WO2016159332A1 - Ophthalmic laser surgery device and ophthalmic laser surgery control program - Google Patents

Ophthalmic laser surgery device and ophthalmic laser surgery control program Download PDF

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Publication number
WO2016159332A1
WO2016159332A1 PCT/JP2016/060859 JP2016060859W WO2016159332A1 WO 2016159332 A1 WO2016159332 A1 WO 2016159332A1 JP 2016060859 W JP2016060859 W JP 2016060859W WO 2016159332 A1 WO2016159332 A1 WO 2016159332A1
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Prior art keywords
eye
unit
light
optical
ophthalmic laser
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PCT/JP2016/060859
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French (fr)
Japanese (ja)
Inventor
通浩 滝井
柴田 隆義
昌明 羽根渕
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株式会社ニデック
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Priority to JP2015-074638 priority Critical
Priority to JP2015074638A priority patent/JP2016193097A/en
Priority to JP2015074639A priority patent/JP2016193098A/en
Priority to JP2015074637A priority patent/JP2016193096A/en
Priority to JP2015-074639 priority
Priority to JP2015-074637 priority
Application filed by 株式会社ニデック filed Critical 株式会社ニデック
Publication of WO2016159332A1 publication Critical patent/WO2016159332A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F9/00Methods 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
    • A61F9/007Methods or devices for eye surgery
    • A61F9/008Methods or devices for eye surgery using laser

Abstract

Provided are an ophthalmic laser surgery device with which at least one of problems of conventional art is solved, and a control program used therefor. The ophthalmic laser surgery device according to the present disclosure is an ophthalmic laser surgery device for treating an eye of a subject by irradiating the eye with surgical laser light, and is provided with: a frontal image capture unit which includes a light receiving element and which captures a frontal image of the anterior eye part of the eye at different magnification ratios in accordance with the distance between a device body and the eye; a focus adjustment unit that adjusts the focus state of reflected light from the anterior eye part of the eye in the light receiving element, by moving an optical member and/or the light receiving element disposed on the optical path of the frontal image capture unit along the optical axis of the optical path; and a control unit. The ophthalmic laser surgery device is characterized in that the control unit adjusts the focus state by driving the focus adjustment unit by processing light including the reflected light reflected by the eye in each of the case where the position of the eye with respect to the device body is in a first region and the case where the position is in a second region closer to the device body than the first region.

Description

Ophthalmic laser surgery apparatus and ophthalmic surgery control program

The present disclosure relates to an ophthalmic laser surgical apparatus that treats an eye of a subject by irradiating surgical laser light, and a control program used therefor.

2. Description of the Related Art An ophthalmic laser surgical apparatus that treats an eye by irradiating the eye of a subject with surgical laser light is known (see Patent Documents 1 and 2). In such an apparatus, in order to observe the anterior segment of the patient's eye, a front image capturing unit that captures a front image of the anterior segment may be provided (see Patent Document 3). The front image capturing unit may share a part of the optical path with the laser irradiation optical system, and the front image capturing unit is connected to the patient's eye via an optical element provided at an interface attached to the tip of the laser irradiation unit of the apparatus. May be taken.

Also, the interface may be changed in the conventional device. For example, the interface is provided with an optical element for adjusting the condensing state of the laser light, and an interface with a different type of optical element may be attached depending on a laser irradiation site or the like.

JP 2000-116694 A JP-T-2004-53344 JP 2013-248303 A

As a first problem, in a conventional apparatus, the laser irradiation unit for irradiating a laser and the front image capturing unit may be moved integrally, and the focus position of the front image capturing unit is shifted with respect to the patient. There was a case.

As a second problem, when the interface is replaced in accordance with the irradiation site of the surgical laser light as described above, the distance between the apparatus main body and the subject's eyes before and after the interface is replaced, and the front surface There is a possibility that the ratio with the magnification of the front image taken for image shooting will change.

In view of the above-described problems, the present disclosure has a typical technical problem to provide an ophthalmic laser surgical apparatus that solves at least one of the problems of the related art, and a control program used therefor.

In order to solve the first problem, the first embodiment according to the present disclosure is characterized by having the following configuration.

(1) An ophthalmic laser surgical apparatus that treats the eye by irradiating the eye of the subject with surgical laser light, and has a light receiving element, and varies depending on the distance between the apparatus main body and the eye At least one of a front image capturing unit that captures a front image of the anterior segment of the eye at a magnification, an optical member provided on the optical path of the front image capturing unit, and the light receiving element is used as an optical axis of the optical path. A focus adjustment unit that adjusts a focus state of reflected light from the anterior ocular segment of the eye in the light receiving element, and a control unit, and the control unit includes the eye for the apparatus main body. The focus adjustment is performed by processing the light including the reflected light reflected by the eye in each of the case where the position is in the first region and the second region closer to the apparatus body than the first region. By driving the part The focus state is adjusted.
(2) An ophthalmic surgery control program for controlling an ophthalmic laser surgical apparatus for treating the eye by irradiating the eye of the subject with surgical laser light, wherein the ophthalmic laser surgical apparatus includes a light receiving element A front image capturing unit that captures a front image of the anterior segment of the eye at different magnifications according to the distance between the apparatus main body and the eye, and an optical path of the front image capturing unit. A focus adjustment unit that adjusts a focus state of reflected light from the anterior segment of the eye in the light receiving element by moving at least one of the optical member and the light receiving element along the optical axis of the optical path; And the ophthalmic surgery control program is executed by the processor of the ophthalmic laser surgical apparatus, so that the position of the eye with respect to the apparatus body is in the first area, and more than the first area. A focus state adjustment step of adjusting the focus state by processing the light including the reflected light reflected by the eye and driving the focus adjustment unit in each case where the second region is close to the apparatus main body. Is performed by the ophthalmic laser surgical apparatus.

In order to solve the first problem, the second embodiment according to the present disclosure is characterized by having the following configuration.

(3) An ophthalmic laser surgical apparatus that treats the eye by irradiating the eye of the subject with surgical laser light, a drive unit that moves at least one of the apparatus main body and the subject, and a light receiving element A front image capturing unit that captures a front image of the anterior ocular segment of the eye at different magnifications according to the distance between the apparatus main body and the eye, and provided on the imaging optical path of the front image capturing unit. By moving at least one of the optical member and the light receiving element along the optical axis of the optical path according to the distance, the focus state of the reflected light from the anterior segment of the eye in the light receiving element is changed. A focus adjustment unit that adjusts the eye that moves relative to the apparatus main body, the distance that is changed by driving of the drive unit, the optical member that is moved by the focus adjustment unit, and The relationship with at least one position of the light receiving element is non-linear.
(4) An ophthalmic surgery control program for controlling an ophthalmic laser surgical apparatus for treating the eye by irradiating the eye of the subject with a surgical laser beam, wherein the ophthalmic laser surgical apparatus is an apparatus main body. And a drive unit that moves at least one of the subjects and a light receiving element, and captures a front image of the anterior segment of the eye at a different magnification according to the distance between the apparatus main body and the eye. By moving at least one of the front image photographing unit, the optical member provided on the photographing optical path of the front image photographing unit, and the light receiving element along the optical axis of the optical path according to the distance, A focus adjustment unit that adjusts a focus state of reflected light from the anterior eye part of the eye in the light receiving element to the eye that moves relative to the apparatus main body, and the ophthalmic surgery control program stores the eye When executed by the processor of the medical laser surgical apparatus, the distance that is changed by driving the driving unit and the position of at least one of the optical member and the light receiving element that are moved by the focus adjusting unit are nonlinear Therefore, the ophthalmic laser surgical apparatus is caused to execute a focus adjustment step of adjusting the focus state according to the distance.

In order to solve the second problem, the third embodiment according to the present disclosure is characterized by having the following configuration.

(5) An ophthalmic laser surgical apparatus that treats the eye by irradiating the eye of the subject with surgical laser light, and has at least a lens disposed on an irradiation optical path of the surgical laser light, A holding unit that holds an interface interposed between the apparatus main body and the eye; and a light receiving element that receives reflected light that has been reflected by the eye and passed through the lens, and the distance between the apparatus main body and the eye A front image capturing unit that captures a front image of the anterior segment of the eye at different magnifications according to
When the interface held by the holding unit is changed, and the magnification of the front image captured by the front image capturing unit changes, a magnification adjusting unit that adjusts the change of the magnification is provided. And
(6) An ophthalmic surgery control program for controlling an ophthalmic laser surgical apparatus for treating the eye by irradiating the eye of the subject with surgical laser light, wherein the ophthalmic laser surgical apparatus includes the surgery And at least a lens arranged on the irradiation light path of the laser beam for use, a holding unit for holding an interface interposed between the apparatus main body and the eye, and a reflected light reflected by the eye and passing through the lens A front image capturing unit that captures a front image of the anterior ocular segment of the eye at different magnifications depending on the distance between the apparatus main body and the eye, and the ophthalmic surgery control program Is executed by the processor of the ophthalmic laser surgical apparatus, the interface held in the holding unit is changed, and the image taken by the front image taking unit is changed. When the magnification of the front image changes, the ophthalmic laser surgical apparatus is caused to execute a magnification adjustment step for adjusting the change in magnification.

1 is a diagram illustrating an overall configuration of an ophthalmic laser surgical apparatus 1. FIG. 2 is a diagram illustrating a schematic configuration of a front image capturing unit 30. FIG. 3 is a diagram showing a schematic configuration of a fixation target projection unit 40. FIG. It is a figure which shows the outline of the mechanical structure of the ophthalmic laser surgery apparatus. 6 is a cross-sectional view of an immersion interface 91 coupled to an eye E. FIG. FIG. 6 is a cross-sectional view of an applanation interface 92 coupled to an eye E. It is a figure explaining the imaging range of a front image. 3 is a flowchart showing control of the ophthalmic laser surgical apparatus 1. FIG. 6 is a diagram for explaining a modification example of a magnification adjustment unit 300. It is a figure explaining the example of a change of magnification adjustment. FIG. 6 is a diagram relating to the amount of movement of the light receiving element 31 with respect to the distance WD between the apparatus main body and the patient's eye E It is a figure explaining the acquisition method of focus information using a front picture. It is a figure explaining the acquisition method of focus information using a front picture. It is a figure explaining the acquisition method of focus information using a tomographic image.

Hereinafter, typical embodiments in the present disclosure will be described. In the present embodiment, an ophthalmic laser surgical apparatus 1 that performs an operation or the like of a subject (patient or subject) is illustrated. The ophthalmic laser surgical apparatus 1 according to this embodiment can treat both the cornea and the crystalline lens of the eye E of the subject. However, the technique exemplified in the present embodiment includes a technique that can be applied to other surgical apparatuses (for example, an apparatus that performs photocoagulation of the fundus using a laser).

<Overall configuration>
Hereinafter, with reference to FIG. 1, about the whole structure of the ophthalmic laser surgical apparatus 1 of this embodiment, from the surgical laser light source 2 side (that is, the upstream side of the optical path of the surgical laser light), the eye E of the subject Description will be made in order on the side (that is, downstream of the optical path of the surgical laser beam). In FIGS. 1 to 3, only part of actual optical elements (lenses, mirrors, etc.) are shown for the sake of simplicity.

