860 and can include suitable components, such as a lens, motor, galvanometer, or any other known optical movement device coupled to the MEMS device. The relationship of beam motion as a function of Y actuator motion need not be fixed or linear. Relationship modeling or relationship measurement calibration or a combination thereof can be determined and used to derive the position of the beam. Alternatively, the functionality of the X scanning device 1995 and the Y scanning device 1997 includes an XY scan configured to scan the OCT beam 2014 in two directions transverse to the Z axis and the transmission direction of the OCT beam 2014. Can be provided by the device. X-scan and Y-scan devices 1995, 1997 change the orientation of the resulting OCT beam 2014, causing a lateral displacement of the OCT beam 2014 located in the patient's eye 1901.

  The OCT sample beam 2014 is then directed to the beam splitter 1973, through the lens 1975, through the quarter wave plate 1971 and aperture 1914, and to the patient's eye 1901. Reflection and scattering from structures in the eye cause patient interface quarter wave plate 1971, lens 175, beam splitter 1973, y scanning device 1997, x scanning device 1995, z scanning device 1993, optical fiber 1996, and beam A return beam returning through the combiner 2004 (FIG. 20) is provided and returned to the OCT detection device 2020. The return back reflection of the sample arm 201 is combined with the return reference portion 2006 and directed toward the detector portion of the OCT detection device 2020. The detector portion produces an OCT signal in response to the combined return beam. The generated OCT signal is finally decoded by the controller 1860 to determine the spatial arrangement of the structure of interest in the patient's eye 1901. The generated OCT signal is also decoded by the controller to measure and determine the spatial arrangement of the structure of interest in the patient's eye 1901. The generated OCT signal can also be interpreted by the control electronics to aim the patient's eye position and orientation within the patient interface.

  The visual acuity measurement system according to the present invention preferably includes an iris imaging subsystem 40. The imaging subsystem 1840 generally includes an infrared light source, preferably an infrared light source 1952 and a detector 1941. In operation, light from the light source 1952 is directed along the second optical path 1960 to the first optical path 1970 and subsequently to the eye 1901 as described above. The light reflected from the iris of the eye 1901 is reflected back to the detector 1941 along the first optical path 1970. In normal use, an operator adjusts the position or aim of assembly 1900 in the X, Y, and Z directions according to image detector array 1941 to aim the patient. In one embodiment of the iris imaging subsystem, eye 1901 is illuminated with infrared light from light source 1952. In this way, the wavefront obtained by the wavefront sensor 1955 is registered in the image from the detector array 1941.

  The image seen by the operator is the iris of the eye 1901. The cornea usually enlarges and slightly displaces the image from the physical location of the iris. Therefore, the aiming performed is actually for the entrance pupil of the eye. This is generally a desirable condition for wavefront sensing and iris registration.

  US Patent Application No. 12/418 entitled “Method for registering multiple data sets”, incorporated herein by reference, with various subsystems of the present invention, images of the iris obtained by the iris imaging subsystem. , 841 can be used for registering and / or merging a plurality of pieces of data obtained by the method described in US Pat. Fusing wavefront aberrations with corneal topography, optical coherence tomography measurement and wavefront, optical coherence tomography measurement and topography, pachymetry, wavefront, etc., as described in patent application 12 / 418,841. it can. For example, image recognition techniques can be used to find the location and size of various traits in the image. For iris registration images, the available traits include the position, size and shape of the pupil, the position, size and shape of the outer boundary (OIB) of the iris, the prominent iris trait (marker), and as required. Other traits are listed. Using these techniques, by measuring the patient's movement between measurements (and / or a series of measurements), as well as changes in the eyes themselves (eg changes in pupil size, changes in pupil position, etc.) (Including those that are triggered).

  In many embodiments, the vision measurement system according to the present invention includes a target fixation subsystem 1850 (FIG. 18), and the assembly 1900 shown in FIGS. 19A and 19B provides a fixation target 1982 for patient identification. A fixation target subsystem 1980 is included. Because it is often desirable to measure refraction and wavefront aberrations when the eye 1901 is focused at a far point (eg, because LASIK treatment is primarily based on this), the fixation target subsystem 1980 To control patient accommodation. In the target fixation subsystem, a target projection, for example, a crosshair pattern, is projected onto the patient's eye, which is formed by a backlight LED and film.

  In operation, light is emitted from the light source 1952 or from the video target backlight 1982 and the lens 1986. The lens 1985 collects light and forms an aerial image T2. This aerial image is what the patient sees. The patient's focus is maintained in the aerial image 1982 during the measurement and maintained at a focal position with a fixed eye.

  The order of operations and the visual acuity measurement system and method of the present invention are not particularly limited. The patient's eye scan may include one or more of wavefront aberration measurement of the patient's eye, corneal topography measurement of the patient's eye, and OCT scan of the patient's eye using the OCT subsystem. An OCT scan may include a scan at each location in the patient's eye, or at one or more locations. These positions of the OCT scan can correspond to the position of the cornea, the position of the anterior part of the lens, the position of the posterior part of the lens, and the position of the retina. In a preferred embodiment, the sequence of operations includes a wavefront aberration measurement, a corneal topography measurement, and an OCT scan, wherein the OCT scan is at least one of the retina, the cornea, and the anterior portion of the patient's lens. Done. The iris image is preferably taken simultaneously or sequentially with each of the measurements made by the wavefront aberration subsystem, the corneal topography subsystem, and the OCT subsystem, and simultaneously or sequentially with the location of each OCT scan. Includes the iris image to be shot. This results in improved accuracy in 3D modeling of the patient's eye by fusing and merging various data chunks into the 3D model.

  FIG. 24 illustrates one embodiment of the sequence and method of operations in which wavefront aberration measurements, corneal topography measurements, and OCT measurements are all performed. The visual acuity measuring device including the method of FIG. 24 can be used before, during, and / or after surgery. In the method of FIG. 24, step 2401 includes aiming the vision measurement system to the patient's eye. Step 2405 includes activating a target fixation subsystem for fixing the patient to the target. Step 2410 includes activating the wavefront aberrometer subsystem, which activates the wavefront aberrometer light source 2410 and measures eye refraction with a wavefront sensor. Step 2415 activates the target fixation system, moves the target to the optimal position, activates the wavefront aberrometer subsystem, activates the wavefront aberrometer light source 1952, and measures eye refraction by the wavefront sensor 1955. including. Step 2420 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is operating. Step 2425 includes operating the z-scan device to set the location of the OCT scan at or near the cornea and performing the OCT scan using the OCT subsystem. Step 2430 includes operating the z-scan device to set the OCT position to or near the front of the lens and performing an OCT scan using the OCT subsystem. Step 2435 includes operating the z-scan device to set the OCT position at or near the back of the lens and performing an OCT scan using the OCT subsystem. Step 2440 includes operating the X and Y scanning devices to prevent light from the OCT from reaching the detector 1941. Step 2445 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is blinking. Step 2450 includes obtaining an iris image using the iris imaging subsystem while the light source 1920 and the Helmholtz light source are blinking. Step 2450 includes measuring the corneal topography using the corneal topography subsystem. Step 2455 includes operating the z-scan device to set the OCT position at or near the retina and performing an OCT scan using the OCT subsystem. Step 2460 includes operating the X and Y scanning devices to prevent light from the OCT from reaching the detector 1941. Optional step 2465 may include measuring the corneal topography using the corneal topography subsystem, thereby providing an improved 3D model of the patient's eye. Optional step 2470 includes obtaining an iris image using an iris imaging subsystem (for a 3D model).

  FIG. 25 illustrates one embodiment of an order of operation and method in which no wavefront aberration measurement is performed. A vision measuring device comprising the method of FIG. 24 can be used before, during, and / or after surgery. In the embodiment of FIG. 25, step 2501 includes aiming the vision measurement system to the patient's eye. Step 2505 includes activating a target fixation subsystem for fixing the patient to the target. Step 2510 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is operating. Step 2515 includes operating the z-scan device to set the position of the OCT scan at or near the cornea and performing the OCT scan using the OCT subsystem. Step 2520 includes operating the Z-scan device to set the OCT position to the front of the lens or a position near the front of the lens and performing an OCT scan using the OCT subsystem. Step 2525 includes operating the z-scan device to set the OCT position at or near the back of the lens and performing an OCT scan using the OCT subsystem. Step 2530 includes operating the X and Y scanning devices to prevent light from the OCT from reaching the detector 1941. Step 2535 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is blinking. Step 2540 includes measuring the corneal topography using the corneal topography subsystem. Step 2545 includes operating the z-scan device to set the OCT position at or near the retina and performing an OCT scan using the OCT subsystem. Step 2550 includes operating the X and Y scanning devices to prevent light from the OCT from reaching the detector 141. Optional step 2555 includes measuring the corneal topography using a corneal topography subsystem, which can result in an improved 3D model of the patient's eye. Optional step 2560 includes obtaining an iris image using an iris imaging subsystem.

