JPWO2020061278A5 - - Google Patents

Description

CROSS-REFERENCES TO RELATED APPLICATIONS This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/733,617 (filed September 19, 2018), the contents of which are fully incorporated herein by reference. incorporated.

FIELD OF THE DISCLOSURE The present disclosure relates to systems and methods for treatment of the eye and, more particularly, to systems and methods for treating corneal dilatation disorders.

Corneal ectasia disorders, or ectasia, are a group of rare non-inflammatory eye disorders characterized by bilateral thinning of the central, paracentral, or peripheral cornea.

For example, keratoconus is a degenerative eye disease in which structural changes within the cornea weaken the cornea and deform it into an abnormal cone shape. Cross-linking therapy (/bridging therapy) can strengthen and stabilize areas weakened by keratoconus and prevent unwanted shape changes.

For example, a complication known as post-LASIK dilatation can result from corneal thinning and weakening caused by LASIK (Laser-Assisted in site Keratomileusis) surgery. There is Post-LASIK dilatation is a progressive steepness (bulging) of the cornea. Therefore, cross-linking therapy can strengthen and stabilize the structure of the cornea after LASIK surgery and prevent post-LASIK ectasia.

To treat corneal dilatation disorders (eg, keratoconus), the system and method can precisely direct photoactivating light to specific regions of the cornea that have been treated with a cross-linking agent.

One exemplary system for treating the eye includes a light source configured to provide photoactivating light to photoactivate a cross-linking agent applied to the eye. The system includes one or more optical elements configured to receive the photoactivating light and transmit the photoactivating light to the eye according to a pattern defined by multiple treatment zones. The treatment zones are delivered to different respective regions on the eye. The plurality of treatment zones includes at least a first treatment zone and a second treatment zone. The first treatment zone provides a first dose of photoactivating light. The second treatment zone provides a second dose of photoactivating light. The first dose is greater than the second dose . The first treatment zone is located within the inner boundary of the second treatment zone.

One exemplary method for treating an eye includes locating a treatment area of the eye. The method operates at least one of a light source for photoactivating light or one or more optical elements coupled to the light source to deliver a pattern of photoactivating light according to the location of the treatment area. includes doing. The photoactivating light photoactivates a cross-linking agent applied to the eye. The pattern of photoactivating light is defined by multiple treatment zones. The treatment zones are delivered to different respective regions on the eye. The plurality of treatment zones includes at least a first treatment zone and a second treatment zone. The first treatment zone provides a first dose of photoactivating light. The second treatment zone provides a second dose of photoactivating light. The first dose is greater than the second dose . The first treatment zone is positioned within an inner boundary of the second treatment zone. optionally, the treatment area may correspond to a cone of expansion of the cornea, wherein at least one of the light source or one or more optical elements delivers the first treatment zone to the cone of expansion; and Manipulated to deliver the second treatment zone to a region of the cornea outside the cone of expansion. In another case, the plurality of treatment zones may include a third treatment zone providing a third dose of photoactivating light, wherein the third dose is greater than the first dose . , the third treatment zone is located within the inner boundary of the first treatment zone. and at least one of the light source or the one or more optical elements to deliver the first treatment zone and the third treatment zone to the cone of expansion; It is manipulated to deliver two treatment zones to regions of the cornea outside the cone of expansion.

1 illustrates one exemplary system for delivering a cross-linking agent and photoactivating light to the cornea of an eye to produce cross-linking of corneal collagen, according to aspects of the present disclosure; FIG. FIG. 10 illustrates an exemplary pattern of photoactivating light that may be delivered to treat corneal dilatation disorders, according to aspects of the present disclosure; 3 illustrates one exemplary method for irradiating the pattern of FIG. 2 to treat corneal dilation disorders, according to aspects of the present disclosure; FIG.