The surgical laser light source 2 emits surgical laser light for treating the eye E. In the present embodiment, when the pulsed laser light emitted from the surgical laser light source 2 is condensed in the tissue of the eye E, plasma is generated at the condensing position (spot), and the tissue is cut and fractured. Is called. The above phenomenon is sometimes referred to as photodisruption. For the surgical laser light source 2 of the present embodiment, for example, a device that emits pulsed laser light in femtosecond to picosecond order can be used. Hereinafter, the direction along the optical path of the surgical laser beam emitted from the surgical laser light source 2 is defined as the Z direction. One of the directions intersecting the Z direction (vertically intersecting in the present embodiment) is defined as the X direction. A direction that intersects both the Z direction and the X direction (vertically intersects in this embodiment) is defined as a Y direction.

The reference light source 3 emits reference light (reference laser light) serving as a reference for performing various controls. For example, the reference light of this embodiment may be used when detecting the irradiation position of the surgical laser light.

The dichroic mirror 4 is provided in the optical path of the surgical laser beam. The dichroic mirror 4 combines the surgical laser light emitted from the surgical laser light source 2 and the reference light emitted from the reference light source 3.

The zoom expander 5 is provided between the surgical laser light source 2 and the XY scanning unit 10 (described later) in the optical path of the surgical laser light. The zoom expander 5 can change the beam diameter of the surgical laser light. The control unit 50 (described later) drives the zoom expander 5 to change the beam diameter of the surgical laser beam, thereby operating the surgical laser beam emitted from the objective lens 20 (described later) toward the eye E. Can be adjusted.

The high-speed Z-scanning unit 6 is a part of the Z-scanning unit that scans the spot where the surgical laser beam is collected in the Z direction. In the present embodiment, the high-speed Z scanning unit 6 is provided between the zoom expander 5 and the XY scanning unit 10 in the optical path of the surgical laser light. As an example, the high-speed Z scanning unit 6 of the present embodiment includes a moving optical element 7 having negative refractive power and a high-speed Z scanning driving unit 8 that moves the moving optical element 7 along the optical axis. For example, a galvano motor or the like that can move the moving optical element 7 at a high speed may be used for the high-speed Z scanning drive unit 8. A lens 9 is provided between the moving optical element 7 and the XY scanning unit 10. The lens 9 guides the laser light that has passed through the high-speed Z scanning unit 8 to the XY scanning unit 10. When the moving optical element 7 moves in the optical axis direction, the spot of the surgical laser beam on the eye E moves in the Z direction. The high speed Z scanning unit 6 can scan the spot in the Z direction at a higher speed than the wide range Z scanning unit 18 (described later).

The XY scanning unit 10 scans the surgical laser beam in the XY direction intersecting the optical axis. The XY scanning unit 10 of this embodiment includes an X deflection device 11 and a Y deflection device 12. The X deflection device 11 scans the surgical laser beam in the X direction. The Y deflection device 12 further scans the surgical laser beam scanned in the X direction by the X deflection device 11 in the Y direction. In this embodiment, galvanometer mirrors are employed for both the X deflection device 11 and the Y deflection device 12. However, another device that scans light (for example, a scanner such as a polygon mirror or an acousto-optic device) may be employed in at least one of the X deflection device 11 and the Y deflection device 12. Further, at least one of the X deflection device 11 and the Y deflection device 12 may include a plurality of scanners.

The relay unit 14 is provided between the XY scanning unit 10 and the objective lens 20. The relay unit 14 relays the surgical laser light that has passed through the XY scanning unit 10 to the objective lens 20 by the upstream relay optical element 15 and the downstream relay optical element 16.

The wide-range Z scanning unit 18 is a part of the Z scanning unit that scans the spot in the Z direction. As an example, the wide-range Z scanning unit 18 of the present embodiment moves the optical unit including the XY scanning unit 10 and the upstream relay optical element 15 along the optical axis by the wide-range Z scanning drive unit 19, thereby The optical path length between the side relay optical element 15 and the objective lens 20 is changed. As a result, the spot is scanned in the Z direction. The wide-range Z scanning unit 18 can scan a spot in a wide range in the Z direction as compared with the high-speed Z scanning unit 10. The configuration of the wide-range Z scanning unit 18 can be changed as appropriate. For example, the ophthalmic laser surgical apparatus 1 includes at least one of optical elements (for example, the upstream relay optical element 15, the downstream relay optical element 16, and the objective lens 20) located on the downstream side of the XY scanning unit 10. The spot may be scanned in the Z direction by moving in the optical axis direction. It is also possible to scan the spot in the Z direction using only the high-speed Z scanning unit 10.

The objective lens 20 is arranged on the downstream side of the optical path of the surgical laser light with respect to the downstream side relay optical element 16 of the relay unit 14. The surgical laser light that has passed through the objective lens 20 is focused on the tissue of the eye E via the interface 90.

The interface 90 is interposed between the apparatus main body and the eye E among optical paths of various lights (surgical laser light, reference light, observation light, OCT light, and fixation target projection light) that pass through the objective lens 20. Coupled to eye E. Various configurations (for example, an immersion interface 91 and an applanation interface 92) can be adopted as the configuration of the interface 90. Details of the interface 90 will be described later with reference to FIGS. 5 and 6.

The dichroic mirror (optical axis combining unit) 22 is provided between the objective lens 20 and the downstream relay optical element 16 in the optical path of the surgical laser beam. The dichroic mirror 22 has coaxial optical axes of various lights propagating between the ophthalmic laser surgical apparatus 1 and the eye E. In the present embodiment, the dichroic mirror 22 reflects most of the surgical laser light emitted from the surgical laser light source 2 toward the objective lens 20. The dichroic mirror 22 reflects part of the reference light emitted from the reference light source 3 and transmits the rest (details of the optical path of the reference light will be described later). The dichroic mirror 22 transmits most of the observation light, the OCT light, and the fixation target projection light. That is, the optical axis of the observation light, the OCT light, and the fixation target projection light and the optical axis of the surgical laser light are branched using the dichroic mirror 22 as a branch point. The observation light is reflected light that is reflected by the eye E and enters the front image capturing unit 30. The OCT light is light emitted from the tomographic image photographing unit 23 for photographing a tomographic image. The fixation target projection light is light emitted from the fixation target projection unit 40 in order to fix the eye E.

The front image capturing unit 30 is a part of a capturing unit that captures an image of the eye E. The front image capturing unit 30 captures a front image of the eye E (in this embodiment, a front image of the anterior segment) by receiving the reflected light (observation light) reflected by the eye E. The front image capturing unit 30 can also capture at least a part of the interface 90 attached to the apparatus main body. In the present embodiment, reflected light of infrared light emitted from the alignment / illumination light source 64 (see FIG. 4) of the alignment index projection unit 63 is received by the front image capturing unit 30 as observation light. Details of the front image capturing unit 30 will be described later with reference to FIG.

Similarly to the front image capturing unit 30, the tomographic image capturing unit 23 is also a part of the capturing unit that captures an image of the eye E. The tomographic image capturing unit 23 can capture a tomographic image of the eye E. The tomographic image capturing unit 23 can also capture tomographic images of the interface lenses 100 and 110 (details will be described later with reference to FIGS. 5 and 6) included in the interface 90. As an example, the tomographic imaging unit 23 of the present embodiment includes an OCT light source, a light splitter, a reference optical system, a scanning unit, and a light receiving element. The OCT light source emits OCT light for capturing a tomographic image. The optical splitter divides the OCT light emitted from the OCT light source into reference light and measurement light. The reference light enters the reference optical system, and the measurement light enters the scanning unit. The reference optical system has a configuration that changes the optical path length difference between the measurement light and the reference light. The scanning unit scans the measurement light in a two-dimensional direction (XY direction). The detector detects an interference state between the measurement light reflected by the subject and the reference light that has passed through the reference optical system. The measurement light is scanned, and the interference state between the reflected measurement light and the reference light is detected, whereby information in the depth direction of the object to be imaged is acquired. A tomographic image to be imaged is acquired based on the acquired depth information.

Various configurations can be used for the tomographic image capturing unit 23. For example, any of SS-OCT, SD-OCT, TD-OCT, and the like may be adopted for the tomographic imaging unit 23. Further, the ophthalmic laser surgical apparatus 1 may capture a tomographic image to be imaged using a technique other than optical interference (for example, Shine-Pluke etc.).

The fixation target projection unit 40 can project a fixation target that guides the line of sight of the eye E of the subject onto the eye E. That is, the fixation target projection unit 40 is used for performing fixation of the eye E. The fixation target projection unit 40 of the present embodiment can change the projection state of the fixation target onto the eye E. Details of the fixation target projecting unit 40 will be described later with reference to FIG.

The dichroic mirror 24 is coaxial with the imaging optical axis of the front image capturing unit 30 (that is, the optical axis 9 of the reflected light incident on the front image capturing unit 30) and the projection optical axis of the fixation target projecting unit 40. Specifically, in the present embodiment, most of the reflected light incident on the front image capturing unit 30 is transmitted through the dichroic mirror 24, and most of the light of the fixation target projected from the fixation target projection unit 40 is dichroic. Reflected by the mirror 24.

The dichroic mirror 25 has the imaging optical axis of the front image capturing unit 30 and the projection optical axis of the fixation target projecting unit 40 coaxial with the imaging optical axis of the tomographic image capturing unit 23. Specifically, in the present embodiment, most of the reflected light incident on the front image capturing unit 30 is transmitted through the dichroic mirror 25. Most of the light of the fixation target projected from the fixation target projection unit 40 also passes through the dichroic mirror 25. Most of the OCT light for capturing a tomographic image is reflected by the dichroic mirror 25.

The irradiation position detection unit 26 is provided on an optical path branched from the optical path of the surgical laser light extending from the surgical laser light source 2 to the eye E. As an example, in the present embodiment, the optical path of the surgical laser light extending from the scanning units 6, 10, 18 to the dichroic mirror 22 is branched by the dichroic mirror 22. An irradiation position detector 26 is installed on the optical path of light that passes through the dichroic mirror 22 among the branched optical paths. However, the installation position of the irradiation position detector 26 can be changed.

The half mirror 27 branches the optical path of the reference light transmitted through the dichroic mirror 22. One of the branched optical paths extends to the irradiation position detector 26 and the other extends to the mirror 28. The mirror 28 reflects the reference light incident from the half mirror 27 and makes it incident on the half mirror 27 again. The optical axis of the reference light incident on the mirror 28 and the optical axis of the reference light reflected by the mirror 28 are coaxial. The reference light reflected by the mirror 28 is reflected again by the half mirror 27 and reflected by the dichroic mirror 22. Thereafter, the reference light passes through the dichroic mirror 25 and the dichroic mirror 24 and enters the front image capturing unit 30. As a result, the reference light is projected onto the light receiving element 31 (see FIG. 2) of the front image photographing unit 30 along the (known) optical axis whose relationship with the optical axis of the surgical laser light is predetermined. . Therefore, the positional relationship of the optical axis of the surgical laser beam with respect to the imaging range of the front image is properly grasped by the front image.

