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Claims  |
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What is claimed is:
1. The method of using an ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
maximum-area circular section producing a spot which is centered on and
equal to the area of the cornea to be subjected to ablation, adjusting the
intensity of laser-beam projection to a limited level at which resultant
corneal-tissue ablation per unit time is to an ascertained elemental depth
which is but a fraction of a predetermined maximum ablation depth into the
stroma, directing the adjusted beam to the cornea in the context of
reflection to define a central circular region within the confined beam,
said directing step being by reflection to the anterior surface and for
that period of time which will accomplish at least some ablative
penetration to the predetermined maximum ablation depth, whereby
laser-beam impingement upon the cornea is a circle having an outer
diameter determined by the central circular region; and, in the course of
said period of time, varying the diameter of said central circular region
to thereby vary the outer diameter of the spot at corneal impact, said
diameter variation proceeding in a range within said maximum-area circular
spot; whereby the cornea is impacted with greatest cumulative ablating
penetration per unit area at the central region of the ablated area and
with ablative penetration decreasing with increasing radius to the outer
portion of the ablated area, whereby a myopia-correcting change in the
anterior surface may be effected by volumetric removal of corneal tissue.
2. The method of using an ultraviolet laser beam to effect a
hyperopia-correcting change in optical properties of an eye by selectively
ablating the anterior surface of the cornea with penetration into the
stroma to achieve a volumetric removal of corneal tissue, which method
comprises confining the laser beam to a circular spot which is centered on
and at least equal to the area of the cornea to be subjected to
hyperopia-correcting ablation, adjusting the intensity of laser-beam
projection to a limited level at which resultant corneal-tissue ablation
per unit time is to an ascertained elemental depth which is but a fraction
of a predetermined maximum ablation depth into the stroma, and directing
the adjusted beam to the cornea in the context of reflection to define the
beam as a circular annulus having at least the outer diameter of said area
of the cornea to be subjected to hyperopia-correcting ablation, said
directing step being by reflection to the anterior surface and for that
period of time which will accomplish at least some ablative penetration to
the predetermined maximum ablation depth, while varying the inner diameter
of the annulus and thus of the projected spot, said inner-diameter
variation proceeding for a range of diameters less than the outer diameter
of said area of the cornea to be subjected to hyperopia-correcting
ablation; whereby the cornea is impacted with greatest cumulative ablating
penetration per unit area at the perimeter of the area of the cornea to be
subjected to hyperopia-correcting ablation, and with ablative penetration
decreasing with decreasing radius to the central portion of the ablated
area, whereby a hyperopia-correcting change in the anterior surface may be
effected by volumetric removal of corneal tissue.
3. The method of claim 1 or claim 2, wherein the diameter variation is in
the direction of diameter reduction.
4. The method of claim 1 or claim 2, wherein the diameter variation is in
the direction of diameter expansion.
5. The method of using an ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
maximum-diameter circular section producing a spot which is centered on
and is predetermined to establish the outer perimeter of the area of the
cornea to be subjected to ablation, adjusting the intensity of laser-beam
projection to a limited level at which resultant corneal-tissue ablation
per unit time is to an ascertained elemental depth which is but a fraction
of a predetermined maximum ablation depth into the stroma, directing the
adjusted beam to the anterior surface of the cornea in the context of
reflection to define the beam as comprising (a) a first circular annulus
having the outer diameter of said spot and a finite inner diameter and (b)
a second circular annulus having an outer diameter contiguous to the
finite inner diameter of said first annulus, said directing step being by
reflection to the anterior surface and for that period of time which will
accomplish at least some ablative penetration to the predetermined maximum
ablation depth, while varying the outer diameter of both annuli to thereby
vary the outer diameter of each of two concentric ablating spots at
corneal impact, the variation in outer diameter of said first annulus
proceeding in a range of diameters up to the diameter of said spot, and
the variation in outer diameter of said second annulus proceeding in the
range of diameters up to said finite diameter, whereby a myopia-correcting
change in the anterior surface may be effected by volumetric removal of
corneal tissue to achieve a Fresnel-type characterization of the anterior
surface.