While the disclosure is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and will herein be described in detail. It is not intended, however, to be limited to the particular forms disclosed, but on the contrary is intended to cover all modifications, equivalents, and alternatives falling within the spirit of this disclosure. It should be understood that

FIG. 1 shows one exemplary treatment system 100 for creating collagen cross-linking in the cornea 2 of an eye 1. As shown in FIG. The treatment system 100 includes an applicator 132 for applying a cross-linking agent 130 to the cornea 2. As shown in FIG. In an exemplary embodiment, the applicator 132 can be an eyedropper, syringe, or the like that applies the photosensitizer 130 to the cornea 2 as droplets. Exemplary systems and methods for delivering cross-linking agents are disclosed in U.S. Pat. No. 10,342,697, entitled "Systems and Methods for Delivering Drugs to an Eye." filed on April 13, 2017). The contents of which are incorporated herein by reference in their entirety.

The cross-linking agent 130 may be provided in a formulation that allows the cross-linking agent 130 to pass through the corneal epithelium 2a to the underlying regions within the corneal stroma 2b. Alternatively, the corneal epithelium 2a may be removed or otherwise incised to allow application of the cross-linking agent 130 more directly to the underlying tissue.

The treatment system 100 includes an illumination system with a light source 110 and an optical element 112 for directing light onto the cornea 2 . This light causes photoactivation of the cross-linking agent 130 to produce cross-linking activity in the cornea 2 . For example, the cross-linking agent can include riboflavin and the photoactivating light (hereinafter referred to as photoactivating light) can include ultraviolet A (UVA) (eg, about 365 nm) light. Alternatively, the photoactivating light may comprise another wavelength, such as visible wavelengths (eg, about 452 nm). As explained further below, corneal cross-linking improves corneal strength by creating chemical bonds within the corneal tissue according to the mechanism of photochemical dynamic reactions. For example, riboflavin and photoactivating light can be administered to stabilize and/or strengthen corneal tissue to combat corneal dilatation disorders (eg, keratoconus or post-LASIK dilatation). In addition, administration of riboflavin and photoactivating light may allow varying degrees of refractive correction, including, for example, myopia, hyperopia, astigmatism, irregular astigmatism, presbyopia, and impaired corneal dilatation. Other conditions such as corneal biomechanical changes/degeneration may also be included, as well as combinations of complex corneal refractive surface corrections by orthopedics.

The treatment system 100 includes one or more controllers 120 that control aspects of the system 100 (including the light source 110 and/or optical elements 112). In one embodiment, the cornea 2 can be treated more extensively with the cross-linking agent 130 (e.g., using eyedroppers, syringes, etc.), and the photoactivating light from the light source 110 directs the cornea 2 to be treated according to a specific pattern. It can be selectively directed to two areas.

Optical element 112 may include one or more mirrors or lenses for directing and focusing the photoactivating light emitted by light source 110 onto a particular pattern on cornea 2 . Optical element 112 is further for partially blocking wavelengths of light emitted by light source 110 and for selecting specific wavelengths of light directed at cornea 2 for photoactivating cross-linking agent 130 . can contain filters. Additionally, optical element 112 may include one or more beam splitters for splitting the beam of light emitted by light source 110 and includes one or more heat sinks for absorbing light emitted by light source 110. It's okay. The optical element 112 can also accurately and precisely focus the photoactivating light to a particular focal plane within the cornea 2 (eg, at a particular depth within the underlying region 2b where cross-linking activity is desired).

Additionally, the intrinsic properties of the photoactivating light can be altered to achieve the desired degree of cross-linking in selected regions of the cornea 2 . One or more controllers 120 may control wavelength, bandwidth, intensity, power, position, depth of penetration, and/or treatment duration (duration of exposure cycle, duration of dark cycle, and duration of exposure and dark cycles). The operation of light source 110 and/or optical element 112 can be controlled to precisely deliver photoactivating light according to any combination of ratios.

The parameters for photoactivation of cross-linking agent 130 can be adjusted, for example, to reduce the time required to achieve the desired cross-linking. In one implementation, the time can be reduced from minutes to seconds. Some configurations can be irradiated with photoactivating light at an irradiance of 5 mW/cm ² , but to reduce the time required to achieve the necessary cross-linking, the photoactivating light can be applied at a higher intensity ( For example, multiples of 5 mW/cm ² ). The total delivered dose of energy absorbed by the cornea 2 can be described as the effective delivered dose, which is the amount of energy absorbed through the area of the corneal epithelium 2a. For example, the effective dose to an area of the corneal surface 2a can be on the order of, for example, about 5 J/cm ² , or about 20 J/cm ² , or about 30 J/cm ² . The stated effective doses can be delivered from a single dose of energy or from repeated doses of energy.

