WO2011109571A1 - Procédé et système pour améliorer la vision d'un œil souffrant de dégénérescence maculaire - Google Patents

Procédé et système pour améliorer la vision d'un œil souffrant de dégénérescence maculaire Download PDF

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WO2011109571A1
WO2011109571A1 PCT/US2011/026941 US2011026941W WO2011109571A1 WO 2011109571 A1 WO2011109571 A1 WO 2011109571A1 US 2011026941 W US2011026941 W US 2011026941W WO 2011109571 A1 WO2011109571 A1 WO 2011109571A1
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lens
cornea
eye
focus
reference axis
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David M. Lieberman
Jonathan Grierson
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Scientific Optics Inc
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Scientific Optics Inc
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    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C7/00—Optical parts
    • G02C7/02—Lenses; Lens systems ; Methods of designing lenses
    • G02C7/04—Contact lenses for the eyes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F9/00802—Methods or devices for eye surgery using laser for photoablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
    • A61F2009/00872—Cornea
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/008—Methods or devices for eye surgery using laser
    • A61F2009/00878—Planning
    • A61F2009/00882—Planning based on topography
    • G—PHYSICS
    • G02—OPTICS
    • G02C—SPECTACLES; SUNGLASSES OR GOGGLES INSOFAR AS THEY HAVE THE SAME FEATURES AS SPECTACLES; CONTACT LENSES
    • G02C2202/00—Generic optical aspects applicable to one or more of the subgroups of G02C7/00
    • G02C2202/10—Optical elements and systems for visual disorders other than refractive errors, low vision

