JP2019081091A - Laser treatment device - Google Patents

Abstract

To improve operability of an ophthalmic laser treatment.SOLUTION: A laser treatment device is used for performing laser treatment of a patient's eye through a contact lens that is brought into contact with the patient's eye. The laser treatment device includes a holding unit for holding the contact lens, a moving mechanism for moving the contact lens held by the holding unit, an irradiation system for deflecting a laser beam output from a light source based on a preset pattern, and irradiating it onto the patient's eye, a control unit for executing control of the irradiation system and control of the moving mechanism in a combined manner, an imaging unit for imaging the patient's eye when at least the control of the irradiation system is executed, and an analysis unit for generating information for controlling the moving mechanism by analyzing the image acquired by the imaging unit. The control unit executes control of the moving mechanism based on the information generated by the analysis unit.SELECTED DRAWING: Figure 3

Description

  The present invention relates to a laser treatment apparatus used in the ophthalmologic field.

  Laser therapy devices are used to treat various eye diseases. For example, in the treatment of certain types of glaucoma, there is a treatment that irradiates a laser at a corner (a region between the cornea and the iris, including the trabecular meshwork) to form an outflow channel of aqueous humor. In addition, retinal photocoagulation is used in retinal diseases such as diabetic retinopathy.

  In a laser treatment apparatus, after aiming at a treatment site using aiming light of a predetermined pattern (arrangement of a plurality of spots), one configured to irradiate the treatment area with a laser beam of a predetermined pattern is known. (See, for example, Patent Documents 1 to 3). Patent Document 3 discloses an embodiment for applying laser treatment to the entire circumference of a corner angle by irradiating a laser beam having a linear or arc pattern one by one so as to join them one after another.

Japanese Patent Application Publication No. 2009-514564 JP 2014-54462 A Patent No. 5166454 gazette

  In such laser treatment, observation of a treatment site and irradiation of a laser are performed through a contact lens that is in contact with the patient's eye. While performing the laser treatment, the doctor holds the contact lens with one hand, operates the slit lamp microscope with the other hand, and further performs an operation for laser irradiation using the hand or foot. In addition, in order to adjust the observation site and the laser irradiation site, the doctor needs to perform operations such as rotating or tilting the contact lens and moving it back and forth (for focusing). In addition, laser treatment generally takes about ten to several tens of minutes. Thus, in the ophthalmic laser treatment, a very complicated task has to be performed for a long time, which places a great burden on the doctor.

  An object of the present invention is to improve the operability of ophthalmic laser treatment.

  The laser treatment apparatus of the embodiment is used to perform laser treatment of a patient's eye via a contact lens that is in contact with the patient's eye. This laser treatment apparatus deflects the laser light output from the light source based on a preset pattern, by holding the contact lens, moving mechanism for moving the contact lens held by the holding unit, and An irradiation system for irradiating the patient's eye, a control unit for executing the control of the irradiation system and the control of the moving mechanism, and an imaging unit for imaging the patient's eye when at least the control of the irradiation system is executed And an analysis unit configured to generate information for controlling the moving mechanism by analyzing the image acquired by the unit. The control unit executes control of the moving mechanism based on the information generated by the analysis unit.

  According to the embodiment, the operability of the ophthalmic laser treatment can be improved.

BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic which shows the structural example of the laser treatment apparatus which concerns on embodiment. BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic which shows the structural example of the laser treatment apparatus which concerns on embodiment. BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic which shows the structural example of the laser treatment apparatus which concerns on embodiment. It is the schematic for demonstrating the laser therapeutic apparatus which concerns on embodiment. It is the schematic for demonstrating the laser therapeutic apparatus which concerns on embodiment. It is the schematic for demonstrating the laser therapeutic apparatus which concerns on embodiment. It is the schematic for demonstrating the laser therapeutic apparatus which concerns on embodiment. It is a flowchart which shows an example of the usage form of the laser treatment apparatus which concerns on embodiment. It is the schematic for demonstrating the usage form of the laser treatment apparatus which concerns on embodiment. It is the schematic for demonstrating the usage form of the laser treatment apparatus which concerns on embodiment. It is the schematic for demonstrating the usage form of the laser treatment apparatus which concerns on embodiment. It is the schematic for demonstrating the usage form of the laser treatment apparatus which concerns on embodiment. BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic which shows the structural example of the laser treatment apparatus which concerns on embodiment.

  Examples of embodiments of the laser treatment device according to the present invention will be described in detail with reference to the drawings. In the following embodiments, the techniques described in the above patent documents can be used arbitrarily. In addition, some of the embodiments and modifications described below can be arbitrarily combined.

  Define the direction. The direction from the device optical system toward the patient is referred to as the forward direction, and the opposite direction is referred to as the backward direction. Further, the horizontal direction orthogonal to the front direction is taken as the left and right direction. Furthermore, the direction perpendicular to both the front-rear direction and the left-right direction is the vertical direction.

First Embodiment
[Constitution]
An example of a structure of the laser treatment apparatus 1 which concerns on this embodiment is shown in FIG. The laser treatment apparatus 1 is used to apply laser treatment to a patient's eye E. Laser treatment is applied to the fundus oculi Ef and corners. The corner is a portion where the cornea Ec and the iris Ei are in contact. The symbol El shown in FIG. 1 represents a crystalline lens.

  The laser treatment apparatus 1 includes a light source unit 2, a slit lamp microscope 3, an optical fiber 4, a processing unit 5, an operation unit 6, and a display unit 7. Note that, instead of the slit lamp microscope 3, a microscope for surgery, an ophthalmoscope, an observation device of an intraocular insertion type, or the like may be used.

  The light source unit 2 and the slit lamp microscope 3 are optically connected via an optical fiber 4. The optical fiber 4 has one or more light guide paths. The light source unit 2 and the processing unit 5 are connected to be able to transmit signals. The slit lamp microscope 3 and the processing unit 5 are connected to be able to transmit signals. The operation unit 6 and the processing unit 5 are connected to be able to transmit signals. The transmission mode of the signal may be wired or wireless.

  The processing unit 5 includes a computer that operates by cooperation of hardware and software. The processing executed by the processing unit 5 will be described later. The operation unit 6 is configured to include various hardware keys and / or software keys (GUI). As an example of a hardware key, a button, a handle, a knob, and a keyboard pointing device (mouse, track ball, etc.) provided in a computer (processing unit 5 etc.) connected to the slit lamp microscope 3 Etc.), and a foot switch, operation panel, etc. provided separately. The software key is displayed, for example, on the slit lamp microscope 3 or a display device provided in the computer.

(Light source unit 2)
The light source unit 2 generates light to be irradiated to the patient's eye E. The light source unit 2 includes an aiming light source 2a, a treatment light source 2b, a galvano mirror 2c, and a light shielding plate 2d. In addition, members other than the members shown in FIG. 1 can be provided in the light source unit 2. For example, an optical element (such as a lens) may be provided just before the optical fiber 4 to cause the light generated by the light source unit 2 to enter the end face of the optical fiber 4.

(Aiming light source 2a)
The aiming light source 2a generates an aiming light LA for aiming at a site to be subjected to the laser treatment. An arbitrary light source is used as the aiming light source 2a. For example, if the configuration aiming while visually observing the patient's eye E is applied, a light source for emitting a recognizable visible light by the operator's eye E ₀ (a laser light source, light emitting diode, or the like) is used as an aiming light source 2a. Moreover, when the structure which aims at aiming while observing the imaging | photography image of patient eye E is applied, the light source (a laser light source, a light emitting diode, etc.) which emits the light of a wavelength range which an imaging device for acquiring a photography image has sensitivity. Is used as the aiming light source 2a. The aiming light LA is guided to the galvano mirror 2c. The operation of the aiming light source 2a is controlled by the processing unit 5.

(Treatment light source 2b)
The treatment light source 2b emits laser light for treatment (treatment light LT). The treatment light LT may be visible laser light or invisible laser light depending on the application. Also, the treatment light source 2b may be a single laser light source or a plurality of laser light sources that emit laser light of different wavelengths. The treatment light LT is guided to the galvano mirror 2c. The operation of the treatment light source 2 b is controlled by the processing unit 5.

(Galvano mirror 2c)
The galvano mirror 2 c is configured to include a mirror having a reflective surface, and an actuator that changes the orientation of the mirror (the orientation of the reflective surface). The sighting light LA and the treatment light LT reach the same position on the reflective surface of the galvano mirror 2c. The aiming light LA and the treatment light LT may be collectively referred to as “irradiation light”. The direction of (the reflection surface of) the Galvano mirror 2c is at least the direction of reflecting the irradiation light toward the optical fiber 4 (the direction of irradiation) and the direction of reflecting the irradiation light toward the light shielding plate 2d (the direction of stopping) And will be changed. The operation of the galvano mirror 2 c is controlled by the processing unit 5.