The optical element 112 of the treatment system 100 is a microelectromechanical system (MEMS) device, such as a digital micromirror device (DMD), to spatially and temporally modulate the illumination of the photoactivating light. -mirror device). Using DMD technology, photoactivating light from light source 110 is projected in a precise spatial pattern created by an array of extremely small mirrors on a semiconductor chip. Each mirror represents one or more pixels of the projected light pattern. With DMD, topograph-directed cross-linking can be performed. DMD control by topography can employ several different spatial and temporal illumination and dose profiles. These spatial and temporal dose profiles can be generated using continuous wave irradiation, but are adjusted via pulsed irradiation by pulsing the irradiation source under varying frequency and duty cycle. can be Alternatively, the DMD can be tuned to vary the pixel frequency and duty cycle from pixel to pixel to provide ultimate flexibility with continuous wave illumination. Alternatively, both pulsed irradiation and a combination of modulated DMD frequencies and duty cycles may be combined. This spatially determined cross-linking can be used for pre-treatment planning and/or real-time monitoring and adjustment of corneal cross-linking during treatment using dosimetry, interferometry, optical coherence tomography (OCT), It can be combined with corneal topography and the like. Aspects of the dosimetry system are described in greater detail below. In addition, preclinical patient information can be combined with finite element biomechanical computer modeling to create patient-specific pretreatment plans.

To control aspects of photoactivating light delivery , embodiments may also employ aspects of multiphoton excitation microscopy. Specifically, rather than delivering a single photon of a specific wavelength to the cornea 2, the treatment system 100 uses multiple photons of longer wavelength (i.e., lower energy) that combine to initiate cross-linking. photons . Advantageously, longer wavelengths are scattered less within the cornea 2 than shorter wavelengths, which means that longer wavelength light reaches the cornea 2 more efficiently than shorter wavelength light. allow to penetrate. The shielding effect of incident radiation deeper within the cornea is also reduced compared to conventional short wavelength radiation. This is because the absorption of light by the photosensitizer is much less at longer wavelengths. This allows for enhanced control over depth-specific cross-linking. For example, in some embodiments two photons may be used. Here, each photon carries approximately half the energy required to excite the molecules within crosslinker 130 to produce the photochemical reactions described further below. When the crosslinker molecule absorbs both photons simultaneously, it absorbs enough energy to release a reactive radical in the corneal tissue. Embodiments may also utilize lower energy photons, such as, for example, 3, 4, or 5 photons must be absorbed simultaneously in order for a crosslinker molecule to release a reactive radical. good. Multiple photons are unlikely to be absorbed nearly simultaneously, thus requiring a high flux of excitation photons, which can be delivered via a femtosecond laser.

A number of conditions and parameters affect the cross-linking of corneal collagen by cross-linking agent 130 . For example, the intensity of the photoactivating light and the dose delivered affect the amount and rate of cross-linking.

When the cross-linking agent 130 is specifically riboflavin, the UVA light may be applied continuously (continuous wave (CW)) or as pulsed light, the choice affecting the amount, rate and extent of cross-linking. give. When UVA light is applied as a pulsed light, the exposure cycle, the duration of the dark cycle, and the ratio of the exposure cycle to the dark cycle duration affect corneal hardening as a result. Pulsed light irradiation can be used to provide greater or lesser stiffening of the corneal tissue than can be achieved with continuous wave irradiation delivering the same amount or dose of energy. Light pulses of appropriate length and frequency can be used to achieve more optimal chemical amplification. For pulsed light therapy, the on/off duty cycle can be between about 1000/1 and about 1/1000. The illumination intensity can be between about 1 mW/cm ² and about 1000 mW/cm ² average illumination intensity, and the pulse rate can be between about 0.01 Hz and about 1000 Hz, or between about 1000 Hz and about 100,000 Hz.