  FIG. 26 illustrates the OCT measurement utilizing the OCT subsystem and the iris imaging using the iris imaging subsystem to improve the 3D modeling of the patient's eye and the improved iris registration of the measurement data cluster. 2 illustrates an embodiment of an order of operations and methods that can be performed simultaneously. As will be readily appreciated by those skilled in the art, the sequence of operations of FIG. 26 can be applied or incorporated into either the sequence of operations and methods of FIG. 24 or FIG. To implement the sequence and method of operation of FIG. 26, a lens is inserted into the optical path 170 between the beam splitter 1973 and detector 1941. The inserted lens is selected to preferentially pass infrared light used for iris imaging and block the OCT beam from the OCT light source from the arrival detector 1941. In this configuration, OCT measurement and iris imaging may be performed simultaneously. Furthermore, in the embodiment of FIG. 26, a constant speed global shutter aperture camera is used operating at 12 frames / second. The sequence of operations and method of FIG. 10 can be used before, during, and / or after surgery.

  In the embodiment of FIG. 26, step 2601 includes aiming the vision measurement system to the patient's eye. Step 2605 includes activating a target fixation subsystem for fixing the patient to the target. Step 2610 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is operating. Step 2615 includes obtaining an iris image using the iris imaging subsystem while the corneal topography light source 1920 and the Helmholtz light source 1932 are operating. Step 2620 includes operating the z-scan device to set the position of the OCT scan at or near the cornea and performing the OCT scan using the OCT subsystem. Step 2625 includes operating the z-scan device to set the OCT position in front of or near the front of the lens and performing an OCT scan using the OCT subsystem. Step 2630 includes operating the z-scan device to set the OCT position to or near the back of the lens and performing an OCT scan using the OCT subsystem. Step 2635 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is operating. Step 2640 includes obtaining an iris image using the iris imaging subsystem while the corneal topography light source 1920 and the Helmholtz light source 1932 are operating. Step 2645 includes operating the z-scan device to set the position of the OCT at or near the retina and performing an OCT scan using the OCT subsystem. Step 2650 includes obtaining an iris image using the iris imaging subsystem while the corneal topography light source 120 and the Helmholtz light source 1932 are operating. Step 2655 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is operating.

  FIG. 27 illustrates the OCT measurement utilizing the OCT subsystem and the iris imaging using the iris imaging subsystem to improve the 3D modeling of the patient's eye and the improved iris registration of the measurement data cluster. Fig. 4 illustrates another embodiment of a sequence and method of operations that can be performed simultaneously. As will be readily appreciated by those skilled in the art, the sequence of operations of this embodiment can be applied or incorporated into either the sequence of operations and methods of FIG. 24 or FIG. Similar to the method of FIG. 26, a lens is inserted into the optical path 1970 between the beam splitter 1973 and the detector 1941 to implement the sequence and method of operation of FIG. The inserted lens is selected to preferentially pass infrared light used for iris imaging and block the OCT beam from the OCT light source from the arrival detector 1941. In this configuration, OCT measurement and iris imaging may be performed simultaneously. Further, in the embodiment of FIG. 26, a high-speed global shutter aperture camera or high-speed frame rate is used while operating at 60 frames / second. Under the fast frame rate conditions of this embodiment, an infrared illumination light source, such as a wavefront aberration light source, is used with one or more second light sources, such as a combination of a corneal topography light source 1920 and a Helmholtz light source, to shorten the patient's eyes Alternate repetitions at intervals (i.e. alternative short flashes) can be applied. Under these conditions, the iris imaging subsystem can be synchronized with blinking from each light source to capture the iris image under both illumination conditions. The sequence and method of operation of FIG. 27 can be used before, during, and / or after surgery.

  In the embodiment of FIG. 27, step 2701 includes aiming the vision measurement system to the patient's eye. Step 2705 includes activating a target fixation subsystem for fixing the patient to the target. Step 2710 obtains an iris image using the iris imaging subsystem while the infrared light source 152 is operating, and the iris imaging subsystem while the corneal topography light source 120 and the Helmholtz light source 132 are operating. Using to obtain an iris image. This can instead be achieved by operating an infrared light source and a combination of corneal topography / Helmholtz light source, preferably at a rate at which the patient's eye cannot resolve “blink”, and This is done by irradiating instead with a combined light source. In this process, the iris imaging subsystem is synchronized with the corresponding illumination light. Step 2715 includes operating the z-scan device to set the position of the OCT scan at or near the cornea and performing the OCT scan using the OCT subsystem. Step 2720 includes operating the Z-scanning device to set the OCT position to or near the front of the lens and performing an OCT scan using the OCT subsystem. Step 2725 includes operating the z-scan device to set the OCT position to or near the back of the lens and performing an OCT scan using the OCT subsystem. Step 2730 includes operating the z-scan device to set the position of the OCT at or near the retina and performing an OCT scan using the OCT subsystem. Step 2735 includes obtaining an iris image using the iris imaging subsystem while the infrared light source 1952 is operating, as described above with respect to step 2710, and the corneal topography light source 120 and Helmholtz light source 132 are In operation, including obtaining an iris image using an iris imaging subsystem.

  The visual acuity measuring device 1801 and the visual acuity obtained using it can be used before surgery, i.e. before cataract surgery or other surgical procedure, for example for biometric and other measurements of the eye, diagnosis and surgical planning. Can be used for The surgical plan can include one or more predictive models. In one or more predictive models, one or more characteristics of the patient's eye or visual post-surgical state are preoperative measurements obtained from the vision measuring device 1801, conceivable surgical interventions, and the vision measurement system 1 Modeled based on one or more selected from the group consisting of one or more algorithms or models stored in memory and executed by a processor. Conceivable surgical interventions include selection of the IOL for placement, selection of the characteristics of the IOL, the nature or type of incision used during the operation (eg, extension incision), or post-surgery required by the patient One or more visual characteristics can be mentioned.

  The vision measurement device 1801 and the vision measurements obtained using it can be used, for example, for eye diagnosis during surgery, IOL placement and position measurement, surgical planning, and / or control of a laser surgical system. It can be used during surgery, i.e. during cataract surgery or other surgical procedures. For example, in the case of a laser cataract surgery procedure, any measurement data obtained by the vision measuring instrument prior to surgery can be obtained before, during, or before the lens capsule incision, amputation, or patient lens or IOL placement during cataract surgery. Or it can be transferred to a memory connected to a laser cataract surgery system for later use. In some embodiments, measurements using the vision measuring device 1801 can be made during a surgical procedure to determine whether the IOL is properly positioned in the patient's eye. In this regard, the state measured during the surgical procedure can be compared to the expected state of the patient's eye based on pre-operative measurements, using the difference between the predicted state and the actual measured state. Additional or corrective procedures can be performed during cataract surgery or other surgical procedures.

  The visual acuity measuring device 1801 and the visual acuity measurement value obtained using the visual acuity measuring device 1801, for example, post-operative measurement, post-operative eye diagnosis, post-operative IOL placement and position measurement, and, if necessary, correction treatment plan Therefore, it can be used after surgery, i.e. after cataract surgery or other surgical procedures. Post-surgical testing can occur after surgery that has sufficient time for the patient's eyes to heal and the patient's vision has achieved a stable post-operative condition. The post-operative condition can be compared to one or more expected conditions performed before surgery, and the difference between the predicted condition before surgery and the condition measured after surgery can be used to treat cataract surgery or other During the surgical procedure, additional or modified treatments can be planned.

  A vision measurement instrument 1801, including a corneal topography subsystem, an OCT subsystem, and a wavefront aberration subsystem, utilizing the preferred sequence of operations disclosed herein, measures one, two or more of the following: It is possible to operate. Eye biometric information, anterior corneal surface information, posterior corneal surface information, anterior lens surface information, posterior lens surface information, lens tilt information, lens position information, and intraocular lens previously implanted Intraocular lens surface and thickness information. In some embodiments, the eye biometric information includes multiple central corneal thicknesses (CCT), anterior chamber depth (ACT), pupil diameter (PD), horizontal corneal distance (WTW), lens thickness. (LT), axial length (AL), and layer thickness of the retina. This measurement data can be stored in a memory 1862 connected to the controller 1860. Multiple features can be measured before and, if appropriate, during and after surgery.