(Light shield 2d)
When the galvano mirror 2c is disposed in the stopping direction, the irradiation light reaches the light shielding plate 2d. The light shielding plate 2d is a member made of, for example, a material and / or a form that absorbs the irradiation light, and has a light shielding function.

  In the present embodiment, the aiming light source 2a and the treatment light source 2b respectively generate light continuously. Then, the irradiation light is irradiated to the patient's eye E by arranging the galvano mirror 2 c in the irradiation direction. In addition, the irradiation of the irradiation light to the patient's eye E is stopped by arranging the galvanometer mirror 2c in the stopping direction.

  In another embodiment, the aiming light source 2a and / or the treatment light source 2b may be configured to be capable of intermittently generating light. That is, the aiming light source 2a and / or the treatment light source 2b may be configured to be capable of generating pulsed light. The pulse control for that is performed by the processing unit 5. When this configuration is applied, it is not necessary to provide the galvano mirror 2c and the light shielding plate 2d.

(Slit lamp microscope 3)
The slit lamp microscope 3 is a device used to observe the anterior segment of the patient's eye E and the fundus oculi Ef. More specifically, the slit lamp microscope 3 is an ophthalmologic apparatus for illuminating the patient's eye E with slit light and observing the illumination field in an enlarged manner. Note that “observation” includes one or both of observation with the naked eye and observation of a photographed image by the imaging device.

  The slit lamp microscope 3 includes an illumination unit 3a, an observation unit 3b, an eyepiece unit 3c, and a laser irradiation unit 3d. The illumination system 10 shown in FIG. 2 is stored in the illumination unit 3a. An observation system 30 is stored in the observation unit 3 b and the eyepiece unit 3 c. A photographing system 40 is further stored in the observation unit 30d. A laser irradiation system 50 is stored in the laser irradiation unit 3d.

  Although not shown, the slit lamp microscope 3 is provided with operation members such as a lever, a handle, a button, and a knob as in the conventional case. These operation members are functionally included in the operation unit 6. In the configuration shown in FIG. 1, the processing unit 5 that receives the signal from the operation unit 6 is configured to control the slit lamp microscope 3. However, only the mechanism that operates using such an electrical driving force Alternatively, a mechanism that operates using the driving force applied by the operator can be applied.

(Optical system of slit lamp microscope 3)
The optical system of the slit lamp microscope 3 will be described with reference to FIG. The patient's eye E is in contact with the fundus oculi Ef and a contact lens CL used for laser treatment of an angle. The slit lamp microscope 3 includes an illumination system 10, an observation system 30, an imaging system 40, and a laser irradiation system 50.

(Lighting system 10)
The illumination system 10 outputs illumination light for observing the patient's eye E. The illumination unit 3a is configured to be capable of changing the direction of the optical axis (illumination optical axis) 10a of the illumination system 10 in the left-right direction and the up-down direction. Thereby, the illumination direction of the patient's eye E can be arbitrarily changed.

  The illumination system 10 includes a light source 11, a condenser lens 12, filters 13, 14 and 15, a slit diaphragm 16, imaging lenses 17, 18 and 19, and a deflection member 20.

  The light source 11 outputs illumination light. The illumination system 10 may be provided with a plurality of light sources. For example, both the light source (halogen lamp, LED, etc.) that outputs steady light and the light source (xenon lamp, LED, etc.) that outputs flash light can be provided as the light source 11. Also, the light source for anterior eye observation and the light source for fundus observation may be provided separately. The condenser lens 12 is a lens (system) that collects the light output from the light source 11. The operation of the light source 11 is controlled by the processing unit 5.

  Each of the filters 13 to 15 is an optical element having the function of removing or weakening a specific component of the illumination light. Examples of the filters 13 to 15 include blue filters, red non-red filters, neutral density filters, heat protection filters, corneal fluorescence filters, color temperature conversion filters, color rendering conversion filters, ultraviolet cut filters, infrared cut filters, and the like. Each of the filters 13 to 15 is insertable into and removable from the light path of the illumination light. Insertion and removal of the filters 13 to 15 are controlled by the processing unit 5.

  The slit diaphragm 16 forms a slit for generating slit light (slit light). The slit diaphragm 16 includes a pair of slit blades. The slit width is changed by changing the distance between the slit blades. In addition, the direction of the slit is changed by integrally rotating these slit blades. The rotation center at this time is the illumination optical axis 10a. A diaphragm member other than the slit diaphragm 16 can be provided in the illumination system 10. Examples of the diaphragm member include an illumination diaphragm for changing the light quantity of the illumination light and an illumination field diaphragm for changing the size of the illumination field. Moreover, it is possible to change the light quantity of illumination light, and the size of an illumination field using members other than these aperture members. A liquid crystal shutter is an example of such a member. The operations of the slit diaphragm 16, the illumination diaphragm, the illumination field diaphragm, and the liquid crystal shutter are controlled by the processing unit 5.

  The imaging lenses 17, 18 and 19 are lens systems for forming an image of illumination light. The deflection member 20 deflects the illumination light having passed through the imaging lenses 17, 18 and 19 to irradiate the patient's eye E. For example, a reflective mirror or a reflective prism is used as the deflection member 20.

  A member other than the above can be provided in the illumination system 10. For example, a diffusion plate can be provided at the rear stage of the deflection member 20 so as to be insertable and removable. The diffusion plate makes the brightness of the illumination field uniform by diffusing the illumination light. Also, a background light source can be provided to illuminate the background area of the illumination field by the illumination light.

(Observation system 30)
Observation system 30 is an optical system that guides the illumination light of the return light from the eye E to the operator's eye E _0. The observation system 30 includes a pair of left and right optical systems that enables observation with the left and right eyes. Since the left and right optical systems have substantially the same configuration, only one optical system is shown in FIG.

  The observation unit 3 b is configured to be capable of changing the direction of the optical axis (observation optical axis) 30 a of the observation system 30 in the left-right direction and the up-down direction. Thereby, the observation direction of the patient's eye E can be arbitrarily changed.

  The observation system 30 includes an objective lens 31, variable magnification lenses 32 and 33, a protection filter 34, an imaging lens 35, a deflection unit 36, a field stop 37, and an eyepiece lens 38.

  The objective lens 31 is disposed at a position facing the patient's eye E. The variable magnification lenses 32 and 33 constitute a variable magnification optical system (zoom lens system). The variable magnification lenses 32 and 33 are movable along the observation optical axis 30a. As another example of the variable magnification optical system, a plurality of variable magnification lens groups which can be selectively inserted into the optical path of the observation system 30 can be provided. These variable power lens groups are configured to provide different magnifications. The variable power lens group disposed in the optical path of the observation system 30 is used as the variable power lenses 32 and 33. With such a variable power optical system, the magnification (field angle) of the macroscopic observation image and the photographed image of the patient's eye E can be changed. The change of the magnification is performed, for example, by operating the observation magnification operation knob included in the operation unit 6. In addition, the processing unit 5 may control the magnification based on an operation by a switch or the like included in the operation unit 6.

The protection filter 34 is a filter that shields the treatment light LT. Thereby, the operator's eye E ₀ can be protected from the laser light. The protection filter 34 is inserted into the light path, for example, in response to the start trigger of the laser treatment (or laser output). During normal observation, the protection filter 34 is retracted from the light path. Insertion and removal of the protection filter 34 is controlled by the processing unit 5. It is also possible to use a multilayer film filter that reduces the apparent color change. This filter is for example always arranged in the light path.

  The imaging lens 35 is a lens (system) that forms an image of the patient's eye E. The deflecting unit 36 is an optical member which is moved in parallel so that the traveling direction of light matches the eye width of the operator, and includes prisms 36 a and 36 b. The eyepiece 37 moves integrally with the deflection unit 36. The deflection unit 36 and the eyepiece lens 37 are stored in the eyepiece unit 3c. The other members in the observation system 30 are stored in the observation unit 3b.

(Shooting system 40)
The imaging system 40 is an optical system for imaging a patient's eye E. The imaging system 40 includes a beam splitter 41, an imaging lens 42, and an image sensor 43. The imaging system 40 is branched from the observation system 30. The beam splitter 41 is disposed between the imaging lens 35 of the observation system 30 and the deflection unit 36. Beam splitter 41 is, for example, a half mirror. The imaging lens 41 is a lens (system) that brings the image of the patient's eye E onto the image sensor 43. The image sensor 43 is, for example, an area sensor including an imaging device such as a CCD or a CMOS. Signals (image signals, video signals) output from the image sensor 43 are sent to the processing unit 5.