Definitions

  • the present invention relates generally to a method and system for diagnosing and improving the vision of an eye and, more particularly, to improvement of the vision of an eye with macular degeneration.
  • Macular degeneration is a progressive disease of the retina of the eye in which the light-sensing cells in the central area of vision (the macula) cease to function properly.
  • the most common form of macular degeneration is age-related macular degeneration, and it is most common in people who are age 60 and over.
  • central vision including a dark or blurry central spot (a central scotoma).
  • central vision is increasingly lost, until it disappears entirely in the advanced stages. This disease is the leading cause of blindness in senior citizens.
  • the present invention provides for the improvement of vision in an eye with macular degeneration. It contemplates ablation procedures of the cornea and the provision of various types of corrective lenses, including contact lenses and spectacles.
  • Ophthalmologists model the cornea as a portion of an ellipsoid defined by orthogonal major and minor axes.
  • Current surgical procedures for correcting visual acuity are typically directed at increasing or decreasing the surface curvature of the cornea, while making its shape more spherical, or conforming it to an "average" ellipse, or making corrections based on wavefront analysis.
  • PAR Corneal Topography System maps the corneal surface topology in three-dimensional Cartesian space, i.e., along x- and y-coordinates as well as depth (z) coordinate.
  • the "line-of-sight" is a straight line segment from a fixation point to the center of the entrance pupil.
  • Mandell "Locating the Corneal Sighting Center From Videokeratography," J. Refractive Surgery, V. 1 1, pp. 253-259, July/August 1995
  • a light ray which is directed toward a point on the entrance pupil from a point of fixation will be refracted by the cornea and aqueous humor and pass through a corresponding point on the real pupil to eventually reach the retina.
  • the point on the cornea at which the line-of-sight intersects the corneal surface is the
  • optical center or “sighting center” of the cornea. It is the primary reference point for refractive surgery in that it usually represents the center of the area to be ablated in
  • the line-of-sight has conventionally been programmed into a laser control system to govern corneal ablation surgery.
  • some surgeons prefer to use the pupillary axis as a reference line.
  • the angle lambda is used to calculate the position of the sighting center relative to the pupillary ("optic") axis. See Mandell, supra, which includes a detailed discussion of the angles kappa and lambda, the disclosure of which incorporated herein by reference as if set forth in its entirety herein.
  • a portion of the corneal surface or a surface under a flap is ablated. Gathered elevational data is used to direct an ablation device such as a laser so that the corneal surface can be selectively ablated to more closely
  • the line-of-sight as a reference line for the procedures may reduce myopia or otherwise correct a pre-surgical dysfunction or a visual abnormality.
  • a more irregularly shaped cornea may result, which may exacerbate existing astigmatism or introduce astigmatism or spherical aberration in the treated eye. This will complicate any subsequent vision correction measures that need be taken.
  • any substantial surface irregularities which are produced can cause development of scar tissue or the local accumulation of tear deposits, either of which can adversely affect vision.
  • Implicit in the use of the-line-of sight or the pupillary axis as a reference axis for surgical procedures is the assumption that the cornea is symmetric about an axis extending along a radius of the eye.
  • the cornea is an "asymmetrically aspheric" surface.
  • “Aspheric” means that the radius of curvature along any corneal “meridian” is not a constant (a “meridian” could be thought of as the curve formed by the intersection of the corneal surface and a plane containing a reference axis, such as the pupillary axis). Indeed, the corneal curvature tends to flatten progressively from the geometric center to the periphery. "Asymmetric” means that the corneal meridians do not exhibit symmetry about their centers. The degree to which the cornea is aspheric and/or asymmetrical varies from patient to patient and from eye to eye within the same person.
  • any ablation procedure which does not take into account the tilt of the cornea is not likely to achieve the desired shaping of the cornea and may therefore be unpredictable in its effect.
  • a contact lens design or any other lens used to improve vision which does not take into account the tilt cannot achieve optimum results.
  • vision can be improved by adjusting the focus of the cornea, referred to as "orthogonalizing", so that different regions focus substantially to the same axis. This can be accomplished by shaping the cornea (e.g. through ablation) or by applying an appropriate corrective lens, effectively reducing radial and axial focus scatter.
  • orthogonalization was that presbyopia (defective near vision) was substantially reduced. That is, presbyopic patients fitted with orthogonalized contact lenses that did not have components that focused at different distances had improved near vision to the extent of not requiring reading glasses.