  In many embodiments, the memory 1862 coupled to the controller 1860 can store intraocular lens (IOL) model data for a plurality of IOL models, each of which has a refractive power, refractive index, non-index, Associated with a plurality of predetermined parameters selected from the group consisting of sphericity, tricity, capsular angle, and lens filter. Visual acuity along with measurement data of the subject's eye obtained by the vision measuring device 1801 for cataract diagnosis or a cataract treatment plan that may include identifying and / or selecting a specific IOL with respect to the subject's eye The IOL data can be used by one or more processors of the measuring device 1801. For example, one or more processors of the vision measuring device 1801 may access a plurality of stored IOL models, and for each of the IOL models, (1) correspond to the measured characteristics of the IOL model and the subject's eyes. Modeling the eye of the subject including the intraocular lens, (2) simulating the eye of the subject based on a predetermined parameter of the plurality of IOLs and the position of the expected IOL, (3) the eye of the subject Performing one of ray tracing and force calculation based on the model, and (4) subject's eye from a plurality of IOL models corresponding to the optimized IOL based on predetermined criteria. An IOL can be executed.

  In many embodiments, the one or more processors of the vision measurement device 1801 determine the desired post-surgical state of the subject's eye and based at least in part on the measured eye characteristics Predicting and estimating at least one parameter of an intraocular lens for implantation in the subject's eye according to the empirical calculation of the post-operative condition and the output of the empirical calculation and eye characteristics Obtaining a post-surgical status of the present invention can be implemented.

  In many embodiments, the eye imaging and measurement system further includes a memory operable to store intraocular lens (“IOL”) data, the IOL data including a plurality of refractive powers, anterior and posterior radii. , IOL thickness, refractive index, asphericity, tricity, echelle trait, capsule angle, and lens filter.

  In many embodiments, the eye imaging and measurement system further includes a memory operable to store intraocular lens (“IOL”) model data for a plurality of IOL models, wherein the IOL model includes refractive power, anterior And a plurality of predetermined parameters selected from the group consisting of posterior radius, IOL thickness, refractive index, asphericity, tricity, echelle trait, capsule angle, and lens filter.

  In many embodiments, methods such as those described above with respect to FIGS. 10 and 12-15 may be used to select and place an intraocular lens (IOL) for implantation in cataract surgery, particularly a subject's eye, With respect to obtaining the desired post-surgical condition, it can be performed by a vision measuring instrument 1801 (including, for example, assembly 1900). In this case, in some embodiments, the pretreatment vector can be replaced with a preoperative vector, the posttreatment vector can be replaced with a postoperative vector, and a valid treatment vector function can be replaced with a valid surgical vector function. Can do. In some embodiments, such methods can be applied to the eyes of a patient who has previously received one or more refractive treatments, eg, by laser surgery.

  For example, in some embodiments, one of the various parameters of the patient's eye to better achieve the desired outcome that can be defined in terms of the desired refractive correction vector (IRC) as described above. The above pre-operative value measurements are combined with pre-op eye data (eg, including higher order aberrations) of previous cataract surgery, and post-op eye data (eg, with eyesight measuring instrument 1801) One or more parameters of the IOL implanted in the patient's eye can be derived during subsequent cataract surgery on the patient's eye. In particular, in some embodiments, the vision measuring device 1801 can be used to perform a method for planning cataract surgery for a patient's eye, which includes a prior correction of the associated eye. For each of the operations, measuring an effective treatment vector function based on multiple previous corrective operations by defining a pre-operative vector that characterizes the measured pre-order higher order aberrations of the associated eye, and the associated eye Defining postoperative vectors that characterize postoperative high-order aberrations, using the correlation between preoperative and postoperative vectors to derive effective surgical vector functions, and An intraocular lens (IO) implanted in the patient's eye by defining an input vector based on the measured pre-operative higher order aberrations and applying a valid surgical vector function to the input vector And deriving one or more parameters of) can contain. In some embodiments, the parameters of the IOL can include the frequency of the IOL and the location in the patient's eye where the IOL will be located. In some embodiments, the one or more parameters of the IOL that are considered to be selected based solely on the measured characteristics of the eye in which the IOL is implanted are measured prior to the measured surgery of the eye on which the previous cataract surgery was performed and By taking into account post-surgical features, corrections are made based on the results of previous cataract surgery. For example, if a number of cataract operations were previously performed with an eye that has the measured characteristics that are the same or nearly the same as the eye on which the cataract operation is performed, select the IOL to be implanted and the location within the eye where the IOL will be located In order to improve the outcome of the cataract surgery and more closely achieve the desired outcome (eg, target eye refraction), the systems and methods described herein enable these previous cataract surgery. Can be taken into account. In some embodiments, the results of previous cataract surgery are used to determine the difference between the relevant eye target refractive vector (IRC) and the related eye surgery-derived refractive vector (SIRC). It can be defined from a viewpoint.

  In some embodiments, methods such as those described above in FIGS. 10 and 12-15 may be used to plan and implement refractive eye treatments, such as by laser surgery, where the IOL has previously been implanted. With respect to the desired patient's eye, it can be performed by a vision measuring device 1801 (eg, including assembly 1900). In some embodiments, the vision measurement device 1801 can define an input vector that is measured by the measurement device 1801 based on pre-surgical features of the patient's eye, including the implanted IOL, The correlation between the pre-treatment vector and the post-treatment vector for each of the eye treatments can be used to derive an effective treatment vector function. In some embodiments, the previous eye treatment set can be limited to eye treatments in which the IOL has been previously implanted.

  Embodiments of the present invention further include systems and methods for collecting, storing, analyzing, and transmitting information related to pre- and post-operative parameters. For example, if a physician or operator performs pre- and / or post-operative measurements on a patient at a clinic or hospital, such information can be transmitted to a computer system. The processor of the computer system can be configured to analyze the information and build a nomogram from the physician. Similarly, information from multiple physicians or information from multiple patients can be provided and analyzed by a computer processor. The computer processor can also be configured to measure an impact matrix, effective treatment vector functions, and / or patient-specific treatment parameters using techniques described elsewhere herein. . In some cases, it may be possible to selectively select which parameters to use in determining the impact matrix, effective treatment vector functions, and / or patient-specific treatment parameters. For example, a particular physician may wish to determine a patient's treatment parameters without using data associated with the particular parameters. Similarly, a physician may wish to use only data related to a particular range of values for a particular parameter (eg, selecting only data relating to eyes treated in a dry climate). In some cases, a physician can obtain treatment output data from a computer system and adjust the treatment output data before applying treatment to a patient. Optionally, such adjustments can be sent to a computer system for further analysis. Further optionally, the treatment information provided by the computer can be based on or in a factor in such adjustment. In some cases, the technique may include providing the physician with an expected outcome based on the proposed treatment, and the physician may compare the expected outcome to the actual outcome obtained. it can. Thus, the technology is a database, eg, a database located in a clinic, hospital, or some other centrally controlled location (optionally networked with multiple clinics and / or hospital databases or computer systems). Can be associated with obtaining relevant eye measurement pre- and / or post-treatment optical properties, or other relevant parameters as discussed elsewhere herein. In some examples, embodiments provide a technique for tracking recommended treatments and treatments actually performed based on the recommended treatments, to compare or analyze such recommendations and performed treatments. Technologies, techniques for archiving such recommendations and actions taken (and comparisons thereof), and techniques for adjusting recommendations based on comparisons.

  For arcuate corneal surgery, an incision can be used to relieve corneal astigmatism and related techniques can be used in IOL surgery. For example, a surgeon can place a corneal incision on the tilt axis of the cornea to alleviate corneal astigmatism and reduce the need for toric IOLs in patients with astigmatism less than 1 diopter. In some cases, the degree and axis of astigmatism prior to surgery, the number of incisions relative to the visual area, arc angle, and radial position, and age can be considered as parameters for this type of surgery. By using a femtosecond (FS) laser in arcuate surgery, the accuracy with which an incision can be generated can be increased, resulting in a better patient outcome. Furthermore, FS laser can be applied to correct corneal astigmatism after corneal transplantation. As with other refractive surgery, the techniques described herein can be applied to improve patient outcomes by using historical outcome data. For corneal arc surgery, it is possible to use the parameters described above (eg preoperative astigmatism degree and axis, number of incisions relative to the visual area, arc angle, and radial position, and age) in the preoperative vector. is there. More advanced predictive modeling can include corneal curvature measurements based on corneal topography, pachymetry, and corneal hydration, if available to improve the accuracy of the model. In the case of FS arc laser surgery, other options can be added to the incision feature as well. These include partial incisions that do not pierce or destroy the surface of the cornea, profiled incisions into the cornea that are not purely normal, and incisions other than straight and arc (eg, corrugated or twisted lines) ) Can be included. In some cases, the technique can include a complete intramacrotomy incision or destruction. In some cases, the technique can include an incision or destruction reaching the corneal surface. In some cases, parameters describing details of the incision and pre-operative parameters can be included in the pre-operative vector.

  All patents, patent applications, journal articles, technical references, etc. mentioned herein are hereby incorporated by reference for all purposes.

  Different arrangements of the components shown or described and components and processes not shown or described are possible. Similarly, some traits and subcombinations are useful and can be used without mentioning other traits and subcombinations. The embodiments of the present invention have been described by way of illustration and not by way of limitation, and alternative embodiments will be apparent to the reader of this patent. Accordingly, the present invention is not limited to the embodiments described above or illustrated in the drawings, and various embodiments and modifications can be made without departing from the scope of the following claims.

