WO2001089373A2 - Procede et appareil d'adaptation controlee de la cornee - Google Patents

Procede et appareil d'adaptation controlee de la cornee Download PDF

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Publication number
WO2001089373A2
WO2001089373A2 PCT/EP2001/005838 EP0105838W WO0189373A2 WO 2001089373 A2 WO2001089373 A2 WO 2001089373A2 EP 0105838 W EP0105838 W EP 0105838W WO 0189373 A2 WO0189373 A2 WO 0189373A2
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WIPO (PCT)
Prior art keywords
eye
coordinate system
dependent
landmarks
treatment
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Application number
PCT/EP2001/005838
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English (en)
Other versions
WO2001089373A3 (fr
Inventor
Natalie Taylor
Peter Lutz
Eberhard Schmidt
Winfried Teiwes
Ralf Weise
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Sensomotoric Instruments Gmbh
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Application filed by Sensomotoric Instruments Gmbh filed Critical Sensomotoric Instruments Gmbh
Priority to AU2001267473A priority Critical patent/AU2001267473A1/en
Publication of WO2001089373A2 publication Critical patent/WO2001089373A2/fr
Publication of WO2001089373A3 publication Critical patent/WO2001089373A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B3/00—Apparatus for testing the eyes; Instruments for examining the eyes
    • A61B3/10—Objective types, i.e. instruments for examining the eyes independent of the patients' perceptions or reactions
    • A61B3/14—Arrangements specially adapted for eye photography
    • A61B3/15—Arrangements specially adapted for eye photography with means for aligning, spacing or blocking spurious reflection ; with means for relaxing
    • A61B3/152—Arrangements specially adapted for eye photography with means for aligning, spacing or blocking spurious reflection ; with means for relaxing for aligning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A61F9/00804—Refractive treatments
    • A61F9/00806—Correction of higher orders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00844—Feedback systems
    • A61F2009/00846—Eyetracking
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00855—Calibration of the laser system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00885—Methods or devices for eye surgery using laser for treating a particular disease
    • A61F2009/00891—Glaucoma
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01B—MEASURING LENGTH, THICKNESS OR SIMILAR LINEAR DIMENSIONS; MEASURING ANGLES; MEASURING AREAS; MEASURING IRREGULARITIES OF SURFACES OR CONTOURS
    • G01B9/00—Measuring instruments characterised by the use of optical techniques
    • G01B9/02—Interferometers
    • G01B9/0209—Low-coherence interferometers
    • G01B9/02091—Tomographic interferometers, e.g. based on optical coherence

Definitions

  • the present invention is directed to improve methods of ophthalmic diagnostics and / or ophthalmic treatment processes and apparatuses implementing such methods.
  • the technique according to the present invention improves the accuracy of diagnosis, comparing or synthesising diagnoses from different devices and/or for performing treatments or corrections based on these diagnoses.
  • the applications relevant to the present invention include refractive surgery of the cornea, (PRK, LASIK or LTK), insertion of prosthetic devices such as intraocular lenses (IOLs) or retinal chips and other corrective surgery such as retinal surgery or glaucoma surgery.
  • Ophthalmic diagnostics require that the optical, spatial, visual or physical characteristics are determined.
  • Visual or refractive performance is measured with auto-refractors, perimeters, corneal topographers or more recently with wave front aberrometry techniques providing information also of higher orders of aberrations of the eye (two dimensional optical characteristics).
  • Topometry / topography systems provide a 2 dimensional elevation map of the shape of the cornea, which has a major influence on the refractive performance of the eye.
  • Spatial characteristics include corneal pachymetry, lens thickness or position, anterior chamber depth, axial length and retinal thickness. The characteristics may be measured with ultrasound, optical coherence tomography, confocal microscopy, video image processing or other optical techniques.
  • Physical characteristics include optical disk size, blood vessel density or features on the retina such as cotton wool spots and these may be measured using a camera, microscope or ophthalmoscope and image processing techniques.
  • a variety of instruments may be used to measure different characteristics of the eye, and each of the measurements will be done at different periods of time. A comparison or synthesis of these measurements may be needed to make a diagnosis and the spatial registration may be critical to the overall accuracy.