The control unit 50 includes a CPU 51, a ROM 52, a RAM 53, a nonvolatile memory (not shown), and the like. The CPU 51 performs various controls of the ophthalmic laser surgical apparatus 1 (for example, control of the surgical laser light source 2, control of the reference light source 3, operation control of the scanning units 6, 10, and 18, image shooting control, and fixation target projection). Control). The ROM 52 stores various programs for controlling the operation of the ophthalmic laser surgical apparatus 1 (for example, an ophthalmic apparatus control program for executing IF adjustment operation control processing, docking processing, irradiation control data creation processing, etc., which will be described later). Is remembered. The RAM 53 temporarily stores various information. A nonvolatile memory is a non-transitory storage medium that can retain stored contents even when power supply is interrupted. The ophthalmologic apparatus control program or the like may be stored in a nonvolatile memory.

The display unit 54 can display various images. The operation unit 55 is operated by a user (for example, an operator, an examiner, an assistant, etc.). The control unit 50 receives input of various operation instructions by the user via the operation unit 55. For the operation unit 55, for example, various devices such as a touch panel, various buttons, a keyboard, and a mouse provided in the display unit 54 may be appropriately employed. The display unit 54 and the operation unit 55 may be incorporated in the apparatus main body of the ophthalmic laser surgical apparatus 1 or may be another device connected to the apparatus main body by wire or wirelessly.

Further, FIG. 1 illustrates the case where one control unit 50 is used as the controller of the ophthalmic laser surgical apparatus 1. However, it goes without saying that the ophthalmic laser surgical apparatus 1 may be controlled by a plurality of controllers. For example, the ophthalmic laser surgical apparatus 1 may include an apparatus main body including various optical elements and actuators, and a personal computer connected to the apparatus main body. In this case, for example, the controller of the personal computer may create laser irradiation control data, and the controller of the apparatus main body may control the driving of the actuator in accordance with the created irradiation control data. Further, display control of the display unit 54, analysis of captured images, calculation of various parameters, and the like may be executed by a controller of a personal computer. That is, it is not necessary for all the control processes described later to be executed by one controller of the apparatus main body.

<Front image shooting unit>
The front image capturing unit 30 will be described with reference to FIG. The front image capturing unit 30 of the present embodiment includes a light receiving element 31, a lens 32, and a light receiving adjustment unit (focus adjustment unit) 33. The light receiving element 31 receives reflected light (observation light) reflected by the eye E. The light receiving element 31 of the present embodiment captures an image of the eye E (specifically, a front image of the anterior eye part) by receiving the reflected light from the eye E. In this embodiment, a two-dimensional light receiving element (for example, CCD, CMOS, etc.) is employed. The lens 32 conjugates the imaging target region of the eye E and the light receiving element 31. In FIG. 2, only one lens 32 is shown for convenience, but it goes without saying that the number of optical elements provided in the optical path is not limited to one. The light receiving adjustment unit 33 adjusts the light receiving state of the reflected light in the light receiving element 31. Specifically, the light receiving adjustment unit 33 of the present embodiment adjusts the focus state of the reflected light at the light receiving element 31. That is, the light receiving adjustment unit 33 according to the present embodiment moves the light receiving element 31 in a direction along the optical axis (imaging optical axis) of reflected light (in the direction of arrow A in FIG. 2), so that the light receiving element 31 and the imaging target part are moved. Can be conjugated. For example, a motor or the like is used for the light receiving adjustment unit 33 of the present embodiment.

The configuration for adjusting the light receiving state can be changed as appropriate. For example, the front image photographing unit 30 may include a light receiving adjustment unit 34 that moves an optical element (for example, a lens 32) provided on the photographing optical path in a direction along the optical path (in the direction of arrow B in FIG. 2). In this case, the ophthalmic laser surgical apparatus 1 can adjust the focus state by moving at least one of the light receiving element 31 and the optical element along the optical axis. Further, the ophthalmic laser surgical apparatus 1 may adjust the light receiving state (for example, the imaging magnification of the front image) other than the focus state by driving the light receiving adjustment unit 34. Further, the front image photographing unit 30 may include a light receiving adjustment unit 36 for inserting the optical element 35 on the photographing optical axis and removing the optical element 35 from the photographing optical axis (arrow C in FIG. 2). reference). In this case, the ophthalmic laser surgical apparatus 1 can adjust the light receiving state in stages according to various conditions. Note that description of the magnification adjustment unit 300 and the luminance adjustment unit 400 illustrated in FIG. 2 will be described later.

<Fixed target projection unit>
The fixation target projection unit 40 will be described with reference to FIG. The fixation target projection unit 40 of the present embodiment includes a fixation target projection light source 41, a first diaphragm 42, a second diaphragm 43, a lens 44, a movable stage 45, a fixation target movement drive unit 46, a fixed lens 47, and movable optics. An element 48 and an optical element movement drive unit 49 are provided. The fixation target projection light source 41 emits light (fixation target projection light) for projecting the fixation target onto the eye E of the subject. The amount of fixation target projection light emitted from the fixation target projection light source 41 is changed by the control unit 50. The first diaphragm 42 and the second diaphragm 43 make the light flux of the fixation target projection light incident on the projection optical path of the fixation target a certain size. The lens 44 is fixed at a predetermined position with respect to the first diaphragm 42 and the second diaphragm 43 in the projection optical path.

The movable stage 45 is equipped with a fixation target projection light source 41, a first diaphragm 42, a second diaphragm 43, and a lens 44. The movable stage 45 can move in a direction intersecting the optical axis (projection optical axis) of the projection optical path (in the direction of arrow D in FIG. 3). When the movable stage 45 moves in the direction intersecting the projection optical axis, the projection position of the fixation target with respect to the eye E moves. As a result, the fixation direction of the eye E is changed. The fixation target moving drive unit 46 moves the movable stage 45. For example, a motor or the like is used for the fixation target movement drive unit 46.

The fixed lens 47 is fixed on the projection optical path. The movable optical element (for example, movable lens) 48 moves between an insertion position where the movable optical element (for example, a movable lens) is inserted on the projection optical path and a removal position where the movable optical element 48 is removed from the projection optical path (see arrow E in FIG. 3). The optical element movement drive unit 49 moves the movable optical element 48. Various actuators such as a motor and a solenoid can be used for the optical element movement drive unit 49.

The ophthalmic laser surgical apparatus 1 of the present embodiment can change the projection state of the fixation target projected onto the eye E. For example, the ophthalmic laser surgical apparatus 1 can change the amount of fixation target projection light by adjusting the power supplied to the fixation target projection light source 41. In this case, the brightness of the fixation target projected toward the eye E is changed. The ophthalmologic laser surgical apparatus 1 changes the focal length of the fixation target projection optical system by switching between insertion of the movable optical element 48 on the projection optical path and removal of the movable optical element 48 from the projection optical path. can do. In this case, the focusing state of the fixation target in the retina of the eye E is changed. The fixation target projection optical system is various optical members provided in a projection optical path extending from the fixation target projection light source 41 to the eye E. The fixation target projection optical system of the present embodiment includes diaphragms 42 and 43, a lens 44, a fixed lens 44, and a movable optical element 48.

Note that the method for changing the projection state of the fixation target can be selected as appropriate. For example, the ophthalmic laser surgical apparatus 1 may move the movable optical element 48 in the direction along the projection optical axis (the direction of arrow F in FIG. 3) by driving the optical element movement drive unit 49. Further, the ophthalmic laser surgical apparatus 1 may move the movable stage 45 in a direction along the projection optical axis (in the direction of arrow G in FIG. 3) by driving the fixation target moving drive unit 46. Also in these methods, the focal length of the fixation target projection optical system is changed. Of course, both the movable optical element 48 and the movable stage 45 may be moved along the projection optical axis.

Needless to say, the method of projecting the fixation target can also be changed. For example, a liquid crystal display may be used instead of the point light source. In this case, the fixation direction of the eye E is changed by changing the display position of the target in the display area of the liquid crystal display. A method of arranging a plurality of point light sources and switching the point light sources to be lit can also be adopted.

<Mechanical configuration>
An outline of the mechanical configuration of the ophthalmic laser surgical apparatus 1 will be described with reference to FIG. The ophthalmic laser surgical apparatus 1 includes a housing 60 that houses various optical systems and scanning units 6, 10, 18, and the like. A cylindrical portion 61 is provided in a part of the lower portion of the housing. The objective lens 20 described above is fixed inside the cylindrical portion 61. The tube portion 61 serves as an irradiation end for irradiating the eye E with a surgical laser beam.

An alignment index projection unit 63 is provided at the lower end of the housing 60. The alignment index projection unit 63 projects the alignment index onto the cornea of the eye E. As an example, the alignment projection unit 63 of the present embodiment includes a plurality of alignment / illumination light sources 64 that are point light sources that emit light of a finite distance. In the present embodiment, the light emitted from the alignment / illumination light source 64 also serves as an illumination light source for capturing a front image. However, an illumination light source may be provided separately from the alignment light source. A plurality (eight in this embodiment) of alignment / illumination light sources 64 are arranged in an annular shape around the central axis of the cylindrical portion 61. Although details will be described later, the control unit 50 processes the front image to detect light emitted from the alignment / illumination light source 64 and reflected by the cornea as a bright spot. The control unit 50 detects the position of the eye E with respect to the apparatus main body based on the detected position of the bright spot.

It should be noted that the configuration of the alignment index projection unit 63 can be changed as appropriate. For example, instead of arranging a plurality of point light sources in an annular shape, an annular light source that projects a continuous ring-shaped index may be employed. Further, in the present embodiment, the position of the eye E in the direction (XY direction) intersecting the photographing optical axis of the front image is detected by projecting the alignment index with light of finite distance. However, the ophthalmic laser surgical apparatus 1 projects the position of the eye E in the direction along the imaging optical axis (Z direction) by projecting both an infinite index and a finite target toward the eye E. You may detect with the position in a direction. In this case, the position of the eye E in the Z direction is detected based on the relationship between the infinity index reflected in the front image and the finite distance target. Further, the illumination light may be applied to the eye E by a light source different from the light source provided in the ophthalmic laser surgical apparatus 1.

The housing 60 includes a coupling drive unit 66. The coupling drive unit 66 couples the interface 90 to the eye E by moving the housing 60 (device main body) and the holding unit 67 (described later) with respect to the eye E. The coupling drive unit 66 of the present embodiment can move the housing 60 and the holding unit 67 in three directions (X, Y, Z directions). Note that the specific method for changing the relative positional relationship between the apparatus main body and the eye E is not limited to the method of moving the housing 60 in three directions. For example, the coupling drive unit may couple the interface 90 to the eye E by moving the subject relative to the apparatus main body.