6. The method of using an ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to an
intermediate-diameter circular section producing a spot which is centered
on and effectively expandable to the maximum diameter of the area of the
cornea to be subjected to ablation, adjusting the intensity of laser-beam
projection to a limited level at which resultant corneal-tissue ablation
per unit time is to an ascertained elemental depth which is but a fraction
of a predetermined maximum ablation depth into the stroma, directing the
adjusted beam to the cornea in the context of reflection to define the
beam as comprising (a) a first circular annulus having the outer diameter
of said spot and a finite inner diameter and (b) a second circular annulus
having an outer diameter contiguous to the finite inner diameter of said
first annulus, said directing step being by reflection to the anterior
surface and for that period of time which will accomplish at least some
ablative penetration to the predetermined maximum ablation depth, while
varying the inner diameter of both annuli to thereby vary the inner
diameter of each of two concentric ablating spots at cornea impact, the
variation in inner diameter of said first annulus proceeding in a range of
diameters up to the diameter of said spot, and the variation in inner
diameter of said second annulus proceeding in a range of diameters up to
said finite diameter, whereby a hyperopia-correcting change in the
anterior surface may be effected by volumetric removal of corneal tissue
to achieve a Fresnel-type characterization of the anterior surface.
7. The method of using an ultraviolet laser beam to correct an astigmatic
property of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
maximum-area section producing a spot which is centered on and spans the
area of the cornea to be subjected to ablation, adjusting the intensity of
laser-beam projection to a limited level at which resultant corneal-tissue
ablation per unit time is to an ascertained elemental depth which is but a
fraction of a predetermined maximum ablation depth into the stroma,
directing the adjusted beam to the cornea in the context of reflection to
define the spot as a projected rectangle which is centered on and of
elongate length which spans said area of the cornea, orienting the
elongate length direction as a central longitudinal axis of the projected
rectangular spot to accord with the orientation of the cylindrical axis of
the astigmatism to be corrected, said directing step being by reflection
to the anterior surface and for that period of time which will accomplish
at least some ablative penetration to the predetermined maximum ablation
depth, and varying the width of the projected rectangular spot, said width
variation being symmetrical laterally of the central longitudinal axis and
within the span of said maximum-area section, whereby the cornea is
impacted with greatest cumulative ablative penetration per unit area along
the central longitudinal axis of spot orientation and with ablative
penetration decreasing with increasing width to the outer portion of the
ablated area, whereby an astigmatism-correcting change in the anterior
surface may be effected by volumetric removal of corneal tissue.
8. The method of using a pulsed ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the section of the laser
beam to a maximum circular area which is centered on and equal to the area
of the cornea to be subjected to ablation, adjusting the beam-exposure
flux per pulse to a level at which resultant corneal-tissue ablation per
pulse is to an ascertained elemental depth which is but a fraction of
desired maximum ablation depth into the stroma, directing a succession of
such pulses to the anterior surface of the cornea in the context of
reflecting a central circular region of said beam, whereby laser-pulse
impingement upon the cornea is a circle having a diameter determined by
the reflection, and varying the diameter of said reflection to thereby
vary the diameter of laser-pulse impingement upon the cornea, said
diameter variation being in a range up to the diameter of said maximum
circular-area, whereby the cornea is impacted with the greatest density of
pulses per unit area at the central region of the ablated area and with
pulse density decreasing with increasing radius to the perimeter of the
ablated area, whereby a myopia-correcting change in the anterior surface
is effected by volumetric removal of corneal tissue.
9. The method of using a pulsed ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the section of the laser
beam to a maximum circular area which is centered on and equal to the area
of the cornea to be subjected to ablation, adjusting the beam-exposure
flux per pulse to a level at which resultant corneal-tissue ablation per
pulse is to an ascertained elemental depth which is but a fraction of
desired maximum ablation depth into the stroma, directing a succession of
such pulses to the anterior surface of the cornea in the context of
reflecting a radially narrow outer circularly annular region of said beam,
whereby laser-pulse impingement upon the cornea is a circular annulus
having an inner diameter determined by the reflection, and varying the
inner diameter of said reflection to thereby vary the inner diameter of
laser-pulse impingement upon the cornea, said diameter variation being in
a range up to the outer diameter of said outer annular region, whereby the
cornea is impacted with greatest density of pulses per unit area at the
perimeter of the ablated area and with pulse density decreasing with
decreasing radius to the center of the ablated area, whereby a
hyperopia-correcting change in the anterior surface is effected by
volumetric removal of corneal tissue.