  The imaging system 40 may be provided to both of the left and right optical systems in the observation system 30, or the imaging system 40 may be provided to only one of them. When the left and right imaging systems 40 are provided, it is possible to acquire a stereoscopic image (stereo image) of the patient's eye E. The stereoscopic image is a still image or a moving image.

(Laser irradiation system 50)
The laser irradiation system 50 is an optical system for guiding the irradiation light transmitted from the light source unit 2 to the slit lamp microscope 3 via the optical fiber 4 to the patient's eye E. The laser irradiation system 50 includes a collimator lens 51, an optical scanner 52, a mirror 53, relay lenses 54 and 55, a mirror 56, a collimator lens 57, and a deflection member 58.

  The collimator lens 51 converts the irradiation light output from the optical fiber 4 into a parallel light flux. The optical scanner 52 two-dimensionally deflects the irradiation light. The optical scanner 52 includes, for example, a pair of galvano scanners. The operation of the light scanner 52 is controlled by the processing unit 5.

  The mirror 53 reflects the irradiation light that has passed through the light scanner 52 and changes its traveling direction. The relay lenses 54 and 55 relay the irradiation light reflected by the mirror 53. The mirror 56 reflects the illumination light passing through the relay lenses 54 and 55 to change its traveling direction. The collimator lens 57 converts the illumination light passed through the relay lenses 54 and 55 into a parallel light flux. The deflection member 58 is disposed behind the objective lens 31 and deflects the irradiation light passed through the collimator lens 57 to irradiate the patient's eye E.

(Contact lens CL)
When performing laser treatment of the fundus oculi Ef and corner angles, the contact lens CL is abutted against the cornea Ec. In order to perform various laser treatments, a plurality of contact lenses having different magnifications and forms are prepared. The user selects the contact lens in accordance with the type of treatment, the treatment site, the state of the patient's eye E, and the like.

[Irradiation conditions]
In the present example, irradiation light of a preset pattern is applied to the patient's eye E. There are various conditions (irradiation conditions) in the pattern of the irradiation light. The projection image of the irradiation light is called a spot. As irradiation conditions, the arrangement pattern of a plurality of spots (arrangement condition), the size of the arrangement pattern (arrangement size condition), the direction of the arrangement pattern (arrangement direction condition), the size of each spot (spot size condition), the spacing of spots ( There are spot spacing conditions etc. The irradiation conditions include those relating to matters other than patterns and spots. For example, the irradiation conditions include the intensity (power) and the wavelength of the irradiation light. The control based on these irradiation conditions is performed in the same manner as the conventional pattern irradiation type laser treatment apparatus.

[Control system]
The control system of the laser treatment apparatus 1 will be described with reference to FIG. The control system of the laser treatment apparatus 1 is configured around a control unit 101 provided in the processing unit 5. In FIG. 3, some constituent parts are omitted.

(Holding portion 61, moving mechanism 62)
The holding unit 61 holds the contact lens CL. Although not shown, the holder 61 includes an arm whose proximal end is connected to the slit lamp microscope 3 and a contact lens holder provided at the tip of the arm. The arm includes, for example, one or more joints, and is configured to be deformable. The contact lens holder is connected to the arm via a movable mechanism. The movable mechanism is configured to be capable of rotational movement, tilt and axial movement of the contact lens CL. The rotational movement is an operation of moving the contact lens CL around its axis. The rotational movement is performed to change the reflection direction of the irradiation light or the illumination light when a contact lens having a reflection surface in the inside, which is used for laser treatment of a corner or the periphery of the fundus is applied. The tilt is an operation to change the direction of the axis, and is performed to change the traveling direction of the irradiation light or the illumination light. Axial movement is performed to adjust the focus on the treatment site or the observation site. The movable mechanism may be configured to be able to execute at least one of rotational movement, tilt, and movement in the axial direction, and may be configured to be able to execute movement modes other than these.

  The moving mechanism 62 includes such a movable mechanism and one or more actuators for operating the movable mechanism. The operation of the moving mechanism 62 is executed by the control unit 101. In the present embodiment, the control unit 101 executes control of rotational movement, tilt, and movement in the axial direction of the contact lens CL held by the holding unit 61.

(Control unit 101)
The control unit 101 controls each part of the laser treatment apparatus 1. For example, the control unit 101 performs control of the light source unit 2, control of the display unit 7, control of the illumination system 10, control of the observation system 30, control of the laser irradiation system 50, movement control of the contact lens CL, and the like. The control unit 101 controls at least each element shown in FIG. For example, the control unit 101 executes control based on the irradiation conditions described above.

  As control of the light source unit 2, the control unit 101 performs control of the aiming light source 2a, control of the treatment light source 2b, control of the galvano mirror 2c, and the like. The control of the aiming light source 2a and the treatment light source 2b includes turning on / off of the output of the irradiation light, control of the output intensity (output light amount) of the irradiation light, and the like. In addition, when a configuration in which a plurality of types of treatment light LT can be output by one or more treatment light sources 2b is applied, the control unit 101 controls the treatment light source 2b to selectively output the treatment light LT. The control of the galvano mirror 2c includes control for changing the direction of the reflective surface of the galvano mirror 2c.

  The display unit 7 receives control of the control unit 101 and displays various information. The display unit 7 is configured to include an arbitrary display device such as a flat panel display such as an LCD and a CRT display. The display unit 7 is provided, for example, in the slit lamp microscope 3 or the processing unit 5 (computer).

  As control of the illumination system 10, the control unit 101 performs control of the light source 11, control of the filters 13 to 15, control of the slit diaphragm 16, control of the other diaphragm members, and the like. The control of the light source 11 includes on / off of the output of the illumination light, the control of the output intensity of the illumination light (output light amount), and the like. The control of the filters 13-15 includes control of inserting and removing the filters 13-15 with respect to the illumination light axis 10a. Control of the filters 13 to 15 is performed by controlling the filter driver 13A. The control of the slit diaphragm 16 includes control to change the distance between the pair of slit blades, and control to move and rotate the pair of slit blades integrally. The former control corresponds to slit width change control. The latter control corresponds to control of changing the irradiation position of the illumination light (slit light) while keeping the slit width constant. As described above, the other aperture members include an illumination aperture for changing the amount of illumination light and an illumination field aperture for changing the size of the illumination field. The control of the slit diaphragm 16, the illumination diaphragm, and the illumination field diaphragm is performed by controlling the diaphragm drive unit 16A.

  As control of the observation system 30, the control unit 101 performs control of the variable magnification lenses 32 and 33, control of the protective filter 34, and the like. The control of the variable magnification lenses 32 and 33 is to control the variable magnification drive unit 32A to move them along the observation optical axis 30a, or to arrange variable magnification lens groups of different magnifications in the optical path of the observation system 30. It is control. Thereby, the observation magnification (angle of view) is changed. The control of the protection filter 34 is to control the protection filter drive unit 34A to insert and remove the protection filter 34 with respect to the observation optical axis 30a.

  As control of the laser irradiation system 50, the control unit 101 performs control of the light scanner 52 and the like. The control unit 101 changes, for example, the directions of the two galvanometer mirrors included in the light scanner 52. Thereby, the irradiation light incident from the light source unit 2 through the optical fiber 4 is two-dimensionally deflected.

  The control unit 101 performs read processing of data stored in the storage unit 102 and write processing of data to the storage unit 102.

  The control unit 101 includes a microprocessor, a RAM, a ROM, a hard disk drive, and the like. A computer program such as a control program is stored in advance in the hard disk drive. The operation of the control unit 101 is realized by the cooperation of a computer program and the above hardware. Also, the control unit 101 may include a communication device for communicating with an external device.

(Storage unit 102)
The storage unit 102 stores various data and computer programs. Storage unit 102 includes, for example, a storage device such as a RAM, a ROM, and a hard disk drive.

  Plan data 102 a is stored in advance in the storage unit 102. The plan data 102a is created in preoperative planning performed prior to laser treatment. Preoperative planning is work to determine the implementation content of laser treatment (laser surgery) based on examination data and diagnostic data acquired in advance. The items to be determined in the preoperative planning include the site of the patient's eye E to be subjected to the laser treatment (target site for treatment), the type of laser light to be applied (treatment light LT), the type of contact lens to be applied, There are the number of implementation and the interval of implementation of the operation. In addition, results of laser treatment performed in the past, images of patient's eye E (front image, cross-sectional image by OCT, etc.), attributes of patient / patient's eye (sex, age, medical history, treatment history, etc.), The intensity of the laser light (the treatment light LT) can be determined based on standard data, statistical data, and the like. The intensity of the treatment light LT may be, for example, an intensity that is actually applied for the treatment, or an initial intensity that is used in a task (trial) to determine the applied intensity. The plan data 102 a of the present embodiment includes at least data representing a region to be treated of the patient's eye E.