  • the treatment that arises from the diagnosis may also be spatially dependent, wherein the efficacy of the treatment depends on where it is placed on the eye. Therefore, the treatment must also be registered on the patient's eye. For example, the positioning of an ablation profile for laser vision correction or laser thermal keratoplasty (LTK), the positioning of an intra-ocular lens (IOL) for refractive correction or other prosthetic device such as retinal implant or artificial cornea, or the positioning of a laser beam for vitrectomy, retinal reattachment or other retinal surgery or for glaucoma surgery.
  • the treatment may be performed using a surgical instrument different to the diagnostic instrument; such as a ref active laser device, microscope, vitrectomy system or other laser delivery system.
  • the shape of the cornea is altered in a way that the optical deficiencies of the whole eye are compensated.
  • complex ablation profiles can be applied to correct for non-spherical optical characteristics (i.e. astigmatism), higher order of aberrations or even perform prismatic corrections on both eyes to adjust vergence / strabism.
  • the actual shape of the cornea and its optical characteristics are determined.
  • modelling comparing actual and ideal corneal surface
  • knowledge about the laser ablation process an individual customized ablation profile can be computed to improve overall vision.
  • corneal tissue is ablated with a multitude of laser shots according to the ablation profile in order to shape the cornea to its ideal profile.
  • eye trackers are commonly used for measurement of the actual eye position and with the use of a positioning device, for example a x-y-scanner for the laser, these eye movements are compensated by correcting the ablation position with the changed eye position.
  • online monitoring such as registration of actual laser ablation positions on the eye or online changes of the elevation (Online - Topography) may be used.
  • the corrected corneal shape may be re-examined with the same or other diagnostic techniques as before treatment.
  • An alternative technique for correcting refractive errors is the insertion of intra-ocular lenses.
  • the present invention can improve the rotational orientation, tilt and centration of the placement of an artificial lens placed inside the eye.
  • These artificial intra-ocular lenses (IOLs) are used to either replace the phakic lens in cataract surgery, or to correct refractive errors.
  • the technique for correcting refractive errors is to implant an artificial lens with a particular form and refractive power to compensate for the measured refractive error of the eye either in front of the lens or iris.
  • the operation is completely reversible and leaves the central area of the cornea intact - two strong advantages over laser refractive surgery.
  • the first step is to measure the refraction spherical error, cylinder and astigmatic axis using an ophthalmic diagnostic device, such as phoropter, corneal topographer, spatial refractor or aberrometer.
  • ophthalmic diagnostic device such as phoropter, corneal topographer, spatial refractor or aberrometer.
  • a suitable lens for the refractive error can either be selected as an off-the-shelf component or manufactured individually for the patient.
  • Intraocular lenses are also used in the treatment of cataracts. When the lens becomes opacified, it must be removed and replaced with an artificial lens. Approximately 20% of cataract patients have pre-existing astigmatism that could be treated using an asymmetric or toric lens.
  • Intraocular lens surgery may be combined with laser refractive surgery to make small adjustments to the refractive correction.
  • centration an adjustment procedure has to be performed, generally referred to as centration, with the purpose of aligning the patient's eye to the diagnostic or treatment device.
  • This device dependent centration procedure is often based on the human judgement of the surgeon or technician performing the alignment with little objective guidance or control, resulting in poor repeatability and accuracy of measurements, inaccurate treatment computation and inaccurate positioning of the treatment or lens on the eye.
  • Centration errors become even more problematic when eye related data from different devices (for example corneal thickness measurement together with topography) are compared, since here these errors sum up. Furthermore centration often is based on the pupil centre even though it is known that pupil diameter changes have an effect on the position of the pupil centre with respect to the optical axis.
  • any centration procedure based on an optical reference axis or the optical system might be biased, resulting in a lack of comparability between pre- and post-surgery diagnosis.
  • a surgical system does include some form of eye tracking, such as laser ablation systems, only a two-dimensional eye tracking during treatment is used, while the eye is kept within a constant distance to the laser source.
  • the eye has in principle 6 degrees of freedom (three translational and three rotational).