10. The method of using an ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
maximum-area circular spot which is centered on and equal to the area of
the cornea to be subjected to ablation, adjusting the intensity of
laser-beam projection to a limited level at which resultant corneal-tissue
ablation per unit time is to an ascertained elemental depth which is but a
fraction of a predetermined maximum ablation depth into the stroma, and
directing the adjusted beam to the anterior surface of the cornea for that
period of time which will accomplish at least some ablative penetration to
the predetermined maximum ablation depth, while varying the diameter of
the projected spot, said variation proceeding in a range within said
maximum-area spot whereby the cornea is impacted with greatest density of
laser-beam exposure per unit area at the central region of the ablated
area and with density of laser-beam exposure decreasing with increasing
radius to the outer portion of the ablated area, whereby a
myopia-correcting change in the anterior surface may be effected by
volumetric removal of corneal tissue.
11. The method of using an ultraviolet laser beam to effect a
hyperopia-correcting change in optical properties of an eye by selectively
ablating the anterior surface of the cornea with penetration into the
stroma to achieve a volumetric removal of corneal tissue, which method
comprises confining the laser beam to a circular spot which is centered on
and of at least the area of the cornea to be subjected to
hyperopia-correcting ablation, adjusting the intensity of laser-beam
projection to a limited level at which resultant corneal-tissue ablation
per unit time is to an ascertained elemental depth which is but a fraction
of a predetermined maximum ablation depth into the stroma, directing the
adjusted beam to the anterior surface of the cornea in the context of
masking a central circular region within said circular spot, said
directing step being for that period of time which will accomplish at
least some ablative penetration to the predetermined maximum ablation
depth, whereby laser-beam impingement upon the cornea is a circular
annulus having an inner diameter determined by the circular mask; and, in
the course of said period of time, varying the diameter of said mask to
thereby vary the inner diameter of the circular annulus, said
mask-diameter variation proceeding to but short of the diameter of said
maximum-area circular spot; whereby the cornea is impacted with greatest
cumulative ablating penetration per unit area at the perimeter of the
hyperopia-correcting area and with ablative penetration decreasing with
decreasing radius to the center of the hyperopia-correcting area.
12. The method of using a pulsed ultraviolet laser beam to effect a
hyperopia-correcting change in optical properties of an eye by selectively
ablating the anterior surface of the cornea with penetration into the
stroma to achieve a volumetric removal of corneal tissue, which method
comprises confining the laser beam to a circular spot which is centered on
and of at least the area of the cornea to be subjected to
hyperopia-correcting ablation, adjusting the beam-exposure flux per pulse
to a level at which resultant corneal-tissue ablation per pulse is to an
ascertained elemental depth which is but a fraction of desired maximum
ablation into the stroma, directing a succession of such pulses to the
anterior surface of the cornea in the context of masking a central
circular region within said circular spot, whereby laser-pulse impingement
upon the cornea is a circular annulus having an inner diameter determined
by the circular mask, and varying the diameter of the circular mask, said
mask-diameter variation being up to the diameter of said
hyperopia-correcting area, whereby the cornea is impacted with the
greatest density of pulses per unit area at the perimeter of the
hyperopia-correcting area and with pulse density decreasing with
decreasing radius to the center of the hyperopia-correcting area.
13. The method of using a pulsed ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
maximum-area circular spot which is centered on and equal to the area of
the cornea to be subjected to ablation, adjusting the beam-exposure flux
per pulse to a level at which resultant corneal-tissue ablation per pulse
is to an ascertained elemental depth which is but a fraction of desired
maximum ablation into the stroma, and directing a succession of such
pulses to the anterior surface of the cornea in a succession of stepped
increments of changing radius of circular spots which are concentric with
respect to the optical center, said succession being continued over the
range up to said maximum area, whereby the cornea is impacted with
greatest density of pulses per unit area at the central region of the
ablated area and with pulse density decreasing with increasing radius to
the outer portion of the ablated area, whereby a myopia-correction change
in the anterior surface may be effected by volumetric removal of corneal
tissue.
14. The method of claim 10 or claim 11, wherein the diameter variation is
in the direction of diameter reduction.
15. The method of claim 10 or claim 11, wherein the diameter variation is
in the direction of diameter expansion.
16. The method of claim 11 or claim 12, wherein the laser-beam spot is
larger than the area of the cornea to be subjected to hyperopia-correcting
ablation, thereby establishing an outer annulus of laser-beam exposure
surrounding the hyperopia-correcting annulus, and varying the outer
diameter of said outer annulus while effecting the hyperopia-correcting
change, said outer-diameter variation commencing at substantially the
outer diameter of the area of hyperopia-correcting change and proceeding
with outward diameter expansion.