(Operation unit 6, display unit 7)
The operation unit 6 includes various hardware keys and / or software keys. Display unit 7 includes, for example, a flat panel display. It is possible to integrally configure at least a part of the operation unit 6 and at least a part of the display unit 7. The touch panel display is one example.

(Data processing unit 110)
The data processing unit 110 performs various data processing. The data processing unit 110 is provided with an analysis unit 111 and a report creation unit 120. The analysis unit 111 analyzes the image of the patient's eye E acquired by the imaging system 40 (image sensor 43) to obtain information for controlling the moving mechanism 62 (that is, for performing movement control of the contact lens CL). Generate information). The analysis unit 111 of the present embodiment includes a treatment target portion specifying unit 112, a spot image specifying unit 113, a treatment excluded area specifying unit 114, and a control information generation unit 115.

(The treatment target site identification unit 112)
The treatment target site specifying unit 112 corresponds to the treatment target site by analyzing the image acquired by the imaging system 40 based on the data (treatment target site data) representing the treatment target site included in the plan data 102a. Identify the image area to be Some typical examples of this process are described below.

  The treatment target site data is, for example, image data or coordinate data. This image data includes, for example, a template image (shaper) that schematically represents the site of the eye. In the preoperative planning, the doctor refers to examination data and diagnostic data to determine a site to which laser treatment is to be applied, and marks the site on a schema. FIG. 4A represents a corner shaper. A front schematic view A of the corner is described in the corner shaper T1. In preoperative planning, the corner shaper T1 is displayed on the display. The doctor marks the site to be treated at the corner of the patient's eye E on the corner angle schema T1, for example, by operating the mouse. An example of treatment target site data created in this manner is shown in FIG. 4B. In the treatment target region data D1, the entire corner is regarded as the treatment target (the entire front schematic view A of the corner is hatched). In addition, although a part of angle may be excluded from a treatment object site | part, it mentions it later.

  A captured image can be used as another example of treatment target site data including image data. FIG. 4C shows a photographed image (fundus oculi image) of the fundus oculi Ef. The fundus image T2 is acquired by a fundus camera or a slit lamp microscope prior to preoperative planning. In preoperative planning, the doctor marks a treatment target site on the fundus image T2 displayed on the display. An example of treatment target site data created in this manner is shown in FIG. 4D (the shaded area is the treatment target site). In addition, when a photographed image of a corner is used, a contact lens (corner mirror) is brought into contact with the cornea Ec, and it is photographed a plurality of times while rotating it, and a plurality of photographed images obtained thereby (corner angles Representing different parts of) to create a panoramic image. This panoramic image is used as a photographed image at a corner.

  The control unit 101 reads out such treatment target site data from the storage unit 102 and sends it to the treatment target site identification unit 112. Since the treatment target site data is information indicating the treatment target site, at least the orientation is made. Furthermore, the treatment target site data may include information indicating the size.

  Further, in this example, the imaging system 40 captures the patient's eye E in a state of being irradiated with the irradiation light (for example, the aiming light LA of the predetermined pattern). The imaging target at this time includes the treatment target site represented by the treatment target site data. When the target of the laser treatment is a corner, imaging of a partial region of the corner including the irradiation range of the aiming light LA is performed using the slit lamp microscope 3. The treatment target site specifying unit 112 determines which part of the treatment target area corresponds to the image (corner angle partial image) acquired by the imaging. This process is performed, for example, with reference to the contents of control of the contact lens CL, the illumination system 10, the observation system 30, and the imaging system 40. As described above, since the control unit 101 controls the moving mechanism 62, the control unit 101 can recognize the current position and posture of the contact lens CL. Furthermore, the control unit 101 can recognize the size, shape, and orientation of the illumination field (shooting field) from the control content of the slit diaphragm 16. In addition, the control unit 101 can recognize the magnification (angle of view) of the photographed image from the control contents of the variable magnification lenses 32 and 33. The control unit 101 sends the information together with the photographed image to the treatment target site identification unit 112.

  The treatment target site specifying unit 112 selects a treatment target site corresponding to the photographed image (corner partial image) based on the information input together with the photographed image and the treatment target site data in which the orientation and the size are defined. Identify the range within. This process can also be said to be a process of specifying an image area in a corner partial image corresponding to a treatment target site. In this manner, the partial region of the treatment site at the corner is associated with the partial region of the corner partial image. When the fundus oculi Ef is a target, since a fundus oculi image that includes the entire treatment target site can be acquired, it is possible to associate the entire treatment target site with the partial region of the fundus oculi image.

(Spot image specification unit 113)
The spot image specifying unit 113 specifies a plurality of spot images representing the irradiation area of the laser light by analyzing the image acquired by the imaging system 40. This process is performed based on the pixel value of the captured image. For example, the spot image specifying unit 113 selects a high-brightness pixel in the captured image, classifies the plurality of selected pixels into respective connected regions (labeling processing and the like), and sets each connected region as a spot image. When the captured image is a color image, the spot image specifying unit 113 refers to the RGB values of the pixels of the captured image to select pixels having RGB values corresponding to the wavelength of the laser light, and select a plurality of selected pixels. Pixels can be classified into respective connected regions, and each connected region can be a spot image. In such processing, the shape of the irradiation area (spot) of the laser beam can be taken into consideration. For example, if the spot is circular (that is, if the cross section of the laser light is circular), the spot image specifying unit 113 searches for a circular image area (or an elliptical image area considering the influence of aberration etc.) be able to.

(Treatment exclusion area identification unit 114)
The treatment excluded area specifying unit 114 analyzes at least a part of the image acquired by the imaging system 40 to specify an area excluded from the laser treatment (a treatment excluded area). This analysis process is performed on at least the image area identified by the treatment target site identification unit 112. In addition, it is possible to analyze including the image area (adjacent image area) around this image area. As a treatment exclusion area | region, there exist a site | part (pre-treatment site | part) to which laser treatment was given within predetermined period (3 months etc.), an adhesion site, etc. The site to be treated is detected, for example, by identifying a scar (treatment scar) by laser light through analysis of pixel values. The adhesion sites are detected, for example, by analysis of pixel values and / or shapes.

(Control information generation unit 115)
The control information generation unit 115 generates control information based on the information acquired by the treatment target site identification unit 112, the spot image identification unit 113, and the treatment exclusion area identification unit 114.

  The control information includes information for controlling the moving mechanism 62 (movement control information). The movement control information includes information representing the movement destination of the irradiation position of the irradiation light (at least the treatment light LT) of a predetermined pattern. The movement destination is set outside the treatment exclusion area identified by the treatment exclusion area identification unit 114. For example, if at least part of the acquired destination (temporary destination) overlaps with at least part of the treatment exclusion area, the control information generation unit 115 finds the next destination, and this new destination and treatment exclusion The comparison with the area is made in the same way. The movement destination is determined by performing such processing one or more times. As another example of processing, when the temporary move destination and the treatment excluded area have the overlapping range, it is possible to determine the move destination by shifting the temporary move destination by the overlapping range.

  When performing laser treatment of a corner using a contact lens CL (corner mirror) having a reflecting surface inside, the movement control information is a contact lens CL for shifting from the present or previous irradiation position to the next irradiation position. Contains information representing the rotation angle of When performing laser treatment of a corner using the contact lens CL having no reflective surface, the movement control information is information indicating the tilt angle of the contact lens CL for transitioning from the present or previous irradiation position to the next irradiation position. including. The next irradiation position is determined in advance, and is, for example, the irradiation position which is disposed in a predetermined direction (clockwise or counterclockwise direction) with respect to the current or previous irradiation position, and is the closest to it. The movement control information is similarly created in the case of the laser treatment of the fundus oculi Ef.

  The control information may include information for changing the irradiation conditions. For example, the control information includes information for changing at least one of an arrangement condition, an arrangement size condition, an arrangement direction condition, a spot size condition, a spot interval condition, an intensity condition of irradiation light, and a wavelength condition. As shown in FIG. 4B, the treatment sites at the corners are distributed in an annular region. The movement (rotational movement or tilt) of the contact lens CL based on the movement control information corresponds to the movement of the irradiation position of the irradiation light in the circumferential direction (declination direction). Therefore, it is desirable to change the alignment direction along with the movement of the contact lens CL, as long as the alignment of the irradiation light does not have a certain symmetry. That is, it is desirable to control the arrangement direction of the irradiation light so that the longitudinal direction of the arrangement of the plurality of spots changes along the corner of a circle or an ellipse. The arrangement of spots applied in this case is, for example, a linear arrangement or an arcuate arrangement. The amount of change in the arrangement direction (arrangement direction condition) corresponds to the amount of change in the direction of the tangent associated with the rotational movement of the irradiation position of the irradiation light.