  • Slight head movements may also result in a different distance of the eye to the device. This is especially problematic for laser delivery systems, which are focussed with their energy constant only over a limited range. Changes in distance therefore result in changed energy on the eye and therefore uncontrolled surgical effect.
  • the eye also performs eye movements about the line of sight - torsional eye movements (vestibular ocular reflex) and the head position in roll may be different when the patient is supine under the one device and sitting up at another device. This results in inaccurate positioning of diagnosis or treatment which may not be rotationally symmetric.
  • the left eye may be treated with the prescription and treatment for ablation profile calculated for a different patient. This unsafe handling of data and missing objective control results in severe mistreatment and possible damage of the patient's eye.
  • the overall objective of the present invention is to provide a common, eye based reference system for ophthalmic diagnosis and treatment to increase reliability and accuracy as well as to enable an improvement of the overall process and outcome of ophthalmic diagnosis and treatment.
  • a further objective is to improve the registration of different diagnostic techniques, where a combination of measurements is needed to diagnose the eye.
  • a further objective of the invention is to provide the basis for aligning or placing individual, non-spherical refractive corrections of high quality to allow correction for astigmatism, higher order aberrations etc.
  • a further objective is to allow the accurate placement of other ophthalmic surgeries such as retinal treatments or inserting corrective prosthetic devices such as IOLs.
  • Still a further objective of the invention is to increase security of the treatment by ensuring identity of the eyes during different diagnostic and treatment steps.
  • FIG. 1 shows the process by which the different coordinate systems are linked.
  • the eye is analysed using pattern recognition techniques, such as iris recognition, in order to provide identification of the eye with each measurement. Before application of any treatment, this identification is performed to secure that the correct patient and correct eye is treated.
  • pattern recognition techniques such as iris recognition
  • the objectives of the present invention are achieved by providing the doctor with an objective measurement of the eye position relative to the device and orientation of the lens relative to an eye-based coordinate system. These positions are calculated in an eye-based coordinate system, based on the reference image taken in the diagnostic process.
  • An image of the eye during the diagnostic measurement is saved to a memory device, and the characteristics of the eye such as but not limited to aberration map, topography, astigmatism axis, retinal thickness, optical disk depth, blood vessel density etc. relative to this eye based coordinate system are recorded.
  • the present invention also makes a quality check of the reference image, to ensure that it can be used as a basis for position comparison at later steps. This check ensures that the features required to fix the coordinate system, or to compare the image with a second image to find a relative transformation, are present in the image.
  • images of the eye can be captured and using image-processing techniques, the position of the eye relative to the eye during the first diagnostic measurement (the original eye-based coordinate system) can be calculated.
  • This displacement can be done in anything up to 6 dimensions (cf. Elander, R., Rich, L.F., Robin, J.B.: "Principles and Practice of Refractive Surgery”; W.B. Saunders Company, Philadelphia; 1 st ed.,1997), but in the preferred embodiment at least x, y and torsion around the visual axis.
  • the pupil is a natural size or constricted
  • naturally occurring iris landmarks can be used to calculate the torsion of the eye around the visual axis.
  • artificial landmarks or markers can be used to calculate the ocular torsion and / or translation. In this way, a transformation is found between the coordinate system of the eye during surgery and the coordinate system of the eye during diagnostics is found.
  • the invention can also return a confidence level based on the level of correspondence between the reference image and measurement image. This indicates the accuracy of the calculated transformation. Once the transformation has been calculated, either the diagnostic data or treatment data is transformed to ensure a constant coordinate system.
  • the position of the lens relative to the eye based coordinate system can be also calculated from the surgical image.
  • the rotational alignment of the lens can be calculated relative to the eye based coordinate system, and hence the astigmatic axis of the eye.
  • Tilt could also be calculated by measuring the distance between these alignment marks or the distortion of the image of the lens relative to the camera. The centration could also be calculated from the alignment marks, or from image processing of the lens.
  • the image of the eye during surgery can then be displayed to the doctor, for example on a computer monitor, with the actual position of the lens and desired position of the lens overlaid. This provides the feedback to the doctor, who can then adjust the location of the lens towards the desired orientation. The measurement is then repeated to ensure the position is correct. Else the lens is readjusted and the measurement repeated etc.
