Ophthalmologic device for laser therapy
Technical field
Invention belongs to the ophthalmology field, is the laser therapy of eye specifically.
Technical merit
The treatment effect of laser emission effect general with improve the eye blood vessel in blood microcirculation and directly the cell source of students encourage relevant.This effect is in particular in the raising vision definition, eliminates the nervous spasm adjust, with the danger that reduces myopia progression with alleviate in-plant visual task, if the nutritious bad variation that causes at the eyeball rear portion can also improve amphiblestroid situation [1-3].
Penetration depth is than the radiation in as seen wide near-infrared spectra district in tissue if utilize, and the incentive action of passing through the laser of sclera strengthens [1-3].For example, in order to improve the underfed effect of the various forms of retinas of treatment, in [3], propose to utilize the laser emission of 1.3 microns of wavelength.Adopt infra-red radiation to carry out laser therapy, because infrared ray be cannot see, how the eye district of selecting being aimed in radiation is a problem.This is important to therapeutic efficiency not only, and is related to the safety of treatment, because corpus ciliare and amphiblestroid permission illumination levels have the difference of magnitude.
Known and utilized the laser emission treatment such as diseases such as retina malnutrition, at this moment infrared ray or visible radiation act on amphiblestroid center.For example, document [3] has proposed to utilize the method for the underfed raising curative effect of laser emission treatment retina various forms of 1.3 micron wave lengths.
Known eye diseases therapy [1] comprises the optical unit that two bands act on the generating laser in eyeball calibration district, optical launcher, and the optical forming device, power supply and band are provided with the control unit of irradiation time timer.These optical units are set on the framework of " glasses " shape, with governor motion, the generating laser of the optics that each is such, and optical launcher, the optical forming device can move (adjustment) relative to the optical axis of eyes.Consistent with patient's interpupillary distance for the position that makes optical unit, this is essential.Light emitter in this covering device (light emitting diode) generates luminous point of aim mark by means of the optical forming device and supplies fixedly sight line usefulness of patient as benchmark.At intervalometer in given time, Laser emission body running, labelling flicker.During this period of time the radiation effects of lasing light emitter focuses on the ciliary muscle projected area in corpus ciliare, at 3 o'clock and the 9 o'clock place of sclera.
In the embodiment of finishing above-mentioned task of this device, though also can guarantee the safety that laser therapy is essential, the untoward reaction of following has reduced curative effect.This is relevant with the vision hypertonicity that may occur, and the patient concentrates on attention on the flicker labelling from light emitter in whole therapeutic process, and regular meeting causes fatigue and discomfort, thereby the effect of laser emission therapeutical effect is reduced.Suffer from assemble weaken, the patient of myopia, high hypermetropia, visual deterioration and generally young child these untoward reaction can appear especially.For these patients, the long enough time is fixed on sight line the hypertonicity that can cause vision on the low coverage luminescent marking.Therefore need find a solution, remain on the direction of requirement, not take place simultaneously or reduce above-mentioned untoward reaction widely to guarantee patient's sight line.
Essence of an invention
Technical assignment of the present invention is the method with the alignment restrictions patient visual field, generates in the direction that requires and observes passage, uses the efficient that improves laser therapy and is reduced in subject discomfort sense in the process for the treatment of.At this moment do not exist to require the patient that attention is concentrated on the problem of near viewing target (passage of scintillation light sign), eyes are in comfortable state, do not have what factor to impel to adjust nervous and cause untoward reaction above-mentioned.Simultaneously, because horizontal visual angle limited (so being called " passage ") watches passage to make patient's sight line remain on the direction of requirement.This direction is preferably consistent with the optical axis of eyeball.
In addition, task of the present invention is to solve amalgamation in the problem of eyeball calibration district and center.Like this, might utilize the instrument of proposition to act on the calibration district of eyeball with laser emission, not only encourage ciliary muscle, and act on the treatment of amphiblestroid center such as diseases such as retina malnutrition, treat retina and excitation ciliary muscle simultaneously with infrared ray or visible light.
The solution of the problems referred to above is, in comprising the device for laser therapy of at least one optical unit, one or several generating laser and optical forming device are arranged, make laser action one or several location in eyeball calibration district, the formation device of watching passage that also has a given direction of visual lines, this device are made the visual field, location limiter.
The binocular constructional device is used for the binocular effect to two above-mentioned optical units, it also comprises an adjustment mechanism, two optical units and/or the visual field, location delimiter are installed in above the adjustment mechanism, relatively move at the widthwise of axis, make the mutual placement of watching passage of these optical units consistent with patient's interpupillary distance perpendicular to them.
