While observing the eye of a patient under a microscope, medical professionals may place an additional optic in contact with the cornea to improve their view of an intraocular structure. Various optics are known which accommodate an ophthalmologist's view of an eye in different ways. For example, a gonioscopy lens provides an ophthalmologist with an angled view through the cornea that allows visualization of the peripheral sections of the anterior chamber that are otherwise difficult to visualize.
Primary Open Angle Glaucoma is a disease state characterized by elevated intraocular pressures, the cause of which is most commonly attributed to a restricted outflow pathway through the trabecular meshwork and Schlemm's canal. These anatomical structures are located within the iridocorneal angle 901 (see
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The inventors of the present invention recognized that the majority of optics used for optical procedures (e.g. a majority of gonioscopy lenses used for anterior surgical procedures) are hand-held lenses that must be manually retained in position on the cornea. In most cases, the surgeon operates with the handheld gonioscopy lens in one hand and a surgical instrument in the other. In straightforward procedures (e.g. bypass shunt placement) this is an effective way to perform the surgery as the surgeon has direct control of the view and the instrument simultaneously. In more complex procedures, limiting the surgeon to use of one hand increases the time and difficulty of the procedure. For this reason, in some cases it may be beneficial or even necessary for the surgeon to be able to operate bimanually using a second instrument. In order to do so, the handheld gonioscopy lens is generally held by an assistant with the understanding that the lens will frequently need to be repositioned through verbal instructions.
The inventors of the present invention recognized that some lenses offer self-stabilization features, e.g. a flange along the lower lens surface that extends to increase the base of the lens. The inventors recognized that while the stabilization features will improve the lens retention, adjustments of the lens will likely still be needed, requiring the surgeon to remove an instrument in order to manually reposition the lens. The inventors also recognized that a flange also presents a different issue in that it can restrict access to various insertion points. The flange may also impede visualization. The inventors of the present device realized the need for an alternative self-stabilizing lens that could be used without the aid of an assistant and enable true bi-manual surgery.
One instance of a microscope suspended gonioscopy lens has been identified in U.S. Patent Publication Number 2013/0182223. The design of this complex system centers on a counterweight style lens holder. However, the inventors of the present invention noticed drawbacks of this suspended lens design including that the lens only has one rotational degree of freedom (about one rotational axis) relative to a lens holder and attachment that is used to suspend the lens from the microscope and that the lens does not feature a translational degree of freedom relative to the attachment. Thus, the inventors of the present invention developed an improved lens holder design herein which features multiple rotational degrees of freedom (about two or more rotational axes) and a translational degree of freedom of the lens relative to the lens holder and an attachment that suspends the lens to the microscope.
Another instance of a suspended gonioscopy lens has been identified in U.S. Pat. No. 8,118,431 ('431 patent hereafter). This design however specifies the attachment to the objective lens of the microscope in its description and abstract. It also focuses on using a mirrored gonioscopy lens and attachment configured to position the lens between the microscope and the eye to simultaneously view the surface and the interior of the eye (a claim taught in U.S. Pat. No. 4,157,859 to Terry, as well as in US20060098274 Kitajima). The '431 patent fails to teach how the lens is suspended from the objective lens to provide a method for compensation of patient eye movement, misalignment of the eye relative to the microscope optical axis, and the necessary safety feature to prevent patient trauma in the event of unintended large microscope movement. Thus, the inventors of the present invention developed the improved lens holder and lens design herein, to overcome these noted drawbacks in the '431 patent.
In vitreo-retinal procedures, or procedures in the posterior chamber of the eye, the inventors recognized that a wide-angle viewing attachment (“viewing attachment” herein) is often used on the ophthalmic operating microscope. A wide-angle viewing attachment is typically mounted to the body of the microscope and suspends a wide-angle lens below the microscope objective, in close proximity to the corneal surface. Though the viewing attachment is not intended to hold the lens in contact with the cornea, the inventors of the present device realized that this could be an effective method of positioning and retaining a lens that would contact the cornea.