17. The method of claim 10 or claim 11 or claim 13 or claim 12, in which
the diameter variation is cumulatively such, in the course of said period
of time, as to effect a radial distribution of laser-beam exposure which
is quasiparabolic about the sectional center of laser-beam projection.
18. The method of claim 11 or claim 12, in which the laser-beam spot is
larger than the area of the cornea to be subjected to hyperopia-correcting
ablation, thereby establshing an outer annulus of laser-beam exposure
surrounding the hyperopia-correcting annulus while effecting the
hyperopia-correcting change, said outer-diameter variation commencing at
substantially the outer diameter of said area of hyperopia-correcting
change and proceeding with outward diameter expansion, and in which the
radial span between inner and outer diameters of said outer annulus is
between 5 and 15 percent of the maximum diameter of the area of
hyperopia-correcting change.
19. The method of claim 11 or claim 12, in which the laser-beam spot is
larger than the area of the cornea to be subjected to hyperopia-correcting
ablation, thereby establishing an outer annulus of laser-beam exposure
surrounding the hyperopia-correcting annulus while effecting the
hyperpia-correcting change, said outer-diameter variation commencing at
substantially the outer diameter of said area of hyperopia-correcting
change and proceeding with outward diameter expansion, and in which the
radial span between inner and outer diameters of said outer annulus is
approximately 10 percent of the maximum diameter of the area of
hyperopia-correcting change.
20. The method of claim 11 or claim 12, in which the laser-beam spot is
larger than the area of the corena to be subjected to hyperopia-correcting
ablation, thereby establishing an outer annulus of laser-beam exposure
surrounding the hyperopia-correcting annulus while effecting the
hyperopia-correcting change, said outer-diameter variation commencing at
substantially the outer diameter of said area of hyperopia-correcting
change and proceeding with outward diameter expansion, and in which said
outer-diameter variation is cumulatively such, in the course of said
period of time, as to effect a radial distribution of laser-beam exposure
which is substantially linear in said outer annulus.
21. The method of using an ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
maximum-diameter circular spot which is centered on and is predetermined
to establish the outer perimeter of the area of the cornea to be subjected
to ablation, adjusting the intensity of laser-beam projection to a limited
level at which resultant corneal-tissue ablation per unit time is to an
ascertained elemental depth which is but a fraction of a predetermined
maximum ablation depth into the stroma, selecting an opaque circular mask
of diameter less than maximum diameter to be subjected to ablation and
centering the mask on an optical axis and between the cornea and the laser
beam, and directing the adjusted beam to the anterior surface of the
cornea for that period of time which will accomplish at least some
ablative penetration to the predetermined maximum ablation depth, while
reducing the spot diameter from said maximum to the diameter of said
circular mask, removing the mask, and directing the adjusted beam to the
anterior surface of the cornea while also continuing to reduce the spot
diameter within the previously masked area, whereby a hyperopia-correcting
change in the anterior surface may be effected by volumetric removal of
corneal tissue to achieve a Fresnel-type characterization of the anterior
surface.
22. The method of using an ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to an
intermediate-diameter circular spot which is centered on and expandable to
the maximum diameter of the area of the cornea to be subjected to
ablation, adjusting the intensity of laser-beam projection to a limited
level at which resultant corneal-tissue ablation per unit time is to an
ascertained elemental depth which is but a fraction of a predetermined
maximum ablation depth into the stroma, selecting an opaque circular mask
of said intermediate diameter, centering the mask on an optical axis and
between the cornea and the laser beam, and varying the expansion of the
spot circle of the adjusted laser beam while directing the same to the
anterior surface of the cornea for that period of time which will
accomplish at least some ablative penetration to the predetermined maximum
ablation depth, said expansion being continued to the point of
expanded-spot size reaching the full periphery of the area to be subjected
to ablation, removing the mask, and directing the adjusted beam to the
anterior surface of the cornea in a program of spot-size variation in the
range up to said intermediate diameter wherein the preponderance of
ablation is near the center of said intermediate-diameter spot, whereby a
myopia-correcting change in the anterior surface may be effected by
volumetric removal of corneal tissue to achieve a Fresnel-type
characterization of the anterior surface.