  • orthogonalization is performed so as to produce a predetermined amount of imperfection in the orthogonalization. This will be referred to as "decentered orthogonalization.”
  • the invention contemplates that light be delivered to the macula in patterns designed to avoid areas of the macula with "dead" light receptors.
  • FIG. 1 is a block diagram illustrating a method for achieving vision correction in accordance with the present invention through either laser ablation of the cornea or an appropriately shaped lens;
  • FIG. 2 is a schematic diagram illustrating a plan view of a point cloud as obtained with a corneal image capture system
  • FIG. 3 is a schematic plan view similar to FIG. 2 illustrating a plurality of splines and how they are connected through the data points of the point cloud;
  • FIG. 4 is a perspective view of a cornea matching surface illustrating how
  • FIG. 5 is a diagram exemplifying the axial focus scatter of a cornea at a 3 millimeter diameter.
  • FIG. 6 illustrates the radial focus scatter corresponding to FIG. 5
  • FIG. 7 is a diagram exemplifying the axial focus scatter of a cornea at a 5 millimeter diameter
  • FIG. 8 illustrates the radial focus scatter corresponding to FIG. 7
  • FIG. 9 is a diagram exemplifying the axial focus scatter of a cornea at a 7 millimeter diameter
  • FIG. 10 illustrates the radial focus scatter corresponding to FIG. 9
  • FIG. 11 illustrates a method for modifying the corneal model by orthogonalizing to the central axis
  • FIG. 12 illustrates the concept of decentered orthogonalization
  • FIGS. 13-15 are plan views of the macula showing the 72 focus points P distributed in spiral, rose and dual rose patterns, respectively, on the anterior surface of the macula.
  • FIG. 1 A process for achieving laser ablation of the cornea and contact lens shaping in accordance the present invention is illustrated in block diagram form in FIG. 1.
  • the process makes use of a Corneal Image Capture System 610, an Elevation Analysis Program 620, a Computer Aided Design System 630, a Command Processor 640 and a Cornea Shaping System 650.
  • the Corneal Image Capture System 610 in conjunction with the Elevation Analysis Program 620, generates a three dimensional topographic map of the cornea of the patient.
  • the Computer Aided Design System 630 is used as an aid in editing or modifying the corneal topographic data, to create a surface model, and data relating to the model is sent to a Cornea Shaping System 650 via the Command Processor 640.
  • the Command Processor 640 uses the topographic data describing the surface of the cornea to be shaped from the Computer Aided Design System 630 to generate a sequence of commands/control signals required by the Cornea/Lens Shaping System 650.
  • the Cornea/Lens Shaping System 650 accepts, from the Command Processor 640, a sequence of commands that describe the three dimensional movements of the Cornea/Lens Shaping System (any coordinate system may be used; e.g., Cartesian, radial or spherical coordinates) to shape the cornea or machine (e.g. a lathe) manufacturing a contact lens.
  • the Corneal Image Capturing System 610 and the Elevation Analysis Program 620 are preferably components of the PAR® Corneal Topography System ("the PAR® System"), which is available from PAR Vision Systems.
  • the Elevation Analysis Program 620 is a software program executed by a processor, for example an IBMTM compatible PC.
  • Program 620 generates a third dimension element (a Z coordinate representing distance away from a reference plane inside the eye) for each of a plurality of sample points on the surface of the cornea measured by system 610. Each point is defined by its X-Y coordinates as mapped into the reference plane, and its Z coordinate is determined from brightness of the point.
  • One method of calculating the elevation of each point, i.e., the Z coordinate is by comparing the X-
  • the reference values can be pre-stored.
  • the final output of the Elevation Analysis Program 620 is the X-Y-Z coordinates for a multiplicity of sample points, commonly known as a point cloud, on the surface of the cornea 14. It will be apparent to those skilled in the art that any method can be used that can generate X, Y, Z corneal data providing both location and elevation information for points on the corneal surface with the required accuracy. In the preferred embodiment about 1200 points are spaced in a grid pattern, as viewed in the X-Y plane, so the projections of the points into the X-
  • Y plane are about 200 microns apart.
  • the X-Y-Z data output from the Elevation Analysis Program 620 can be formatted in any number of well-known machine-specific formats.
  • the data are formatted in Data Exchange File (DXF) format, an industry standard format which is typically used for the inter-application transfer of data.
  • DXF file is an ASCII data file, which can be read by most computer aided design systems.
  • a point cloud 100 is depicted as it would appear when viewing the reference plane along the Z-axis (i.e., as projected into the X-Y plane).
  • Each point corresponds to a particular location on the patient's cornea.
  • the data are usually generated from an approximately 10mm x 10mm bounded area of the cornea, the working area. Thus, there may be as many as 50 rows of data points.
  • a surface 108 (see FIG. 4) that models or matches the topography of the surface of the patient's cornea is generated by the computer aided design system 630 from the data points generated by the Elevation Analysis Program.