The treatment system 100 may be controlled by employing a DMD (electronically turning the light source 110 on and off) and/or using a mechanical or optoelectronic (e.g., Pockels cell) shutter or mechanical chopper or rotating aperture. By using it, pulsed light can be generated. Complex biomechanical stiffness patterns can be imparted to the cornea because of the inherent modulation capabilities of the DMD's pixels and subsequent stiffening based on modulated frequency, duty cycle, illuminance, and dose delivered to the cornea . . A particular advantage of the DMD system and method is that it provides aperiodic, uniform-appearing illumination (the illumination is sensitive to pulse frequencies between 2 Hz and 84 Hz) due to random, asynchronous pulse topography patterning. (which eliminates the possibility of causing epileptic seizures or flicker vertigo).

Although exemplary embodiments may use a stepped on/off pulsed light feature, it is understood that other features of directing light to the cornea may be used to achieve a similar effect. For example, light can be directed to the cornea according to a sinusoidal function, a sawtooth function, or other complex functions or curves, or any combination of functions or curves. In fact, it will be appreciated that the function can be substantially stepped, even though it can be a more gradual transition between on/off values. Furthermore, it will be appreciated that the illumination need not decrease to a value of zero during the off-cycle, but may be above zero during the off-cycle. A desired effect can be achieved by illuminating the cornea according to a curve that varies the intensity between two or more values.

Examples of systems and methods for delivering photoactivating light are found, for example, in the US patent application entitled "Systems and Methods for Applying and Monitoring Eye Therapy" Publication No. 2011/0237999 (filed March 18, 2011), U.S. Patent Application Publication No. entitled "Systems and Methods for Applying and Monitoring Eye Therapy" 2012/0215155 (filed April 3, 2012), and U.S. Patent Application Publication No., entitled "Systems and Methods for Corneal Cross-Linking with Pulsed Light." 2013/0245536 (filed March 15, 2013). The contents of these applications are incorporated herein by reference in their entirety. Embodiments can produce cross-linking activity within the cornea according to a circular and/or annular pattern defined by delivery of photoactivating light (eg, via the DMD described above). Additionally or alternatively, embodiments may produce cross-linking activity within the cornea according to non-circular and/or non-circular patterns defined by delivery of photoactivating light (e.g., via DMD). .

Multiple patterns of photoactivating light can be delivered (eg, via a DMD) to the eye in separate treatment zones with different doses delivered sequentially or sequentially. For example, one treatment zone can be "turned off" (i.e., the delivery of the corresponding photoactivating light is stopped) while the other treatment zone is "left on" (i.e., , the delivery of the corresponding photoactivating light is continued). A treatment zone may, for example, be formed annularly around the center point of the eye. There may also be discontinuous zones that are not irradiated with photoactivating light (eg, a central treatment zone surrounded by a ring of no light surrounded by annular treatment zones of light). The width of the annular zones can be of different dimensions (eg one annular zone has a width of 1 mm and another zone has a width of 2 mm). Delivering photoactivating light to an annular treatment zone on the periphery of the eye without a central treatment zone, for example, results in hyperopia correction by increasing the curvature of the central region of the eye while the periphery is enhanced. sell. In some cases, the central and peripheral treatment zones can be elliptical in shape to address astigmatism, for example, by producing cross-linking activity preferentially in regions of the cornea to correct astigmatism. . Such an elliptical annular treatment zone is preferentially oriented with the axis of the annular treatment zone aligned according to the orientation of the astigmatism. The elliptical treatment zone may also be irregularly asymmetric (ie, have major and minor axes that are not perpendicular to each other and may be positioned with separate center points (centroids)).

Crosslinking treatment may be tailored according to one or more biomechanical properties of the eye, such as corneal topography (ie, shape), corneal strength (ie, stiffness), and/or corneal thickness. Optical correction and/or enhancement of the cornea is accomplished by applying the cross-linking agent and/or photoactivating light in one or more iterations (with tunable properties for each iteration). sell. In general, the treatment regimen developed includes multiple uses of the cross-linking agent, the dosage and concentration of the cross-linking agent for each use, the number and timing, duration, power, energy dose, and number of exposures of the photoactivating light. A pattern of photoactivating light for each application may be included. In addition, bridging therapy can be adapted based on real-time collected feedback information regarding biomechanical properties during therapy or during therapy interruptions.

