WO1998019642A1

WO1998019642A1 - Device for optically examining and/or treating the human eye

Info

Publication number: WO1998019642A1
Application number: PCT/CH1997/000417
Authority: WO
Inventors: Ulrich Dürr; Franz Fankhauser; Greg Heacock
Original assignee: Meridian Ag
Priority date: 1996-11-05
Filing date: 1997-11-03
Publication date: 1998-05-14
Also published as: KR20000053044A; EP0942695A1; CA2270837A1; JP2001515376A

Abstract

A device for optically examining and/or treating a patient's eye has a lighting and/or observation optical unit (3) that can be freely moved and oriented in the direction of all co-ordinates in space above the left or right eye (29) and has a flat area that can be set on the surface of the eye. The optical unit is preferably retained in the adjusted position relative to the eye so as to maintain itself in a fixed position in relation to the patient's head and to move together with the head, when the patient can move his head. The treating doctor thus does not need to carry out manual positioning and/or securing operations while diagnosing and/or treating the patient. On the contrary of known optical treatment devices, unwanted degrees of freedom of motion are excluded by the disclosed device, and the risk of injuries is considerably reduced. In particular, laser beams can be more safely used for treating the eye.

Description

Device for the optical examination and / or treatment of the human eye

The invention relates to a device according to the preamble of patent claim 1.

Ophthalmic examinations are preferably carried out with light. Typically during examinations of the human eye, the forehead was pressed against a headband arranged on a table and the chin was placed on a chin rest also arranged on the table. The headband and chin rest served as adjustment elements to fix the patient's head in an examination position. A slit lamp pivotally connected to this table was used as the lighting source, which was connected in a suitable manner with a so-called biomicroscope. In many diagnostic cases, a contact glass had to be used, which the doctor had to hold in the beam path of the biomicroscope and the slit beam. At the same time, the doctor had to look through the biomicroscope and ensure that the patient remained in position. -? -

A photocoagulator is known from US Pat. No. 4,477,159 in which, as explained above, the doctor held a focusing or a contact lens with his hand and pressed it against the surface of the eye. A telescope was attached to his head so that he could look into the patient's eye through the hand-held contact lens / lens. The radiation from a laser was faded into the telescope via a beam guide, which was then guided from the telescope as a free beam to the contact glass. Illumination radiation analogous to laser radiation could also be guided to the contact glass.

The object of the invention is to provide the doctor with a device which allows him to carry out a safe, problem-free examination and treatment of the human eye, in particular with preferably high-intensity laser beams,

The object is achieved in that, in contrast to the known optical treatment devices, the lighting and / or treatment optics to be placed on the eye to be treated are no longer held by the hand of the doctor to be treated, but by a holding device, which is preferably on the head is attachable to the patient. In particular, the optics can be manually adjusted by the doctor (a remote-controlled adjustment is of course also possible) and then remains in the set position, the one surface of the optics (contact glass) also remaining in contact with the surface of the eye. The optics are only moved again for a new setting and then remain locked in this newly set position. When the patient's head moves, the setting made remains relative to the respective eye. Also, the patient's head no longer has to be held in a fixed position for a longer period of time. When using the device according to the invention, treatments with laser beams (retinal coagulation, ...) can be carried out without any problems, since long-term alignment of the eye to the radiation source is possible without any problems. This eliminates the security problems that occurred earlier. Also, the doctor no longer lacks a "third" or "fourth" hand to hold the observation or treatment optics.

The holding or guiding device of the device according to the invention can also be attached to a free-standing patient head holder, through which the head can be positioned in a defined manner on the forehead and chin.

The device is preferably designed to be as light as possible. For this purpose, radiation sources for lighting and in particular also for the treatment of the eye will be removed from the device and the light or the radiation [also a radiation adjacent to the visible spectral range, such as infrared, will be equated with light below] via light guides (light guide bundles ) initiate.

It will also be advantageous to dispense with direct observation using a microscope. An image of the eye, its background, the retina, the chamber angle or other parts can be taken with an image acquisition system whose CCD chip, for example, weighs only a few grams. This also saves weight. The doctor can also better observe the patient or his devices and keep them under control.

As a further advantage, it should be noted that the device according to the invention can be used both on the seated and on the lying patient.

Working with light guides for feeding lighting Treatment energy and treatment energy as well as the image transmission via cable, in addition to a substantial saving in weight, result in an informality for the patient, since his head is no longer fixed on a treatment device arranged, for example, on a treatment table. He can move his head.