  • Computer Aided Design System 630 is the Anvil 5000 program which is available from Manufacturing Consulting Services of Scottsdale, Arizona.
  • Cornea matching surface 108 is preferably produced by first generating a plurality of splines 102, each defined by a plurality of the data points of the point cloud 100.
  • the generation of a spline that intersects a plurality of data points (i.e., knot points) is, per se, known to those skilled in the art and can be accomplished by the Anvil 5QQQTM program once the input data have been entered.
  • Anvil 5QQQTM program For more information regarding the generation of a surface model, see U.S. Patent No. 5,807,381, the disclosure of which is incorporated herein by reference in its entirety.
  • each of the splines 102 lies in a plane that is parallel to the X and Z axes and includes a row of points from the cloud 100 in FIG. 3.
  • Surface 108 which matches the corneal surface of the scanned eye, is then generated from splines 102.
  • splines 102 There are a number of well-known mathematical formulas that may be used to generate a surface from a plurality of splines 102.
  • the well known nurb surface equation is used to generate a corneal surface from splines 102.
  • the scanned area of the eye is approximately 10mm x 10mm, approximately 50 splines 102 are created.
  • a skinned surface segment 104 is created for a small number (e.g., five) of the adjacent splines. Adjacent skinned surface segments 104 share a common border spline.
  • Adjacent skinned surface segments 104 share a common border spline.
  • about ten skinned surface segments are generated from the point cloud and are then merged together by the Anvil 5000TM program in a manner known to those skilled in the art, to produce one composite surface 108.
  • the HIGH point on the generated corneal matching surface 108 (i.e., the point having the greatest Z value) is determined.
  • a cylinder 106 of a predetermined diameter is then projected onto the corneal matching surface 108 along an axis which is parallel to the Z-axis and passes through the HIGH point.
  • Cylinder 106 preferably has a diameter of about 3mm to about 8mm, typically about 7mm, and the closed contour formed by the intersection of cylinder 106 with surface 108 projects as a circle 106' in the X-Y plane. On the matching surface 108, this contour defines the outer margin 26 of the working area of the cornea.
  • the cornea is the most symmetric and spherical about the HIGH point and, therefore, provides the best optics at this point.
  • the outer margin 26 must fit within the point cloud, so that the surfaces of the cornea can be formed based on the measured corneal data.
  • the computer aided design system 630 can then illustrate a default circle 106' (in the X -Y plane) with respect to the point cloud, for example on a monitor screen, so that the operator can be assured that circle 106' falls within the point cloud. Additionally, system 630 can be set up to determine if circle 106' falls within point cloud 100 and, if it does not fall completely within point cloud 100, to alert the user to manipulate the circle (i.e., move the center point and/or change the radius of the circle) so that circle 106' lies within the corneal data point cloud 100. In a worst case scenario, the eye should be rescanned if insufficient data is available from the scanned eye to ensure that the working area of the cornea will fit properly within the point cloud. Alternatively, the area of the point cloud can be made larger.
  • circle 106' is only a circle when viewed in the X-Y plane (i.e., looking along the Z-axis).
  • the periphery 26 is approximately elliptical and lies in a plane which is tilted relative to the reference plane.
  • a line Perpendicular to this tilted plane which passes through the HIGH point will be referred to as the "LOCAL Z-AXIS” or "tilted axis", and the tilt of the tilted plane relative to the reference plane will be considered the tilt angle of the working area of the cornea.
  • the cornea is about 600pm thick. In most corneal ablation procedures, less than 100pm depth of cornea is ablated because there is virtually no risk of scarring with the type of lasers that are typically used. Beyond the 100pm depth, the risk of scar-like imperfections. For example, 120pm depth ablation is known to cause scarring. However, there exists the possibility that the risk of scarring for surface ablations may be reduced by drug therapy prior to or contemporaneous with the laser treatment. However, most of today's laser surgery does not cause scarring, as most procedures are under the LASIK flap. The fear in LASIK is ablating too deep wherein the residual bed is less than -250pm. If the bed is less than this amount, structural failure can occur.
  • the magnitude of the corneal undulations is typically about fifteen to twenty microns from the crest of a hill to the trough of a valley and may be as great as about thirty microns.
  • the doctor is able to vary the power or diopter correction about two orthogonal axes, as well as the degree of rotation of those axes about a Z-axis along the line-of-sight.
  • the doctor continues to modify these three parameters until he achieves the optimum vision.
  • the results of the refraction test are usually given in the form "a, b, c", where "a” is the diopter correction at the first axis, "b” is the additional diopter correction required at the second, orthogonal axis, and "c” is the angle of rotation of the first axis relative to the horizontal. This form of information is given for each eye and is immediately useful in grinding a pair of lenses for eyeglasses.