The adjustment driving unit 70 is connected to the housing 60 and the holding unit 67. At least a part of the interface 90 is detachably attached to the holding unit 67. The holding unit 67 holds the mounting interface in a state where at least one of the position and the angle of the mounted interface 90 (hereinafter sometimes referred to as “mounting interface”) with respect to the apparatus main body can be adjusted. As an example, the adjustment driving unit 70 of the present embodiment adjusts the position of the mounting interface with respect to the apparatus main body by moving the holding unit 67 in the XY directions with respect to the apparatus main body. However, the adjustment holding unit may adjust the angle of the mounting interface (details will be described later).

The holding part 67 includes a base part 68, a first link 71, a second link 72, a lock mechanism 73, a connecting part 74, a position detection sensor 75, an interface mounting part 76, and a pressure sensor 77. In addition, the holding portion 67 serves as a base for holding the interface 90 while the nut base portion 68 is connected to the adjustment driving portion 70. The first link 71 is connected to a part of the upper end of the base portion 68 so as to be rotatable about a horizontal axis. The second link 72 is connected to one end of the first link 71 so as to be rotatable about a horizontal axis. The second link 72 extends in the vertical direction. When the first link 71 rotates, the second link 72 moves in the vertical direction (Z direction). The movement of the second link 72 in the Z direction is guided by a part of the base portion 68.

The lock mechanism 73 is connected to a part of the second link 72 (in the vicinity of the lower end in the present embodiment). The lock mechanism 73 can lock and unlock the movement of the second link 72. The connecting portion 74 is fixed to a part of the second link 72 (in the present embodiment, near the center in the vertical direction) and moves in the Z direction together with the second link 72. The connecting part 74 connects the second link 72 and the interface mounting part 76. The position detection sensor 74 can detect the position of the interface 90 in the Z direction by detecting the position of the second link 72 in the Z direction.

The interface 90 is detachably mounted on the interface mounting portion 76. In the present embodiment, when the user attaches the base portion of the interface 90 to a predetermined location of the interface mounting portion 76, a space 78 is formed between the base portion of the interface 90 and the interface mounting portion 76. By generating a negative pressure in the space 78 by a pump (not shown), the interface 90 is sucked and fixed to the interface mounting portion 76. The pressure sensor (for example, load cell) 77 detects a load applied between the interface mounting portion 76 and the connecting portion 74. In the present embodiment, the CPU 51 of the control unit 50 can detect whether the interface 90 is in contact with the eye E using the pressure sensor 77.

The nut 80 is mounted in a hole formed in the base portion 68 so as to be movable in the Z direction. A pin 81 that contacts the first link 71 from below is provided at the upper end of the nut 80. The feed screw 82 is screwed into the nut 80. The motor 83 rotates the feed screw 82. When the motor 83 is driven and the feed screw 82 rotates, the nut 80 and the pin 81 move in the Z direction. As a result, the first link 71 rotates, and the second link 72, the connecting portion 74, the interface mounting portion 76, and the interface 90 move in the Z direction. In the present embodiment, when the pressure sensor 77 detects that an excessive load is applied to the eye E, the lock mechanism 73 unlocks the second link 72 and the interface 90 is movable upward. It becomes. As a result, the safety for the eye E is improved.

<Interface>
The interface 90 will be described with reference to FIGS. 5 and 6. The interface 90 is disposed between the apparatus main body and the eye E among optical paths of various lights (surgical laser light, reference light, observation light, OCT light, and fixation target projection light) extending between the apparatus main body and the eye E. Intervenes and is coupled to eye E. In the present embodiment, the user can selectively use a plurality of types of interfaces 90 according to the region to be operated, the surgical procedure, and the like. As an example, the plurality of types of interfaces 90 in the present embodiment include an immersion interface 91 (see FIG. 5) and an applanation interface 92 (see FIG. 6). First, a configuration common to the immersion interface 91 and the applanation interface 92 will be described. The details of the configuration described below may be different between the immersion interface 91 and the applanation interface 92.

As shown in FIGS. 5 and 6, the interface 90 includes a mount 93, a suction path 94, an eye fixing portion 95, and an interface lens (an immersion lens 100 or a contact lens 110).

The mount 93 is a member that becomes a base of the interface 90. The mount 93 is mounted on the interface mounting portion 76 (see FIG. 4) of the holding portion 67 and holds the eye fixing portion 95 and the like. The mount 93 is formed with a circular hole penetrating in the Z direction (vertical direction in FIGS. 5 and 6). Various types of light can propagate inside the circular hole. The suction path 94 is provided in the mount 93 and allows gas to flow between a space 96 described later and a pump (not shown).

The eye fixing part (suction ring in the present embodiment) 95 is an annular (annular in the present embodiment) member. The eye fixing part 95 is provided at the lower part of the mount 93 so as to surround the lower end of the circular hole formed in the mount 93. The eye fixing unit 95 is coupled to the eye E (in this embodiment, the cornea or sclera of the eye E), so that the apparatus main body (specifically, the objective lens 20 provided in the apparatus main body and the surgical laser) The position of the eye E with respect to the light reference axis or the like is fixed. In this embodiment, the eye fixing part 95 and the mount 93 are separate members. The eye fixing part 95 is fixed to the mount 93 by fitting, welding, adhesive bonding, or the like. However, the eye fixing part 95 may be formed integrally with the mount 93. Further, the eye fixing portion 95 may be detachably attached to the mount 93 or the arm portion of the mount 93 by suction or the like. When the eye fixing part 95 contacts the eye E, a sealed space 96 is formed between the surface of the eye E and the eye fixing part 95. As the gas in the space 96 is discharged through the suction passage 94, the eye fixing portion 95 is sucked and fixed to the eye E.

The interface lens (the immersion lens 100 and the contact lens 110) is disposed on the apparatus main body side (above the eye fixing unit 95 in the present embodiment) of the various light paths of the light. The interface lenses 100 and 110 of this embodiment are fixed to the upper part of a circular hole formed in the mount 93 by an adhesive or the like. However, the interface lenses 100 and 110 and the eye fixing part 95 may be separate members instead of being integrally fixed. The interface lenses 100 and 110 may be detachably attached to the mount 93 or the arm portion of the mount 93 by suction or the like.

The immersion lens 100 of the immersion interface 91 will be described with reference to FIG. When the immersion interface 91 contacts the eye E, a space 103 is generated between the immersion lens 100 and the surface (cornea) of the eye E. A substance (for example, a liquid such as water or a viscoelastic substance or an elastic body) whose refractive index difference between the transparent tissues of the eye E (eg, cornea) is smaller than that of air is disposed in the space 103. As a result, at least a portion through which various types of light pass between the immersion lens 100 and the eye E is filled with a substance such as a liquid. Therefore, the influence (for example, generation | occurrence | production of an aberration) of the refractive index difference between the transparent structure | tissue of the eye E and air is suppressed.

In this embodiment, an injection path (not shown) for injecting liquid into the space 103 is formed in the mount 93. The liquid is injected into the space 103 through the injection path with the immersion interface 91 in contact with the eye E. However, the method of arranging a substance such as a liquid in the space 103 can be changed as appropriate. For example, the user may place a substance such as a liquid on the eye E from above while the immersion interface 91 is in contact with the eye E, and then attach the immersion lens 100 to the mount 93.

As an example, out of the lens surfaces of the immersion lens 100 of the present embodiment, the rear surface 101 located on the eye E side and the front surface 102 located on the apparatus main body side are both convex toward the eye E side (lower side). Is curved. In this case, for example, a problem that the OCT light is directly reflected by the lens surface (particularly the rear surface 101) and incident on the tomographic image capturing unit 23 is suppressed. Further, the surfaces of the rear surface 101 and the front surface 102 are shaped along a spherical surface. However, the shapes of the rear surface 101 and the front surface 102 can be changed. For example, at least one of the rear surface 101 and the front surface 102 may be a flat surface. In this case, the occurrence of aberration due to the lens surface is suppressed. Further, at least one of the rear surface 101 and the front surface may be curved in a convex shape toward the apparatus main body side (upper side). In this case, the control unit 50 can also detect the center position of the immersion lens 100 by the light (bright spot) that is irradiated from the alignment index projection unit 63 (see FIG. 4) and reflected by the lens surface. . The lens surface may be curved along an aspheric surface.

The contact lens 110 of the applanation interface 92 will be described with reference to FIG. When the applanation interface 92 is sucked and fixed to the eye E, the rear surface 111 of the contact lens 110 (the surface of the lens surface on the eye E side) comes into contact with the surface of the eye E (including the cornea). That is, the cornea of the eye E is applanated. As a result, the shape of the cornea surface is deformed to the shape of the rear surface 111 of the contact lens 110. Therefore, the irradiation position of the surgical laser beam is set appropriately. Further, as compared with the case where air is interposed between the rear surface 111 and the cornea, an adverse effect (for example, generation of aberration) due to light refraction is suppressed. Note that the contact lens 110 may be applanated by the eye E by sucking the gas between the rear surface 111 of the contact lens 110 and the surface of the eye E.

As an example, in the contact lens 110 of this embodiment, the rear surface 111 located on the eye E side is curved in a convex shape toward the upper side. Therefore, an increase in intraocular pressure during applanation is suppressed as compared with the case where the eye E is applanated by a flat surface. Further, the control unit 50 can detect the center position of the contact lens 110 by the light emitted from the alignment index projection unit 63 (see FIG. 4) and reflected by the rear surface 111. The front surface 112 of the contact lens 110 is curved in a convex shape toward the apparatus main body, similarly to the front surface 102 of the immersion lens 100 described above. Both the rear surface 111 and the front surface 112 are formed in a curved shape along the spherical surface. However, the shapes of the rear surface 111 and the front surface 102 of the contact lens 110 can be changed in the same manner as the immersion lens 100. For example, the rear surface 111 of the contact lens 110 may be a flat surface. As is apparent from the above description, the term applanation includes not only the meaning of deforming the cornea of the eye E into a flat shape but also the meaning of deforming the cornea of the eye E into a predetermined shape that is not flat.

In this embodiment, the refractive power of the interface lens (for example, the immersion lens 100 and the contact lens 110) differs depending on the type of the interface 90.

Further, the interface lenses 100 and 110 are arranged in the photographing optical path of the front image photographing unit 30 when the interface 90 is attached to the interface attaching unit 76. Therefore, when the refractive powers of the interface lenses 100 and 110 differ depending on the type of the interface 90, the refractive power of the optical elements in the entire photographing optical path of the front image photographing unit 30 changes, and the photographing magnification of the front image photographing unit 30 changes.

For example, FIG. 7A shows the distance WD between the apparatus main body and the eye E and the diameter φ of the photographing range of the front image photographing unit 30 when the immersion interface 91 is used and when the applanation interface 92 is used. It is an example of the graph which shows a relationship. In the graph of FIG. 7A, the horizontal axis is the distance WD, and the vertical axis is the diameter φ of the imaging range. In FIG. 7, the solid line indicates when the liquid immersion interface 91 is used, and the dotted line indicates when the applanation interface 92 is used. As can be seen from the graph of FIG. 7A, the diameter φ of the imaging range is wider when the applanation interface 92 is used than when the immersion interface 91 is used. That is, the photographing magnification is smaller when the applanation interface 92 is used than when the immersion interface 91 is used.

