JP6937564B2 - Ophthalmic laser system - Google Patents

Description

The present invention relates to an ophthalmic laser system that irradiates an affected area with laser light as a spot pattern for performing retinal photocoagulation.

Currently, diseases such as diabetic retinopathy and age-related macular degeneration are the targets of photocoagulation treatment using visible laser light. This type of visible laser light therapy stops the progression of the original disease, but can be problematic. For example, this treatment exposes the eye to visible laser light for extended periods of time (usually about 100 ms), which can cause damage to the patient's sensory retina due to the heat generated. During treatment, fever occurs primarily in the pigment epithelium (RPE) of the retina, which is the melanin-containing layer of the retina just below the photoreceptors of the sensory retina. Although light is absorbed within the RPE, this type of treatment irreversibly damages the overlying sensory retina and adversely affects the patient's visual field.

Also, other treatments require multiple laser irradiations of the retina, which is boring and time consuming for the patient. Such treatment requires irradiation of each dose in the form of a laser beam spot that irradiates the target tissue for a predetermined amount of time. The physician is responsible for ensuring that each laser beam spot is properly positioned away from sensitive areas of the eye that can cause permanent damage. In addition, treatment can require hundreds of laser beam spots to evenly treat the target tissue, so the total treatment time can be significantly longer and unevenness in the entire target tissue range. Excellent doctor skills are required to ensure proper treatment.

To reduce the treatment time required for retinal photocoagulation, a large number of laser spots were automatically irradiated in a spot pattern fashion, so that the area of the target tissue was pre-positioned on the tissue in a pattern fashion. Systems and methods have been proposed that allow efficient treatment with a large number of spots (see, eg, Patent Document 1). However, the rapid delivery of a large number of beam spots in the pattern pattern poses new problems. For example, rapid and continuous delivery of adjacent beam spots in a pattern can result in local heating. In addition, various patterns are needed to provide better exclusion area and beam spot density control (for both uniform density and variable density), and better system control with a graphic user interface. Become.

At present, the retinal disease part fissure pattern (asymmetrical pattern) is treated using triple perfect circles, but most of the actual diseased part fissures are elliptical, so multiple arcs, etc. The treatment is performed by surrounding with. However, since it is complicated and time-consuming to perform treatment by surrounding with a plurality of arcs or the like, another method has been desired.

Conventionally, an ophthalmic laser system that irradiates a laser with an elliptical pattern is also known. However, pattern laser irradiation matching the retinal disease portion was not performed. Therefore, the efficiency of treatment can be improved by using an elliptical pattern (asymmetrical pattern) and enclosing the treatment with a plurality of elliptical patterns (asymmetrical pattern) if necessary (see Patent Document 2). ..

U.S. Patent Publication No. 2006/0100677 Japanese Patent No. 5192383

In the above-mentioned ophthalmic laser system, the spot pattern needs to match the size and angle of the retinal foramen to be treated. In addition, since the retinal column is linear, if treatment is performed to surround it, the spot pattern must be an ellipse or oval with a minor axis and a major axis, and the major axis is one with the direction of the wound. It is desirable to do it. Therefore, an ophthalmic laser system that can easily and surely specify the dimensions of the major axis and the minor axis and the angle of the major axis is desired.

However, although the conventional ophthalmic laser system described above can be selected and specified from a plurality of prepared patterns, the dimensions of the spot pattern, that is, the dimensions of the major axis and the minor axis, and the angle of the major axis can be easily determined. Cannot be specified for.

The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to provide an ophthalmic laser system capable of easily and surely specifying the dimensions and angles of a spot pattern.