  • the eye doctor adjusts the phoropter at a series of equally spaced angles, say every 15 from the horizontal, and obtains the optimum refraction at each angle. Typically, the more angles that are measured, the better the results.
  • the manner of using the modified refraction test will be described in detail below.
  • a plane 1 10 is constructed which contains the LOCAL Z- AXIS (See FIG. 4). The intersection between plane 1 10 and surface 108 defines a first characterizing curve 112. Plane 110 is then rotated about the LOCAL Z-AXIS, for example by a 5 increment counterclockwise, as represented by line 1 14, where its intersection with surface 108 defines a second characterizing curve 1 16, which is illustrated as a dashed line in FIG. 4.
  • This process continues at fixed rotational increments about the LOCAL Z- AXIS, for example every 5 , until plane 110 has swept 360 , to produce a complete set of characterizing curves (meridians), in this case seventy -two (360 % 5 ).
  • Each of these characterizing curves is then estimated by a best-fit spherical (circular) arc.
  • One manner of doing this is simply to select a circular arc which passes through three known points for each curve (e.g. the point at which it touches the contour 106', the HIGH point, and that point which is halfway between those two points when viewed in projection along the local Z axis).
  • the focal point of a portion of the cornea represented by a circular arc can be estimated by the center of that arc.
  • Techniques for locating the center of a spherical arc are well-known.
  • the resulting set of arc centers then provides a representation of focus scattering.
  • the preceding procedure was performed on the corneal model of a patient having 20/15 uncorrected visual acuity.
  • FIG. 5 is a focus scatter diagram along the LOCAL Z-AXIS for that portion of the cornea extending out to a 3.0mm diameter.
  • the focal points start at 7.06mm along the LOCAL Z-AXIS and extend out an additional 6.91mm.
  • FIG. 6 illustrates that the radial scatter within a 3mm diameter is 1.2mm.
  • FIG. 7 illustrates that the axial focus scatter of a 5mm diameter portion of the cornea begins at 8.99mm and extends for an additional 1.69mm.
  • the radial scatter of the same portion of the cornea is .49mm.
  • FIG. 9 illustrates that the axial focus scatter at 7mm begins at 8.68mm and extends axially for an additional .47mm
  • FIG. 10 illustrates that the corresponding radial scatter is .33mm.
  • focus scatter is most severe in the central portion of the cornea, and decreases significantly as larger portions of the cornea are considered.
  • orthogonalizing refers to a re-shaping of the surface model so as to piecewise re- focus the cornea towards the LOCAL Z-AXIS.
  • the re-shaped surface model can then be applied to the cornea (e.g. through ablation) or to shape the posterior surface of a contact lens (or another type of optical lens) so as to achieve the required focus scatter correction. It has been found that orthogonalizing the cornea not only reduces radial focus scatter, but simultaneously reduces axial focus scatter substantially and produces more uniformity in the radius of curvature of the orthogonalized portion of the cornea.
  • FIG. 11 illustrates the process of orthogonalization. The process is carried out on each of the arcs which represent characteristic curves, in the manner explained below. After this piecewise refocusing, the modified arcs are reassembled into a modified surface model having the refocused characteristics.
  • 130 represents one of the half- meridian arcs corresponding to a
  • Arc 130 has a center point C, the location of which has been exaggerated to demonstrate focus which is radially spaced from the LOCAL Z- AXIS.
  • Orthogonalization of arc 130 begins with creating a chord 132 between the two ends of the arc.
  • a perpendicular bisector 134 of chord 132 may be constructed, and it will pass through point C and intersect the LOCAL Z-AXIS at a point X.
  • a new arc 130' can now be drawn between the two end points of arc 130.
  • Arc 130' will be focused on the LOCAL Z-AXIS and will have a larger radius of curvature than arc 130.
  • arc 130' could be accepted as an arc defining the modified surface model 108'.
  • a certain threshold is defined (for example .0075mm), and if any portion of arc 130' is more than a distance inside or outside the surface 108, arch 130' is not accepted for use in the modified surface model. Instead, point x can be moved up or down on the LOCAL Z- AXIS (depending upon which direction arch 130' needs to be moved) by half the excess over.
  • Arc 130' can then be re-drawn and re-tested against the threshold. This readjustment and testing continues until an acceptable arc 130' has been found. Then, the next arc is
  • the orthogonalization process is applicable to corneal ablation procedures.
  • a corrected corneal surface model is generated, which is shaped to provide relief from macular degeneration and correction of refraction established by an eye test (as described in the patents cited above), and all the arcs are orthogonalized.
  • the corrected corneal surface model is then registered with the unmodified corneal surface model, and it is moved towards the unmodified surface until the corrected surface just contacts the unmodified surface. If the point of initial contact is at the center of the corrected surface, it is moved toward the uncorrected surface until the periphery of the corrected surface just contacts the uncorrected surface.