The assignee of the present invention (OCULUS GmbH) manufactures wide-angle viewing attachments and adapters to mount to a variety of operating microscopes. One embodiment of the present invention employs a wide-angle viewing attachment and adapter in a method for attaching a novel apparatus (e.g. for positioning a hands-free lens on the cornea) to various operating microscopes.
One type of wide angle-viewing attachment requires sterilization in between uses. In an example, the assignee developed an example of this wide-angle viewing attachment (OCULUS® Binocular Indirect Ophthalmomicroscope or “OCULUS BIOM” herein, and disclosed in U.S. Pat. No. 7,092,152 which is incorporated by reference herein).
Another type of wide angle-viewing attachment is for use as a single-use disposable. In an example, the assignee developed an example of this wide-angle viewing attachment (OCULUS Binocular Indirect Ophthalmomicroscope Ready or “BIOM READY” herein and disclosed in U.S. Pat. No. 9,155,593 which is incorporated by reference herein). In one example, the BIOM READY wide-angle viewing attachment is injection molded and is for use as a single-use disposable.
In one embodiment, the inventors recognized that it would be advantageous to provide an apparatus that attaches a hands-free lens to a wide angle-viewing attachment, such that the apparatus permits the lens to contact the eye without the need to manually hold the lens. The inventors recognized that it would be further advantageous if such an apparatus is designed to accommodate relative movement between the eye and the wide-angle viewing attachment (and/or microscope) along multiple degrees of freedom (e.g. translational and/or rotational). In an example embodiment, the apparatus is made for use with any viewing attachment, such as the OCULUS BIOM or the BIOM READY wide angle viewing attachments. With the BIOM READY wide angle viewing attachment, the apparatus can be used as an all-encompassing disposable system.
Advantageous embodiments of the proposed invention disclose a means to attach a lens (e.g. surgical contact lens) to a wide-angle viewing attachment (e.g. OCULUS BIOM, BIOM READY, etc.) in a method that allows for stable and hands-free positioning of the lens atop the cornea.
In a first set of embodiments, an apparatus is presented for attaching a lens to a microscope with an optical attachment. The apparatus includes the lens with a translational degree of freedom such that the lens is configured to translate along a first direction relative to the microscope and the optical attachment.
In a second set of embodiments, a system is presented for attaching a lens to a microscope with an optical attachment. The system includes a lens and the optical attachment to attach the lens to the microscope. The optical attachment includes a lens holder and/or the viewing attachment configured to move the lens and the lens holder relative to the microscope.
In a third set of embodiments, a method is presented for using an optical attachment to position a lens relative to a microscope. The method includes securing the lens to a first end of the optical attachment and securing a second end of the optical attachment to the microscope. The method also includes moving the lens with the optical attachment until the lens makes contact with an eye of a patient. The method also includes translating the lens along a first direction relative to the microscope and the optical attachment, based on relative movement of the eye in the first direction such that the lens maintains contact with the eye.
Still other aspects, features, and advantages are readily apparent from the following detailed description, simply by illustrating a number of particular embodiments and implementations, including the best mode contemplated for carrying out the invention. Other embodiments are also capable of other and different features and advantages, and its several details can be modified in various obvious respects, all without departing from the spirit and scope of the invention. Accordingly, the drawings and description are to be regarded as illustrative in nature, and not as restrictive.
Embodiments are illustrated by way of example, and not by way of limitation, in the figures of the accompanying drawings in which like reference numerals refer to similar elements and in which:
A method and apparatus are described for attaching a lens to a microscope with an optical attachment (e.g. for use during a surgical procedure). In the following description, for the purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the present invention. It will be apparent, however, to one skilled in the art that the present invention may be practiced without these specific details. In other instances, well-known structures and devices are shown in block diagram form in order to avoid unnecessarily obscuring the present invention.