  The control information may include information for changing the size and orientation of the illumination field by the slit light. In laser treatment at a corner, movement (rotational movement or tilt) of the contact lens CL based on movement control information corresponds to movement of the illumination field in the circumferential direction (declination direction) by the slit light. Therefore, as long as the shape of the illumination field does not have a certain symmetry, it is desirable to change the direction of the illumination field (the orientation of the slit diaphragm 16) along with the movement of the contact lens CL. That is, it is desirable to control the orientation of the slit diaphragm 16 so that the longitudinal direction of the illumination field by the slit light changes along the corner of a circle or an ellipse. The change amount of the direction of the illumination field corresponds to the change amount of the direction of the tangent associated with the rotational movement of the irradiation position of the irradiation light.

(Report creation unit 120)
The report generator 120 generates a report on laser treatment of the patient's eye. The report is to keep track of what kind of laser treatment was performed. The report is created based on at least the contents of control executed by the control unit 101. The control content includes the content of the movement control of the contact lens CL and the content of the control regarding the irradiation condition. Examples of the irradiation conditions include the intensity (power) and the wavelength of the treatment light LT. The power of the treatment light LT may be the power of each spot or the sum of the powers of all the spots. The report creation unit 120 inputs such control contents into a report template of a predetermined format.

  The report may include a captured image acquired in the laser treatment. In that case, the report creation unit 120 can select a captured image (frame) acquired at a predetermined timing. The predetermined timing may be before and / or after the movement control of the contact lens CL. Also, the predetermined timing may be before and / or after the irradiation of the treatment light LT. For example, the report may include captured images of each treatment target site. In addition, the report may include a photographed image before the treatment light LT is irradiated to each treatment target site, and a photographed image after the irradiation.

  In addition, the information contained in a report is not limited to what was illustrated here, Arbitrary information may be sufficient. The user can select the information described in the report. In that case, the control unit 101 causes the display unit 7 to display a screen for selecting information described in the report. On this screen, for example, information that can be described in a report is listed. The user can select desired information using the operation unit 6. The selection result is stored in the storage unit 102. The report creation unit 120 selects information by referring to the selection result, and inputs the selected information into a report template. For example, in preoperative planning or the like, it is possible to select information using a computer (not shown) and send the selection result to the laser treatment apparatus 1.

[Use form]
The flow of laser treatment using the laser treatment apparatus 1 will be described, including its preliminary steps. An example of the usage form of the laser treatment apparatus 1 is shown in FIG.

(S1: Preoperative planning)
Preoperative planning is performed as a preliminary step of laser treatment. In preoperative planning, a computer not shown is used. This computer is used, for example, for viewing a patient's electronic medical chart and images, and for creating plan data. The doctor creates plan data with reference to examination data and diagnosis data of the patient's eye E. As described above, the plan data includes at least data representing a treatment target site of the patient's eye E. In addition, the type and intensity of the treatment light, the type of the contact lens, the number of times of performing the surgery, the execution interval, and the like may be included in the plan data. The created plan data is sent to the laser treatment apparatus 1 via, for example, a filing system such as an electronic medical record system or a recording medium, and stored in the storage unit 102 (plan data 102a shown in FIG. 3). The following is the stage of laser treatment.

(S2: Wear a contact lens)
First, the contact lens CL is attached to the contact lens holder at the tip of the holding portion 61. When the information indicating the type of contact lens is included in the plan data 102 a, the control unit 101 causes the display unit 7 to display the information indicating the type. The doctor or nurse can select the contact lens by referring to the displayed information.

(S3: Apply the contact lens to the patient's eye)
The user applies the contact lens CL mounted on the holder 61 to the cornea Ec of the patient's eye E. At this time, the arm of the holding portion 61 can be arbitrarily deformed. In addition, at this stage, the moving mechanism 62 can be manually operated freely. In this example, it is assumed that a corner contact lens CL having a reflective surface inside is used.

  When the information indicating the type and / or the intensity of the treatment light is included in the plan data 102a, the control unit 101 selects the type of the treatment light LT and / or sets the intensity. Further, the control unit 101 sets an arrangement pattern of the irradiation light (spots). In this example, a linear or arcuate array pattern is selected for treatment of the corners. Further, the control unit 101 can control the slit diaphragm 16 (diaphragm driving unit 16A) so as to have a predetermined slit width. The control unit 101 can execute predetermined control other than the above.

(S4: Start observation and shooting)
When the user performs a predetermined operation, the control unit 101 turns on the light source 11 of the illumination system 10. Thereby, observation of the patient's eye E (corner angle) can be started. Also, the control unit 101 causes the image sensor 43 to start shooting. The shooting field includes an illumination field (illumination range by slit light) by the illumination system 10. Although moving image shooting is applied in this example, still image shooting may be performed at an appropriate timing. Still image photography is synchronized with control for irradiating aiming light LA and / or treatment light LT, for example.

  The control unit 101 can cause the display unit 7 to display the moving image of the patient's eye E (corner angle) acquired by the image sensor 43 in real time. The user adjusts the position and posture of the contact lens CL while referring to the observation image and the moving image of the corner so that the desired part of the corner is included in the observation visual field and the photographing visual field. Also, the user can perform a desired operation such as adjustment of the slit width.

(S5: Start irradiation of aiming light)
The control unit 101 controls the light source unit 2 and the laser irradiation system 50 to start the irradiation of the aiming light LA to the patient's eye E.

(S6: Target the first treatment target)
The treatment target portion specifying unit 112 specifies a region (corner angle region) in the photographed image corresponding to a corner by analyzing the photographed image (frame of moving image). This processing includes arbitrary image processing such as threshold processing on pixel values and pattern matching.

  Next, the treatment target site specifying unit 112 determines which part of the treatment target site (the whole or a part of the circle) of the corner shown in the plan data 102a (the treatment target site data) the specified corner area is Identify if it corresponds to An example of this process will be described. As described above, the treatment target site data is oriented, and the position and posture of the contact lens CL can be recognized. The treatment target site specifying unit 112 can obtain the direction of the imaging field of the photographed image from the recognition result of the position and posture of the contact lens CL, and specifies a portion of the treatment target site data corresponding to the direction. As another processing example, based on the fact that the corner area is substantially arc-shaped (where an arc approximating the corner area may be obtained), treatment target region data substantially corresponding to this corner area Ask for a part. This process includes, for example, an affine transformation that translates a corner area (arc-shaped area) on the treatment target site data. Note that this affine transformation does not include rotational movement. In addition, this affine transformation may include enlargement / reduction for matching the size of the corner area according to the imaging magnification and the size of the treatment target region data.

  Subsequently, the spot image specifying unit 113 specifies a plurality of spot images by analyzing the photographed image. The plurality of spot images are arranged in a predetermined pattern (e.g., linear array or arc array).

  The control information generation unit 115 obtains displacement between the plurality of spot images identified by the spot image identification unit 113 and the corner area identified by the treatment target region identification unit 112. Furthermore, the control information generation unit 115 obtains the amount of change (rotational movement amount, tilt amount, etc.) of the position and posture of the contact lens CL that cancels this displacement. The amount of change corresponds to movement control information for controlling the movement mechanism 62.

  The control unit 101 controls the moving mechanism 62 based on the movement control information to guide the spot image (the irradiation position of the pattern of the aiming light LA) onto the corner area. Tracking can be performed in parallel with such processing. The tracking is processing for causing the position and posture of the contact lens CL and / or the irradiation position of the aiming light LA to follow the movement (eye movement, body movement, pulsation, etc.) of the patient's eye E. Tracking is a process of sequentially and sequentially obtaining displacement (displacement of a feature point) between a plurality of captured images (frames) acquired at different timings, and moving mechanism 62 and / or so as to cancel this displacement. Or a process of controlling the optical scanner 52 in real time.

  By carrying out the above-described process shown as a typical example, a pattern of aiming light LA is placed at the first treatment target site at the corner. A state in which aiming is made in this way is shown in FIG. 6A. In FIG. 6A, the symbol AI represents the corner of the eye E, the symbol L1 represents the illumination field (slit illumination field) by slit light, and the symbol M1 represents the first treatment target site (the first treatment target site). Symbol SP1 represents a spot group. The vertical direction and the horizontal direction in FIG. 6A correspond to the definition of the direction described above. In this example, the first treatment target site M1 is set at the uppermost position of the corner angle AI, but in general, the first treatment target site M1 can be set at any position of the corner angle AI. At this stage, the slit illumination field L1 includes the first treatment target site M1. The spot group SP1 is a plurality of spots of the aiming light LA. According to the state as shown in FIG. 6A, the user observes the first treatment target site M1 of the corner angle AI and the spot group SP1 is formed in this site M1, that is, the sight is matched to the site M1. Can confirm that In addition, when the spot group SP1 is formed at a position deviated from the part M1 (that is, when the aim is not matched), the user adjusts the position and the posture of the contact lens CL to adjust the part M1. You can aim it.