  While exemplary embodiments have been described in some detail and by way of example for clarity of understanding, numerous adaptations, changes and modifications will become apparent to those skilled in the art. Accordingly, the scope of the invention is limited only by the claims associated with the invention.

を判定することを含む、実施態様２に記載の方法。
（４）

は、前記関連する目に関して、

となるように、前記ＳＩＲＣを前記ＩＲＣに関連付け、
式中、Ｅは誤差ベクトルであり、
前記有効な手術ベクトル関数を前記入力ベクトルに適用することは、調節した目的の屈折矯正ベクトル（ＡＩＲＣ）を算出することを含み、

であり、
式中、

の逆数であり、

は前記患者の目の前記ＩＲＣに基づく、実施態様３に記載の方法。
（５） 前記患者の目の前記ＩＲＣに、
前記ＩＲＣに対する医師の調節、及び
前記ＩＲＣに対するノモグラム調節からなる群から選択される少なくとも１つの調節を適用することにより、前記患者の目に対するＩＲＣ’を定義することを更に含み、
前記入力ベクトルは、前記ＩＲＣ’に基づいている、実施態様２に記載の方法。 Embodiment
(1) A method for planning cataract surgery for a patient's eyes, the method comprising:
Regarding previous corrective surgery for each of the relevant eyes
Defining a preoperative vector characterizing the relevant pre-measurement pre-operative higher order aberrations;
Defining a post-operative vector characterizing the relevant post-measurement post-operative high-order aberrations;
Using the correlation between the preoperative vector and the postoperative vector to derive an effective surgical vector function, thereby determining an effective therapeutic vector function based on a plurality of previous corrective operations To do
Defining an input vector based on the pre-operative high order aberrations of the patient's eye;
Deriving one or more parameters of an intraocular lens (IOL) implanted in the patient's eye by applying the effective surgical vector function to the input vector.
(2) Defining the input vector
Identifying a target refraction of the patient's eye generated by the cataract surgery;
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the measured pre-operative aberration of the patient's eye and the target;
Deriving the effective surgical vector function from previous corrective surgery
Determining a refractive correction vector (IRC) for the relevant eye purpose;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, each SIRC characterizing a difference between the measured preoperative aberration and the postoperative aberration of the associated eye Embodiment 2. The method of embodiment 1 comprising:
(3) Deriving the effective surgical vector function is an influence matrix that associates the SIRC with the IRC.

Embodiment 3. The method of embodiment 2, comprising determining
(4)

Is related to the related eye

Associating the SIRC with the IRC so that
Where E is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

Is the reciprocal of

4. The method of embodiment 3, wherein is based on the IRC of the patient's eye.
(5) In the IRC of the patient's eye,
Further comprising defining an IRC ′ for the patient's eye by applying at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC;
3. The method of embodiment 2, wherein the input vector is based on the IRC ′.

6. The method of embodiment 1, wherein the effective surgical vector function is derived using an influence matrix.
(7) The planned surgery of the patient's eye is characterized by a planned surgery vector, and the influence matrix causes the components of the input vector to change the components of the planned surgery vector, respectively. Embodiment 7. The method of embodiment 6, derived in
(8) The planned operation of the eye of the patient is characterized by a planned operation vector, and the influence matrix is such that a plurality of the planned operation vector components are changed by a plurality of components of the input vector, respectively. Embodiment 7. The method of embodiment 6, derived in
9. The method of embodiment 1, wherein the preoperative vector and the input vector characterize refraction, a non-refractive cofactor that characterizes the patient and / or surgical settings, and the higher order aberrations of the eye.
(10) The one or more parameters of the intraocular lens are derived by multiplying the influence matrix of the effective surgical vector function by the input vector to define a conditional input vector, the conditional input Embodiment 7. The method of embodiment 6, derived by planning the cataract surgery with a matrix component of a vector.

(11) The embodiment wherein the one or more parameters of the IOL implanted in the patient's eye include the frequency of the IOL and a position in the patient's eye where the IOL is located. The method according to 1.
(12) A method for planning cataract surgery for a patient's eye, the method comprising:
Regarding previous corrective surgery for each of the relevant eyes
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, which characterizes a difference between the measured preoperative aberration and the measured postoperative aberration of the associated eye, wherein the influence matrix is Deriving the influence matrix from a plurality of previous corrective operations, derived to provide a correlation between the IRC and the SIRC;
Defining a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix.
(13) A method for planning cataract surgery for a patient's eye, wherein an influence matrix determines the relevant target eye refraction for each previous corrective surgery of the relevant eye; Determining a target refractive correction vector (IRC) that characterizes a difference between the pre-measurement pre-order high-order aberrations of the eye and the target, and the associated pre- and post-measurement aberrations of the eye Determining the refraction correction vector (SIRC) induced by the associated eye surgery that characterizes the difference between, wherein the influence matrix is derived from the IRC and the SIRC. Derived so as to provide a correlation between
Receiving a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix.
(14) A system for planning cataract surgery for a patient's eye, the system comprising:
An input for receiving preoperative high order aberrations of the patient's eye;
A processor coupled to the input, the processor applying an effective surgical vector function to embed an eye in the patient's eye in accordance with the higher order aberrations of the patient's eye Deriving one or more parameters of an inner lens (IOL), the effective surgical vector function for each of a plurality of previous corrective operations, a preoperative vector characterizing the associated higher-order aberrations of the eye prior to surgery; A processor derived from a correlation between postoperative vectors characterizing postoperative higher order aberrations of the associated eye;
And an output coupled to the processor to transmit the one or more parameters of the IOL implanted in the patient's eye.
15. The embodiment of claim 14, wherein the processor includes a tangible medium that embodies machine readable instructions for performing the derivation of the one or more parameters of the IOL implanted in the patient's eye. System.

となるように、前記ＳＩＲＣを前記ＩＲＣに関連付け、
式中、

は誤差ベクトルであり、
前記有効な手術ベクトル関数を前記入力ベクトルに適用することは、調節した目的の屈折矯正ベクトル（ＡＩＲＣ）を算出することを含み、

であり、
式中、

はｆの逆数であり、ＩＲＣ’は前記患者の目の前記ＩＲＣに基づく、実施態様１９に記載のシステム。 (16) The processor may calculate an input vector for the patient's eye according to a target refraction of the patient's eye induced by the cataract surgery, between the pre-measurement aberration of the patient's eye and the target. 15. The system of embodiment 14, wherein the system is configured to generate by determining an intended refractive correction (IRC) to characterize the difference.
17. The system according to embodiment 16, further comprising an aberrometer coupled to the input unit, wherein the aberrometer senses higher order aberrations of the eyes and transmits the higher order aberrations to the processor.
(18) The processor derives the effective surgical vector function from a previous corrective surgery in response to the relevant eye target refractive vector (IRC), and the refraction induced by the associated eye surgery. 18. The system of embodiment 17, wherein the system is configured to determine a correction vector (SIRC), each SIRC characterizing a difference between the measured preoperative aberration and the postoperative aberration of an associated eye.
19. The system of embodiment 14, wherein the effective surgical vector function is based on an influence matrix f that associates the SIRC with the IRC.
(20) For f related eyes, f

Associating the SIRC with the IRC so that
Where

Is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

20. The system of embodiment 19, wherein is the reciprocal of f and IRC ′ is based on the IRC of the patient's eye.

(21) further comprising an additional input coupled to the processor for receiving at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC;
The processor is configured to define an IRC ′ for the patient's eye by applying the at least one adjustment to the IRC of the patient's eye, and the input vector is based on the IRC ′. Embodiment 17. The system of embodiment 16 wherein
22. The system of embodiment 14, wherein the effective surgical vector function is based on an influence matrix.
(23) the planned cataract surgery of the patient's eye includes a planned surgical vector, wherein each of the plurality of components of the input vector changes a plurality of components of the planned surgical vector and / or 23. The system of embodiment 22, wherein the planned surgical vector component varies with each of a plurality of components of the input vector.
(24) The input vector includes a refractive component that characterizes refraction of the patient's eyes, a non-refractive cofactor that characterizes the patient and / or treatment settings, and a higher order component that characterizes the higher order aberrations of the eye. Embodiment 23. The system of embodiment 22.
(25) The processor is configured to derive the one or more parameters of the IOL to be implanted in the patient's eye by multiplying the input matrix by the influence matrix of the effective surgical vector function. Embodiment 23. The system of embodiment 22 wherein