Notwithstanding that the numerical ranges and parameters setting forth the broad scope are approximations, the numerical values set forth in specific non-limiting examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements at the time of this writing. Furthermore, unless otherwise clear from the context, a numerical value presented herein has an implied precision given by the least significant digit. Thus, a value 1.1 implies a value from 1.05 to 1.15. The term “about” is used to indicate a broader range centered on the given value, and unless otherwise clear from the context implies a broader range around the least significant digit, such as “about 1.1” implies a range from 1.0 to 1.2. If the least significant digit is unclear, then the term “about” implies a factor of two, e.g., “about X” implies a value in the range from 0.5 X to 2 X, for example, about 100 implies a value in a range from 50 to 200. Moreover, all ranges disclosed herein are to be understood to encompass any and all sub-ranges subsumed therein. For example, a range of “less than 10” for a positive only parameter can include any and all sub-ranges between (and including) the minimum value of zero and the maximum value of 10, that is, any and all sub-ranges having a minimum value of equal to or greater than zero and a maximum value of equal to or less than 10, e.g., 1 to 4.
Some embodiments of the invention are described below in the context of optical devices used to treat or examine a patient (e.g. examine the patient, perform surgery on the patient, etc.). In some embodiments, the invention is described in a context of a system provided including a lens, and an apparatus to position the lens and secure the lens to the body of an ophthalmic operating microscope. In one embodiment, the system is intended to safely position the lens onto the eye in a way that is stable and non-obstructive for the user, avoiding the need to manually hold a lens. In another embodiment, a method is provided for using the microscope with the addition of the system, including its installation. In yet another embodiment, a method is provided for forming the system. For purposes of this description, “optical device” means a device with oculars or a camera and an objective lens through which a medical professional views a region of interest of a patient, for diagnostic or therapeutic purposes. In one embodiment, the optical device is an operating microscope (e.g. ophthalmic operating microscope).
In an embodiment, the system 100 includes an optical attachment to attach a lens 113 to a microscope 101. For purposes of this description, “optical attachment” means one or more components that are used to independently or collectively position the lens 113 at a desired position, relative to the microscope 101. In one embodiment, the optical attachment includes a wide angle viewing attachment 107 (e.g. single use disposable). In an example embodiment, the wide angle viewing attachment 107 is the BIOM READY. In an example embodiment, a first end of the viewing attachment 107 is secured to the adapter plate 105 and a second end opposite to the first end is secured to a lens holder 111 that positions the lens 113 (e.g. on an eye 115). In some embodiments, the optical attachment also includes the lens holder 111. In one embodiment, the viewing attachment 107 has a knob 109 that can be adjusted (e.g. rotated) to vary a separation between the second end (e.g. the lens holder 111 and lens 113) and the microscope objective lens 103 (e.g. along the optical axis 106). In one embodiment, the system 100 includes the lens 113 (e.g. gonioscopy lens) and/or the optical attachment (e.g. the lens holder 111 and the viewing attachment 107) that is configured to move the lens 113 and the lens holder 111 relative to the microscope 101. In some embodiments, the lens 113 is a non-prismatic lens, a plano-concave lens, a mirrored lens, a double mirrored lens, a bioconcave lens or a combination thereof.
In one embodiment, the lens holder 111 and the lens 113 define an apparatus 110 that is used to position or couple the lens 113 to the microscope 101 such that the lens 113 has one or more degrees of freedom to accommodate relative movement between the eye 115 and the microscope 101 (e.g. translational degree of freedom to accommodate relative translational (axial) movement between the eye 115 and the microscope 101 and/or one or more rotational degrees of freedom to accommodate relative translational (lateral) movements between the eye 115 and the microscope 101). In the illustrated embodiment of
In an embodiment, the viewing attachment 107 (e.g. BIOM READY) is formed in such a way that the lens holder 111 and gonioscopy lens 113 are movable, essentially without resistance, in a direction towards the microscope objective (e.g. along the optical axis 106). In an example embodiment, where the viewing attachment 107 is the BIOM READY, the mechanics of the viewing attachment 107 is disclosed in U.S. Pat. No. 9,155,593, which is incorporated by reference herein. The inventors of the present invention recognized that this feature protects the eye from injury caused by the lens 113 during movement of the patient or movement of the microscope 101.