The invention according to claim 1 is an ophthalmic laser system for treating a target tissue, wherein a light source that generates a laser beam and a spot pattern of the laser beam that is scanned from the laser beam are scanned. A scanner unit for forming the scanner unit, a light collecting element that collects the spot pattern on the target tissue, a control unit for controlling the scanner unit, and the spot. A display unit capable of displaying a plurality of different pattern configurations in which the spot pattern is selected while displaying the pattern configuration, and a type and size of the spot pattern formed by the scanner unit are specified in the control unit. A closed curve having a first delivery dimension in one direction and a second delivery dimension in the other direction in which the spot pattern intersects the one direction, and the spot pattern is longitudinal in a predetermined angular direction. the shape, the instruction input section, first diametral dimension of the spot pattern, the second diametral dimension, and Ri specifiable der an angle of the spot pattern, the instruction input unit, the display unit The first delivery dimension and the second delivery dimension are operated by touching the touch panel with a finger with respect to the spot pattern displayed on the display unit through the touch panel, including the arranged light source. Is possible, and the angle of the spot pattern can be specified by rotating two fingers while touching the touch panel with two fingers. ..

Similarly, according to the second aspect of the present invention, in the ophthalmic laser system according to the first aspect, the instruction input unit sets the ratio of the first delivery dimension and the second delivery dimension of the spot pattern. It is a feature.

Similarly, the invention according to claim 3 is characterized in that, in the ophthalmic laser system according to claim 1, the instruction input unit specifies the first delivery dimension and the second delivery dimension.

Similarly, the invention according to claim 4 is the ophthalmic laser system according to any one of claims 1 to 3, wherein the instruction input unit is a pointing device that designates one point of the display unit. It is characterized by.

Similarly, the invention according to claim 5 is characterized in that, in the ophthalmic laser system according to any one of claims 1 to 4 , the instruction input unit includes a keyboard.

Similarly, the invention according to claim 6 is the oval laser system according to any one of claims 1 to 5 , wherein the spot pattern has an oval shape including an ellipse, an oval, and an oval shape. characterized in that there.

Similarly, in the invention according to claim 7, in the ophthalmic laser system according to any one of claims 1 to 6 , the spots constituting the spot pattern are arranged at a substantially constant density. It is characterized by that.

According to the ophthalmic laser system according to the present invention, the dimensions and angles of the spot pattern having a shape corresponding to the injury to be treated can be easily and appropriately specified.

That is, according to the ophthalmic laser system according to claim 1, since the first transfer dimension of the spot pattern, the second transfer dimension, and the angle of the spot pattern can be specified by the instruction input unit, the spot pattern can be specified. The dimensions and angle of the pattern can be easily specified , and the instruction input section includes a touch panel located on the display section, and can be operated by touch operations such as tapping, swiping, pinch-in, and pinch-out. , Ru can be easily and intuitively designated by the angle of the touch panel operation.

Further, according to the ophthalmic laser system according to claim 2, the ratio of the first delivery dimension and the second delivery dimension of the spot pattern can be set by the instruction input unit, and the dimensions and angles of the spot pattern can be set. Can be easily specified.

Further, according to the ophthalmic laser system according to claim 3, since the first delivery dimension and the second delivery dimension can be specified by the instruction input unit, the dimensions and angles of the spot pattern can be easily specified.

Further, according to the ophthalmic laser system according to claim 4, since the instruction input unit is a pointing device that specifies one point of the display unit, the dimensions and angles of the spot pattern can be easily and intuitively operated by operating the pointing device. Can be specified.

Further, according to the ophthalmic laser system according to claim 5, since the instruction input unit is a keyboard, the dimensions and angles of the spot pattern can be easily and strictly specified.

Further, according to the ophthalmic laser system according to claim 6, since the spot pattern is an oval shape including an ellipse, an oval, and an oval shape, the periphery of the retinal column can be efficiently irradiated.

According to the ophthalmic laser system according to claim 7, since the spots constituting the spot pattern are arranged at a substantially constant density, the periphery of the retinal column can be evenly irradiated.