23. The method of using an ultraviolet laser beam to correct an astigmatic
property of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
projected rectangular spot which is centered on and of elongate length
which diametrically spans the area of the cornea to be subjected to
ablation, adjusting the intensity of laser-beam projection to a limited
level at which resultant corneal-tissue ablation per unit time is to an
ascertained elemental depth which is but a fraction of a predetermined
maximum ablation depth into the stroma, orienting the elongate length
direction of the projected rectangular spot to accord with the orientation
of the cylindrical axis of the astigmatism to be corrected, and directing
the adjusted beam to the anterior surface of the cornea for that period of
time which will accomplish at least some ablative penetration to the
predetermined maximum ablation depth, and varying the width of the
projected rectangular spot, said width variation being in the range up to
the diametrical span of said area, whereby the cornea is impacted with
greatest cumulative ablative penetration per unit area along the diameter
of spot orientation and with ablative penetration decreasing with
increasing spot width to the outer portion of the ablated area, whereby an
astigmatism-correcting change in the anterior surface may be effected by
volumetric removal of corneal tissue.
24. The method of using an ultraviolet laser beam to change optical
properties of an eye having both astigmatic and myopia errors, by
selectively ablating the anterior surface of the cornea with penetration
into the stroma to achieve a volumetric removal of corneal tissue, which
method comprises confining the laser beam to a projected spot in the
nature of an elongate line oriented on the corneal diameter which
corresponds to the axis of astigmatic error, adjusting the intensity of
laser-beam projection to a limited level at which resultant corneal-tissue
ablation per unit time is to an ascertained elemental depth which is but a
fraction of a maximum ablation depth, said maximum ablation depth having
been predetermined in terms of the period of time necessary to reduce to
substantially zero the cylindrical curvature responsible for the
astigmatism, and for said period of time directing the adjusted beam to
the anterior surface of the cornea while varying the width of the
projected spot, whereby an astigmatism-correcting change may be effected
in the anterior surface of the cornea by volumetric removal of corneal
tissue, to thereby leave essentially only spherical error to be corrected;
then confining the laser beam to a circular spot which is centered on and
equal to the maximum area of the cornea to be subjected to
myopia-correcting ablation, predetermining a second period of time for
accomplishment of at least some further ablative penetration which
corresponds to the maximum required for myopia-correction, and for said
second period of time directing the circular spot to the anterior surface
of the cornea while varying the diameter of the circular spot within the
range up to the diameter of said maximum area, whereby a myopia-correcting
change in the anterior surface may be effected by further volumetric
removal of corneal tissue.
25. The method of using an ultraviolet laser beam to change optical
properties of an eye having both astigmatic and hyperopia errors, by
selectively ablating the anterior surface of the cornea with penetration
into the stroma to achieve a volumetric removal of corneal tissue, which
method comprises confining the laser beam to a projected spot in the
nature of an elongate line oriented on the corneal diameter which
corresponds to the axis of astigmatic error, adjusting the intensity of
laser-beam projection to a limited level at which resultant cornea-tissue
ablation per unit time is to an ascertained elemental depth which is but a
fraction of a maximum ablation depth, said maximum ablation depth having
been predetermined in terms of the period of time necessary to reduce to
substantially zero the cylindrical curvature responsible for the
astigmatism, and for said period of time directing the adjusted beam to
the anterior surface of the cornea while varying the width of the
projected spot, whereby an astigmatism-correcting change may be effected
in the anterior surface of the cornea by volumetric removal of corneal
tissue, to thereby leave essentially only spherical error to be corrected;
then confining the laser beam to a circular spot which is centered on and
at least equal to the area of the cornea to be subjected to
hyperopia-correcting ablation, predetermining a second period of time for
accomplishment of at least some further ablative penetration which
corresponds to the maximum required for hyperopia correction, selecting an
opaque mask providing circular masking at diameters varying up to the
diameter of said hyperopia-correcting area, and for said second period of
time directing the circular spot to the cornea while varying the circular
masking diameter up to substantially the diameter of said
hyperopia-correcting area, whereby a hyperopia-correcting change in the
anterior surface may be effected by further volumetric removal of corneal
tissue.
26. The method of using a pulsed ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
circular spot which is centered on and equal to a predetermined area of
the cornea to be subjected to ablation, adjusting the beam-exposure flux
per pulse to a level at which resultant corneal-tissue ablation per pulse
is to an ascertained elemental depth which is but a fraction of desired
maximum ablation into the stroma, selecting an opaque circular mask of
area less than the predetermined area to be subjected to ablation,
centering the mask on the optical axis and between the cornea and the
laser beam, whereby an annular area is defined for ablation of an
elemental Fresnel-characterized surface, and directing a succession of
such pulses to the anterior surface of the cornea in a succession of
varying outer radius of said annular area, such variation being between
the area of the mask and said predetermined area, whereby a first
myopia-correcting curvature change in the anterior surface may be effected
by a first volumetric removal of corneal tissue within said annular area;
removing the mask, and directing another succession of such pulses to the
anterior surface of the cornea in a succession of stepped increments of
varying circular-spot area which (a) are concentric to the optical center
and (b) are within the previously-masked area, whereby a second
myopia-correcting curvature change in the anterior surface may be effected
by a second volumetric removal of corneal tissue within the
previously-masked area.