  • the invention may also give the position on the eye at which the laser beam is aimed as feedback to the clinician.
  • this invention provides a common eye-fixed coordinate system and the methods to localize this reference system by determination of all six degrees of freedom of the eye during each pre-/post diagnostic measurement and laser treatment.
  • the origin of the eye-fixed co-ordinate system preferably Cartesian
  • the xe-ye-plane lies perpendicular to the optical axis of the eye, which itself is aligned with the ze- axis of the eye fixed coordinate system.
  • ze-axis and origin are well defined
  • the orientation of the xe- and ye-axis withing the xe-ye plane must still be fixed to the eye.
  • This fixation is done by acquiring an image of the eye to document the eye position with respect to the device fixed reference system. It is appropriate to define the torsion to be equal to zero to the eye position as acquired in the reference image.
  • PSI can be identified with the torsion angle of the eye.
  • PHI and THETA determine the inclination angles of the eye.
  • the most important coordinates are the translational coordinates x, y, z, determining the resulting angles under which the centre of the pupil or limbus or fundus occur relative to the optical axis of the camera as well as the distance from eye to the observing device.
  • the angle PSI of the torsional rotation of the eye about its optical axis can also vary significantly between measurements and treatments due to eye and, head movements and different positions of the head relative to the instrument(s).
  • the inclination angles PHI and THETA are of minor importance, since they are usually held approximately constant by asking the patient to fixate a marker and to avoid head movements. Nevertheless, for increase accuracy, these angles should also be included.
  • a ⁇ is the transposed matrix of the rotation matrix A, which is given by its elements A y , with
  • T and TINV map the position vectors R and R' of different device fixed coordinate systems of the same point on the eye onto each other, as shown in fig. 4.
  • T and TINV can be calculated using the indirect way over the eye fixed coordinates e.
  • the device fixed (System APP) position vector R' due to eye position x', y', z' and eye orientations PHP, THETA' and PSF is linked to its position vector R (in system REF) with eye position x,y,z and eye orientations PHI, THETA and PSI by the transformations T:
  • APP and REF do not have to be different devices: This invention is also applicable to one device with APP and REF referring to different eye positions in the same device at subsequent times or eye positions relative to different camera positions in a more camera system.
  • Fig. 2 shows a possible processing path for localisation of the eye based co-ordinate system by image transformations.
  • the eye position has to be determined for all six degrees of freedom.
  • different techniques can be combined:
  • a triangulation procedure is used in order to determine the translational coordinates of the eye in the space-bound reference system.
  • Any triangulation procedure using more than one camera, can determine the exact position of the eye in three dimensions without the need to perform advanced image evaluation due to geometric distortions etc.
  • all cameras measure individual optical angles, i.e. horizontal and vertical angles between optical axis of the camera and the visual axis under which a prominent spatial characteristic on of the eye occurs. If all camera positions and orientations are known, the spatial coordinates of this prominent spatial characteristic are given by the intersection of the visual axes of the cameras. For triangulation only two cameras are necessary, as the intersection is already possible for two visual axes. Due to imperfect adjustment of the cameras, a calculation of the intersection point of the visual axes might fail, although the visual axes should intersect. In this case no conclusions can be drawn about the correct camera positions. With a triangulation using more than two cameras, the camera positions and orientations need not be known with great accuracy, because this additional information enables a correction of the camera positions.
  • the eye's translational coordinates are measured with a triangulation procedure using up to three cameras for eye tracking as shown in fig. 5.
  • One camera (Camera 1) is positioned in front of the eye in the optical axis of the eye.
  • the others (Camera 2 and 3) are positioned to the left and right of the eye, viewing the eye from below the line of sight.
  • the camera positions form a triangle in front of the eye, with the optical axis intersection preferably at the centre of the eye.
  • the cameras measure the visual angles, i.e. the horizontal and vertical angles between the optical axis of each camera and the visual axis, i.e. the direction under which the origin of the eye fixed reference system occurs.
  • the intersection point of these visual axes is identical with the origin of the eye fixed reference system and therefore the eye's translational coordinates can be calculated, if all positions and orientations of the cameras are known.