It is a block diagram which shows the structure of the scanning type photocoagulation apparatus which is an ophthalmic laser system which concerns on embodiment of this invention. It is a schematic diagram which shows the spot pattern of the light pattern which irradiates the retinal column hole in the scanning type photocoagulation apparatus. It is a schematic diagram explaining the designation of the spot pattern. It is a schematic diagram which shows the other shape example of the spot pattern. It is a flowchart which shows the process of the scanning type photocoagulation apparatus.

The ophthalmic laser system according to the embodiment for carrying out the present invention will be described. Hereinafter, a scanning photocoagulator will be described as an ophthalmic laser system. FIG. 1 is a block diagram showing a configuration of a scanning photocoagulator which is an ophthalmic laser system according to an embodiment of the present invention. The scanning photocoagulator 1 which is an ophthalmic laser system generates and irradiates an aiming or treatment spot pattern on the patient's retina R. The scanning photocoagulator 1 includes a light source assembly 2 and a slit lamp assembly 3.

The light source assembly 2 includes a therapeutic light source 12 that produces a therapeutic beam 14 that is a laser beam for performing treatment, and an aiming light source 16 that produces an aiming beam 18 for performing aiming. The treatment beam 14 from the treatment light source 12 is first adjusted by the lens 20. The lens 20 adjusts the treatment beam 14 so that the emitted light is used in combination with the curved mirror 22 to enter the optical fiber bundle 24. After incident on the lens 20, the treatment beam 14 is sampled by the partial reflector 26.

The light reflected by the partial reflector 26 is used as an input to the photodiode 28 that monitors the output power of the treatment beam 14 to ensure that the treatment light source 12 is operating at the desired output. The mirror 30 is used to direct the treatment beam 14 toward the curved mirror 22, and the curved mirror 22 directs the treatment beam 14 toward the movable mirror 32. The aiming beam 18 from the aiming light source 16 is directed at the movable mirror 32 via the mirrors 34 and 36.

The movable mirror 32 is preferably mounted on a galvano scanner, and the treatment beam 14 and the aiming beam 18 are attached to one of the optical fibers 24a, 24b, 24c, and 24d of the optical fiber bundle 24 at an arbitrary given time. Move to selectively point. It should be noted that the galvano scanner can be moved by a piezo actuator or other well-known optical moving device instead of the galvano scanner.

At that time, the lenses 42 and 44 focus the treatment and treatment beam 14 and the aiming beam 18 into the selected optical fiber. The movable mirror 32 is preferably separated from the lens 20 by one focal length to provide telecentric scanning conditions. It should be noted that the treatment beam 14 can be injected into all the optical fibers 24a to 24d in a parallel path, which maintains the launch aperture over the optical fiber bundle. Beam dumps 38, 40 are arranged adjacent to the optical fibers 24a to 24d, and the beam dumps 38, 40 contribute to holding the treatment beam 14 in the "standby position".

The optical fibers 24a to 24d transmit the treatment and treatment beam 14 from the light source assembly 2 and the aiming beam 18 to the slit lamp assembly 3. The additional optical fiber 46 can be used to direct the treatment and / or treatment beam 14, aiming beam 18 to the patient via other means such as an end probe or laser indirect ophthalmoscope (not shown). ..

The slit lamp assembly 3 includes an optical fiber input unit 50 that receives optical fibers 24a to 24d, a scanner assembly 52 that is a scanner unit, a transmission assembly 54, and a binoculars assembly 56. The optical fiber input section 50 includes an optical adjustment system specific to each of the optical fibers 24a to 24d, so that each optical fiber has a specific (preferably unique) spot on the image plane IP of the slit lamp assembly 3. -It is preferable to be able to make a size.

For example, the light from the optical fiber 24a first encounters a lens 58a that collimates the light, and then an aperture 60 that reduces the numerical aperture by covering everything but the central portion of the light beam. The light from the optical fibers 24b to 24d first encounters the lenses 58b to 58d, respectively. Lenses 58b-58d are preferably configured to form different spot sizes in the image plane IP, followed by the target tissue (retina).