27. The method of using a pulsed ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
circular spot which is centered on and equal to a predetermined area of
the cornea to be subjected to ablation, adjusting the beam-exposure flux
per pulse to a level at which resultant corneal-tissue ablation per pulse
is to an ascertained elemental depth which is but a fraction of desired
maximum ablation into the stroma; directing a first succession of such
pulses to the anterior surface of the cornea in a succession of varying
outer radius within a central circle of diameter less than that of said
predetermined area, whereby a first myopia-correcting curvature change in
the anterior surface may be effected by a first volumetric removal of
corneal tissue within said central circle; opaquely masking the central
circle; and then directing a second succession of such pulses to the
anterior surface of the cornea in a succession of varying outer radius
within the annulus defined by presence of the mask within said
predetermined area, whereby a second myopia-correcting curvature change in
the anterior surface may be effected by a second volumetric removal of
corneal tissue within said annulus.
28. The method of using a pulsed ultraviolet laser beam to change optical
properties of an eye by selectively ablating the anterior surface of the
cornea with penetration into the stroma to achieve a volumetric removal of
corneal tissue, which method comprises confining the laser beam to a
circular spot which is centered on and equal to a predetermined area of
the cornea to be subjected to ablation, adjusting the beam-exposure flux
per pulse to a level at which resultant corneal-tissue ablation per pulse
is to an ascertained elemental depth which is but a fraction of desired
maximum ablation into the stroma; opaquely masking the predetermined area
with a succession of circles of varying outer diameter in a range between
said predetermined area and the area of an intermediate circle of diameter
less than that of said predetermined area, and directing a first
succession of such pulses to the anterior surface of the cornea in the
course of masking with said succession of circles of varying outer
diameter, whereby a first hyperopia-correcting curvature change in the
anterior surface may be effected by a first volumetric removal of corneal
tissue within an annulus defined by the diameter of the predetermined area
and by the diameter of said intermediate circle; masking said annulus to
prevent further ablation within said annulus; then opaquely masking said
intermediate circle with a succession of circles of varying outer diameter
in a range within the inner diameter of said annulus, and directing a
second succession of such pulses to the anterior surface of the cornea in
the course of masking said intermediate circle with a succession of
circles of varying outer diameter, whereby a second hyperopia-correcting
curvature change in the anterior surface may be effected by a second
volumetric removal of corneal tissue within said intermediate circle.
29. The method of using a pulsed ultraviolet laser beam to correct an
astigmatic property of an eye by selectively ablating the anterior surface
of a cornea with penetration into the stroma to achieve a volumetric
removal of corneal tissue, which method comprises focusing the laser beam
to a rectangular spot which is centered on and of elongate length which
diametrically spans the area of the cornea to be subjectd to ablation,
adjusting the beam-exposure flux per pulse to a level at which resultant
corneal-tissue ablation per pulse is to an ascertained elemental depth
which is but a fraction of desired maximum ablation into the stroma,
orienting the elongate length direction of the rectangular spot to accord
with the orientation of the cylindrical axis of the astigmatism to be
corrected, and directing a succession of such pulses to the anterior
surface of the cornea in a succession of stepped increments of varying
width of rectangular spots which are symmetrically positioned with respect
to the optical center, whereby the cornea is impacted with greatest
density of pulses per unit area along the diameter of spot orientation and
with pulse density decreasing with increasing spot width to the outer
portion of the ablated area, whereby an astigmatism-correcting change in
the anterior surface is effected by volumetric removal of corneal tissue.
30. The method of using an ultraviolet laser beam to effect a
myopia-correcting change in optical properties of an eye by selectively
ablating the anterior surface of the cornea with penetration into the
stroma to achieve a volumetric removal of cornea tissue, which method
comprises delivering the laser beam to impact the cornea as a circular
spot having a variable radius that is centered on the central axis of the
eye, and varying the radius of said spot in the course of at treatment
program to achieve such ablative penetration depth and profile as to
characterize the anterior surface with the myopia-correcting change.