  • the coordinates x, y, z in the space-bound reference system can be determined.
  • only one camera is used for calculating x and y translational coordinates, wherein a fixed landmark on the eye such as pupil centre, limbus centre, fundus or other retinal landmarks can be used to locate the eye.
  • a fixed landmark on the eye such as pupil centre, limbus centre, fundus or other retinal landmarks can be used to locate the eye.
  • further dimensions such as z may be found using a second measurement technique; such as optical coherence tomography, interferometery or ultrasound.
  • IR-diodes are used to measure x and y based on the limbus border and a camera is used to measure the rotation around the visual axis. The other rotations are not considered.
  • another embodiment uses a pattern projection onto the cornea and two cameras to measure x,y and z position and rotations of this pattern PHI and THETA. Rotation around the z axis is measured using an IR diode array measuring the movement based on markers. This illustrates the breadth of implementation options for this invention which can be based on large number of combinations of measurement techniques to cover the different degrees of freedom.
  • torsion has to be determined by comparing the current image with the image acquired for definition of the reference.
  • eye torsion is measured using a cross-correlation technique. Images acquired by Camera 1 are compared with the image acquired for definition of the eye fixed reference system.
  • the greyscale values of an iris segment are cross-correlated with the corresponding segment of the reference iris image (cf. A.H. Clarke, W. Teiwes, and H. Scherer.
  • Video-Oculography An Alternative Method For Measurement Of Three Dimensional Eye Movements. In: Oculomotor Control and Cognitive Processes, eds. R. Schmid and D. Zambarbieri.
  • a maximum of the resulting cross-correlation function indicates a matching of the underlying greyscale profiles, i.e. an equal torsion angle.
  • the torsion angle is then determined from the abscissa of the maximum.
  • temporary or artificial landmarks such as ink, threads, LASIK flaps, visual patterns generated by the laser during surgery like the shot pattern of a femto-second laser within the stroma or suction rings may be used to calculate torsion or x and y between two measurement or treatment devices. The position of two or more of these landmarks is used to calculate the rotation, PSI.
  • PSI can be found by cross-correlation of the fundus image or finding several landmarks on the retina to locate the eye.
  • the remaining degrees of freedom PHI and THETA are determined by measurement of the geometric distortions of the pupil/limbus border according to the camera position. As three cameras measure these distortions with known angles between their visual axes, size and shape of the pupil/limbus can be compensated. Geometric distortions are small, if the camera is placed close to the visual axis of the eye as the camera observes only the projection of the pupil/limbus. Therefore the above described three camera system provides the possibility to measure distortions with the camera under the best angle.
  • the reference image used to define the 0-torsion angle, is also used for comparison with an image of the eye acquired in a different device or a different step of the diagnosis and treatment process.
  • An iris recognition procedure or security check is applied to check, whether the eyes in those images are identical, i.e. belong to the same person and refer to the same side of the patient (OD/OS).
  • the reference image (or several images or measurement data sets depending on the techniques employed) for definition of the eye fixed reference system and the diagnostic or treatment data in eye fixed coordinates are stored together in electronic form.
  • This combination provides the possibility to take full advantage of the invention, because a linkage to the reference eye fixed coordinate system is reached by the coordinate transformations at any step in the diagnosis/ treatment chain. This also holds for the security check or patient eye recognition check. Therefore any two eye related data sets can safely and reliably be compared with each other.
  • the reference images undergo a quality check, in which the spatially fixed landmarks are checked to ensure that the image is suitable for further processing ie.
  • Each image at each stage of the process is checked to ensure sufficient quality and features are present on which to base the coordinate system and calculate a transformation.
  • the calculation of the correlation performed to find the transformation between eye locations will also return a confidence value. This value gives the level of correlation and reliability of the coordinate transformation.
  • the present invention outputs the required coordinate transformation and either transforms the diagnostic data or treatment, so that the subsequent diagnostic measurement or surgery is registered to the first.
  • a visual comparison check is made of the eye registration, wherein an overlay is used as a marker to facilitate the clinician visually checking the registration against obvious landmarks.