(S7: Irradiate therapeutic light)
When the user performs a predetermined operation (irradiation execution operation) using the operation unit 6 after completion of aiming at the treatment target site, the control unit 101 controls the light source unit 2 and the laser irradiation system 50 to perform this treatment. The treatment light LT is irradiated toward the target site. The therapeutic light LT has, for example, the same pattern as the aiming light LA. Generally, the pattern of the treatment light LT is emitted to a part or the whole of the range of the patient's eye E defined by the aiming light LA of the predetermined pattern, or to a range including a part or the whole of the defined range Be done.

(S8: Treatment complete?)
When the laser treatment of the patient's eye E is completed by the irradiation of the treatment light LT performed in step S7 (S8: Yes), the process of this example proceeds to step S13. On the other hand, when the laser treatment is to be continued (S8: No), the process of the present example proceeds to step S9. Steps S9 to 12 include processing for aiming at the site where the laser treatment is to be performed next.

  The determination of whether the laser treatment is complete may be performed automatically or by the user. In the case of the automatic determination, the laser treatment apparatus 1 (for example, the control unit 101 or the analysis unit 111) records the treatment target site where the laser treatment has already been performed, and the history of this record (that is, the treatment where the laser treatment has already been performed) The entire target site) is compared with the treatment target site data in the plan data 102a. When this recording history reaches the entire range indicated by the treatment target site data, the laser treatment apparatus 1 determines that the laser treatment is completed. As another example, it can be determined whether the laser treatment has been completed based on the change history of the direction of the pattern of the irradiation light and the change history of the direction of the slit illumination field. For example, when the start point and the end point of the laser treatment coincide with each other as in the case of a corner, the direction of the pattern of irradiation light or the like changes over 360 degrees between the start and the end of the laser treatment. It is possible to make the above determination using such a history of change in direction. Alternatively, the end point of the laser treatment is specified based on the treatment target site data (and the position of the first treatment target site) in the plan data 102a, and the direction such as the pattern of the irradiation light applied at this end point is reached. It can be determined that the laser treatment has been completed when the irradiation of the treatment light LT is performed. As another example, it can be determined based on the photographed image of the patient's eye E whether the laser treatment has been completed. For example, the laser treatment apparatus 1 (for example, the analysis unit 111) captures an image of the patient's eye E at least immediately before and / or immediately after the laser therapy is being performed (moving image capturing is applied in this example). The laser treatment apparatus 1 detects a characteristic site (for example, a corner, a pupil, etc.) of the patient's eye E by analyzing the photographed image acquired thereby, and the laser treatment is completed from the position and direction of the characteristic site It is possible to determine whether or not. When the laser treatment of another part (part other than the corner) of the patient's eye E is subsequently performed, the laser treatment apparatus 1 may output (display etc.) information representing a change in the target of the laser treatment, for example. it can.

  The case where the user makes the determination will be described. The user can recognize the site where the laser treatment has already been performed. For example, in the case of a corner, it is possible to refer to the orientation of the image being observed, the operation contents of the contact lens CL up to that point, and the like. When it is determined that the laser treatment of the range planned by the preoperative planning is completed, the user performs a predetermined operation (treatment completion operation) using the operation unit 6.

  Laser treatment may be interrupted before the treatment of the area planned by preoperative planning is completed. For example, treatment is interrupted if the patient complains of pain. In such a case, the user can use the operation unit 6 to issue an instruction to stop the treatment. This instruction operation may be the above-described treatment completion operation or a different operation (treatment interruption operation). In the case where the operation for interrupting the treatment is the same as the operation for completing the treatment, the laser treatment apparatus 1 records the treatment history in the treatment target site and the treatment target site in the plan data 102a as in the case of the automatic determination. By comparing the data with the data, it can be determined whether the treatment completion operation corresponds to a treatment interruption.

  When the treatment is interrupted, the laser treatment apparatus 1 (the control unit 101, the analysis unit 111, etc.) can generate information (interruption stage information) representing the interrupted stage. The interruption stage information is, for example, information indicating the position where the treatment was interrupted, the range where the treatment was performed, the range where the treatment was not performed, and the like. The interruption stage information is, for example, added to the treatment target site data in the plan data 102a.

(S9: Generate control information)
If it is determined in step S8 that the laser treatment is to be continued (S8: No), the analysis unit 111 generates control information by performing the above-described process on the image of the patient's eye E. The control information includes at least movement control information including information indicating the movement destination (rotation angle of the contact lens CL) of the irradiation position of the irradiation light (the aiming light LA and the treatment light LT) of the predetermined pattern. In this example, the control information may include information for changing the irradiation condition (irradiation condition control information) and information for changing the size and direction of the illumination field by the slit light (slit control information). Good.

(S10: Move contact lens)
The control unit 101 controls the moving mechanism 62 based on the movement control information generated in step S9 to rotate the contact lens CL by the rotation angle indicated by the movement control information.

(S11: Move the slit diaphragm)
The control unit 101 controls the diaphragm control unit 16A based on the slit control condition generated in step S9 to rotate the slit diaphragm 16 and arrange the slit diaphragm 16 in the direction indicated by the slit control condition. Note that step S10 and step S11 may be performed in the reverse order. Alternatively, step S10 and step S11 may be performed in parallel.

(S12: Aiming at the next treatment target site)
By the steps S10 and S11, the pattern of the aiming light LA is placed at the next treatment target site at the corner. FIG. 6B shows a state in which aiming is achieved at the next treatment target site (second treatment target site) M2 following the first treatment target site M1 shown in FIG. 6A. The second treatment target site M2 is disposed at a position adjacent to the first treatment target site M1 in the clockwise direction. The slit illumination field L2 includes the second treatment target site M2, and the spot group SP2 is formed in the slit illumination field L2 (and the second treatment target site M2). The user can confirm that the spot group SP2 is formed at the site M2, that is, that the sight M2 is aligned with the site M2, while observing the second treatment target site M2 of the corner angle AI. In addition, when the spot group SP2 is formed at a position deviated from the site M2 (that is, when the aim is not matched), the user adjusts the position and the attitude of the contact lens CL to adjust the site M2. You can aim it.

  When step S12 is completed, the process proceeds to step S7. In step S7, in response to the irradiation execution operation by the user, the treatment light LT having a predetermined pattern is irradiated to the second treatment target site M2.

  The processes of steps S7 to 12 are repeatedly performed until it is determined as "Yes" in step S8. The state in the middle is shown in FIG. 6C. In FIG. 6C, the symbol Mi indicates the ith treatment target site, the symbol Li indicates a slit illumination field including the site Mi, and the symbol SPi indicates a spot group (i = 1 to n). The slit illumination field Li and the spot group SPi are set in a direction according to the i-th treatment target site Mi of the corner angle AI. The user can confirm that the site Mi is aimed while observing the i-th treatment target site Mi. In addition, when the spot group SPi is formed at a position deviated from the site Mi, the user can aim at the site Mi by adjusting the position and the posture of the contact lens CL.

(S13: Create a report)
If "Yes" is determined in step S8, the report creation unit 120 creates a report as described above. This report includes patient ID, patient name, disease name, surgery site, surgery type, surgery date, surgery time (start time, finish time), surgery time (time taken for surgery), right eye / left eye etc. Along with the information, information such as position information of each treatment target site Mi based on movement control of the contact lens CL and / or the slit diaphragm 16 and information such as the power (total power) of the applied treatment light LT is included.

(S14: Save the report)
The control unit 101 stores the report created in step S13 in the storage unit 102 or another storage device. The other storage device may be any storage device located outside the laser treatment apparatus 1 and may be a database such as an electronic medical record system. The other storage device may be a recording medium that can be attached to the laser treatment apparatus 1. This completes the description of this usage pattern.

[effect]
The effects of the laser treatment apparatus according to the present embodiment will be described.

  The laser treatment device (1) is used to perform laser treatment of the patient's eye via a contact lens (CL) that is abutted on the patient's eye (E). The laser treatment apparatus includes a holding unit (61), a moving mechanism (62), and a control unit (101). The holder holds the contact lens. The moving mechanism is configured to move the contact lens held by the holder. The control unit controls the moving mechanism.