Under the part situation, the visual field, location delimiter adopts diaphragm or telescopic system.
Sometimes locate the visual field limiter entrance hole diameter of optical unit above-mentioned is included, at this moment the entrance hole diameter is the ingate or the eyepiece of above-mentioned optical unit.
25 millimeters of the above-mentioned optical unit of the common distance of above-mentioned diaphragm ingates.
In order to realize that on an equipment amalgamation is in retina and corpus ciliare, treat retina and excitation corpus ciliare simultaneously, that device also includes watching of one or several and optical unit is channel attached, acts on foveal region of retina district, infrared ray or visible radiation source.
In order to guarantee to encourage the sensory probability of eyes, impel raising vision definition and supplemental laser radiation spectrum to act synergistically on the eyes organ, thereby enlarge the function and the medical probability of equipment, above-mentioned for the radiation source that acts on the nethike embrane center be to realize the visible light lasing source of optical coupling with watching passage by means of interferogram in order or at random.
Be shaped in order image or at random the constructional device of interference image comprise diffraction grating or diffuse scattering system.
In certain embodiments, the above-mentioned radiation source that acts on the foveal region of retina district is the visible light lasing light emitter, realizes optical coupling by means of the diffuser screen that other adds with watching passage.
In another case, in order to shine amphiblestroid core, one of lasing light emitter is realized optical coupling through radiation diverter and this unitary passage of watching in each optical unit, and acts on intensity little 3 magnitudes of the radiant intensity in foveal region of retina district than generating laser.
Wherein, diverter is made by glass plate or quartz plate system, or is made by the semitransparent reflector mirror system.
The simple description of accompanying drawing
The embodiment that essence of the present invention described above is made patient visual field limiter in order to diaphragm is illustrated.
Fig. 1-the 3rd adopts the different schemes compound action in the optical schematic diagram of the Ophthalmologic device for laser therapy in eye calibration district and foveal region of retina district: to utilize the additional independent infrared light or the monocular instrumnent scheme (Fig. 1) of visible radiation source, binocular scheme (Fig. 2), or utilize a lasing light emitter as described source (Fig. 3).
Invention embodiment
Ophthalmologic device for laser therapy comprises (Fig. 1) optical unit 1, it is with two lasing light emitters 2 (semiconductor laser), each lasing light emitter is furnished with optical forming device 3 (lens, be installed on the axis of this emitter), supply laser emission to act on the position (on Fig. 1, not marking) of a correspondence in calibration district (schematically illustrating).Optical unit 1 also includes location visual field limiter (for example, diaphragm) generation and watches passage 5, provides the direction of patient's sight line.Diaphragm 4 (3 millimeters in aperture) is positioned on the axis 6 of optical unit 1, and 25 millimeters apart from the ingate, the purposes of this unitary ingate 7 (duck eye or eyepiece) is to watch in therapeutic process for the patient.In order to shine the position at 3 o'clock of calibration district and 9 o'clock, generating laser 2 is arranged in the both sides of diaphragm 4, is symmetrical in the axis 6 of optical unit 1.The laser irradiation direction of at this moment watching passage and acting on eyes is conllinear not.
In addition, optical unit 1 can comprise to be used to shine the foveal region of retina district has the visible light lasing light emitter 8 (He-Ne laser instrument) of optical coupling with the passage 5 of watching unit 1.Realize coupling with half-mirror 9, reflecting mirror is installed in source 8 and watches on the axis of passage 5, constitutes suitable angle.The condition of choosing of the penetrating coefficient of reflecting mirror 9 is not hinder the patient to watch the target in a distant place by the outlet opening 10 of optical unit 1 with it.In order to make the patient watch laser spot figure, on the axis in source 8, diffuse scattering mechanism (clouded glass) can be installed between source and reflecting mirror 9 from source 8.
Device can be made into the monocular structure, also can be the binocular structure.Different with the monocular device that Fig. 1 shows, in the binocular device of Fig. 2, each eyepiece respectively has the laser emitting source 2 of a band optical forming device 3.In addition, source 8 is whole device service, by means of half-mirror 9, watches passage 5 that optical coupling is arranged for two of it and the first and second two optical units.Patient's eyes are through ingate 7, diaphragm 4, reflecting mirror 9, outlet 10 distant place targets of watching the visual field of being limited by passage 5 that is arranged in optical unit 1.Fig. 2 apparatus features is that to watch the light path of passage 5 are broken lines, has dislocation between the outlet 10 relative ingates 1 of optical unit 1.Two reflecting mirrors 12,13 that above characteristics rely on relative unit axis 6 to tilt realize that their mutually countershaft 6 directions are laterally placed, and one of them is towards the ingate 7, and another is towards outlet opening 10.