  • the coordinate transformation is applicable to any subset of coordinates, if one takes care, that the remaining coordinates are constant in both systems. For example, if the patient fixates a mark, thus ensuring constant inclination angles of the cornea in both devices, then it is sufficient to apply the above methods to the subset of coordinates x, y, z, psi. In this case an accurate laser treatment of non-spherical eye deficiencies (e.g. astigmatism) is already possible.
  • non-spherical eye deficiencies e.g. astigmatism
  • IR diode based limbus or marker tracking x, y or x, y and z.

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Abstract

La présente invention concerne un procédé et un appareil permettant de mesurer la position de l'oeil jusqu'à 6° de liberté, de mesurer le diamètre de la pupille et de l'identité de l'oeil dans différents instruments de diagnostic et de traitement, et de relier ensemble ces différentes positions mesurées à différents moments et/ou dans différents instruments. Ce procédé utilisé pour relier ensemble les mesures de position constitue une transformation de coordonnées entre les différents systèmes de coordonnées système et le système de coordonnées de l'oeil tel que mesuré par le traitement d'image ou par d'autres techniques de mesure pour obtenir soit des mesures simples, soit des mesures combinées de degrés de liberté. En plus de la position de l'oeil, on peut mesurer et reconnaître l'identité de l'oeil soumis à un diagnostic ou à un traitement dans les différents instruments et systèmes. On peut également mesurer la position de l'oeil et le diamètre de la pupille par différentes techniques de mesure, notamment l'analyse d'images vidéo normalisée ou non à partir d'une ou de plusieurs caméras par système, la tomographie par cohérence optique, l'interférométrie laser ou autres.
PCT/EP2001/005838 2000-05-20 2001-05-21 Procede et appareil d'adaptation controlee de la cornee WO2001089373A2 (fr)

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AU2001267473A AU2001267473A1 (en) 2000-05-20 2001-05-21 Method and apparatus for a controlled customisation of the cornea

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US20609100P 2000-05-20 2000-05-20
US60/206,091 2000-05-20

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Cited By (22)

* Cited by examiner, † Cited by third party
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WO2004089214A3 (fr) * 2003-04-11 2005-01-06 Bausch & Lomb Systeme et procede pour acquerir des donnees et aligner et suivre un oeil
EP1682927A2 (fr) * 2003-11-10 2006-07-26 Visx, Inc. Procedes et dispositifs de test de l'alignement en torsion d'un dispositif de diagnostic avec un systeme a refraction laser
US7160288B2 (en) 2002-02-27 2007-01-09 Nidek Co., Ltd. Ophthalmic apparatus
WO2007025728A1 (fr) * 2005-09-01 2007-03-08 Suphi Taneri Procede et dispositif de mesure pour determiner la position du globe oculaire, y compris lors d'un mouvement de roulis
US7320685B2 (en) 2000-10-20 2008-01-22 Carl Zeiss Meditec Ag Method and device for identifying an eye that is to be treated in operations
DE102010007922A1 (de) * 2010-02-12 2011-08-18 Carl Zeiss Vision GmbH, 73430 Vorrichtung und Verfahren zum Ermitteln eines Pupillenabstandes
EP2457497A1 (fr) * 2010-11-26 2012-05-30 SensoMotoric Instruments GmbH Procédé et appareil pour l'enregistrement oculaire à plusieurs niveaux
WO2013024326A1 (fr) * 2011-08-17 2013-02-21 Technolas Perfect Vision Gmbh Appareil et procédé pour transformer une surface cible tridimensionnelle en une image bidimensionnelle destinée à être utilisée dans le guidage d'un faisceau laser dans une chirurgie oculaire
US8414123B2 (en) 2007-08-13 2013-04-09 Novartis Ag Toric lenses alignment using pre-operative images
EP2582284A2 (fr) * 2010-06-19 2013-04-24 Chronos Vision GmbH Procédé et appareil de détermination de la position oculaire
US8529060B2 (en) 2009-02-19 2013-09-10 Alcon Research, Ltd. Intraocular lens alignment using corneal center
CN103654721A (zh) * 2013-12-27 2014-03-26 深圳市斯尔顿科技有限公司 一种角膜顶点精确对准的方法
US8807752B2 (en) 2012-03-08 2014-08-19 Technolas Perfect Vision Gmbh System and method with refractive corrections for controlled placement of a laser beam's focal point
US9398979B2 (en) 2013-03-11 2016-07-26 Technolas Perfect Vision Gmbh Dimensional compensator for use with a patient interface
US9552517B2 (en) 2013-12-06 2017-01-24 International Business Machines Corporation Tracking eye recovery
US9655775B2 (en) 2007-08-13 2017-05-23 Novartis Ag Toric lenses alignment using pre-operative images
WO2018009704A1 (fr) * 2016-07-06 2018-01-11 Amo Wavefront Sciences, Llc Imagerie rétinienne pour référence pendant une chirurgie oculaire au laser.