Note that the front image capturing unit 30 of the present embodiment is non-telecentric on the image side, and the diameter φ of the capturing range varies depending on the distance WD. That is, the shooting magnification varies depending on the size of the distance WD.

In the example of FIG. 7A, when the immersion interface 91 is used, the diameter φ of the imaging range when the distance WD is 0 mm is approximately 15 mm, and the diameter φ of the imaging range when the distance WD is 100 mm is , Approximately 40 mm (see FIG. 7B). Accordingly, the ratio of the change in the diameter φ of the shooting range to the change in the distance WD (that is, the ratio of the change amount in the shooting range to the change amount in the distance WD) is, for example, (40-15) /100-0=0.25. It becomes. When the applanation interface 92 is used, the diameter φ of the photographing range when the distance WD is 0 mm is about 20 mm, and the diameter φ of the photographing range when the distance WD is 100 mm is about 70 mm (FIG. 7C). Reference). Therefore, the ratio of the change in the diameter φ of the shooting range to the change in the distance WD is, for example, (70-20) /100-0=0.5.

Thus, when a difference in imaging magnification occurs depending on the type of interface 90 to be used, the operator feels uncomfortable due to the difference in imaging magnification, making it difficult to observe the state of the patient's eyes. Therefore, in the present embodiment, a magnification adjustment unit 300 described later is provided, and the photographing magnification of the front image photographing unit 30 is adjusted so that a change in the photographing range that occurs according to the type of the interface 90 does not become too large. For example, the magnification adjustment unit 300 may adjust the magnification so that a change in the photographing range that occurs according to the type of the interface 90 is reduced.

<Magnification adjustment section>
Hereinafter, the magnification adjustment unit 300 will be described with reference to FIGS. 1 and 2. For example, the magnification adjustment unit 300 adjusts the photographing magnification of the front image photographing unit 30. For example, the magnification adjustment unit 300 includes an optical element 301 and a drive unit 302. For example, the optical element 301 is provided in the photographing optical path of the front image photographing unit 30. For example, the drive unit 302 drives (moves) the optical element 301. For example, the drive unit 302 inserts and removes the optical element 301 on the photographing optical path (see arrow H in FIG. 2).

For example, a lens that increases the imaging magnification of the front image capturing unit 30 is used as the optical element 301 of the present embodiment. In this case, the magnification adjusting unit 300 may insert the optical element 301 on the photographing optical path when the interface 90 having a small photographing magnification is mounted among the plurality of types of interfaces 90.

In the case where a lens for reducing the photographing magnification of the front image photographing unit 30 is used as the optical element 301, the magnification adjusting unit 300 is mounted when the interface 90 having a large photographing magnification is mounted among the plurality of types of interfaces 90. The optical element 301 may be inserted on the photographing optical path.

Note that the magnification adjustment unit 300 may include a plurality of optical elements. For example, as illustrated in FIG. 2, the magnification adjustment unit 300 may include an optical element 303 in addition to the optical element 301. For example, the magnification adjustment unit 300 may adjust the photographing magnification of the front image photographing unit 30 by driving the optical element 303 by the driving unit 304. Thus, the imaging magnification and telecentricity (degree of telecentricity) of the front image capturing unit 30 may be easily adjusted.

<Overall control action>
A control operation of the ophthalmic laser surgical apparatus 1 having the above configuration will be described with reference to FIG. First, the surgeon selects a treatment laser light irradiation mode according to the content of the surgery (step S1). For example, by applying a therapeutic laser beam to the cornea of the patient's eye E, a LASIK mode for performing refractive surgery, and performing a cataract surgery by irradiating the cornea and the lens of the patient's eye E with the therapeutic laser beam. An irradiation mode such as a cataract mode may be provided. In the following description, the case where the LASIK mode is selected will be exemplified.

When the LASIK mode is selected by operating the operation unit 55 or the like, the CPU 51 sets the irradiation mode to LASIK mode. When the LASIK mode is set, the CPU 51 controls the magnification adjustment unit 300, inserts the optical element 301 on the optical path of the front image capturing unit 30, and sets the shooting magnification of the front image capturing unit 30 to be suitable for the LASIK mode. The magnification is adjusted (step S2). Details of the control in step S2 will be described later.

Further, the CPU 51 adjusts the focus of the front image photographing unit 30 to the first position before starting the alignment (step S3). Here, the first position is an alignment start position between the apparatus 1 and the patient's eye E. For example, the first position is set at a position about 100 mm away from the position where the patient eye E and the interface 90 are docked in the optical axis direction of the treatment laser light. For example, the CPU 50 controls the light receiving adjustment unit 33 to adjust the focus of the light receiving element 31 to the first position. By adjusting the focus to the first position, the patient's eye E can be observed from a position where the patient's eye E and the interface 90 are separated from each other. Therefore, for example, unintentional contact between the patient's eye E and the interface 90 can be reduced.

The surgeon attaches the interface 90 suitable for the selected irradiation mode to the interface attaching part 76. For example, in the LASIK mode, the surgeon attaches the applanation interface 92 to the interface attachment portion 76. The CPU 51 may detect the type of the interface 90 attached to the interface attachment unit 76 using a sensor or the like. In this case, the CPU 90 may set the irradiation mode according to the type of the detected interface 90.

Furthermore, the operator uses an opener or the like to fix the patient's heel lying on the bed in an open state. Then, the operator starts automatic alignment between the patient's eye E and the applanation interface 92 by operating the operation unit 55 or the like.

First, the CPU 51 executes the first focus control in order to focus the light receiving element 31 on the patient's eye E (step S4). Details of the first focus control will be described later.

When the reflected light from the patient's eye E is focused on the light receiving element 31 by the first focus control, the CPU 51 acquires alignment information in the XYZ directions based on the bright spot reflected in the front image (step S5). Then, the CPU 51 drives the coupling drive unit 66 in the XYZ directions based on the acquired alignment information, and brings the interface 92 closer to the patient's eye E while adjusting the alignment in the XY directions. At this time, the CPU 51 controls the light receiving adjustment unit 33 to drive the light receiving element 31 based on the drive amount of the imaging drive unit 66, thereby adjusting the focus of the light receiving element 31 (step S6). Details of the method of driving the light receiving element 31 at this time will be described later.

The CPU 51 drives the coupling drive unit 66 to drive the apparatus 1 by about 100 mm, and moves the position of the patient's eye E relative to the apparatus 1 to the second position. Here, the second position is the vicinity of the position where the docking between the patient's eye E and the interface 90 is completed, and is the vicinity of the irradiation position when the laser light is irradiated. Note that the first position and the second position may be separated from a bright spot disappearance section in which a bright spot formed on the cornea of the patient's eye disappears due to the light beam from the alignment index projection unit 63. When the position of the patient's eye E relative to the apparatus 1 is moved to the second position, the CPU 51 executes the second focus control in order to refocus the light receiving element 31 with respect to the patient's eye E (Step S7).

When the CPU 51 adjusts the focus state of the light receiving element 31 at the second position by the second focus control, the CPU 51 starts docking the applanation interface 92 and the patient's eye E (step S8). When docking is completed, the surgeon performs laser irradiation planning and the like, and performs irradiation with therapeutic laser light (step S9). By the steps as described above, surgery for the patient's eye using the ophthalmic laser surgical apparatus is performed.

<Control operation of magnification adjustment unit>
The control operation of the magnification adjustment unit 300 in step S2 of FIG. 8 will be described. The magnification adjustment unit 300 according to the present embodiment switches the imaging magnification of the front image by switching insertion and removal of the optical element 301 according to the type of the interface 90 used.

For example, when the applanation interface 92 is mounted, the CPU 51 controls the magnification adjustment unit 300 and inserts the optical element 301 on the optical path of the front image photographing unit 30 in order to reduce the change ratio of the photographing magnification. As a result, the change in the photographing magnification of the front image photographing unit 30 in the LASIK mode is reduced, and the photographing magnification can be made closer when the applanation interface 92 is attached and when the immersion interface 91 is attached.

For example, by inserting the optical element 301 into the optical path when the applanation interface 92 is mounted, the relationship between the distance WD and the shooting range diameter φ is adjusted from the relationship indicated by the dotted line in FIG. Is done. As a result, the ophthalmic laser surgical apparatus 1 can reduce a sense of incongruity caused by different magnification changes with respect to the distance WD when different types of interfaces 90 are used.

For example, the timing at which the CPU 51 switches the photographing magnification by the magnification adjusting unit 300 may be when the setting of the irradiation mode is switched. For example, every time the irradiation mode is switched between the LASIK mode and the cataract mode by the operator's operation on the operation unit 55, the CPU 51 may control the magnification adjustment unit 300 to switch the imaging magnification. For example, when the irradiation mode is switched to the LASIK mode, the CPU 51 may control the driving of the driving unit 302 and insert the optical element 301 into the optical path of the front image capturing unit 30. Further, when the irradiation mode is switched to the cataract mode, the CPU 51 may control the driving of the driving unit 302 and remove the optical element 301 out of the optical path of the front image capturing unit 30.

A method other than inserting the optical element 301 in the LASIK mode as described above is also conceivable. For example, the optical element 301 may be inserted in the cataract mode, and the optical element 301 may be removed from the optical path in the LASIK mode. In any mode, the photographing magnification may be adjusted by inserting / removing the optical element 301.

Note that the magnification adjustment unit 300 may adjust the change in the magnification of the front image caused by the difference in the interface 90 by adjusting the ratio of the change in the magnification of the front image to the change in the distance WD.

In the above example, the optical element 301 is inserted into and removed from the optical path of the front image capturing unit 30, but the change ratio of the imaging magnification is adjusted by moving the optical element 301 in the optical axis direction of the optical path. May be. For example, as illustrated in FIG. 2, the magnification adjustment unit 300 may adjust the change ratio of the imaging magnification by moving the optical element 301 disposed on the optical path of the front image capturing unit 30 in the optical axis direction. Good.

Note that not only the lens but also a reflecting member, a prism, or the like may be used as the optical element 301 of the magnification adjusting unit 300. For example, the magnification adjustment unit 300 may adjust the change ratio of the photographing magnification by inserting and removing the reflecting member on the photographing optical path. For example, the reflecting member may be a mirror, a half mirror, a dichroic mirror, or the like. For example, in FIG. 9, when the optical element (here, the reflecting member) 301 is arranged on the optical path of the front image capturing unit 30 by driving the driving unit 302, the reflected light from the patient's eye E is reflected by the optical element 301. The Then, the light passes through the mirror 303, the relay lens 304, the diaphragm 37b, and the imaging lens 32b and is received by the light receiving element 31b. As described above, the optical element 301 is inserted into and removed from the photographing optical path by the driving unit 302, thereby photographing from the first photographing optical path L1 to the second photographing optical path L2 having a photographing magnification different from that of the first photographing optical path L1. The photographing magnification of the front image photographing unit 30 may be adjusted by switching the optical path.