In the illustrated embodiment, the optics 24a and 24b have the same core diameter, but are made to use different lenses 58a and 58b to form different spot sizes. The optical fibers 24c and 24d have different core diameters. It is preferable that all optical fibers transmit light with the same numerical aperture. This configuration is not essential. Therefore, in order to keep the numerical apertures equal for these different channels, the aperture 60 is used to counteract changes in the optical output of the lens 58a with respect to the lenses 58b, 58c, 58d.

The optical output of each optical fiber 24a-24d is adjusted by an accompanying optical system (eg, lenses 58a-58d, aperture 60, etc.) and then any well known, such as two galvano scanners 66, 68 (piezo actuators, etc.). It is directed to a scanner assembly 52 with two movable mirrors 62, 64 attached to (although an optical moving device can be used). The movable mirrors 62, 64 are configured to rotate in two orthogonal axes to scan (ie, move) the incident light to form any desired light pattern P.

The movable mirror 62 can rotate to direct light from any given one of the optics 24a to 24d towards the rest of the slit lamp assembly 3, thus directing the output from the optics. At the same time as "selecting", it acts to prevent any light from other optics from continuing throughout the slit lamp assembly 3. Since the output ends of the optical fibers 24a to 24d do not match, the movable mirror 62 needs to rotate to block the light from the desired optical fiber and send the light to the movable mirror 64, and the movable mirror 64 has an orthogonal axis. Light can be further moved within.

This configuration has the added advantage of preventing any stray light emitted by unselected optics from leaving the system. In FIG. 1, the optical fiber 24b is depicted as the selected fiber, where the output of this fiber is scanned by the movable mirrors 62, 64 to form a scanning pattern of light traveling over the rest of the system.

The light pattern P scanned by the therapeutic light source 12 and / or the aiming light source 16 exiting the scanner assembly 52 passes through the sending assembly 54, which is the lens 70 (on the image plane IP) which is the condensing means. With an intermediate scanning pattern), lens 72 (adjusts the light pattern to focus on the eyeball), mirror 74 (points the light pattern toward the target eye tissue), lens 76 (infinity-corrected microscope objective lens) It is provided with a lens 78 (preferably a contact lens that finally condenses the light pattern P onto a target eye tissue such as the retina R). The illumination light source 80 (eg, a halogen bulb) is used to illuminate the target eye tissue, the retina R, so that the physician can see the target eye tissue.

The user, the physician, can see the retina R directly through the binoculars assembly 56. The binocular assembly 56 includes a magnifying optic (eg, one or more lenses used to magnify an image of the target eye tissue in an adjustable manner), an eye safety filter 84 (potentially harmful). It is provided with an optical element 86, and an eyepiece 88, which prevents light from reaching a high level of light and provides a brightly neutral transmittance).

The light pattern P is finally generated on the patient's retina R by using the treatment light source 12, the treatment beam 14 from the aiming light source 16, and the aiming beam 18 under the control of the control unit 91. The light pattern P draws a spot pattern on the retina R. The control unit 91 is connected to each part of the system by the input / output interface 90, and monitors and / or controls each part of the system.

For example, the control unit 91 monitors the photodiode 28 to ensure that the therapeutic beam 14 is produced at the desired output level. Further, the control unit 91 performs operations such as turning on / off the switch of the treatment light source 12 and the aiming light source 16, setting the output level, treating the movable mirror 32 and / or optics for the treatment beam 14 and the aiming beam 18. Operate to choose whether to use fiber. Then, the directions of the galvano scanners 66 and 68 are controlled to generate a desired light pattern P on the target eye tissue.