31. The method of using an ultraviolet laser beam to effect a
hyperopia-correcting change in optical properties of an eye by selectively
ablating the anterior surface of the cornea with penetration into the
stroma to achieve a volumetric removal of corneal tissue, which method
comprises delivering the laser beam to impact the cornea as a circular
annulus having a variable inner radius that is centered on the central
axis of the eye, and varying the inner radius of said annulus in the
course of a treatment program to achieve such ablative penetration depth
and profile as to characterize the anterior surface with the
hyperopia-corrected change.
32. The method of claim 30 or claim 31, in which said correcting change in
optical properties of the eye is effected upon the anterior surface of a
donor-cornea inlay after transplanted assembly thereof to a host cornea,
the correcting change being to such stroma-penetration depth in the donor
inlay as to complete the correcting change with a profile that is
continuous and smooth at adjacency of the anterior surfaces of the host
and donor-inlay surfaces.
33. The method of claim 30 or claim 31, in which said correcting change in
optical properties of the eye is effected upon the anterior surface of a
donor-cornea inlay after transplanted assembly thereof to a host cornea,
the correcting change being to such stroma-penetration depth in the donor
inlay as to complete the correcting change with a profile that is
continuous and smooth at adjacency of the anterior surfaces of the host
and donor-inlay surfaces, said host cornea having been first prepared for
donor-cornea reception by laser-beam delivery using a circular spot of
fixed radius to the point of accomplishing ablative penetration to
predetermined maximum ablation depth, and said donor-cornea inlay having
been first prepared from a donor cornea for such translated assembled by
laser-beam delivery to the posterior surface of the donor cornea until
achieving at least some ablative penetration into the stroma region of the
donor cornea, the extent of the latter ablative penetration being such as
to leave unpenetrated donor-cornea thickness which is at least as great as
the extent of laser penetration into the host cornea, and assembling the
donor inlay in stroma-to-stroma contact with the ablated region of the
host cornea.
34. The method of using an ultraviolet laser beam to effect
curvature-correcting change in optical propertries of an eye by
selectively ablating the anterior surface of the cornea with penetration
into the stroma to achieve a volumetric removal of corneal tissue, which
method comprises delivering the laser beam to impact the cornea with a
circular spot maximum area which is greater than the optically used
central area of the cornea, causing the beam to impact the cornea within
said central area in a treatment program of beam-size variation to produce
an optically corrected curvature in said central area, and causing the
mean to impact the cornea with beam-size variation in an outer area which
is adjacent to said central area such that in the course of the treatment
program the corneal profile in said outer area provides a relatively
smooth transition from the area of optically corrected curvature to the
corneal profile adjacent to but outside said maximum area, whereby to
condition the eye for favorable epithelial regrowth over the area of
surgery. |
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Claims  |
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Description  |
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BACKGROUND OF THE INVENTION
The invention relates to that aspect of ophthalmological surgery which is
concerned with operations upon the external surface of the cornea.
Operations of the character indicated include corneal transplants and
keratotomies; such operations have traditionally required skilled
manipulation of a cutting instrument. But, however keen the cutting edge,
the mere entry of the edge into the surface of the cornea necessarily
means a wedge-like lateral pressure against body cells displaced by the
entry, on both sides of the entry. Such lateral pressue is damaging to
several layers of cells on both sides of the entry, to the extent
impairing the ability of the wound to heal, and resulting in the formation
of scar tissue.
My original patent application Ser. No. 552,983, filed Nov. 17, 1983,
includes a background discussion of the effects of various available
wavelengths of laser radiation in ophthalmologic surgery and, in
particular, surgery performed on the anterior surface of the cornea. It is
explained that radiation at ultraviolet wavelengths is desirable by reason
of its high photon energy. This energy is greatly effective on impact with
tissue, in that molecules of tissue are decomposed on photon impact,
resulting in tissue ablation by photodecomposition. Molecules at the
irradiated surface are broken into smaller volatile fragments without
heating the remaining substrate; the mechanism of the ablation is
photochemical, i.e., the direct breaking of intra-molecular bonds.
Photothermal and/or photocoagulation effects are neither characteristic
nor observable in ablations at ultraviolet wavelengths, and cell damage
adjacent the photodecomposed ablation is insignificant. The order of
magnitude of this ablative process, in the case of radiation exposure at
ultraviolet wavelengths (in the range of about 400 nm or less), is that an
energy density of 1 joule/cm.sup.2 incises to a depth of 1 micron (1.mu.).