EP2373207B1 (fr) 2008-10-22 2019-09-11 Alcon Pharmaceuticals Ltd. Appareil et procédé pour le traitement d'images pour chirurgie des yeux assistée par ordinateur
WO2020212199A1 (fr) * 2019-04-15 2020-10-22 Carl Zeiss Meditec Ag Dispositifs et méthodes de chirurgie au laser d'un œil, en particulier à des fins de kératoplastie
WO2021198106A1 (fr) * 2020-04-01 2021-10-07 Carl Zeiss Meditec Ag Équipement et méthodes de chirurgie réfractive, en particulier pour kératoplastie
EP4197428A1 (fr) * 2021-12-20 2023-06-21 Ziemer Ophthalmic Systems AG Dispositif de traitement ophtalmologique pour déterminer un angle de rotation d'un oeil

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Cited By (40)

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US7320685B2 (en) 2000-10-20 2008-01-22 Carl Zeiss Meditec Ag Method and device for identifying an eye that is to be treated in operations
WO2003059157A1 (fr) * 2002-01-16 2003-07-24 Ioltechnologie-Production Dispositif et procede de mesure du diametre de l'angle irido-corneen
FR2834627A1 (fr) * 2002-01-16 2003-07-18 Ioltechnologie Production Dispositif et procede de mesure du diametre de l'angle irido-corneen
EP1369078A3 (fr) * 2002-02-27 2009-08-26 Nidek Co., Ltd. Appareil ophtalmique
US7160288B2 (en) 2002-02-27 2007-01-09 Nidek Co., Ltd. Ophthalmic apparatus
US7467869B2 (en) 2003-04-11 2008-12-23 Bausch & Lomb Incorporated System and method for acquiring data and aligning and tracking of an eye
AU2004228923B2 (en) * 2003-04-11 2009-03-19 Bausch & Lomb Inc. System and method for acquiring data and aligning and tracking of an eye
WO2004089214A3 (fr) * 2003-04-11 2005-01-06 Bausch & Lomb Systeme et procede pour acquerir des donnees et aligner et suivre un oeil
EP1682927A2 (fr) * 2003-11-10 2006-07-26 Visx, Inc. Procedes et dispositifs de test de l'alignement en torsion d'un dispositif de diagnostic avec un systeme a refraction laser
EP1682927A4 (fr) * 2003-11-10 2009-12-23 Amo Mfg Usa Llc Procedes et dispositifs de test de l'alignement en torsion d'un dispositif de diagnostic avec un systeme a refraction laser
WO2007025728A1 (fr) * 2005-09-01 2007-03-08 Suphi Taneri Procede et dispositif de mesure pour determiner la position du globe oculaire, y compris lors d'un mouvement de roulis
US8414123B2 (en) 2007-08-13 2013-04-09 Novartis Ag Toric lenses alignment using pre-operative images
US9655775B2 (en) 2007-08-13 2017-05-23 Novartis Ag Toric lenses alignment using pre-operative images
EP2373207B1 (fr) 2008-10-22 2019-09-11 Alcon Pharmaceuticals Ltd. Appareil et procédé pour le traitement d'images pour chirurgie des yeux assistée par ordinateur
US10398300B2 (en) 2009-02-19 2019-09-03 Alcon Research, Ltd. Intraocular lens alignment
US8529060B2 (en) 2009-02-19 2013-09-10 Alcon Research, Ltd. Intraocular lens alignment using corneal center
US9119565B2 (en) 2009-02-19 2015-09-01 Alcon Research, Ltd. Intraocular lens alignment
DE102010007922B4 (de) 2010-02-12 2024-06-13 Carl Zeiss Vision International Gmbh Vorrichtung und Verfahren zum Ermitteln eines Pupillenabstandes