(26) A system for planning cataract surgery for a patient's eye, said system comprising:
A processor,
For receiving data about multiple previous corrective surgeries and for each previous corrective surgery of the associated eye,
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction;
Determining from the data the refractive correction vector (SIRC) induced by the associated eye surgery that characterizes the difference between the measured preoperative aberration and the measured postoperative aberration of the associated eye. An input unit for deriving an influence matrix, wherein the influence matrix includes a correlation between the IRC and the SIRC;
A processor having another input for receiving a patient's IRC vector that characterizes the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
An output coupled to the processor for transmitting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in the cataract surgery of the patient's eye, A processor configured to derive one or more parameters of the IOL to be implanted in the patient's eye by adjusting the patient's IRC vector based on the influence matrix; A system comprising:
27. The embodiment wherein the one or more parameters of the IOL implanted in the patient's eye include the frequency of the IOL and a position in the patient's eye where the IOL is located. 26. The system according to 26.
(28) A system for planning cataract surgery in a patient's eye, wherein an influence matrix determines the relevant target eye refraction for each previous corrective surgery of the relevant eye; Determining a target refractive correction vector (IRC) that characterizes a difference between the pre-measurement pre-order high-order aberrations of the eye and the target, and the associated pre- and post-measurement aberrations of the eye Determining a refractive correction vector (SIRC) derived from the associated eye surgery that characterizes the difference between, and wherein the influence matrix is derived from the IRC and Derived to provide a correlation with the SIRC, the system comprising:
An input for receiving a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
A processor coupled to the input, the processor configured to adjust an IRC vector of the patient based on the influence matrix.
(29) A method for planning cataract surgery for a patient's eye, the method comprising:
Regarding the previous eye treatment of each relevant eye,
Defining a preoperative vector characterizing the relevant pre-measurement optical properties of the eye;
Defining a post-operative vector characterizing the relevant post-measurement optical properties of the eye;
Deriving an effective surgical vector function using a correlation between the pre-operative vector and the post-operative vector, and based on a plurality of previous eye treatments, the effective surgical vector function Determining
Defining an input vector based on the pre-operative optical properties of the patient's eye;
Deriving a treatment for the eye of the patient by applying the effective surgical vector function to the input vector.
(30) Embodiment 29 wherein the pre-measurement optical properties include elements selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. The method described in 1.

を判定することを含む、実施態様３１に記載の方法。
（３３）

は、前記関連する目に関して、

となるように、前記ＳＩＲＣを前記ＩＲＣに関連付け、
式中、Ｅは誤差ベクトルであり、
前記有効な手術ベクトル関数を前記入力ベクトルに適用することは、調節した目的の屈折矯正ベクトル（ＡＩＲＣ）を算出することを含み、

であり、
式中、

の逆数であり、

は前記患者の目の前記ＩＲＣに基づく、実施態様３２に記載の方法。
（３４） 前記患者の目の前記ＩＲＣに、
前記ＩＲＣに対する医師の調節、及び
前記ＩＲＣに対するノモグラム調節からなる群から選択される少なくとも１つの調節を適用することにより、前記患者の目に対するＩＲＣ’を定義することを更に含み、
前記入力ベクトルは、前記ＩＲＣ’に基づいている、実施態様３１に記載の方法。
（３５） 前記有効な手術ベクトル関数は、影響マトリクスを使用して導出される、実施態様２９に記載の方法。 (31) Defining the input vector
Identifying a target refraction of the patient's eye induced by the cataract surgery;
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the measured pre-operative aberration of the patient's eye and the target;
Deriving the effective surgical vector function from previous treatments
Determining a refractive correction vector (IRC) for the relevant eye purpose;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, each SIRC characterizing a difference between the measured preoperative aberration and the postoperative aberration of the associated eye 30. The method of embodiment 29, comprising:
(32) Deriving the effective surgical vector function is an influence matrix relating the SIRC to the IRC.

32. The method of embodiment 31, comprising determining.
(33)

Is related to the related eye

Associating the SIRC with the IRC so that
Where E is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

Is the reciprocal of

35. The method of embodiment 32, wherein is based on the IRC of the patient's eye.
(34) In the IRC of the patient's eye,
Further comprising defining an IRC ′ for the patient's eye by applying at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC;
32. The method of embodiment 31, wherein the input vector is based on the IRC ′.
35. The method of embodiment 29, wherein the effective surgical vector function is derived using an influence matrix.

(36) The planned cataract surgery of the patient's eye is characterized by a planned surgical vector, and the influence matrix has a plurality of components of the input vector that change a plurality of components of the planned surgical vector, respectively. 36. The method of embodiment 35, wherein the method is derived.
(37) The planned cataract surgery of the patient's eye is characterized by a planned surgical vector, and the influence matrix has a plurality of the planned surgical vector components that are changed by a plurality of components of the input vector, respectively. 38. The method of embodiment 36, derived as follows.
(38) The planned cataract surgery of the patient's eye is characterized by a planned surgery vector, and the influence matrix includes all components of the input vector that characterize the refractive shape of the patient's eye, 38. The method of embodiment 36, derived so that all components of the planned surgical vector characterizing the change in the refractive shape of the planned surgical vector can be changed.
39. The method of embodiment 29, wherein the preoperative vector and the input vector characterize refraction, a non-refractive cofactor that characterizes the patient and / or cataract surgery settings, and the optical properties of the eye.
(40) In the cataract surgery of the patient's eye, one or more parameters of an intraocular lens (IOL) implanted in the patient's eye are the input vector in the influence matrix of the effective surgery vector function 37. The method of embodiment 36, derived by multiplying and defining a conditional input vector and derived by planning the cataract surgery by a matrix component of the conditional input vector.

(41) A method for planning cataract surgery for a patient's eye, said method comprising:
Regarding previous corrective surgery for each of the relevant eyes
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, which characterizes a difference between the measured preoperative aberration and the measured postoperative aberration of the associated eye, wherein the influence matrix is Deriving the influence matrix from a plurality of previous corrective operations, derived to provide a correlation between the IRC and the SIRC;
Defining a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix.
(42) For each previous corrective operation of the associated eye, the IRC is further determined to characterize the difference between the measured pre-operative low order aberration and the target low order aberration, and the patient's IRC vector is 42. The method of embodiment 41, further defined to characterize a difference between a measured pre-operative low order aberration and the target refraction.
(43) further comprising selecting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in the cataract surgery of the patient's eye based on the adjusted IRC; Embodiment 43. A method according to embodiment 42.
(44) A method for planning cataract surgery for a patient's eye, wherein an influence matrix determines the relevant target eye refraction for each previous corrective surgery of the relevant eye; Determining a target refractive correction vector (IRC) that characterizes the difference between the pre-measurement optical characteristic of the eye and the target; and the pre- and post-measurement optical characteristic of the associated eye; Determining the refraction correction vector (SIRC) induced by the associated eye surgery, which characterizes the difference between, and the influence matrix is derived from the IRC Derived to provide a correlation between the SIRC and the SIRC, the method comprising:
Receiving a patient's IRC vector characterizing a difference between the pre-operative optical properties of the patient's eye and a target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix.
(45) A system for planning cataract surgery for a patient's eye, the system comprising:
An input for receiving preoperative optical properties of the patient's eye;
A processor coupled to the input unit, wherein the processor applies a valid surgical vector function to the patient in the cataract surgery of the patient's eye according to the optical properties of the patient's eye Deriving one or more parameters of an intraocular lens (IOL) implanted in the eye of the eye, the effective surgical vector function for each of a plurality of previous corrective operations, the associated eye optics prior to surgery A processor derived from a correlation between a preoperative vector characterizing a characteristic and a postoperative vector characterizing the associated postoperative optical characteristic of the eye;
And an output coupled to the processor to transmit the one or more parameters of the IOL implanted in the patient's eye during the cataract surgery.

(46) The preoperative optical characteristic of the eye of the patient is at least one selected from the group consisting of low-order aberration, high-order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement Contains elements,
For each of the plurality of previous corrective operations, the preoperative vector characterizes the optical characteristics of the associated eye prior to surgery, the optical characteristics including low order aberrations, high order aberrations, corneal topography measurements, light Including one or more elements selected from the group consisting of coherence tomography measurements and corneal curvature measurements, wherein the postoperative vector characterizes optical properties of the associated eye prior to surgery, 46. The system of embodiment 45, comprising one or more elements selected from the group consisting of: low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements.
(47) The one or more parameters of the IOL implanted in the patient's eye in the cataract surgery include a frequency of the IOL and a position in the patient's eye where the IOL is implanted. 47. The system according to aspect 46.
(48) The processor may calculate an input vector for the patient's eye according to a target refraction of the patient's eye induced by the cataract surgery, between the pre-measurement aberration of the patient's eye and the target. 46. The system of embodiment 45, wherein the system is configured to generate by determining a target refractive correction (IRC) that characterizes the difference.
(49) The apparatus further comprises an aberrometer connected to the input unit, wherein the aberrometer senses the low-order aberration of the eye and the high-order aberration of the eye, and the low-order aberration and the high-order aberration of the eye 46. The system according to embodiment 45, wherein the system is transmitted to a processor.
50. The system of embodiment 49, wherein the aberrometer is configured to sense a corneal topography and send the corneal topography to the processor.