In the binocular acting device, the outlet opening 10 of optical unit 1 may have displacement each other, that is to say, the distance between them may be less than the interpupillary distance of patient's eye.Above measure makes and might reduce to the above-mentioned untoward reaction of patient minimum.
The binocular acting device can add adjustment mechanism in addition, and the optical unit of band visual field delimiter is housed thereon.Optical unit can move (as opera glass) each other at the horizontal direction perpendicular to their axis makes the distance of watching passage of two optical units consistent with patient's interpupillary distance.
On Fig. 3, adopt generating laser 2 as source 8 (referring to Fig. 1), for this reason it by diverter and with these unitary passage 5 optical coupled of watching, diverter also is in order to act on the foveal region of retina district.This radiation diverter is made of two half-mirrors 14 and 15, and one of them (14) towards the ingate 7 of optical unit 1, another is towards lasing light emitter 2.
Can be made into plate shape on diaphragm 4 structures, for example, stripe board with holes, the hole is positioned on the above-mentioned axle of optical unit, in its one or both sides (be fixed on the cell enclosure, diaphragm is as the same) one or two lasing light emitter (for example laser diode) is installed, each emitter all is with an optical forming device.If the use circular iris can shine the position by the quilt that arrives eye in order to make the radiation from lasing light emitter, (in case of necessity) opens via hole on it.Diaphragm 4 can be installed on the shell of unit 1, can move (in order to provide the channel direction of watching of demand) and be fixed on selected position on the plane of diaphragm.Certainly may be with other scheme limits vision, for example with lens or the telescopic system be made up of mirror, corresponding its amplification patient's visual field reduces.Adopt this visual field limiter scheme, the inlet of optical unit is on the axis of visual field limiter system, and the axis of visual field limiter system is the axis of optical unit just.The aperture of telescopic system, its determining positions in the unit guarantee that in the visual field visual field is the 3-6 degree.
Can exceed above-mentioned field-of-view angle scope.Lower limit is not require great effort especially the minimum angles patient to differentiate object.The upper limit is that pupil is moving within sweep of the eye, and the ray of lasing light emitter can not got to pupil.
Can see visual field limiter importantly being arranged from above discussion, and not lie in its specific embodiments for this invention.In order to affact amphiblestroid center, implement to watch the scheme of passage to have multiple.Each optical unit 1 of the first has an infrared ray or visible radiation source (for example laser) 8, and with this unitary passage of watching optical coupling is arranged.Another program is to carry out optical coupling for the passage (the monocular instrumnent device is, and the binocular device is two) of watching that whole device adds one or several such source and they and all optical unit.As such source, can in each optical unit, utilize among the generating laser, interpolation is with this unitary optical coupling of watching passage, send a part of radiant light to the foveal region of retina part through the overshoot diverter, the radiant intensity of telling should be than low 3 magnitudes of generating laser radiant intensity.Therefore, the radiation diverter can be made up of two coupled thin glass of plane parallel optics or piezoid.One of them inclination is installed on the Laser emission body axis, and another is installed on the axis of optical unit in a similar fashion.Replace above-mentioned thin slice and also can use translucent optical coupling reflecting mirror (the same magnitude of penetrating coefficient), one of them is towards the inlet of optical unit, and another is towards generating laser.Such diverter does not hinder device to finish the basic function of oneself-with watching the passage patient sight line to be remained on laser stimulation ciliary muscle under the condition of desired direction.
The schematic diagram shows of describing source and the optical coupling of watching passage.For above-mentioned invention embodiment important only be to exist optical coupling to guarantee that laser emission acts on the calibration district that the foveal region of retina district acts on eye simultaneously, rather than concrete form of implementation.
Utilize the visible light lasing light emitter fascinating especially,, realize the optical coupling of watching passage of radiation and optical unit by means of generating in order or the device of interference image at random as the above-mentioned source that acts on the foveal region of retina district.Can utilize for example suitable diffraction grating or diffuse scattering device (for example clouded glass) as such device.The laser spot point diagram that the medium diffuse scattering generates under latter event itself is the object of watching for the patient.The state of interferogram clearly that at this moment generates on retina and eyes optics organ and condition of illness are irrelevant.The patient accepts the organ of adjusting of so visual eyes can be nervous, loosens fully.In order to watch laser irradiation speckle figure in therapeutic process, above-mentioned scattering mechanism can be placed on the source and as the source with watch between the tilting mirror of passage optical coupling.Should emphasize once more, watch the observed speckle figure of passage can play immobilized patients sight line object.Other device design also is feasible, and independently unit is made in the additional laser source that acts on the foveal region of retina district, and it watches the optical coupling of passage to realize by means of the diffuser screen that is arranged in the patient visual field of additional introducing device with optical unit.