The addition of oxygen also affects the degree of hardening of the cornea. In human tissues, the _O2 content is extremely low compared to the atmosphere. However, the rate of cross-linking in the cornea is related to the concentration of _O2 when the photoactivating light is applied. Therefore, it may be advantageous to actively increase or decrease the concentration of O ₂ during irradiation in order to control the rate of cross-linking until the desired degree of cross-linking is achieved. Oxygen may be administered during cross-linking therapy in several different ways. One approach is to supersaturate riboflavin with _O2 . In this way, when riboflavin is applied to the eye, high concentrations of _O2 are delivered directly into the cornea along with riboflavin, resulting in reactions involving _O2 when riboflavin is exposed to photoactivating light. influence. According to another approach, a steady state of _O2 (at a selected concentration) is maintained at the surface of the cornea and the cornea is exposed to a selected amount of _O2 , allowing _O2 to enter the cornea. can. As shown in FIG. 1, for example, the treatment system 100 also includes an oxygen source 140 and an oxygen delivery device 142 that optionally delivers oxygen to the cornea 2 at an optionally selected concentration. Exemplary systems and methods for administering oxygen during cross-linking therapy are described, for example, in U.S. Pat. and Methods for Corneal Cross-Linking with Pulsed Light,” US Pat. No. 9,707,126, filed Oct. 31, 2012. The contents of these applications are incorporated herein by reference in their entirety. Additionally, an exemplary mask device for delivering oxygen concentration and photoactivating light in treating an eye is described in Systems and Methods for Treating an Eye with a Mask Device. Method),” U.S. Provisional Patent Application Publication No. 2017/0156926 (filed December 3, 2016). The contents of which are incorporated herein by reference in their entirety. For example, a mask can be placed over the eye to provide a consistent and known concentration of oxygen on the surface of the eye.

Riboflavin undergoes photoactivation upon absorption of radiation energy, particularly light. There are two photochemical dynamic pathways for photoactivation of riboflavin, type I and type II. Reactions involved in both Type I and Type II mechanisms and other aspects of the photochemical dynamic reactions that generate cross-linking activity are described in Systems and Methods for Cross-Linking Treatments of an Eye. US Patent No. 10,350,111 (filed April 27, 2016), entitled "Systems and Methods for The contents of which are incorporated herein by reference in their entirety.

To treat corneal dilatation disorders (eg, keratoconus), effective bridging surgery precisely irradiates a specific region of the cornea that has been treated with a cross-linking agent with photoactivating light. For example, FIG. 2 illustrates an exemplary pattern 200 of photoactivating light that may be applied to treat corneal dilatation disorders associated with the cornea 2 of eye 1 . As noted above, UV light may be delivered according to pattern 200 to photoactivate a cross-linking agent (eg, rioflavin) that has been applied to cornea 2 . As shown, pattern 200 includes high dose treatment zones 202 a,b and low dose treatment zones 204 . The high dose treatment zones 202 a,b are greater than the low dose treatment zones 204 . Provides greater energy via photoactivating light.

High dose treatment zones 202a ,b are centered on and cover areas of cones of expansion caused by disorders such as keratoconus. Accordingly, the high dose treatment zones 202a ,b can reduce the curvature of the cone of expansion (ie flatten). The location of the cone of expansion can be determined by evaluating topography, tomography, and/or thickness measurements of the cornea 2, for example. As shown in FIG. 2, high dose treatment zone 202a is concentrically disposed within high dose treatment zone 202b . The inner high dose treatment zone 202a provides a dose of about 10.5 J/cm ² and the outer high dose treatment zone 202b provides a dose of about 8.5 J/cm ² .

The low dose treatment zone 204, on the other hand, extends from the outer edges of the high dose treatment zones 202a ,b to cover the peripheral area of the cornea, but the outer edge of the low dose treatment zone 204 extends beyond the limbus. does not extend. Thus, the low dose treatment zone 204 stabilizes the surrounding non-dilated cornea. As shown in FIG. 2, the low dose treatment zone 204 provides a dose greater than zero and approximately 5.4 J/cm ² . In some embodiments , another approach is that irradiation of a region outside the expansion cone of photoactivation light may undesirably affect the efficacy of the photoactivation light applied to the expansion cone (e.g., expansion It teaches to discourage the use of low dose treatment zones 204 in pattern 200, as it is believed that they may provide the desired flattening of the cone of symmetry.