  • the point of initial contact is at the periphery of the corrected surface, it is moved toward the uncorrected surface until the center of the corrected surface just contacts the uncorrected surface.
  • the corrected surface will then be displaced so that it is, at least partially, inside the cornea, and the cornea is ablated until the displaced corrected surface becomes its new surface.
  • This procedure can be expected to reduce substantially the amount of material removed from the cornea, in comparison to all prior ablation techniques.
  • the central region of the retina is called the macula, and the very center of the macula, called the foveola, is the most sensitive.
  • the macula typically has a diameter in the range of 6 to 7 millimeters, and the foveola typically has a diameter of about .35mm.
  • orthogonalization all sub-portions of the cornea are refocused to the center of the macula, the foveola. However, this is the area usually affected by macular degeneration first, so it becomes necessary to spread the focus points away from the foveola while still controlling them.
  • orthogonalization is performed by refocusing all of the sub-regions onto the LOCAL Z-AXIS, orthogonalization is not perfect. The sub-portions of the cornea still focus on different points of the macula; some relief from macular degeneration is achieved. However, further adjustment of orthogonalization appears to be necessary in order to compensate effectively for macular degeneration.
  • sub-portions of the cornea are refocused so as to place their focal points outside the foveola yet still within the macula at a controlled distance from the LOCAL Z-AXIS.
  • the macula has approximately the shape of a cap-shaped segment of a sphere, is usually between 6 millimeter and 7 millimeters in diameter and is approximately 0.88 millimeters deep.
  • Optimum correction for macular degeneration is achieved when all sub-portions of the cornea are focused so as to make use of portions of the macula which are not affected by macular degeneration.
  • FIG. 12 illustrates the concept of decentered orthogonalization.
  • the arc 130 is a sub- portion of the cornea which has a scattered focal point X.
  • Ordinary orthogonalization as shown in FIG. 11 would move the focal point X to the LOCAL Z-AXIS, LZ. Perfect orthogonalization would move it to the foveola F on the macula M.
  • Decentered orthogonalization as shown in FIG. 11 would move the focal point X to the LOCAL Z-AXIS, LZ. Perfect orthogonalization would move it to the foveola F on the macula M.
  • orthogonalization creates a new arc 130"' which focuses at a point X', which is at a predefined radius r from the foveola.
  • the axis Z' is parallel to the LOCAL Z-AXIS and passes through the point X.
  • the macula can be considered flat in the region between the axes LZ and Z'.
  • FIG. 13 is a top plan view of the foveola showing the 72 points P distributed in a spiral pattern on the surface of the foveola.
  • FIG. 14 Another preferred pattern for the focus point is illustrated in FIG. 14.
  • the pattern is formed from two overlaid rose patterns, a large one 150 and a small one 150', which is offset by 45° from the pattern 150. Only one petal of each rose pattern is shown to have points, but it will be understood that each of the other petals is similarly provided with points. The points are shared evenly between the patterns 150 and 150'. However, the pattern 150 provides the outermost points and has points distributed at over its outermost two-thirds.
  • Pattern 150' provides the innermost points and has them evenly distributed. As a result, the pattern in FIG. 14 provides a good distribution of points near to and distant from the foveola.
  • a further method, defining a further embodiment of the invention, has been developed for decentered orthogonalization which is preferred over all those described previously for dealing with the effects of macular degeneration.
  • the method proceeds exactly as in the FIG. 11, except that once arc 130' has been reshaped, it is tilted clockwise so as to move the point X, the endpoint of the arc's axis, to the left, across the local z-axis so that it lies at a preselected distance from the local z-axis.
  • the preferred distance is approximately .01mm. However, distances in the range of approximately .0025mm to approximately 0.01mm would still be effective to overcome the effects of macular degeneration.
  • the lens may be constructed as explained with respect to any of FIGS. 11-15, and so that its position relative to the cornea is rotated circumferentially so as to tilt the local z-axis relative to the position shown and FIGS. 1 1 and 12.
  • the tilt of this axis is less than approximately 5 .
  • Modern analysis methods permit an ophthalmologist to determine those areas of the macula which remain functional. After making such a determination, the lens construction orientation is modified, as explained above, so that local z- axis is tilted sufficiently to move the image produced by the lens off- center and onto a functional portion of the macula.
  • the computer aided design system 630 (FIG. 1) can achieve such rotation of the entire structure by methods that are well- known.
  • the present invention is applicable not only to corneal ablation and contact lenses, but to any other kind of lens, including cataract, phakic, intraocular, intracorneal and spectacle lenses.