Said original patent application discloses a technique of scanning a laser
beam over the anterior surface of a cornea in such a controlled pattern as
to sculpture said surface, imparting a new curvature to said surface,
whereby to achieve optical correction of an optically deficient eye. But
the scanner and scanner control to perform the technique are relatively
complex and expensive.
BRIEF STATEMENT OF THE INVENTION
It is an object of the invention to provide an improved apparatus and
technique for surgically operating upon the outer surface of the cornea.
Another object of the invention is to simplify and reduce the cost of
apparatus and technique for surgically modifying optical properties of the
eye through surgical procedure on the outer surface of the cornea.
It is a specific object to achieve the above objects with surgical
techniques and apparatus for reducing a myopic, for reducing a hyperopic,
and/or for reducing an astigmatic condition of an eye.
Another specific object is to provide an improved surgical technique in
performing corneal-transplant operations.
A still further specific object is to achieve the above objects with
automatic means for safely applying ultraviolet irradiation in surgical
procedures on the cornea.
It is also an object to achieve the above objects without use of scanning
techniques or apparatus.
The invention achieves these objects with apparatus which effectively fixes
the position of an eye with respect to a non-scanning laser characterized
by ultraviolet radiation, at an energy level capable of achieving
controlled ablative photodecomposition of the cornea, namely, of the
epithelium, Bowman's membrane, and stroma levels of the cornea. Irradiated
flux density and exposure time are so controlled as to achieve desired
depth of the ablation. As distinguished from the scanning procedure
described in said application Ser. No. 552,983, a sculpturing action
results from controlled change of projected laser-spot size, in the course
of a given treatment, wherein spot size ranges from a maximum which covers
the entire area to be treated for curvature correction, down to a
predetermined minimum tolerable size. In one embodiment, a zoom lens in
the optical path of projection is the means of changing spot size, and in
another embodiment an indexible mask or mirror is employed; in both cases,
the weighted allocation of time as function of spot size is such as to
achieve a desired ultimate optically corrected cornea, from prior
ascertainment of an optically deficient corneal curvature. Spot-size
control is not only disclosed for effecting spherical-curvature
correction, but also for cylindrical correction in reduction of
astigmatism; still further use is described in connection with a
corneal-transplant procedure.
DETAILED DESCRIPTION
The invention will be illustratively described in detail, in conjunction
with the accompanying drawings, in which:
FIG. 1 is a schematic diagram in perspective, to show the general
arrangement of operative components of the invention;
FIG. 2 is a simplified view in longitudinal section, showing an
eye-retaining fixture used with the apparatus of FIG. 1;
FIGS. 3, 4 and 5 are simplified diagrams to illustrate the nature of
ablative corneal sculpture, performed with apparatus as in FIG. 1, for the
case of correcting a myopia condition;
FIG. 6 is a simplified diagram schematically showing operative components
of another embodiment of the invention;
FIG. 7 is a plan view of an indexible mask usable in the embodiment of FIG.
6;
FIG. 8 is a diagram similar to FIG. 6, to show a modification;
FIG. 9 is a fragmentary plan view of an indexible mask usable in the
modification of FIG. 8;
FIGS. 10 and 11 are simplified diagrams to illustrate use of the invention,
for the case of correcting a hyperopia condition;
FIGS. 12, 13 and 14 are simplified diagrams to illustrate use of the
invention to achieve a Fresnel-type optically corrective contour at the
anterior surface of the cornea;
FIGS. 15 and 16 respectively illustrate components and features of an
embodiment of the invention to achieve correction of an astigmatic eye;
FIGS. 17 and 18 are simplified diagrams to illustrate use of the invention
in connection with a corneal-transplant operation;
FIGS. 19 and 20 are simplified diagrams to illustrate two different
alternatives for the embodiment of FIGS. 15 and 16;
FIGS. 21 to 26 correspond to FIGS. 6, 7, 8, 9, 11 and 14, respectively, in
illustration of a further aspect of the invention;
FIGS. 27 and 28 are graphical diagrams to illustrate a principle of
reflector design;
FIGS. 29 and 30 are diagrams similar to FIGS. 10 and 11, respectively, to
illustrate a special-purpose refinement of the invention;
FIG. 31 is a schematic diagram to illustrate an alternative for FIG. 30;
and
FIGS. 32 and 33 are similar diagrams il | | |