The shape of pattern 200 along the xy plane shown in FIG. 2 can be achieved by adjusting aspects of optical element 112 as described above. For example, the DMD can be programmed via the controller 120 to define the high dose treatment zones 202 a,b and the low dose treatment zones 204 as different respective pixelated shapes to be delivered to the cornea 2 . The depth along the z-axis for delivery of the photoactivating light can be achieved by adjusting the illumination of the photoactivating light.

FIG. 3 shows an exemplary method 300 for applying photoactivating light according to pattern 200 . At time t=0, delivery of photoactivating light to all treatment zones 202a,b,204 is initiated substantially simultaneously in operation 302. FIG. At time t=t ₂₀₄ , delivery of photoactivating light to the lower treatment zone 204 is stopped at operation 304 because the desired lower dose (eg, about 5.4 J/cm ² ) has been achieved. At time t=t _202b , the desired higher dose (e.g., about 8.5 J/cm ² ) is achieved, so delivery of photoactivating light to the outer higher dose treatment zone 202b follows. at operation 306 of . At time t=t _202a , the desired higher dose (eg, about 10.5 J/cm ² ) is achieved, and delivery of photoactivating light to the inner higher dose treatment zone 202a follows. at operation 308 of .

The exemplary pattern 200 shown in FIG. 2 may include two high dose treatment zones 202a ,b, and another pattern may include only one high dose treatment zone. (Equal doses may be provided in treatment zones 202a,b, for example, as shown in FIG. 2.) Alternatively, another pattern may include three or more higher dose treatment zones. The exemplary pattern 200 shown in FIG. 2 may include one low dose treatment zone 204, and another pattern may include multiple low dose treatment zones outside the cone of expansion.

It is also understood that the treatment zones may be arranged and/or shaped differently than shown in FIG. For example, the treatment zone can be oval. Further, although treatment zones 202a,b, 204 may provide specific doses as described above, alternative patterns may provide different doses in each treatment zone. Additionally, the dose relationship between different treatment zones may differ from that shown in FIG. For example, the dose delivered outside the cone of expansion may be greater than the dose delivered to the cone of expansion.

As noted above, according to some aspects of the disclosure, some or all steps of the procedures described and illustrated above may be automated or guided under the control of a controller (eg, controller 120). In general, controllers may be implemented as a combination of hardware and software elements . A hardware aspect may include a microprocessor, logic circuitry, communication/network ports, digital filters, memory, or any combination of operably coupled hardware components including logic circuitry. The controller may be adapted to perform operations specified by computer-executable code, which may be stored on a computer-readable medium.

As noted above, the controller is a programmable processing device (e.g., an external conventional computer, or an on-board Field Programmable Gate Array (FPGA), or a digital signal processor (e.g., a digital signal processor) that executes software or stored program instructions). DSP)). In general, a physical processor and/or machine used by embodiments of the present disclosure for any processing or evaluation may be understood by those skilled in the computer and software arts to be understood by exemplary embodiments of the present disclosure. may include one or more networked or non-networked general purpose computer systems, microprocessors, field programmable gate arrays (FPGAs), digital signal processors (DSPs), microcontrollers, etc. programmed according to the teachings of . A physical processor and/or machine may be externally networked with the image capture device or integrated to reside within the image capture device. Appropriate software can readily be prepared by programmers of ordinary skill based on the teachings of the exemplary embodiments, as will be understood by those skilled in the software art. Further, the devices and subsystems of the exemplary embodiments may be provided by provision of an application specific integrated circuit or by interconnecting multiple conventional component circuits in a suitable network, as will be understood by those skilled in the electrical arts. can be implemented by Thus, example embodiments are not limited to any specific combination of hardware circuitry and/or software.

Exemplary embodiments of the present disclosure may be stored on any one or combination of computer readable media and may be stored on exemplary embodiment devices and subsystems for controlling exemplary embodiment devices and subsystems. may include software or stored program instructions for driving the example embodiment devices and subsystems to enable interaction with a human user or the like. Such software includes, but is not limited to, device drivers, firmware, operating systems, development tools, application software, and the like. Such computer-readable media may further include a computer program product of embodiments of the present disclosure for performing all or part of the processing performed in an implementation (if the processing is distributed). Computer code devices of exemplary embodiments of the present disclosure include, but are not limited to, scripts, interpretable programs, dynamic link libraries (DLLs), Java classes and applets, complete executable programs, and the like. Any suitable interpretable or executable code mechanism may be included. Additionally, portions of the processing of exemplary embodiments of the present disclosure may be distributed for better performance, reliability, cost, and the like.