Note that when the optical path is switched by the optical element 301, two light receiving elements 31a and 31b may be provided as in the example of FIG. For example, as described above, the light receiving elements 31a and 31b may be provided in the first photographing optical path L1 and the second photographing optical path L2, respectively. In this case, the front image capturing unit 30 may switch the light reception signals received from the two light receiving elements 31 a and 31 b according to the type of the interface 90. Of course, even when the imaging optical path is switched by the optical element 301, the imaging magnification may be switched using a single light receiving element by once branching the optical path and then recombining the optical paths.

In the above example, the imaging optical axis of the front image capturing unit 30 and the irradiation optical path of the therapeutic laser beam are partially coaxial. In this case, the magnification adjusting unit 300 receives the light receiving element from the branch point where the irradiation optical axis of the imaging optical axis of the front image capturing unit 30 and the therapeutic laser beam is branched by the optical path branching member (for example, the dichroic mirror 22). The optical element 301 may be driven in the optical path on the 31st side to adjust the photographing magnification of the front image photographing unit 30. Thereby, the imaging magnification of the front image capturing unit 30 can be adjusted without affecting the irradiation of the therapeutic laser beam.

In the above example, the photographing optical axis of the front image photographing unit 30 and the photographing optical axis of the tomographic image photographing unit 23 are partially coaxial. In this case, as in the present embodiment, the optical paths of the front image capturing unit 30 and the tomographic image capturing unit 23 are closer to the light receiving element 31 than the branch point where the optical path branching member (for example, the dichroic mirror 25) branches. The optical element 301 may be driven to adjust the photographing magnification of the front image photographing unit 30. Thereby, the imaging magnification of the front image capturing unit 30 can be adjusted without affecting the tomographic image capturing by the tomographic image capturing unit 23.

Note that, when the shooting magnification is switched according to the type of the interface 90 as described above, the luminance of the image acquired by the front image shooting unit 30 changes. Therefore, the present apparatus 1 may include a luminance adjusting unit 400 that suppresses a change in luminance of the front image before and after the magnification switching by the magnification adjusting unit 300 (see FIG. 2). For example, the brightness adjusting unit 400 may include an aperture value changing unit 410 that switches the aperture value of the front image capturing unit 30 in accordance with the interface 90. For example, the aperture value changing unit 410 may include a variable aperture 411 that can change the aperture value and a drive unit 412 that drives the variable aperture 411. Then, the aperture value changing unit 410 may change the aperture value of the variable aperture 411 by driving the drive unit 412. The aperture value changing unit 410 may include a plurality of apertures having different aperture values (for example, the apertures 411a and 411b in FIG. 9). In this case, the diaphragm arranged in the optical path may be switched by a drive unit (not shown), or the diaphragm may be changed in accordance with the switching of the photographing optical path by the magnification adjusting unit 300 as shown in FIG.

For example, the luminance adjustment unit 400 may include a gain adjustment unit 420. For example, the gain adjustment unit 420 is provided in the control unit 50 (see FIG. 1), and adjusts the gain of the signal output from the light receiving element 31 according to the switching of the photographing magnification, thereby adjusting the brightness of the front image. May be.

Of course, the brightness adjustment unit 400 may include a light amount adjustment unit 430. For example, the light amount adjustment unit 430 may be provided in the control unit 50 (see FIG. 1), and may adjust the brightness of the front image by adjusting the light amount of the alignment / illumination light source 64 according to switching of the photographing magnification. .

As described above, even when the shooting magnification is adjusted by the magnification adjustment unit 300, the luminance adjustment unit 400 can acquire a front image with little luminance change.

In the above description, the magnification adjusting unit 300 includes the optical element 301 and the driving unit 302, and optically adjusts the imaging magnification of the front image capturing unit 30 by driving the optical element 301 by the driving unit 302. However, it is not limited to this. For example, the magnification adjustment unit 300 may be provided in the control unit 50 (see FIG. 1) and adjust the display magnification of the front image captured by the front image capturing unit 30. For example, when the photographing magnification is reduced by changing the interface 90, as shown in FIG. 10, a part of the front image photographed by the front image photographing unit 30 is cut out and displayed on the display unit with the display magnification increased. Also good. Accordingly, it is possible to suppress a change in magnification of the front image without providing the configuration of the optical element 301 and the drive unit 302 and the like.

The distance WD between the apparatus main body and the eye E may be, for example, a distance from the interface 90 to the eye E, a distance from the cylindrical portion 61 to the eye E, or a distance from the objective lens 20 to the eye E. Alternatively, the distance from the light receiving element 31 to the eye E may be used. It is only necessary to know the positional relationship between the apparatus main body and the eye E.

The movement control of the light receiving element 31 in step S6 in FIG. 8 will be described with reference to FIG. FIG. 11 is a graph showing the relationship of the movement amount M (that is, the movement amount (distance) from the reference position) of the light receiving element 31 with respect to the distance WD between the apparatus main body and the patient's eye E. The solid line is one point in the cataract mode. A chain line indicates a relationship in LASIK mode. As described above, the present embodiment is a non-telecentric optical system on the image side, and as shown in FIG. 11, the amount of movement M of the light receiving element 31 with respect to the distance WD has a non-linear relationship. Therefore, the CPU 51 controls the light receiving adjustment unit 33 to adjust the focus state of the front image by moving the light receiving element 31 nonlinearly.

For example, when the CPU 51 brings the device 1 close to the eye E by the coupling drive unit 66, the front of the CPU 51 so that the relationship between the driving amount of the coupling driving unit 66 and the amount of movement of the light receiving element 31 by the light receiving adjustment unit 33 becomes nonlinear. The focus state of the image may be adjusted. For example, the relationship between the distance WD and the amount of movement of the light receiving element 31 can be theoretically obtained using an imaging magnification or the like. For example, in the front image photographing unit 30, the amount of change in the image plane, that is, the amount of movement of the light receiving element 31 is obtained by the square of the magnification β. For example, the movement amount M of the light receiving element with respect to the minute change amount ΔWD of the distance WD is expressed by the following equation (1).

Figure JPOXMLDOC01-appb-M000001

For example, if the magnification at a certain position is × 0.3, 1 × (0.3) ^ 2≈0.09 mm for the movement of the subject eye 1 mm. In practice, however, the magnification β changes continuously and is expressed by the following equation (2) using constants a and b.

Figure JPOXMLDOC01-appb-M000002

Therefore, the moving amount M of the light receiving element 31 is obtained by integration shown by the following equation (3).

Figure JPOXMLDOC01-appb-M000003

For example, the ROM 52 may store an arithmetic expression as described above, a data table created based on the arithmetic expression, or a data table created based on the experimental data. In this case, the CPU 51 may obtain at least one of the position and the movement amount of the light receiving element 31 using at least one of the arithmetic expression stored in the ROM 52 and the data table.

For example, the CPU 51 obtains the apparatus main body, the patient's eye E, and the distance WD based on the driving amount of the coupling driving unit 66 from the first position, and drives the light receiving adjustment unit 33 using the above-described arithmetic expression or data table. An amount may be obtained. Then, the CPU 51 may adjust the focus by linking the driving of the coupling driving unit 66 and the driving of the light receiving adjustment unit 33 and moving the light receiving element 31 non-linearly with the movement of the device 1. . Of course, the CPU 51 may move the light reception adjusting unit 33 stepwise with respect to the driving of the coupling drive unit 66 based on the drive amount of the light reception adjustment unit 33 acquired using the above-described arithmetic expression or data table. .

Note that, as described above, the photographing magnification of the front image photographing unit 30 varies depending on the type of the interface 90. Therefore, the CPU 51 may acquire the relationship between the distance WD and the movement amount M of the light receiving element 31 for each type of interface 90. For example, a data table or an arithmetic expression in which the distance WD and the amount of movement of the light receiving element 31 are associated with each type of the interface 90 may be stored in the ROM 52. For example, the CPU 51 may switch an arithmetic expression and a data table for obtaining at least one of the position and the movement amount of the light receiving element 31 according to the irradiation mode corresponding to the type of the interface 90.

As described above, the front image capturing unit 30 is a non-telecentric optical system, and the relationship of the position of the light receiving element 31 with respect to the distance WD is nonlinear. For example, as the distance WD decreases, the amount of movement for moving the light receiving element 31 increases. Therefore, the CPU 51 may increase the moving speed of the light receiving element 31 as the distance WD decreases when the apparatus 1 and the patient's eye E are brought close to each other at a constant speed by the coupling drive unit 66. Thereby, the focus adjustment is performed in conjunction with the movement of the apparatus 1 without delaying the focus adjustment.

In the present embodiment, the CPU 51 detects the distance between the apparatus main body and the eye E when the position of the eye E with respect to the apparatus main body is in a specific area (an area in the vicinity of the first position in the present embodiment). The CPU 51 detects the distance between the apparatus main body and the eye E detected at the first position, and the relative movement amount of the position of the eye E relative to the apparatus main body from the position at which the distance is detected (relative position change amount). Based on the above, the position of the light receiving element 31 is determined. Therefore, the CPU 51 can appropriately adjust the focus state.

Although details will be described later, when the eye E is in the vicinity of the first position, the CPU 51 of the present embodiment adjusts the focus state based on the front image while moving the light receiving element 31 along the optical axis. The distance of the eye E with respect to the apparatus main body is detected based on the position of the light receiving element 31 in a state where the focus state is adjusted. Therefore, the ophthalmic laser surgical apparatus 1 according to the present embodiment can appropriately detect the distance from the eye E using the front image without using a sensor or the like for detecting the position of the eye E. it can. However, the ophthalmic laser surgical apparatus 1 can also detect the distance by other methods (for example, a method using a sensor or the like).

Although details will be described later, the CPU 51 of the present embodiment projects alignment light onto the eye E in the vicinity of the first position, and the apparatus main body and the eye E based on the reflected light of the alignment light reflected by the eye E. The distance between can be detected. Therefore, the ophthalmic laser surgical apparatus 1 according to the present embodiment can appropriately detect the distance to the eye E. However, the CPU 51 may detect the distance between the apparatus main body and the eye E with reference to a tissue or the like other than the bright spot reflected in the front image (for example, the iris of the eye E).

The first focus control in step S4 in FIG. 8 and the second focus control in S7 will be described. First, the first focus control will be described. For example, the first focus control is control for adjusting the focus of the light receiving element 31 with respect to the patient's eye E located around the first position.

For example, in the first focus control, the CPU 51 may detect the focus state with respect to the patient's eye E by analyzing the front image captured by the front image capturing unit 30. For example, the CPU 51 may acquire the focus information of the light receiving element 31 by detecting a bright spot or tissue reflected in the front image.

For example, the CPU 51 adjusts the focus state of the light receiving element 31 by controlling the driving of the light receiving adjustment unit 33 based on the detected focus information.