となるように、前記ＳＩＲＣを前記ＩＲＣに関連付け、
式中、

は誤差ベクトルであり、
前記有効な手術ベクトル関数を前記入力ベクトルに適用することは、調節した目的の屈折矯正ベクトル（ＡＩＲＣ）を算出することを含み、

であり、
式中、

はｆの逆数であり、ＩＲＣ’は前記患者の目の前記ＩＲＣに基づく、実施態様５４に記載のシステム。 (51) The optical coherence tomography measurement apparatus further connected to the input unit, wherein the optical coherence tomography measurement apparatus senses the optical characteristic of an eye and transmits the optical characteristic to the processor. The system described in.
(52) The corneal curvature measuring device coupled to the input unit, wherein the corneal curvature measuring device senses the optical characteristic of an eye and transmits the optical characteristic to the processor. system.
(53) The processor derives the effective surgical vector function from a previous corrective surgery in response to the relevant eye target refractive vector (IRC), and the refraction induced by the associated eye surgery. 49. The system of embodiment 48, configured to determine a correction vector (SIRC), each SIRC characterizing a difference between the measured pre-operative aberration and the post-operative aberration of an associated eye.
54. The system of embodiment 53, wherein the effective surgical vector function is based on an influence matrix f that associates the SIRC with the IRC.
(55) For f related eyes, f

Associating the SIRC with the IRC so that
Where

Is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

55. The system of embodiment 54, wherein is the reciprocal of f and IRC ′ is based on the IRC of the patient's eye.

(56) An additional input coupled to the processor for receiving at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC, the processor comprising: Configured to define an IRC ′ for the patient's eye by applying the at least one adjustment to the IRC of the patient's eye, the input vector being based on the IRC ′ 56. A system according to aspect 55.
57. The system of embodiment 45, wherein the effective surgical vector function is based on an influence matrix.
(58) the planned cataract surgery of the patient's eye includes a planned surgery vector, wherein the plurality of components of the input vector each change a plurality of components of the planned surgery vector and / or 49. The system of embodiment 48, wherein the planned surgical vector component varies with each of a plurality of components of the input vector.
59. The embodiment wherein the input vector includes a refractive component that characterizes refraction of the patient's eyes, a non-refractive cofactor that characterizes the patient and / or surgical settings, and a component that characterizes the optical properties of the eye. 48. The system according to 48.
(60) The components that characterize the optical characteristics of the eye include high-order components that characterize high-order aberrations of the eye, low-order components that characterize low-order aberrations of the eye, and corneal topography that characterizes corneal topography measurements of the eye. Embodiment 59 includes an element selected from the group consisting of a measurement component, an optical coherence tomography measurement component characterizing the optical coherence topography measurement of the eye, and a corneal curvature measurement component characterizing the corneal curvature measurement of the eye The system described.

(61) The processor is configured to derive the one or more parameters of the IOL to be implanted in the patient's eye by multiplying the influence matrix of the effective surgical vector function by the input vector. 59. The system of embodiment 58, wherein:
(62) A system for planning cataract surgery for a patient's eye, the system comprising:
A processor,
For receiving data about multiple previous corrective surgeries and for each previous corrective surgery of the associated eye,
Determining a target refractive correction vector (IRC) that characterizes the difference between the relevant pre-measurement pre-operative higher order aberrations and the relevant target eye refraction;
Determining the refraction correction vector (SIRC) induced by the associated eye surgery that characterizes the difference between the pre- and post-measurement aberrations of the associated eye and affecting the data by An input unit for deriving a matrix, wherein the influence matrix includes a correlation between the IRC and the SIRC;
A processor having another input for receiving a patient's IRC vector characterizing a difference between the pre-measurement pre-order aberrations of the patient's eye and a target refraction of the patient's eye;
An output coupled to the processor for transmitting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in the cataract surgery, the processor comprising the influence matrix And an output configured to derive the one or more parameters of the IOL by adjusting an IRC vector of the patient based on the system.
(63) The preoperative optical characteristic of the eye of the patient is at least one selected from the group consisting of low-order aberration, high-order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement Contains elements,
For each of the plurality of previous corrective operations, the preoperative vector characterizes the optical characteristics of the associated eye prior to surgery, the optical characteristics including low order aberrations, high order aberrations, corneal topography measurements, light Including one or more elements selected from the group consisting of coherence tomography measurements and corneal curvature measurements, wherein the post-operative vector characterizes optical properties of the associated eye after surgery, the optical properties being 63. The system of embodiment 62, comprising one or more elements selected from the group consisting of: low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements.
(64) The pre-measurement optical characteristic of the eye of the patient is an element selected from the group consisting of low-order aberration, high-order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement 64. The system of embodiment 62, comprising.
(65) The one or more parameters of the IOL implanted in the patient's eye in the cataract surgery include a frequency of the IOL and a position in the patient's eye where the IOL is implanted. Embodiment 63. The system of embodiment 62.

66. A system for planning cataract surgery for a patient's eye, wherein an influence matrix determines the relevant eye target refraction for each previous corrective surgery of the relevant eye, and said association Determining a target refractive correction vector (IRC) that characterizes the difference between the pre-measurement optical properties of the eye and the target, and between the pre- and post-measurement aberrations of the associated eye Deriving from a plurality of previous corrective operations by determining a refractive correction vector (SIRC) induced by the associated eye surgery, which characterizes the difference between the IRC and the Derived to provide a correlation with SIRC, the system
An input for receiving a patient's IRC vector characterizing the difference between the pre-operative optical properties of the patient's eye and a target refraction of the patient's eye;
A processor coupled to the input, the processor configured to adjust an IRC vector of the patient based on the influence matrix.
(67) The pre-measurement optical characteristics of the related eye may include an element selected from the group consisting of low-order aberration, high-order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement 68. The system of embodiment 66, comprising.
68. The system of embodiment 66, wherein the influence matrix is based on a correlation between pre-operative cylinder values, post-operative spherical values, and pre-operative corneal curvature measurements of the associated eye. .
69. The system of embodiment 66, wherein the influence matrix is based on a correlation between higher order aberrations and preoperative corneal curvature measurements of the associated eye.

Claims (69)

A method for planning cataract surgery for a patient's eye, said method comprising:
Regarding previous corrective surgery for each of the relevant eyes
Defining a preoperative vector characterizing the relevant pre-measurement pre-operative higher order aberrations;
Defining a post-operative vector characterizing the relevant post-measurement post-operative high-order aberrations;
Using the correlation between the preoperative vector and the postoperative vector to derive an effective surgical vector function, thereby determining an effective therapeutic vector function based on a plurality of previous corrective operations To do
Defining an input vector based on the pre-operative high order aberrations of the patient's eye;
Deriving one or more parameters of an intraocular lens (IOL) implanted in the patient's eye by applying the effective surgical vector function to the input vector. Defining the input vector is
Identifying a target refraction of the patient's eye generated by the cataract surgery;
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the measured pre-operative aberration of the patient's eye and the target;
Deriving the effective surgical vector function from previous corrective surgery
Determining a refractive correction vector (IRC) for the relevant eye purpose;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, each SIRC characterizing a difference between the measured preoperative aberration and the postoperative aberration of the associated eye The method of claim 1, comprising: Deriving the effective surgical vector function includes an influence matrix relating the SIRC to the IRC.

The method of claim 2 including determining.

Is related to the related eye

Associating the SIRC with the IRC so that
Where E is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