Measuring sensors (e.g. for measuring eye mobility, eye pressure, etc.) can also be integrated in a simple manner on or in the device according to the invention.

Light-generating elements, such as LEDs, can also be integrated into the contact glass.

The device according to the invention can be used analogously to the photocoagulator already described above and described in US Pat. No. 4,477,159. In contrast to the known photocoagulator, the doctor in the device according to the invention no longer has an optical system on his head which makes him immobile and restricts his field of vision. Adjustment coordination of observation and / or treatment optics as a result of patient head movements is eliminated. Furthermore, the position of the optical units necessary for the treatment, once set, is also fixed, even if the patient should move. In particular, the fixation of the laser beam path in photocoagulation, for example, can be seen as a great advantage. Careless slipping of the contact glass or incorrect positioning of the lens, which could damage the eye, is no longer possible.

Examples of the device according to the invention are explained in more detail below with reference to drawings. Further advantages of the invention result from the following description. Show it: 1 is a perspective view of the device according to the invention,

2 shows a variant of the device shown in FIG. 1

3 shows a schematic representation of the components of an exemplary optical head of the device shown in FIG. 2,

4 an enlarged side view of an example contact glass holder in the viewing direction III indicated in FIG. 2, compared to the illustration in FIG. 2,

Fig. 5 shows a variant of the optical head shown in Figure 3 and

6 shows a cross section through an example of a contact glass which can be inserted into the holder indicated in FIG. 4.

The device according to the invention shown in FIG. 1 has a holding part 1 with a housing 3, into which the lighting, observation and treatment devices shown in FIG. 4 are installed. The device can be placed on the patient's head.

The holding part 1 has a headband 5a running around the head and a holding band 5b, between which the housing 3 is held by a so-called gooseneck 2. The gooseneck 2 is designed such that it holds the housing 3 in the respectively deflected position, in particular without springing back. Furthermore, the holding part 1 has an apex band 7. One end of the headband 5a, the retaining band 5b and the apex band 7 each run at one location on the left and right (in the state when placed on the head about over the ears) and are held together with a locking device 6a and 6b.

The headband 5a and the crown band 7 are flexible, preferably with a padding 9a and 9b. The tether 5b is rigid. The headband 5a and the crown band 7 can be adjusted in length by the adjusting device 10a or 10b to the shape of the head of the corresponding patient.

Figure 2 shows an embodiment variant of the device shown in Figure 1. The housing, here marked 3, is detachably fastened to the holding strap 5b with a clamping device _^ 11. It can be moved from one eye to the other in the direction of the double arrow 12 in FIG. 2 on the holding band 5b. The detachability of the housing 3 also allows it to be used on a head holder. The housing 3 has a positioning device 13 for three-dimensional adjustment of an optical head 15 by means of handles 22a and 22b. The optical head 15 contains the lighting, observation and optical treatment devices described below.

Approximately at the location of the clamping (and sliding) device 11, the housing 3 has a positioning device 13 with a self-locking swivel device 19, which can be locked with a locking button 20 and by pressing a button located on the other side (not visible in FIG. 2) can be unlocked. With the pivoting device 19, pivoting about an axis approximately parallel to the connecting axis of the two locking devices 6a and 6b is possible. In FIG. 2, below the swiveling device 19, the positioning device 13 has a self-locking displacing device 21 with which the optical head 15 can be displaced perpendicular to the swiveling axis of the swiveling device 19. The displacement device 21 can be locked by a left and right locking lever 22a or 22b. This enables the treating doctor to work with either the left or the right hand. Analogously, the locking handle 20 could be designed for two-handed work. The optical head 15 itself can also be adjusted three-dimensionally and can be pivoted in a self-locking manner on a ball joint. The adjustment of the optical head 15 serves for fine adjustment, in particular during the eye examination and / or treatment.

The swivel and two displacement devices are spring-loaded in such a clamping manner that self-locking is achieved. The locking handles and locking levers set the spring force for clamping from completely loose to firmly fixed.

In FIG. 2 at the top of the housing 3, the electrical supply lines described below, the signal lines and a light guide or a light guide bundle 37 are combined in a cable 25 via a plug 26. The light guide 37 for the laser radiation is supplied separately, but could also take place via the cable 25 if the optical head 15 is designed differently. The cable 25 is held for strain relief on the crown band 7 with a clamp 27.