When adjusting the focus based on the focus state of the bright spot or tissue reflected in the front image, the CPU 51 detects a change in the focus state of the bright spot or tissue while controlling the driving of the light receiving adjustment unit 33. Thus, it may be detected whether or not the driving direction of the light receiving adjustment unit 33 is correct. For example, the CPU 51 controls driving of the light receiving adjustment unit 33 to move at least one of the light receiving element 31 and the optical member in the first direction, while changing the focus state of the bright spot or the tissue on the front image ( For example, a change in the size of a bright spot) is detected. When the focus state is improved (for example, when the size of the bright spot on the front image changes small as the light receiving adjustment unit is driven), the CPU 51 determines whether the light receiving element 31 and the optical member are At least one of them is continuously moved in the first direction. On the other hand, when the focus state is deteriorated (for example, when the size of the bright spot on the front image changes greatly with the driving of the light receiving adjustment unit), the CPU 51 and the light receiving element 31 and At least one of the optical members is switched to a second direction opposite to the first direction. In this case, the automatic adjustment of the focus state is executed more smoothly.

Further, the CPU 51 may drive the coupling drive unit 66 when the focus cannot be adjusted within the drive range of the light receiving element 31. At this time, the CPU 51 detects a change in the size of the bright spot on the front image when driving the combined drive unit 66 as described above, and detects whether the drive direction of the combined drive unit 66 is correct. Also good. As described above, even when the position of the patient's eye E is greatly deviated from the first position, the focus of the light receiving element 31 can be adjusted by controlling the light receiving adjustment unit 33 and the coupling driving unit 66.

Subsequently, the second focus control will be described. For example, the second focus control is a control for adjusting the focus of the light receiving element 31 with respect to the patient's eye E located around the second position. Further, the second focus control may adjust a focus shift caused by moving the position of the patient's eye E from the vicinity of the first position to the vicinity of the second position.

For example, the focus state is detected at the first position, the focus is adjusted, and the position is further moved to the second position. At this time, the focus state is adjusted according to the distance from the first position to the second position. However, since the focus state may be deviated even after being moved to the second position, the focus state is detected again at the second position. Adjust the focus.

For example, the front image capturing unit 30 of the present embodiment is a non-telecentric optical system on the image side, and the front image capturing magnification varies depending on the distance WD between the apparatus main body and the patient's eye E. Therefore, the shooting range of the front image can be widened at a position where the distance WD is large, but the depth of field changes according to the size of the distance WD. For example, the depth of field is greater when the distance WD is large and the magnification is small than when the distance WD is small and the magnification is large. For example, as shown in FIG. 2, in the depth of field F1 at the first position and the depth of field F2 at the second position, the range of the depth of field F1 at the first position where the distance WD is large is larger. large.

Therefore, even when the focus at the first position is adjusted by the first focus control described above, the second position where the distance WD is smaller than the first position corresponds to the difference in the depth of field F1, F2. There may be a focus shift. For example, when the focus is adjusted at a position close to the limit of the depth of field range at the first position, the depth of field becomes small at the second position, and the focus may not be achieved. Therefore, the CPU 51 detects the focus state again at the second position and adjusts the focus state of the light receiving element 31.

For example, the CPU 51 detects the focus state with respect to the patient's eye E by analyzing the front image captured by the front image capturing unit 30 as in the first focus control, and focuses the light receiving element 31 at the second position. You may adjust.

As described above, the present apparatus 1 can capture a front image in focus at both the first position and the second position by executing the first focus control and the second focus control. That is, the focus state is adjusted by processing the light including the reflected light reflected by the eyes at each of the first position and the second position and driving the focus adjustment unit (for example, the light reception adjustment unit 33). Therefore, the surgeon can confirm the focused front images at the first position where observation of the patient's eye E is started for alignment and at the second position where the patient's eye E docks the interface 90. .

As a method for detecting the focus information of the light receiving element 31 by detecting the bright spot, there is a method for detecting the focus information based on the size of the bright spot. For example, as shown in FIG. 12A, the CPU 51 acquires the size of the bright spots a to h projected onto the patient's eye E by the alignment index projection unit 63 by image analysis, and acquires the acquired bright spots a to The focus state may be detected based on the magnitude of h. For example, the CPU 51 may detect the size of the bright spot reflected in the front image by detecting the brightness edge.

In this case, as shown in FIG. 12B, the CPU 51 may adjust the focus of the light receiving element 31 by driving the light receiving adjustment unit 33 so that the sizes of the bright spots a to h become small. .

Also, as a method for detecting the focus information of the light receiving element 31 by detecting the bright spot, a method for detecting the focus information based on the position of the bright spot may be used. For example, when both an infinitely bright spot and a finite bright spot are projected toward the eye E by the alignment / illumination light source 64, as shown in FIG. The distance K1 is constant regardless of the size of the distance WD, and the distance K2 between the finite bright points c and f varies depending on the size of the distance WD. Therefore, the CPU 51 may acquire the focus information of the light receiving element 31 by detecting a bright spot from the front image and comparing the distance K1 and the distance K2. In this case, as shown in FIG. 13A, the CPU 51 may adjust the focus of the light receiving element 31 by driving the light receiving adjustment unit 33 so that the distance K1 and the distance K2 are equal.

Further, the CPU 51 detects the distance between the apparatus main body and the eye E using the bright spot of the index at infinity without using the bright spot of the finite target, and adjusts the focus state according to the detected distance. May be. In this case, the ophthalmic laser surgical apparatus 1 may project, for example, an index at infinity from an oblique direction with respect to the imaging optical path of the front image capturing unit 30 onto the eye. For example, the CPU 51 determines whether or not the distance between the apparatus main body and the eye E is a predetermined distance depending on whether or not an infinite index reflected by the eye E is reflected in a predetermined location of the light receiving element 31. The distance may be detected.

Note that as a method of detecting focus information by analyzing the front image, a method of detecting focus information based on the contrast size of the front image may be used. For example, the CPU 51 may detect the magnitude of the contrast of each tissue shown in the front image and drive the light receiving adjustment unit 33 so that the contrast becomes large.

The method for detecting the focus information of the light receiving element 31 is not limited to the method based on the image analysis of the front image. For example, there is a method for detecting the focus information based on the tomographic image captured by the tomographic image capturing unit 23. May be used. For example, the CPU 51 may acquire position information in the Z direction of the patient's eye E from the tomographic image, and drive the light receiving adjustment unit 33 based on the acquired position information. For example, as shown in FIG. 14, the CPU 51 detects the position H in the Z direction of the corneal apex of the patient's eye E by image processing of the tomographic image, and calculates the position of the light receiving element 31 based on the detected position H. Also good. When the focus state is detected by analyzing the tomographic image, the focus state can be detected more reliably because it is not affected by the depth of field unlike the front image. In addition, when using tomographic image analysis, it is not necessary to adjust the focus state while moving the light receiving element 31 and the like along the optical axis. Therefore, the ophthalmic laser surgical apparatus 1 can adjust the focus state while changing the distance between the apparatus main body and the eye E.

The CPU 51 may switch the method for detecting the focus information of the light receiving element 31 in the first focus control and the second focus control. For example, in the first focus control, the CPU 51 acquires focus information based on the size of the bright spot that appears in the front image, and in the second focus control, acquires focus information from the position of the patient eye E that appears in the tomographic image. May be. For example, when the eye E is at the first position, the OCT light emitted from the tomographic imaging unit 23 may not reach the eye E. In such a case, the CPU 51 can adjust the focus state by an appropriate method according to the position of the eye E by using the front image in the first focus control and using the tomographic image in the second focus control. it can.

In the first focus control, the CPU 51 obtains focus information based on the size of the bright spot reflected in the front image, and in the second focus control, the CPU 51 obtains an infinite bright spot and a finite distance reflected in the front image. Focus information may be acquired based on the positional relationship with the bright spot.

Of course, the CPU 51 may acquire focus information by analyzing the tomographic image in the first focus control, or based on the positional relationship between the infinity bright spot and the finite bright spot reflected in the front image. Focus information may be acquired.

The timing at which the CPU 51 starts the second focus control may be when the eye E and the interface 90 are in contact. For example, the CPU 51 may switch the focus information acquisition method based on the detection result of the pressure sensor 77 that detects that the eye E and the interface 90 are in contact with each other. Thereby, the focus adjustment by the second focus control can be executed smoothly. Of course, the CPU 51 may start the second focus control when the driving amount of the coupling driving unit 66 reaches a predetermined value.

DESCRIPTION OF SYMBOLS 1 Ophthalmic laser surgery apparatus 2 Surgical laser light source 3 Reference light source 6 High-speed Z scanning part 10 XY scanning part 18 Wide-range Z scanning part 20 Objective lens 23 Cross-section image photographing part 26 Irradiation position detection part 30 Front image photographing part 31 Light receiving element 33 , 34, 36 Light reception adjustment unit 35 Optical element 40 Fixation target projection unit 48 Movable optical element 49 Optical element movement drive unit 50 Control unit 51 CPU
54 display unit 55 operation unit 63 alignment index projection unit 64 alignment / illumination light source 66 coupling drive unit 67 holding unit 70 adjustment drive unit 90 interface 91 immersion interface 92 applanation interface 95 eye fixation unit 97 edge 100 immersion lens 108 reference view Mark 110 Contact lens 128 IF lens adjustment drive unit 129 Suction adjustment drive unit 300 Magnification adjustment unit 301 Light receiving element 302 Drive unit

Claims (28)