Is the reciprocal of

4. The method of claim 3, wherein is based on the IRC of the patient's eye. In the IRC of the patient's eye,
Further comprising defining an IRC ′ for the patient's eye by applying at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC;
The method of claim 2, wherein the input vector is based on the IRC ′.   The method of claim 1, wherein the effective surgical vector function is derived using an influence matrix.   The planned surgery of the patient's eye is characterized by a planned surgical vector, and the influence matrix is derived such that multiple components of the input vector each change multiple components of the planned surgical vector. The method according to claim 6.   The planned surgery of the patient's eye is characterized by a planned surgical vector, and the influence matrix is derived such that a plurality of the planned surgical vector components are respectively changed by a plurality of components of the input vector. The method according to claim 6.   The method of claim 1, wherein the preoperative vector and the input vector characterize refraction, a non-refractive cofactor that characterizes the patient and / or surgical settings, and the higher order aberrations of the eye.   The one or more parameters of the intraocular lens are derived by multiplying the influence matrix of the effective surgical vector function by the input vector to define a conditional input vector, the conditional input vector matrix 7. The method of claim 6, wherein the method is derived by planning the cataract surgery by component.   The one or more parameters of the IOL implanted in the patient's eye include the frequency of the IOL and a position in the patient's eye where the IOL is located. the method of. A method for planning cataract surgery for a patient's eye, said method comprising:
Regarding previous corrective surgery for each of the relevant eyes
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, which characterizes a difference between the measured preoperative aberration and the measured postoperative aberration of the associated eye, wherein the influence matrix is Deriving the influence matrix from a plurality of previous corrective operations, derived to provide a correlation between the IRC and the SIRC;
Defining a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix. A method for planning cataract surgery for a patient's eye, wherein an influence matrix determines the relevant eye target refraction for each previous corrective surgery for the associated eye, and the associated eye Determining a refractive correction vector (IRC) for purposes of characterizing the difference between pre-measurement high-order aberrations and the target, and the difference between the pre-measurement aberrations and post-measurement aberrations of the associated eye Determining the refractive vector (SIRC) derived by the associated eye surgery that characterizes the relationship, and wherein the influence matrix is between the IRC and the SIRC. Derived to provide a correlation of:
Receiving a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix. A system for planning cataract surgery for a patient's eye, the system comprising:
An input for receiving preoperative high order aberrations of the patient's eye;
A processor coupled to the input, the processor applying an effective surgical vector function to embed an eye in the patient's eye in accordance with the higher order aberrations of the patient's eye Deriving one or more parameters of an inner lens (IOL), the effective surgical vector function for each of a plurality of previous corrective operations, a preoperative vector characterizing the associated higher-order aberrations of the eye prior to surgery; A processor derived from a correlation between postoperative vectors characterizing postoperative higher order aberrations of the associated eye;
And an output coupled to the processor to transmit the one or more parameters of the IOL implanted in the patient's eye.   The system of claim 14, wherein the processor includes a tangible medium that embodies machine readable instructions for performing the derivation of the one or more parameters of the IOL implanted in the patient's eye.   In response to a target refraction of the patient's eye induced by the cataract surgery, the processor calculates an input vector for the patient's eye as a difference between the measured preoperative aberration of the patient's eye and the target. The system of claim 14, wherein the system is configured to generate by determining a refractive correction (IRC) for characterization purposes.   The system of claim 16, further comprising an aberrometer coupled to the input, wherein the aberrometer senses higher order aberrations of the eye and transmits the higher order aberrations to the processor.   The processor derives the effective surgical vector function from a previous corrective surgery in response to the relevant eye objective refractive vector (IRC) and produces a refractive vector ( 18. The system of claim 17, wherein the system is configured to determine a SIRC), each SIRC characterizing a difference between the measured pre-operative aberration and the post-operative aberration of an associated eye.   15. The system of claim 14, wherein the effective surgical vector function is based on an influence matrix f that associates the SIRC with the IRC. f is related to the related eye

Associating the SIRC with the IRC so that
Where

Is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

20. The system of claim 19, wherein is the reciprocal of f and IRC 'is based on the IRC of the patient's eye. An additional input coupled to the processor for receiving at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC;
The processor is configured to define an IRC ′ for the patient's eye by applying the at least one adjustment to the IRC of the patient's eye, and the input vector is based on the IRC ′. The system of claim 16.   The system of claim 14, wherein the effective surgical vector function is based on an influence matrix.   The planned cataract surgery of the patient's eye includes a planned surgical vector, wherein the plurality of components of the input vector each change a plurality of components of the planned surgical vector and / or a plurality of the planned The system of claim 22, wherein a surgical vector component varies with each of a plurality of components of the input vector.   The input vector includes a refractive component that characterizes refraction of the patient's eyes, a non-refractive cofactor that characterizes the patient and / or treatment settings, and a higher order component that characterizes the higher order aberrations of the eye. 23. The system according to 22.   The processor is configured to derive the one or more parameters of the IOL to be implanted in the patient's eye by multiplying the input matrix by the influence matrix of the effective surgical vector function. The system of claim 22. A system for planning cataract surgery for a patient's eye, the system comprising:
A processor,
For receiving data about multiple previous corrective surgeries and for each previous corrective surgery of the associated eye,
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction;
Determining from the data the refractive correction vector (SIRC) induced by the associated eye surgery that characterizes the difference between the measured preoperative aberration and the measured postoperative aberration of the associated eye. An input unit for deriving an influence matrix, wherein the influence matrix includes a correlation between the IRC and the SIRC;
A processor having another input for receiving a patient's IRC vector that characterizes the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
An output coupled to the processor for transmitting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in the cataract surgery of the patient's eye, A processor configured to derive one or more parameters of the IOL to be implanted in the patient's eye by adjusting the patient's IRC vector based on the influence matrix; A system comprising:   27. The one or more parameters of the IOL implanted in the patient's eye include the frequency of the IOL and a position in the patient's eye where the IOL is located. System. A system for planning cataract surgery for a patient's eye, wherein an influence matrix determines the target eye refraction for each previous corrective surgery for the associated eye, and the associated eye Determining a refractive correction vector (IRC) for purposes of characterizing the difference between pre-measurement high-order aberrations and the target, and the difference between the pre-measurement aberrations and post-measurement aberrations of the associated eye Determining the refraction correction vector (SIRC) induced by the associated eye surgery, wherein the influence matrix is the IRC and the SIRC. Derived so as to provide a correlation between
An input for receiving a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
A processor coupled to the input, the processor configured to adjust an IRC vector of the patient based on the influence matrix. A method for planning cataract surgery for a patient's eye, said method comprising:
Regarding the previous eye treatment of each relevant eye,
Defining a preoperative vector characterizing the relevant pre-measurement optical properties of the eye;
Defining a post-operative vector characterizing the relevant post-measurement optical properties of the eye;
Deriving an effective surgical vector function using a correlation between the pre-operative vector and the post-operative vector, and based on a plurality of previous eye treatments, the effective surgical vector function Determining
Defining an input vector based on the pre-operative optical properties of the patient's eye;
Deriving a treatment for the eye of the patient by applying the effective surgical vector function to the input vector.   30. The pre-measurement optical characteristic includes an element selected from the group consisting of low order aberration, high order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement. Method. Defining the input vector is
Identifying a target refraction of the patient's eye induced by the cataract surgery;
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the measured pre-operative aberration of the patient's eye and the target;
Deriving the effective surgical vector function from previous treatments
Determining a refractive correction vector (IRC) for the relevant eye purpose;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, each SIRC characterizing a difference between the measured preoperative aberration and the postoperative aberration of the associated eye 30. The method of claim 29, comprising: Deriving the effective surgical vector function includes an influence matrix that relates the SIRC to the IRC.

32. The method of claim 31, comprising determining.

Is related to the related eye

Associating the SIRC with the IRC so that
Where E is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