Common forms of computer readable media include, for example, floppy disks, floppy disks, hard disks, magnetic tapes, other suitable magnetic media, CD-ROMs, CDRWs, DVDs, other suitable optical media, punch cards, paper tapes, Optical marksheets, other suitable physical media with hole patterns or other optically recognizable indicia, RAM, PROM, EPROM, FLASH-EPROM, other suitable memory chips or cartridges, computer readable It may include a carrier wave or other suitable medium.

Although this disclosure has been described with reference to one or more specific embodiments, those skilled in the art will recognize that many changes can be made thereto without departing from the spirit and scope of this disclosure. . Each of these embodiments and their obvious variations are considered to fall within the spirit and scope of this disclosure. It is also envisioned that additional embodiments according to aspects of the present disclosure may combine any number of features of any of the embodiments described herein.

Claims (10)

A system for treating an eye, comprising:
a light source configured to provide photoactivating light to photoactivate a cross-linking agent applied to the eye; and receiving said photoactivating light and having said photoactivating light defined by a plurality of treatment zones. one or more optical elements configured to deliver to the eye according to a pattern;
with
The plurality of treatment zones are delivered to different respective regions on the eye, the plurality of treatment zones including at least a first treatment zone and a second treatment zone, the first treatment zone comprising photoactivating light. and a second treatment zone provides a second dose of photoactivating light, said first dose being greater than said second dose , and said first the treatment zone is positioned within an inner boundary of the second treatment zone;
the above system. The plurality of treatment zones includes a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose , and the third treatment 3. The system of claim 1, wherein a zone is located within an inner boundary of said first treatment zone. 2. The system of claim 1, wherein the plurality of treatment zones are defined by the pixels of photoactivating light. 3. The system of Claim 1, wherein the one or more optical elements comprise a digital micromirror device configured to generate the pattern defined by the plurality of treatment zones. Further comprising a controller including one or more processors configured to execute program instructions stored on one or more computer readable media, the program instructions directing the one or more processors to the treatment area on the eye. 2. The system of claim 1, wherein at least one of the light sources or the one or more optical elements are controlled to determine position and deliver the pattern of photoactivating light according to the position of the treatment area. The program instructions cause the one or more processors to determine the location of the treatment area on the cornea based on information associated with at least one of corneal topography, tomography, or thickness measurements. Item 6. The system according to item 5. The treatment area corresponds to a cone of expansion in the cornea, and the one or more processors control at least one of the light source or the one or more optical elements to expand the first treatment zone. 7. The system of claim 6 , delivering the cone of expansion and delivering the second treatment zone to the region of the cornea outside the cone of expansion. The plurality of treatment zones includes a third treatment zone providing a third dose of the photoactivating light, the third dose being greater than the first dose , the third treatment zone is positioned within the inner boundary of the first treatment zone, and the one or more processors are configured to deliver the first treatment zone and the third treatment zone to the expandable cone; 8. The system of claim 7, controlling at least one of the light source or the one or more optical elements to deliver the second treatment zone of to a region of the cornea outside the cone of expansion. . at least one of the light source or the one or more optical elements ;
simultaneously initiating delivery of the first treatment zone and the second treatment zone to the eye;
stopping delivery of the second treatment zone after the second dose has been delivered ;
stopping delivery of the first treatment zone after the first dose has been delivered , wherein delivery of the second treatment zone is stopped before delivery of the first treatment zone is stopped; to be suspended;
by
2. The system of claim 1, configured to deliver the first dose of photoactivating light and the second dose of photoactivating light. At least one of the light source or the one or more optical elements is aligned on an axis extending below the surface of the eye by adjusting the intensity of the photoactivating light in each of the plurality of treatment zones. 2. The system of claim 1, configured to deliver the photoactivating light to one or more depths along a plane, and wherein the pattern of photoactivating light is defined along a plane transverse to the axis. .