  According to such a laser treatment apparatus, since the contact lens is held by the holding unit, the user (doctor) does not have to hold the contact lens. Furthermore, since the contact lens is moved by the moving mechanism and the control unit, operations such as rotating or tilting the contact lens and moving it back and forth in order to adjust the observation site and the laser irradiation site are not performed manually but electrically. It is possible to do. When performing the operation manually as in the past, the user had to hold both the contact lens and the operation with one hand for a long time. The other hand is used to operate the slit lamp microscope. On the other hand, according to this embodiment, it is possible to perform the same operation using arbitrary operation means. In addition, movement control of the contact lens can be automatically performed based on the information prepared in advance. Therefore, the present embodiment can improve the operability of the ophthalmic laser treatment and reduce the burden on the user.

  The movement mechanism (62) may be configured to be able to perform at least one movement mode of rotational movement, tilt and axial movement of the contact lens. Here, the rotational movement corresponds to moving the contact lens around a predetermined axis, and the tilt corresponds to changing the direction of the axis of the contact lens. Rotational movement and tilting are performed to change or adjust the observation site or the laser irradiation site. Also, axial movement corresponds to movement along the axis of the contact lens and is performed for focusing. The specific configuration for realizing the applied movement mode may be arbitrary. According to this configuration, it is possible to electrically control the position and posture of the contact lens. In particular, the position and posture of the contact lens can be performed using any operation means, or can be performed automatically.

  In addition, when the function which detects the classification of a contact lens is provided, it is possible to comprise so that the movement aspect according to the classification can be performed selectively. For example, when a contact lens having a reflective surface inside is applied, one or more movement modes including rotational movement can be performed, and when a contact lens having no reflective surface is applied, other than rotational movement. It can be configured to be able to perform one or more movement modes.

  The laser treatment apparatus of the present embodiment may include an irradiation system that deflects the laser light output from the light source (the aiming light source 2a and the treatment light source 2b) based on a preset pattern and irradiate the patient's eye with the laser light. In the above configuration example, the irradiation system includes the light source unit 2, the optical fiber 4 and the laser irradiation system 50, and the function of deflecting the laser light is realized by the optical scanner 52. Furthermore, the control unit can execute control of the irradiation system and control of the moving mechanism in combination. According to this configuration, the movement of the contact lens and the irradiation of the laser light can be alternately performed, so that laser treatment can be sequentially performed on a plurality of positions of the patient's eye E. In the above configuration example, as shown in FIGS. 6A to 6D, it is possible to sequentially apply laser treatment to a plurality of treatment target portions Mi (i = 1 to n) of the corner angle AI. Moreover, since the movement of the treatment target site Mi can be performed automatically, the operation is easier than the conventional technique in which it is performed manually.

  The laser treatment apparatus of the present embodiment may include an imaging unit and an analysis unit. The imaging unit captures an image of the patient's eye when at least control of the irradiation system is performed. In the above configuration example, the imaging unit includes the slit lamp microscope 3. The analysis unit (111) generates information (movement control information) for controlling the movement mechanism by analyzing the image acquired by the imaging unit. The control unit can control the moving mechanism based on the information generated by the analysis unit. According to this configuration, it is possible to photograph a patient's eye irradiated with the aiming light and / or the treatment light, and to generate movement control information based on the photographed image. Thereby, it becomes possible to perform aiming and laser irradiation according to the current situation of the patient's eye. Since the patient's eye generally involves eye movement, it is assumed that the aiming position or the laser irradiation position is shifted. However, according to this configuration, since movement control information can be generated according to the displacement of the patient's eye, it is possible to prevent (suppress) the occurrence of the deviation of the aiming position or the laser irradiation position.

  The laser treatment apparatus of the present embodiment may include a first storage unit that stores data representing a treatment target site of a patient eye set in advance. In the above configuration example, the storage unit 102 corresponds to a first storage unit, and the plan data 102 a corresponds to the data. Here, the storage unit 102 may be provided outside the laser treatment apparatus. For example, a computer connected to the laser treatment apparatus, a database on a network (LAN or the like), or the like can be used as the first storage unit. Furthermore, the analysis unit includes a first identification unit, a second identification unit, and an information generation unit. The first identification unit identifies an image area corresponding to the treatment target by analyzing the image acquired by the imaging unit based on the data stored in the first storage unit. The second identification unit identifies a plurality of spot images representing the irradiation area of the laser beam by analyzing the image acquired by the imaging unit. The information generation unit, based on the image area identified by the first identification unit and the plurality of spot images identified by the second identification unit, represents information indicating a movement destination of the irradiation position of the laser beam of the pattern (movement control Generate information). In the above configuration example, the treatment target site identification unit 112 corresponds to a first identification unit, the spot image identification unit 113 corresponds to a second identification unit, and the control information generation unit 115 corresponds to a control information generation unit. Further, the control unit can control the moving mechanism so as to move the irradiation position of the laser light of the pattern to the movement destination represented by the information generated by the information generation unit. According to this configuration, a specific method for generating mobility control information is provided. Note that the method of generating movement control information is not limited to this.

  The analysis unit may include a third identification unit that identifies a treatment exclusion region by analyzing the image region identified by the first identification unit. The control unit can execute control of the moving mechanism so as to skip the region of the patient's eye corresponding to the treatment exclusion region identified by the third identification unit. According to this configuration, it is possible to automatically specify a site to be excluded from laser treatment and execute movement control of the contact lens so as to fly the site. Thereby, it is possible to avoid the situation where the laser treatment is applied to the site to be excluded from the laser treatment.

  The imaging unit may include an illumination system (10) that illuminates the patient's eye with slit light of variable width and orientation. The analysis unit can generate information (slit control information) for changing the width and / or direction of the slit light by analyzing the image acquired by the imaging unit. The control unit can execute control of the illumination system based on the slit control information. According to this configuration, it is possible to automatically control the width and direction of the slit light based on the actual photographed image. In the above configuration example, the irradiation position of the slit light is moved in synchronization with the transition of the treatment target site Mi (the transition from the treatment target site Mi to the treatment target site M (i + 1)) by the rotation of the contact lens CL (slit The direction of the slit light (the direction of the slit illumination field Li) is automatically changed according to the direction of transition from the illumination field Li to the slit illumination field L (i + 1) and the direction of each treatment target site Mi. In the latter, the direction of the slit light is automatically changed so that the longitudinal direction (slit length) of the slit illumination field Li matches the direction of each treatment target site Mi. According to this configuration, since the change of the position and the direction of the slit illumination field conventionally performed manually is automated, the operation becomes easy.

Second Embodiment
The laser treatment apparatus according to the present embodiment automatically detects the type of contact lens to be applied, and controls the power of the irradiation light (in particular, the treatment light) based on the detection result. This laser treatment apparatus may have the same general configuration and optical system as the first embodiment (see FIGS. 1 and 2).

  A configuration example of a control system of the laser treatment apparatus is shown in FIG. The storage unit 102 in this example stores the related information 102 b in advance. Furthermore, the present example includes the detection unit 63 and the strength acquisition unit 130. The strength acquisition unit 130 is provided in the data processing unit 110. Other components may be similar to those of the first embodiment. Hereinafter, the codes used in the first embodiment are applied mutatis mutandis.

  In the present embodiment, a plurality of contact lenses having different magnifications and shapes are prepared and selectively applied. The related information 102 b associates the plurality of contact lens types with the intensity (power) of the laser light. Typically, the related information 102b is table information that associates the contact lens type Kj with the power Pj (j = 1 to m). Here, the powers P1 to Pm do not have to be all different. It is possible to change (update) the related information 102b. This process is performed when introducing a new type of contact lens or when discarding an existing contact lens.

  The detection unit 63 detects the type of the contact lens CL held by the holding unit 61. That is, the detection unit 63 detects the type of the contact lens CL applied to the patient's eye E. Detection unit 63 is provided, for example, in holding unit 61 or in the vicinity thereof. The detection unit 63 may be contact type or non-contact type.

  A micro switch can be used as an example of the contact type detection unit 63. The detection unit 63 includes a plurality of micro switches. On the outer surface of each contact lens, a contact portion having a concavo-convex shape of a predetermined pattern is formed. The contact portions of the plurality of prepared contact lenses have different uneven shapes. When the contact lens is attached to the holding portion 61, the concavo-convex shape of the contact portion presses one or more micro switches. Each pressed microswitch outputs a unique electrical signal. The detection unit 63 specifies the type of the contact lens mounted on the holding unit 61 based on (the combination of) the output electric signals. In this identification process, information in which (the combination of) the type of electric signal, that is, (the combination of) the micro switch and the type of the contact lens are associated is referred to. This information is stored in advance in the storage unit 102 or the detection unit 63.