Device is running in the following manner.The suggestion patient 7 watches the distant place object (not shown on Fig. 1) that is positioned at outlet opening 10 back from the ingate, the speckle figure that perhaps watches diffuse scattering mechanism 11 to generate.At this moment the so fixing sight line of patient: make and watch object or speckle to be positioned at center, the visual field.After this, connect generating laser 2.With watching passage 5, the direction of patient's sight line that shaping diaphragm 4 is given, two positions at 3 o'clock of calibration district and 9 o'clock 4, about 14 millimeters apart from the center of speckles are delivered in the radiation of the emitter 2 that is shaped through optical forming device 3 simultaneously.The duration of a laser therapy, was generally 2 to 5 minutes by timer given (not shown on Fig. 1) as the way of [1].The treatment retina also inserts source 8 when needing, its radiation with reflecting mirror 9 along watching passage 5 to pass 7 directive foveal region of retina districts, ingate.The work (not shown on Fig. 1) in independent timer control source 8.After the scheduled time had arrived, timer was turned off generating laser 2 and source 8.The work of several timers is independently of one another.The frame mode of Fig. 3 is preferably adopted in their work synchronously if desired, and 8 effect simultaneously originates from source 2 here.With the work of timer by power supply and control device (not shown on Fig. 1) control source 2 and source 8 is not characteristics of the present invention, so it is not limited.Can utilize suitable shutter (for example electric light formula) to cut off the conveying of radiation to eyes calibration district and foveal region of retina district at emitter 2 and source 8 outputs place.When using binocular constructional device (Fig. 2), the working method of opticator is similar.Difference is before every treatment, watches the position of passage to put and own interpupillary distance consistent location for handle, and the patient need move the opticator 1 that links together with diaphragm 4 with the horizontal direction of adjustment mechanism (not shown on Fig. 2) mutually countershaft 6.Whether the patient is integrated according to two observed targets of eyes makes a decision.At this moment the optic axis 6 of watching axle and unit 1 of eyes should overlap fully.After this, above-described synergism can be realized simultaneously at patient's eyes.
In order to confirm to invent the probability of realization and the high efficiency that provides the laser therapy eye to adjust organ lesion, enumerate the example that uses apparatus of the present invention.
Patient K diagnoses 10 years progressivity myopia.Do not have the binocular vision 0.1 of correction, astigmatism-2.5Dptr is 0.9.Adjusting reserves relatively is-2.0Dptr.Patient carries out 10 days one courses of treatment of laser therapy.Act on 3 o'clock of calibration district and 9 o'clock place with 1.3 micron wave length iraser radiation monocular instrumnents.Accumulated dose 0.2J/cm
2Shine the calibration district and observe the combination of LASER SPECKLE structure by the passage of watching that collimates out with diaphragm simultaneously.
Because treatment is adjusted accretion of stock relatively to 4.0Dptr.Do not have the binocular vision of correction and become 0.2, astigmatism-2.0Dptr is 1.0.
Industrial applicibility
The present invention can be used for improving treatment eyes by the laser stimulation ciliary muscle and adjusts organ lesion Efficient is improved the ability of adjusting of eyes, and visual performance and vision ability to work and reduction were treated The bad reaction that discomfort in the journey and minimizing are followed. In addition, utilize it can realize laser The comprehensive function for the treatment of: pass sclera on the one hand and act on ciliary body and act on simultaneously retina The center promotes the blood circulation in the choroid, improves retina and sense organ allomeric function, Can also optimize therapeutic process according to patient's concrete condition.
List of references
1. be used for the treatment of eyes and adjust the iraser therapeutic instrument of ability damage, nineteen ninety-five is interfered and the nonlinear optics meeting paper in the 8th " laser optics " meeting and the 15th world
2. the application of treatment method of helium neon laser in eye function research and vision drill method treatment amblyopia and nystagmus introduced, Russian Ministry of Public Health, the female Ge Erci in Hull hospital
3. the application of mental retardation iraser radiation in improving retina patient blood supply and raising eye function, the doctor uses Therapeutic Method reference material Russia Ministry of Public Health, the female Ge Erci in Hull hospital