The optical head 15 shown schematically in FIG. 2 pressed against an eye 29 has a contact glass 30 on the side adjacent to the eye. As shown for example in FIG. 4, the contact glass 30 held in a tube 32 has an upper and a lower eyelid deflector 28a and 28b for the upper and lower eyelids. The tube 32 can have corresponding adapters or coupling elements for the different contact glasses mentioned below. It is exchangeably preferably held in a ring holder. Different contact glasses 30 are used for certain areas of the eye (retinal fundus, retinal periphery, chamber angle, ...). The one to be placed on the eye 29 As shown in FIG. 6 for the exemplary embodiment described here, the surface of the contact glass 30 has two different curve radii r _F and r _G. The central part 33a of the surface has a smaller curve radius r _G than the edge region 33b with r _F. The smaller radius r _G is between 6 mm and 8 mm and the radius r _F between 10 mm and 14 mm depending on the area of application. The ring holder for the contact glass 30 sits in the tube 32. Instead of the contact glass 30 described here with the two radii r _F and r _G, it is of course also possible to use one with only one radius. However, the contact glass 30 described here gives better optical imaging and observation properties.

To illuminate the eye 29, as shown in FIG. 3, the illuminating radiation is supplied via the light guide 37 in the cable 25 and via the plug 26. Moving the source of illumination out of the optical head 15 reduces its weight, facilitates replacement of the lighting source, creates free space in the optical head 15 for the

Eye 29 further aligned units and sensors and also reduces heat generation in the immediate vicinity of the eye 29 and the manipulating hand or hands of the doctor. There is also a beam shaping device for the illuminating beam, which is symbolically represented as a lens 39. There may also be a filter device for the illuminating radiation, which, however, can also be assigned to an external light source. After beam shaping and any filtering (color, intensity, polarization), the illuminating beam 40 passes a first deflecting mirror 41, is then with a second deflecting mirror 43 onto a focusing lens 44 and from there via the contact glass 30 into or onto the eye 29 directed. The first deflecting mirror 41 is now coated or constructed in such a way that the radiation from the illuminating light is transmitted almost unhindered (preferably 99%), but a laser radiation described below is is steered. Radiation can be separated by remuneration, but also by a suitable choice of beam paths. The second deflecting mirror 43 allows a (as small as possible) part of the illuminating radiation to be transmitted and directs the remainder of the radiation onto the lens 44. Here too, the laser radiation is (almost) completely deflected. The radiation emanating from the illuminated eye areas is imaged by the lens 44 through the second deflecting mirror 43 with less than 50% radiation loss on an image capturing element (CCD chip) 45 as an observation device. The electrical signals of the image capture element 45 are reproduced as an image on a monitor and simultaneously stored in a computer, where they are ready for further processing. Computer storage can of course also be dispensed with. The monitor can now be designed as a free-standing device (stand-alone) or as a small so-called headband monitor. The treating doctor would prefer to wear this small headband monitor on a headband.

If necessary, the electronic image capture element 45 can be removed and the illuminated interior of the eye or its surface can be viewed using a microscope (so-called biomicroscope).

In addition to the lighting and observation device, a radiation physical processing device is arranged in the optical head 15. The radiation for the processing device is guided through a separate light guide 47 to a holder 49, with which the through the

Light guide 47 transported laser radiation for processing is directionally manipulated. As indicated in FIG. 3, the holder 49 can be designed as a three-dimensionally pivotable, preferably self-locking, ball holder. There is also a beam shaping device 51 for generating different beam cross sections for the laser light emerging from the light guide 47. The laser Radiation is guided into the eye 29 via the mirrors 41 and 43 and the focusing lens 44 and the contact glass 30.

Instead of the device described above, a helmet can also be used, which is put over the patient's head. However, the above device is preferred because it is less restrictive to the patient. The advantage of the helmet would, however, be that an earpiece could be attached in it, with which music, information and instructions could be transmitted to the patient.

For a non-centric machining z. B. in the chamber angle of the eye, a beam path can now be selected, as shown in FIG. 5. A radiation shaping device 52 (generally an adjustable expander) for the laser beam 53 being processed by a laser is shown here only symbolically with a pair of lenses 52. The imaging optics for an image converter element, here designated 55, are only indicated by a pair of lenses 56. A mirror 57 lying in the laser beam path is “transparently coated” for the laser radiation (on both sides). The observation beam path 59 is deflected by the mirror 57 and separated from the laser beam path. Laser and observation beam paths 53 and 59 are guided laterally with a mirror 61 arranged laterally to the eye axis 62 through a contact glass 65 lying on the eye surface 63 into the chamber angle of the eye. In contrast to the above explanations, no specially designed beam shaping optics have to be used for the lighting; the end of a light guide 66 connected to an illumination source is inserted into an opening or a blind hole 67 in the contact glass 65 such that it comes to lie close to the eye surface 63 when the contact glass 65 is attached. (The lighting could also be designed as ring lighting.) The contact glass 65 is preferably designed analogously to the contact glass 19. Appropriately adapted contact glass optics are used for areas of the eye which are to be viewed at predetermined angles.