  As an example of the non-contact type detection unit 63, an RFID (Radio Frequency Identifier) or a magnetic sensor can be used. Even in such a case, the information in which the physical quantity (radio wave, magnetism, etc.) and the type of the contact lens are associated is referred to. Another example of the non-contact type detection unit 63 includes a camera for photographing the mounted contact lens, and analyzes the image of the contact lens acquired by the camera to specify the type of the contact lens. Also in this example, the information in which the visual characteristics (size, shape, characteristic portion, etc.) of the contact lens are associated with the type of the contact lens is referred to.

  The intensity acquisition unit 130 obtains the power of the laser beam corresponding to the type of the contact lens CL detected by the detection unit 63. In this process, the related information 102 b stored in the storage unit 102 is referred to. Specifically, the intensity acquisition unit 130 receives information indicating the type of the contact lens CL detected by the detection unit 63. Then, the intensity acquisition unit 130 specifies the power of the laser beam associated with the type of the contact lens CL by referring to the related information 102b. Information representing the power of the laser light acquired by the intensity acquisition unit 130 is sent to the control unit 101.

  The control unit 101 controls the light source unit 2 so as to output the laser light of the power acquired by the intensity acquisition unit 130. The control of the light source unit 2 includes at least the control of the treatment light source 2b. Specifically, the control unit 101 outputs the treatment light LT of the power acquired by the intensity acquisition unit 130 as the treatment light source 2b.

  The effects of the laser treatment apparatus according to the present embodiment will be described. The laser treatment apparatus includes a holding unit (61), a moving mechanism (62), and a control unit (101), as in the first embodiment. Furthermore, the laser treatment apparatus includes an irradiation system, a second storage unit, a detection unit, and an intensity acquisition unit.

  The irradiation system deflects the laser light (at least the treatment light LT) output from the light source (light source unit 2) based on a preset pattern to irradiate the patient's eye (E). In the above configuration example, the irradiation system includes the light source unit 2, the optical fiber 4 and the laser irradiation system 50, and the function of deflecting the laser light is realized by the optical scanner 52. The second storage unit stores in advance related information in which the plurality of contact lens types and the intensity of the laser light are associated with each other. In the above configuration example, the second storage unit corresponds to the storage unit 102 in which the related information 102 b is stored in advance. The detection unit (63) detects the type of contact lens held by the holding unit. The intensity acquisition unit (130) acquires the intensity of the laser beam corresponding to the type of the contact lens detected by the detection unit based on the related information. The control unit controls the light source (at least the treatment light source 2b) so as to output the laser light of the intensity acquired by the intensity acquisition unit.

  There are contact lenses of various magnifications. The magnification affects the value of the power delivered to the patient's eye. In the past, the user performed power adjustment according to the contact lens to be applied. In laser treatment, various contact lenses may be used while switching. Therefore, it is bothersome for the user to perform the operation for setting the power during the laser treatment, and the setting error is not permitted for the safety of the patient's eye.

  According to the laser treatment apparatus of the present embodiment, as in the first embodiment, the operability of the ophthalmic laser treatment can be improved, the burden imposed on the user can be reduced, and the type of the contact lens to be applied is Laser treatment of the patient's eye can be performed using laser light of a corresponding intensity (power).

  Another example of the laser treatment apparatus according to the present embodiment has a configuration for detecting the type of contact lens to control the power of the irradiation light, and does not have a configuration related to movement control of the contact lens. According to this laser treatment apparatus, laser treatment of the patient's eye can be performed using laser light of intensity (power) corresponding to the type of contact lens to be applied.

<Modification example>
The above embodiments are merely illustrative for practicing the present invention. A person who intends to practice the present invention can make any modification, omission, addition, substitution, etc. within the scope of the present invention. Such variations are described below. In addition, it is possible to combine the arbitrary structure contained in said embodiment, and the arbitrary structure contained in the following modification.

  The failure of laser surgery is mostly due to missetting of the intensity (power) of laser light. For example, there is a failure that the power is too strong and causes bleeding, or the power is too weak and the therapeutic effect is insufficient. Therefore, before actually performing the laser treatment, a "test shot" for setting the power is performed. Specifically, a test shot is performed with a predetermined power, and the power is set based on the change in color of the cauterized site. Thus, conventional power settings are based on the physician's experience and depend on the skill of the laser treatment. As described above, a technique capable of objectively performing power setting, which has conventionally been subjective, will be described below.

  The first example of the laser treatment apparatus according to this modification has a function of capturing a test shot site and acquiring a front image, analyzing this front image, and displaying the test shot site (change in color, color, And a function of providing information on the power setting based on the drawing state. Also, in the second example, the function of executing OCT of the test shot site to acquire an OCT image (cross-sectional image, three-dimensional image, etc.) and analyzing the OCT image to determine the form of the test shot site (shape, shape) Change, range, range change, etc.), and a function to provide information on power setting based on this form. The information on the power setting may include information representing the result of comparison between the power applied in the test shot and the predetermined appropriate power.

  In the case where a plurality of trial shots are performed, information obtained regarding a plurality of trial shot sites can be statistically processed. Also, a plurality of test shots may be performed with the same power or different powers.

  The laser treatment apparatus of the present modification may have a function of setting the power of the treatment light based on the power applied by trial and the front image or the OCT image. In this function, a process of calculating an evaluation value representing the result of the test shot based on the front image or the OCT image, and a process of correcting the power applied by the test shot based on the evaluation value can be performed. . The power obtained by this correction process is applied in the actual laser treatment.

DESCRIPTION OF SYMBOLS 1 laser treatment apparatus 2 light source unit 3 slit lamp microscope 5 processing unit 10 illumination system 16 slit diaphragm 16 A diaphragm drive unit 30 observation system 50 laser irradiation system 52 light scanner 61 holding unit 62 moving mechanism 63 detection unit 101 control unit 102 storage unit 102 a Plan data 102 b Related information 110 Data processing unit 111 Analysis unit 112 Treatment target site identification unit 113 Spot image identification unit 114 Treatment exclusion area identification unit 115 Control information generation unit 120 Report creation unit 130 Strength acquisition unit

Claims (7)

A laser treatment apparatus for performing laser treatment of a patient's eye through a contact lens in contact with the patient's eye, comprising:
A holder for holding the contact lens;
A moving mechanism for moving the contact lens held by the holder;
An irradiation system for deflecting laser light output from a light source based on a preset pattern to irradiate the patient's eye;
A control unit that executes control of the irradiation system and control of the movement mechanism in combination;
An imaging unit for imaging the patient's eye when at least control of the irradiation system is performed;
And an analysis unit that generates information for controlling the movement mechanism by analyzing the image acquired by the imaging unit.
The control unit executes control of the movement mechanism based on the information generated by the analysis unit. A first storage unit configured to store data representing a treatment target site of the patient's eye set in advance;
The analysis unit
A first identification unit that identifies an image area corresponding to the region to be treated by analyzing an image acquired by the imaging unit based on the data stored in the first storage unit;
A second identification unit that identifies a plurality of spot images representing an irradiation area of the laser beam by analyzing the image;
Information for generating information indicating the movement destination of the irradiation position of the laser beam of the pattern based on the image area specified by the first specifying unit and the plurality of spot images specified by the second specifying unit Including generators and
The control unit executes control of the movement mechanism so as to move the irradiation position of the laser beam of the pattern to the movement destination represented by the information generated by the information generation unit. The laser treatment apparatus according to Item 1. The analysis unit includes a third identification unit that identifies a treatment exclusion region by analyzing the image region identified by the first identification unit,
The said control part performs control of the said moving mechanism so that the site | part of the said patient's eye corresponded to the said treatment exclusion area | region identified by the said 3rd identification part may be skipped. Laser therapy device. The imaging unit includes an illumination system that illuminates the patient's eye with slit light of variable width and orientation;
The analysis unit generates information for changing the width and / or direction of the slit light by analyzing the image acquired by the imaging unit.
The said control part performs control of the said illumination system based on this information. The laser treatment apparatus as described in any one of the Claims 1-3 characterized by the above-mentioned.   The laser according to any one of claims 1 to 4, wherein the movement mechanism is capable of performing at least one of rotational movement, tilt, and axial movement of the contact lens. Treatment device. An irradiation system for deflecting laser light output from a light source based on a preset pattern to irradiate the patient's eye;
A second storage unit for storing in advance related information in which a plurality of contact lens types and the intensity of the laser light are associated;
A detection unit that detects the type of the contact lens held by the holding unit;
An intensity acquisition unit that acquires the intensity of the laser beam corresponding to the type detected by the detection unit based on the related information;
The said control part controls the said light source so that the laser beam of the intensity | strength acquired by the said intensity | strength acquisition part may be output The laser treatment apparatus as described in any one of the Claims 1-5 characterized by the above-mentioned. . The laser according to any one of claims 1 to 6, further comprising: a report creation unit configured to create a report on laser treatment of the patient's eye based on the contents of control executed by the control unit. Treatment device.