DE102010007922A1 (de) * 2010-02-12 2011-08-18 Carl Zeiss Vision GmbH, 73430 Vorrichtung und Verfahren zum Ermitteln eines Pupillenabstandes
DE102010024407B4 (de) 2010-06-19 2017-03-30 Chronos Vision Gmbh Verfahren und Vorrichtung zur Bestimmung der Augenposition
EP2582284A2 (fr) * 2010-06-19 2013-04-24 Chronos Vision GmbH Procédé et appareil de détermination de la position oculaire
EP2582284B1 (fr) * 2010-06-19 2023-08-02 Chronos Vision GmbH Procédé et appareil de détermination de la position oculaire
US9861279B2 (en) 2010-06-19 2018-01-09 Chronos Vision Gmbh Method and device for determining the eye position
WO2012069624A1 (fr) * 2010-11-26 2012-05-31 Sensomotoric Instruments Gmbh Procédé et appareil pour l'alignement d'oeil multiniveau
US9295380B2 (en) 2010-11-26 2016-03-29 Alcon Pharmaceuticals Ltd. Method and apparatus for multi-level eye registration
US9189849B2 (en) 2010-11-26 2015-11-17 Alcon Pharmaceuticals Ltd. Method and apparatus for multi-level eye registration
EP2457497A1 (fr) * 2010-11-26 2012-05-30 SensoMotoric Instruments GmbH Procédé et appareil pour l'enregistrement oculaire à plusieurs niveaux
CN103313647A (zh) * 2010-11-26 2013-09-18 阿尔康药品有限公司 用于多级眼睛配准的方法和装置
WO2013024326A1 (fr) * 2011-08-17 2013-02-21 Technolas Perfect Vision Gmbh Appareil et procédé pour transformer une surface cible tridimensionnelle en une image bidimensionnelle destinée à être utilisée dans le guidage d'un faisceau laser dans une chirurgie oculaire
US8807752B2 (en) 2012-03-08 2014-08-19 Technolas Perfect Vision Gmbh System and method with refractive corrections for controlled placement of a laser beam's focal point
US9398979B2 (en) 2013-03-11 2016-07-26 Technolas Perfect Vision Gmbh Dimensional compensator for use with a patient interface
US9552517B2 (en) 2013-12-06 2017-01-24 International Business Machines Corporation Tracking eye recovery
CN103654721A (zh) * 2013-12-27 2014-03-26 深圳市斯尔顿科技有限公司 一种角膜顶点精确对准的方法
WO2018009704A1 (fr) * 2016-07-06 2018-01-11 Amo Wavefront Sciences, Llc Imagerie rétinienne pour référence pendant une chirurgie oculaire au laser.
US10842673B2 (en) 2016-07-06 2020-11-24 Amo Development, Llc Retinal imaging for reference during laser eye surgery
AU2017292847B2 (en) * 2016-07-06 2022-05-19 Amo Development, Llc Retinal imaging for reference during laser eye surgery
WO2020212199A1 (fr) * 2019-04-15 2020-10-22 Carl Zeiss Meditec Ag Dispositifs et méthodes de chirurgie au laser d'un œil, en particulier à des fins de kératoplastie
US12011394B2 (en) 2019-04-15 2024-06-18 Carl Zeiss Meditec Ag Devices and methods for laser surgery of an eye, especially for keratoplasty
WO2021198106A1 (fr) * 2020-04-01 2021-10-07 Carl Zeiss Meditec Ag Équipement et méthodes de chirurgie réfractive, en particulier pour kératoplastie
EP4197428A1 (fr) * 2021-12-20 2023-06-21 Ziemer Ophthalmic Systems AG Dispositif de traitement ophtalmologique pour déterminer un angle de rotation d'un oeil

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