Is the reciprocal of

35. The method of claim 32, wherein is based on the IRC of the patient's eye. In the IRC of the patient's eye,
Further comprising defining an IRC ′ for the patient's eye by applying at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC;
32. The method of claim 31, wherein the input vector is based on the IRC '.   30. The method of claim 29, wherein the effective surgical vector function is derived using an influence matrix.   The planned cataract surgery of the patient's eye is characterized by a planned surgical vector, and the influence matrix is such that multiple components of the input vector each change multiple components of the planned surgical vector. 36. The method of claim 35, wherein the method is derived.   The planned cataract surgery of the patient's eye is characterized by a planned surgical vector, and the influence matrix is derived such that a plurality of the planned surgical vector components are respectively changed by a plurality of components of the input vector. 40. The method of claim 36, wherein:   The planned cataract surgery of the patient's eye is characterized by a planned surgery vector, and the influence matrix is such that all components of the input vector characterizing the refractive shape of the patient's eye are the refractive of the patient's eye. 38. The method of claim 36, derived so that all components of the planned surgical vector characterizing a change in shape can be changed.   30. The method of claim 29, wherein the preoperative vector and the input vector characterize refraction, a non-refractive cofactor that characterizes the patient and / or cataract surgery settings, and the optical properties of the eye.   In the cataract surgery of the patient's eye, one or more parameters of an intraocular lens (IOL) implanted in the patient's eye are multiplied by the input vector to the influence matrix of the effective surgical vector function. 38. The method of claim 36, derived by defining a conditional input vector, and by planning the cataract surgery with a matrix component of the conditional input vector. A method for planning cataract surgery for a patient's eye, said method comprising:
Regarding previous corrective surgery for each of the relevant eyes
Determining a refractive correction vector (IRC) for purposes of characterizing a difference between the associated pre-measurement pre-operative higher order aberrations and the associated target eye refraction;
Determining a refractive correction vector (SIRC) induced by the associated eye surgery, which characterizes a difference between the measured preoperative aberration and the measured postoperative aberration of the associated eye, wherein the influence matrix is Deriving the influence matrix from a plurality of previous corrective operations, derived to provide a correlation between the IRC and the SIRC;
Defining a patient's IRC vector characterizing the difference between the pre-operative higher order aberrations of the patient's eye and the target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix.   For each previous corrective operation of the associated eye, the IRC is further determined to characterize the difference between the measured pre-operative low order aberration and the target low order aberration, and the patient's IRC vector 42. The method of claim 41, further defined to characterize a difference between pre-low order aberrations and the target refraction.   43. Further comprising selecting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in the cataract surgery of the patient's eye based on the adjusted IRC. The method described in 1. A method for planning cataract surgery for a patient's eye, wherein an influence matrix determines the relevant eye target refraction for each previous corrective surgery for the associated eye, and the associated eye Determining a refractive vector (IRC) for purposes of characterizing the difference between the pre-measurement optical property and the target; and between the pre-measurement optical property and the post-measurement optical property of the associated eye Determining a refractive vector (SIRC) derived from the associated eye surgery that characterizes the difference, and wherein the influence matrix is derived from the IRC and the SIRC. Derived so as to provide a correlation between
Receiving a patient's IRC vector characterizing a difference between the pre-operative optical properties of the patient's eye and a target refraction of the patient's eye;
Adjusting the IRC vector of the patient based on the influence matrix. A system for planning cataract surgery for a patient's eye, the system comprising:
An input for receiving preoperative optical properties of the patient's eye;
A processor coupled to the input unit, wherein the processor applies a valid surgical vector function to the patient in the cataract surgery of the patient's eye according to the optical properties of the patient's eye Deriving one or more parameters of an intraocular lens (IOL) implanted in the eye of the eye, the effective surgical vector function for each of a plurality of previous corrective operations, the associated eye optics prior to surgery A processor derived from a correlation between a preoperative vector characterizing a characteristic and a postoperative vector characterizing the associated postoperative optical characteristic of the eye;
And an output coupled to the processor to transmit the one or more parameters of the IOL implanted in the patient's eye during the cataract surgery. The preoperative optical properties of the patient's eye include at least one element selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. ,
For each of the plurality of previous corrective operations, the preoperative vector characterizes the optical characteristics of the associated eye prior to surgery, the optical characteristics including low order aberrations, high order aberrations, corneal topography measurements, light Including one or more elements selected from the group consisting of coherence tomography measurements and corneal curvature measurements, wherein the postoperative vector characterizes optical properties of the associated eye prior to surgery, 46. The system of claim 45, comprising one or more elements selected from the group consisting of: low order aberration, high order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement.   47. The one or more parameters of the IOL implanted in the patient's eye in the cataract surgery include a frequency of the IOL and a position in the patient's eye where the IOL is implanted. The described system.   In response to a target refraction of the patient's eye induced by the cataract surgery, the processor calculates an input vector for the patient's eye as a difference between the measured preoperative aberration of the patient's eye and the target. 46. The system of claim 45, wherein the system is configured to generate by determining a target refractive correction (IRC) to be characterized.   An aberrometer connected to the input unit, wherein the aberrometer senses the low-order aberration of the eye and the high-order aberration of the eye, and transmits the low-order aberration and the high-order aberration to the processor; 46. The system of claim 45.   50. The system of claim 49, wherein the aberrometer is configured to sense a corneal topography and send the corneal topography to the processor.   46. The optical coherence tomography measurement device coupled to the input unit, wherein the optical coherence tomography measurement device senses the optical characteristic of an eye and transmits the optical characteristic to the processor. system.   46. The system of claim 45, further comprising a corneal curvature measurement device coupled to the input, wherein the corneal curvature measurement device senses the optical characteristic of an eye and transmits the optical characteristic to the processor.   The processor derives the effective surgical vector function from a previous corrective surgery in response to the relevant eye objective refractive vector (IRC) and produces a refractive vector ( 49. The system of claim 48, configured to determine a SIRC), each SIRC characterizing a difference between the measured pre-operative aberration and the post-operative aberration of an associated eye.   54. The system of claim 53, wherein the effective surgical vector function is based on an influence matrix f that associates the SIRC with the IRC. f is related to the related eye

Associating the SIRC with the IRC so that
Where

Is the error vector,
Applying the effective surgical vector function to the input vector includes calculating an adjusted target refractive vector (AIRC);

And
Where

55. The system of claim 54, wherein is the reciprocal of f and IRC ′ is based on the IRC of the patient's eye. An additional input coupled to the processor for receiving at least one adjustment selected from the group consisting of a physician adjustment to the IRC and a nomogram adjustment to the IRC, the processor comprising the patient 56. The apparatus of claim 55, wherein the input vector is based on the IRC ', wherein the input vector is configured to define an IRC' for the patient's eye by applying the at least one adjustment to the IRC of the eye. The system described.   46. The system of claim 45, wherein the effective surgical vector function is based on an influence matrix.   The planned cataract surgery of the patient's eye includes a planned surgical vector, wherein the plurality of components of the input vector each change a plurality of components of the planned surgical vector and / or a plurality of the planned 49. The system of claim 48, wherein a surgical vector component varies with each of a plurality of components of the input vector.   49. The input vector includes a refractive component that characterizes refraction of the patient's eyes, a non-refractive cofactor that characterizes the patient and / or surgical settings, and a component that characterizes the optical properties of the eye. System.   The component characterizing the optical characteristics of the eye includes a high-order component characterizing high-order aberrations of the eye, a low-order component characterizing low-order aberrations of the eye, a corneal topography measurement component characterizing the corneal topography measurement value of the eye, 60. The system of claim 59, comprising an element selected from the group consisting of an optical coherence tomography measurement component that characterizes the optical coherence topography measurement of the eye and a corneal curvature measurement component that characterizes the corneal curvature measurement of the eye. .   The processor is configured to derive the one or more parameters of the IOL to be implanted in the patient's eye by multiplying the input matrix by the influence matrix of the effective surgical vector function. 59. The system of claim 58. A system for planning cataract surgery for a patient's eye, the system comprising:
A processor,
For receiving data about multiple previous corrective surgeries and for each previous corrective surgery of the associated eye,
Determining a target refractive correction vector (IRC) that characterizes the difference between the relevant pre-measurement pre-operative higher order aberrations and the relevant target eye refraction;
Determining the refraction correction vector (SIRC) induced by the associated eye surgery that characterizes the difference between the pre- and post-measurement aberrations of the associated eye and affecting the data by An input unit for deriving a matrix, wherein the influence matrix includes a correlation between the IRC and the SIRC;
A processor having another input for receiving a patient's IRC vector characterizing a difference between the pre-measurement pre-order aberrations of the patient's eye and a target refraction of the patient's eye;
An output coupled to the processor for transmitting one or more parameters of an intraocular lens (IOL) implanted in the patient's eye in the cataract surgery, the processor comprising the influence matrix And an output configured to derive the one or more parameters of the IOL by adjusting an IRC vector of the patient based on the system. The preoperative optical properties of the patient's eye include at least one element selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. ,
For each of the plurality of previous corrective operations, the preoperative vector characterizes the optical characteristics of the associated eye prior to surgery, the optical characteristics including low order aberrations, high order aberrations, corneal topography measurements, light Including one or more elements selected from the group consisting of coherence tomography measurements and corneal curvature measurements, wherein the post-operative vector characterizes optical properties of the associated eye after surgery, the optical properties being 64. The system of claim 62, comprising one or more elements selected from the group consisting of: low order aberration, high order aberration, corneal topography measurement, optical coherence tomography measurement, and corneal curvature measurement.   The preoperative optical properties of the patient's eye include elements selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. Item 63. The system according to Item 62.   The one or more parameters of the IOL implanted in the patient's eye in the cataract surgery include a frequency of the IOL and a position in the patient's eye where the IOL is implanted. 63. The system according to 62. A system for planning cataract surgery for a patient's eye, wherein an influence matrix determines the target eye refraction for each previous corrective surgery for the associated eye, and the associated eye Determining a refractive correction vector (IRC) for purposes of characterizing the difference between the pre-measurement optical property and the target, and determining the difference between the pre-measurement aberration and the post-measurement aberration of the associated eye. Determining a refractive vector (SIRC) derived from the associated eye surgery that is characterized and derived from a plurality of previous corrective surgeries, wherein the influence matrix is calculated between the IRC and the SIRC. Derived to provide a correlation between, the system
An input for receiving a patient's IRC vector characterizing the difference between the pre-operative optical properties of the patient's eye and a target refraction of the patient's eye;
A processor coupled to the input, the processor configured to adjust an IRC vector of the patient based on the influence matrix.   The pre-measurement optical properties of the associated eye include elements selected from the group consisting of low order aberrations, high order aberrations, corneal topography measurements, optical coherence tomography measurements, and corneal curvature measurements. Item 66. The system according to Item 66.   68. The system of claim 66, wherein the influence matrix is based on a correlation between pre-operative cylinder values, post-operative spherical values, and pre-operative corneal curvature measurements of the associated eye.   68. The system of claim 66, wherein the influence matrix is based on a correlation between higher order aberrations and preoperative corneal curvature measurements of the associated eye.

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