The control unit 91 includes a CPU (Central Processing Unit) as a control unit, a ROM (ReadOnly Memory) and (Random Access Memory) as a main storage device, and an HDD (Hard Disc Drive) as an auxiliary storage device, and executes a program by the CPU. .. A liquid crystal display (LCD) 92 is connected to the control unit 91 as a display unit. Further, the control unit 91 is connected to a keyboard 93, a pointing device 94 such as a mouse or a joystick, and a touch panel 95 that can be input by touching a finger or a stylus pen as an instruction input unit. The touch panel 95 has a touch panel arranged on the surface of the liquid crystal display device 92.

The keyboard 93, the pointing device 94, and the touch panel 95 issue commands regarding, for example, the transmission spot size and pattern, the pulse time width, and the light output from the therapeutic light source 12 and the aiming light source 16. In addition to the user's physical movement of the slit lamp assembly 3 for coarse adjustment, the final fine adjustment of the light pattern P on the target tissue is when the movable mirrors 62, 64 scan the light beam. Further control can be performed by using a pointing device 94 or a touch panel 95 that changes the angle of rotation to move the entire pattern onto the target tissue. This method provides very fine control over the placement of the scanning beam.

An additional input device can be added as the pointing device 94. The additional input device may include a therapeutic light source 12, a knob for adjusting the output of the aiming light source 16, a foot switch for activating the irradiation of the aiming pattern and / or the treatment pattern, or other activation device. The final arrangement of the light outputs of the therapeutic light source 12 and the aiming light source 16 is to generate a light pattern P in the shape of the circumference of the retinal row hole generated in the patient's retina R.

Next, the spot pattern drawn by the light pattern P will be described. The light pattern P is basically formed by a row of fixed spots of uniform size and uniform spacing, which are separated. Using a GUI with a keyboard 93, a pointing device 94, and a touch panel 95, the user can use the spot size, spot spacing (ie, spot density), total number of spots, pattern size and shape, output level, pulse time width, and much more. Pattern variables can be selected, modified, and / or specified.

In response, the control unit 91 controls the treatment light source 12 (assuming a pulse light source) or additionally a shutter mechanism (not shown) somewhere along the treatment beam 14 to provide pulse treatment light. To generate. The movable mirrors 62, 64 move between the pulses, directing each pulse to a different position to form a rest spot.

FIG. 2 is a schematic diagram showing a spot pattern that irradiates the retinal foramen. In this pattern 100, a large number of dots 101 surround the retinal row hole 110 in three rows. The pattern 100 shape is selected as the most effective shape for treating the retinal foramen 110. For example, when an ellipse is specified as the pattern 100, as shown in FIG. 3, the angle θ (angle direction) formed by the major axis with the Y axis, the delivery dimension y in the Y direction (first delivery dimension), and the delivery dimension x in the X direction. The shape can be specified by specifying (second delivery dimension). As this designation, it can be specified by setting the ratio of x and y.

These values (x, y, θ) can be input from the keyboard 93, but in the present embodiment, a finger is touched on the pattern displayed on the liquid crystal display device 92 through the touch panel 95, and the touch panel 95 is touched. You can set x and y by operating. Further, θ can also be specified by rotating two fingers while touching with two fingers.

To input to the touch panel, touch the screen with one finger and slide it in either the up, down, left, or right direction, "tap" to touch the menus, icons, or links on the screen with one finger, or finger on the screen. It is performed by "pinch in" and "pinch out", in which the distance between the fingers is shortened or widened by touching with two fingers.

As the shape of the spot pattern, a shape other than the ellipse described above is selected according to the state of the retinal column 110. FIG. 4 is a schematic view showing a shape example of a spot pattern that irradiates the retinal column. Oval shapes such as the oval 120 shown in FIG. 4A and various egg shapes 130, 140, 150 shown in FIG. 4B are stored in advance in the control unit 91, and these shapes are displayed on a liquid crystal display. It is displayed on the device 92 and selected on the touch panel 95. As the spot pattern, a closed curve other than the shape described above can be set, and the size and angle are set by operating the touch panel 95. From the above, it is possible to select a dot pattern suitable for the size and angle of the retinal detachment and improve the efficiency of treatment.