Instead of the configuration as shown in FIG. 2, the device according to the invention can also be designed as glasses with a face shell surrounding the eyes analogous to dust protection glasses. The observation, lighting and, if applicable, the processing device are then integrated in this face shell analogously to the embodiment described above.

Instead of holding the optical head 15 with the swivel and the two displacement devices 19 and 21 on the holding band 5b, a holder can also be made with a so-called gooseneck or a manipulator. The optical head 15 can also be arranged with an analog gooseneck or a manipulator on a fixed head holder on which the patient's forehead and chin are fixed.

In addition to the contact glass mentioned above, there are numerous other contact glass designs. The above-described optical head 15 or its tube 32 can be equipped with a corresponding adapter such that these different contact glasses can also be inserted or attached (flange-mounted). With these additional contact glasses, different magnifications and image fields of different dimensions can be achieved. Contact glasses, adapted to the child's eye and to the eyes of different races, can also be used.

Depending on the treatment and examination requirements, the contact glass 30 or 65 can also be omitted, in which case consideration is then given to the optical system belonging to the image converter element 45 or 55, but then modified. In FIG. 3, the illumination and treatment beam (laser) are brought together via the mirror 41 to form a beam path, which is then superimposed with the mirror 43 on the observation beam. In FIG. 5, only the treatment and observation beam are brought together by the mirror 57. The lighting takes place via a separate beam path. Illumination, observation and treatment beam paths can be merged or separated as required by beam combining or separating elements using spectral filters, among other things. A combination and separation can also be carried out using radiation polarization. In addition to the mirrors described, beam splitter prisms or binary optics can also be used as separating and combining elements.

If a semiconductor laser is used as the laser, it can already be integrated into the optical head 15, as a result of which the light guide feed 47 would then be omitted. However, the increasing weight and the additional space required must be taken into account. There are also additional electrical power supply cables for the laser.

The device according to the invention is so easy to use that it can be used not only for treatment on humans, but also on animals whose instantaneous movements are often not predictable.

Claims

claims

1. Device for the optical examination and / or treatment of a patient's eye (29), characterized by lighting and / or observation optics (3, 15) that can be freely adjusted or aligned in all spatial coordinates on the left or right eye (29) , 30) with a surface area (33a, 33b) that can be placed on the surface of the eye, the optics (3, 15, 30) in the respective set position to the eye (29) being self-holding and motionless in space in relation to the patient's head without substantial manual holding force is held, whereby the attending physician is relieved of manual positioning and / or holding manipulations during the diagnosis and / or treatment and can thus preferably concentrate on manipulating observation and / or treatment radiation.

2. Device according to claim 1, characterized by a holding device (1, 11, 13) for the illumination and / or observation optics (3, 15, 30) with at least one head band (5a, 5b) which can be placed on the freely movable patient head and can be held rigidly on this , 7), so that the optics can also be moved when the head moves.

3. Apparatus according to claim 2, characterized in that the illumination and / or observation optics (15, 30) is or are arranged in a housing (3) which is self-holding and self-locking, but adjustable with the holding device (1, 11, 13) is held, and the holding device (1, 11, 13) in particular has a gooseneck or manipulator connected to a headband (5a, 5b, 7).

4. Device according to one of claims 1 to 3, characterized characterized in that the optics (15, 30) has a contact glass (65) on which a light-emitting element (66, 67, 37) is arranged.

5. Device according to one of claims 1 to 4, characterized in that the optics (15, 30) has a contact glass, which in particular in a housing (3), is held interchangeably to contact glasses (30, 65) for the different eye areas to be able to use.

6. Device according to one of claims 1 to 5, characterized in that suitable for at least two of the lighting, observation and optical treatment devices, a superposition component (41, 43; 57) for superimposing or separating lighting and / or

Observation radiation and / or treatment radiation is present.

7. Device according to one of claims 1 to 6, characterized in that the illuminating and / or processing radiation via light guides (37, 47) can be supplied.

8. Device according to one of claims 1 to 7, characterized by an electronic image display device and an associated with the observation device, in particular removable image capture element (45; 55), which converts the optical observation image into electronic signals for the image display device.

Apparatus according to claim 8, characterized in that the image capture element is removably held in an adapter socket, which enables the use of a microscope when the image capture element is removed.