  1. An ophthalmic laser surgical apparatus that treats the eye by irradiating the eye of the subject with surgical laser light,
    A front image capturing unit that has a light receiving element and captures a front image of the anterior segment of the eye at different magnifications depending on a distance between the apparatus main body and the eye;
    Reflected light from the anterior segment of the eye in the light receiving element by moving at least one of the optical member provided on the optical path of the front image capturing unit and the light receiving element along the optical axis of the optical path. A focus adjustment unit for adjusting the focus state of
    A control unit,
    The control unit reflects the eye reflected in each of the case where the position of the eye relative to the apparatus main body is in the first area and the case where the eye is in the second area closer to the apparatus main body than the first area. An ophthalmic laser surgical apparatus for adjusting the focus state by processing light including light and driving the focus adjustment unit.
  2. The controller is
    When the position of the eye is in the first region,
    The ophthalmic laser surgical apparatus according to claim 1, wherein the focus state is adjusted by analyzing the front image captured by the front image capturing unit while driving the focus adjusting unit.
  3. The controller is
    When the position of the eye is in the second region,
    3. The ophthalmic laser surgical apparatus according to claim 1, wherein the focus state is adjusted by analyzing the front image captured by the front image capturing unit while driving the focus state.
  4. A finite light source for irradiating the eye with finite light;
    When the control unit adjusts the focus state by analyzing the front image, the control unit detects a bright spot formed by reflected light emitted from the finite light source and reflected by the anterior segment of the eye, 4. The ophthalmic laser surgical apparatus according to claim 2, wherein the focus state is detected based on the size of the detected bright spot.
  5. An interference signal acquisition unit that includes a measurement light source, and that acquires an interference signal using reflected light that is irradiated from the measurement light source and reflected by the eye, and reference light that corresponds to the measurement light source;
    The controller is
    When the position of the eye is in the second region,
    The ophthalmic laser surgical apparatus according to claim 1, wherein the focus state is adjusted by driving the focus adjustment unit according to the distance detected from the interference signal.
  6. Further comprising an infinite light source for irradiating the eye with infinite light,
    The controller is
    When the position of the eye is in the second region,
    By analyzing the front image photographed by the front image photographing unit, a bright spot formed by reflected light irradiated from the infinite light source and reflected by the anterior eye part of the eye is detected, and the bright spot 3. The ophthalmic laser surgical apparatus according to claim 1, wherein the focus state is adjusted by driving the focus adjustment unit in accordance with the distance detected from the eye.
  7. A drive unit that moves at least one of the apparatus body and the eyes of the subject;
    The controller is
    After adjusting the focus state for the eye moved to the first region by the driving unit,
    When the eye is moved to the second region by the driving unit,
    7. The ophthalmic laser surgical apparatus according to claim 1, wherein the focus state is adjusted by driving the focus adjustment unit based on a drive amount of the drive unit.
  8. The ophthalmic laser surgery according to any one of claims 1 to 7, wherein the front image capturing unit captures the front image at different magnifications according to the distance between the apparatus main body and the subject. apparatus.
  9. An ophthalmic surgery control program for controlling an ophthalmic laser surgery apparatus that treats the eye by irradiating the eye of the subject with laser light for surgery,
    The ophthalmic laser surgical apparatus is:
    A front image capturing unit that has a light receiving element and captures a front image of the anterior segment of the eye at different magnifications depending on a distance between the apparatus main body and the eye;
    Reflected light from the anterior segment of the eye in the light receiving element by moving at least one of the optical member provided on the optical path of the front image capturing unit and the light receiving element along the optical axis of the optical path. A focus adjustment unit for adjusting the focus state of
    The ophthalmic surgery control program is executed by the processor of the ophthalmic laser surgery apparatus,
    Light including reflected light reflected by the eye in each of the case where the position of the eye with respect to the device main body is in the first region and the case where the eye is in the second region closer to the device main body than the first region. An ophthalmic surgery control program that causes the ophthalmic laser surgical apparatus to execute a focus state adjustment step of adjusting the focus state by processing and driving the focus adjustment unit.
  10. An ophthalmic laser surgical apparatus that treats the eye by irradiating the eye of the subject with surgical laser light,
    A drive unit for moving at least one of the apparatus main body and the subject; and
    A front image capturing unit that includes a light receiving element and captures a front image of the anterior segment of the eye at different magnifications according to a distance between the apparatus main body and the eye;
    By moving at least one of the optical member and the light receiving element provided on the photographing optical path of the front image photographing unit along the optical axis of the optical path according to the distance, A focus adjustment unit that adjusts the focus state of the reflected light from the anterior eye part to the eye that moves relative to the apparatus main body,
    An ophthalmic laser surgical apparatus, wherein a relationship between the distance changed by driving of the driving unit and a position of at least one of the optical member and the light receiving element moved by the focus adjusting unit is non-linear .
  11. At least a lens disposed on the optical path of the surgical laser beam, and further comprising a holding unit that holds an interface interposed between the apparatus main body and the eye;
    The focus adjustment unit is configured so that a relationship between the distance changed by driving of the driving unit and a position of at least one of the optical member and the light receiving element depends on a type of the interface held by the holding unit. The ophthalmic laser surgical apparatus according to claim 10, wherein at least one of the optical member and the light receiving element is moved along an optical axis of the optical path so as to have a different relationship.
  12. A distance detecting means for detecting the distance between the apparatus main body and the eye when the position of the eye relative to the apparatus main body is in a specific region;
    The focus adjustment unit is configured to detect the optical member and the light reception based on the distance detected by the distance detection unit and a relative movement amount of the eye and the apparatus main body from the position where the distance is detected. 12. The ophthalmic laser surgical apparatus according to claim 10, wherein the position of at least one of the elements is determined.
  13. The distance detection unit adjusts the focus state based on the front image captured by the front image capturing unit while moving at least one of the optical member and the light receiving element along the optical axis of the optical path. The ophthalmic laser surgical apparatus according to claim 12, wherein the distance is detected by a position of at least one of the optical member and the light receiving element in a state in which the focus state is adjusted.
  14. The distance detection unit projects alignment light onto the eye located in the specific region, and detects the distance based on reflected light of the alignment light reflected by the eye. 12 or 13 ophthalmic laser surgical devices.
  15. The focus adjustment unit increases a movement amount of at least one of the optical member and the light receiving element per unit change amount of the distance as the distance is decreased by driving of the driving unit. The ophthalmic laser surgical apparatus according to any one of claims 10 to 14.
  16. Corresponding relationship output means for outputting the position of at least one of the optical member or the light receiving element when the distance is inputted,
    The focus adjustment unit uses at least one of the optical member or the light receiving element as an optical axis of the optical path according to a position of at least one of the optical member or the light receiving element output by the correspondence output unit. The ophthalmic laser surgical apparatus according to any one of claims 10 to 15, wherein the ophthalmic laser surgical apparatus is moved along the axis.
  17. An ophthalmic surgery control program for controlling an ophthalmic laser surgery apparatus that treats the eye by irradiating the eye of the subject with laser light for surgery,
    The ophthalmic laser surgical apparatus is:
    A drive unit for moving at least one of the apparatus main body and the subject; and
    A front image capturing unit that includes a light receiving element and captures a front image of the anterior segment of the eye at different magnifications according to a distance between the apparatus main body and the eye;
    By moving at least one of the optical member and the light receiving element provided on the photographing optical path of the front image photographing unit along the optical axis of the optical path according to the distance, A focus adjustment unit that adjusts the focus state of the reflected light from the anterior eye part to the eye that moves relative to the apparatus main body,
    The ophthalmic surgery control program is executed by the processor of the ophthalmic laser surgery apparatus,
    The focus state is changed according to the distance in a relationship in which the distance changed by driving the driving unit and the position of at least one of the optical member and the light receiving element moved by the focus adjusting unit are nonlinear. An ophthalmic laser surgical apparatus that causes the ophthalmic laser surgical apparatus to perform a focus adjustment step for adjustment.
  18. An ophthalmic laser surgical apparatus that treats the eye by irradiating the eye of the subject with surgical laser light,
    A holding unit that holds at least a lens disposed on an irradiation optical path of the surgical laser light, and holds an interface interposed between the apparatus main body and the eye;
    A light receiving element that receives reflected light that has been reflected by the eye and passed through the lens is captured, and a front image of the anterior segment of the eye is captured at different magnifications depending on the distance between the apparatus body and the eye A front image capturing unit,
    When the interface held by the holding unit is changed, and the magnification of the front image captured by the front image capturing unit changes, a magnification adjusting unit that adjusts the change of the magnification is provided. Ophthalmic laser surgery device.
  19. The magnification adjusting means includes
    The ratio change between the change amount of the distance between the apparatus main body and the eye of the subject and the change amount of the shooting range of the front image captured by the front image capturing unit is adjusted. 18 ophthalmic laser surgical devices.
  20. The magnification adjusting means adjusts the change in magnification by changing the focal length of an optical element located in the optical path between the interface and the light receiving element in the imaging optical path of the front image capturing unit. The ophthalmic laser surgical apparatus according to claim 18, further comprising a changing unit.
  21. The focal length changing unit changes a focal length of an optical element from a branch point where the irradiation path of the surgical laser light and the imaging optical path are branched from the imaging optical path to the light receiving element. The ophthalmic laser surgical apparatus according to claim 20.
  22. An OCT optical system for obtaining an interference signal between the measurement light reflected by the eye of the subject and passing through the lens of the interface and the reference light;
    The focal length changing unit changes a focal length of the optical element between a branch point where the measurement optical path of the OCT optical system and the imaging optical path are branched from the imaging optical path to the light receiving element. The ophthalmic laser surgical apparatus according to claim 20 or 21, wherein:
  23. The focal length changing unit includes at least one first optical element and a driving unit that drives the first optical element,
    The ophthalmic laser according to any one of claims 20 to 22, wherein the focal length of the photographing optical path is changed by driving the driving unit and inserting and removing the first optical element with respect to the photographing optical path. Surgical device.
  24. The focal length changing unit is
    Comprising at least one second optical element and a drive unit for driving the second optical element;
    The focal length of the photographing optical path is changed by driving the driving unit and moving at least one of the second optical element and the light receiving element in an optical axis direction of the photographing optical path. The ophthalmic laser surgical apparatus according to any one of 20 to 22.
  25. The focal length changing unit is
    An optical path switching unit that changes a focal length of the imaging optical path by switching a first optical path that is at least a part of the imaging optical path to a second optical path having a different focal length of an optical element from the first optical path; The ophthalmic laser surgical apparatus according to any one of claims 20 to 22.
  26. 19. The ophthalmic laser surgical apparatus according to claim 18, wherein the magnification adjusting unit adjusts a change in magnification of the front image by adjusting a magnification when the front image is displayed on a display unit.
  27. The ophthalmic laser surgical apparatus according to any one of claims 18 to 26, further comprising a luminance adjusting unit that adjusts a luminance of the front image when a change in magnification of the front image is adjusted by the magnification adjusting unit. .
  28. An ophthalmic surgery control program for controlling an ophthalmic laser surgery apparatus that treats the eye by irradiating the eye of the subject with laser light for surgery,
    The ophthalmic laser surgical apparatus is:
    A holding unit that holds at least a lens disposed on an irradiation optical path of the surgical laser light, and holds an interface interposed between the apparatus main body and the eye;
    A light receiving element that receives reflected light that has been reflected by the eye and passed through the lens is captured, and a front image of the anterior segment of the eye is captured at different magnifications depending on the distance between the apparatus body and the eye A front image capturing unit that
    The ophthalmic surgery control program is executed by the processor of the ophthalmic laser surgery apparatus,
    When the interface held by the holding unit is changed to change the magnification of the front image captured by the front image capturing unit, a magnification adjustment step for adjusting the change in the magnification is performed in the ophthalmic laser. An ophthalmic surgery control program that is executed by a surgical apparatus.

PCT/JP2016/060859 2015-03-31 2016-03-31 Ophthalmic laser surgery device and ophthalmic laser surgery control program WO2016159332A1 (en)

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JP2015074637A JP2016193096A (en) 2015-03-31 2015-03-31 Ophthalmic laser treatment device and ophthalmic surgery control program
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JP2015163093A (en) * 2014-02-28 2015-09-10 株式会社ニデック Ophthalmic laser surgery device

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JP2005160549A (en) * 2003-11-28 2005-06-23 Nidek Co Ltd Fundus camera
JP2009291253A (en) * 2008-06-02 2009-12-17 Nidek Co Ltd Ophthalmic photographing apparatus
WO2014074598A1 (en) * 2012-11-07 2014-05-15 Clarity Medical Systems, Inc. Apparatus and method for operating a real time large diopter range sequential wavefront sensor
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