Next, a procedure for treating the retinal foramen by the scanning photocoagulator 1 according to the present embodiment will be described. FIG. 5 is a flowchart showing the processing of the scanning photocoagulator. First, the user grasps the state of the patient's retinal foramen (step ST1). Then, the keyboard 93, the pointing device 94, or the touch panel 95 of the scanning photocoagulation device 1 is operated to display a spot pattern that can be used on the liquid crystal display device 92 (step ST2). Then, the user operates the touch panel 95 to select a spot pattern to be used (step ST3). Next, the touch panel 95 is pinched in, pinched out, and the like to set (x, y, z) of the pattern 100 (step ST4). As a result, the spot pattern of the light pattern P to irradiate the retina R is determined.

Then, this pattern is irradiated to the retina R with the aiming beam 18 from the aiming light source 16 and displayed so as to be superimposed on the retina column hole (step ST5). The user observes and confirms this state by the binocular assembly 56 (step ST6). If the light pattern P is good, the treatment beam 14 is irradiated from the treatment light source 12, and the light pattern P in the designated spot pattern is irradiated to the retina R for treatment. If the spot pattern by the aiming beam 18 is not good, the process from the spot pattern selection (step ST2) is performed.

As described above, according to the scanning photocoagulation apparatus 1 according to the present embodiment, the size and angle of the spot pattern can be set reliably and easily.

1: Scanning type photocoagulator 2: Light source assembly 12: Treatment light source 14: Treatment beam 16: Aiming light source 18: Aiming beam 20: Lens 22: Curved mirror 24: Optical fiber bundle 24a to 24d: Optical fiber 62: Movable mirror 64 : Movable mirror 66: Galvano scanner 68: Galvano scanner 70, 72: Lens 90: Input / output interface 91: Control unit 92: Liquid crystal display device 93: Keyboard 94: Pointing device 95: Touch panel 100: Pattern 101: Dot 110: Retinal row Hole

Claims (7)

An ophthalmic laser system for treating target tissue
A light source that produces laser light and
A scanner unit for scanning the laser beam to form a spot pattern of the laser beam, and
A condensing element that condenses the spot pattern on the target tissue,
A control unit for controlling the scanner unit and
A display unit connected to the control unit and capable of displaying the configuration of the spot pattern and displaying a plurality of different pattern configurations from which the spot pattern is selected.
The control unit is provided with an instruction input unit for designating the type and size of the spot pattern formed by the scanner unit.
A closed curve shape in which the spot pattern has a first crossing dimension in one direction and a second crossing dimension in the other direction intersecting the one direction, and is longitudinal in a predetermined angular direction.
The instruction input unit can specify the first delivery dimension of the spot pattern, the second delivery dimension, and the angle of the spot pattern.
The instruction input unit includes a touch panel arranged on the display unit, and the spot pattern displayed on the display unit through the touch panel is operated by touching the touch panel with a finger. may be specified a first diametral dimension and said second diametral dimension, while the angle of the spot pattern touched on the touch panel with two fingers, can be designated by rotating the two fingers ophthalmic laser system, characterized in that. The ophthalmic laser system according to claim 1, wherein the instruction input unit sets a ratio of the first delivery dimension and the second delivery dimension of the spot pattern. The ophthalmic laser system according to claim 1, wherein the instruction input unit specifies the first delivery dimension and the second delivery dimension. The ophthalmic laser system according to any one of claims 1 to 3, wherein the instruction input unit includes a pointing device that designates one point of the display unit. The ophthalmic laser system according to any one of claims 1 to 4, wherein the instruction input unit includes a keyboard. The ophthalmic laser system according to any one of claims 1 to 5 , wherein the spot pattern has an oval shape including an ellipse, an oval, and an oval shape. The ophthalmic laser system according to any one of claims 1 to 6, wherein the spots constituting the spot pattern are arranged at a substantially constant density.

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