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  • Eye Examination Apparatus (AREA)

Abstract

L'invention concerne des procédés et des appareils de diagnostic de la vision et d'amélioration de la vision, par exemple en réduisant ou en éliminant les effets de la dégénérescence maculaire d'une manière qui n'interfère pas avec la forme naturelle de la cornée ou son orientation par rapport au reste de l'œil, mais qui modifie la courbure de sa surface de manière appropriée pour corriger adéquatement la vision. La mise au point des régions secondaires de la cornée est ajustée de telle sorte que les différentes régions effectuent la mise au point à une distance contrôlée autour d'un axe de référence. Cela peut être réalisé par un façonnage de la cornée (par exemple par le biais d'une ablation) ou en appliquant une lentille de contact appropriée ou une autre lentille optique.
PCT/US2011/026941 2010-03-03 2011-03-03 Procédé et système pour améliorer la vision d'un œil souffrant de dégénérescence maculaire Ceased WO2011109571A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US14/522,686 US20160015262A1 (en) 2011-03-03 2014-10-24 Method and system for improving vision of an eye with macular degeneration

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US31007310P 2010-03-03 2010-03-03
US61/310,073 2010-03-03

Related Child Applications (1)

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US14/522,686 Continuation US20160015262A1 (en) 2011-03-03 2014-10-24 Method and system for improving vision of an eye with macular degeneration

Publications (1)

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WO2011109571A1 true WO2011109571A1 (fr) 2011-09-09

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PCT/US2011/026941 Ceased WO2011109571A1 (fr) 2010-03-03 2011-03-03 Procédé et système pour améliorer la vision d'un œil souffrant de dégénérescence maculaire

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WO (1) WO2011109571A1 (fr)

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5807381A (en) * 1995-10-18 1998-09-15 Scientific Optics, Inc. Method and apparatus for improving vision
US20060189966A1 (en) * 2002-06-03 2006-08-24 Scientific Optics, Inc. Method and system for improving vision
US20080058780A1 (en) * 2006-08-07 2008-03-06 Wavelight Ag Laser System for Refractive Surgery
US20090062911A1 (en) * 2007-08-27 2009-03-05 Amo Groningen Bv Multizonal lens with extended depth of focus

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5807381A (en) * 1995-10-18 1998-09-15 Scientific Optics, Inc. Method and apparatus for improving vision
US20060189966A1 (en) * 2002-06-03 2006-08-24 Scientific Optics, Inc. Method and system for improving vision
US20080058780A1 (en) * 2006-08-07 2008-03-06 Wavelight Ag Laser System for Refractive Surgery
US20090062911A1 (en) * 2007-08-27 2009-03-05 Amo Groningen Bv Multizonal lens with extended depth of focus

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