In an embodiment, the apparatus 110 includes the lens holder 111 that defines a slot 203 configured to receive a portion of the lens 113 such that the lens is configured to translate within the slot 203 along the first direction. In one embodiment,
In one example embodiment, the lens 113 includes a pair of posts 201a, 201b on opposite sides of the lens 113. In this example embodiment, the lens holder 111 defines a pair of slots 203a, 203b configured to receive the respective pair of posts 201a, 201b such that the pair of posts are configured to translate within the pair of slots 203a, 203b along the first direction. In other embodiments, the posts are provided on the lens holder 111 and the slots are provided on the lens 113. Although
In an example embodiment, a diameter of the slots 203 is slightly larger than the diameter of the posts 201, to advantageously permit the lens 113 to independently move in the first direction (e.g. along the objective optical axis 106). Additionally, the gonioscopy lens 113 features a cutout 205 which allows the surgeon surgical access to the eye.
In an embodiment,
In one embodiment,
In one embodiment, one or more characteristics of the lens 113 enable the lens 113 to be retained within the beam path (e.g. objective optical axis 106) of the microscope 101 by the lens holder 111. In an example embodiment, while retaining the lens 113, one or more characteristics of the lens holder 111 allow the lens 113 to pivot back-to-front, pivot side-to-side and/or move in a translational direction (e.g. vertically along the objective optical axis 106 for optimal positioning). In an example embodiment, the lens holder 111 also possesses features that allow it to interface and be retained by hardware typically used for a non-contact, wide-angle viewing lens for vitreoretinal procedures (e.g. the viewing attachment 107). In an example embodiment, one or more characteristics of the lens holder 111 also ensure alignment of the imaging lens 113 in the optical axis 106 and for positioning at the proper focal distance. In an example embodiment, a height of the lens holder 111 (e.g. defined as a dimension of the lens holder 111 along an axis that is orthogonal to the first portion 207) is about 22 millimeters (mm) or in a range from about 15 mm to about 30 mm. In another example embodiment, a length of the lens holder 111 (e.g. defined as a dimension of the lens holder 111 along an axis that is parallel to the first portion 207) is about 35 mm or in a range from about 30 mm to about 40 mm. In another example embodiment, the lens holder 111 includes angled portions 209a, 209b that are angled relative to the first portion 207 (
In another example embodiment, the lens holder 111 is retained by the viewing attachment 601 when inserted into a slot 605 at the base of the viewing attachment 601. In this embodiment, when the lens holder 111 is fully inserted into the slot 605, a ball detent housed in a telescoping rod 603 of the viewing attachment 601 falls into place in the feature 403 along a first portion 207 of the lens holder 111. In an example embodiment, the feature 403 is a shallow divot that matches the geometry of the ball detent housed within the telescoping rod 603 of the viewing attachment 601. As with the viewing attachment 107 of the system 100, the telescoping rod 603 of the viewing attachment 601 allows the lens holder 111 and gonioscopy lens 113 to be movable, essentially without resistance, in a direction towards the microscope objective 103. In an example embodiment, the mechanics of the viewing attachment 601 are described in U.S. Pat. No. 7,092,152, which is incorporated by reference herein.
In an example embodiment, the viewing attachment 601 (as with the viewing attachment 107) is configured to move the lens 113 into contact with an eye 115 of a patient. In an example embodiment, the viewing attachment 601 includes an interface (e.g. knob 607) for manual adjustment of the position of the lens 113 relative to the microscope 101 (e.g. along the objective optical axis 106).
In yet another example embodiment, the lens 113 is configured to translate relative to the lens holder 111 in the first direction (e.g. along the objective optical axis 106) by a first extent and the lens 113 is configured to translate relative to the viewing attachment 601 by a second extent that is greater than the first extent. In an example embodiment, the first extent is about 3 mm or in a range from about 2 mm to about 4 mm. In another example embodiment, the second extent is about 35 mm or in a range from about 25 mm to about 45 mm.
In an embodiment, the rotation of the viewing attachment 107 about the microscope objective axis 106 is provided, enabling the surgeon more field of view for those procedures where surgery is required at different circumferential regions of the eye. In an embodiment,
In an embodiment, the first rotational axis 210 is angled relative to the first direction (e.g. translation direction of the lens 113 relative to the lens holder 111, such as along the slot 203 direction and the objective optical axis 106). In an example embodiment, the first rotational axis 210 is about orthogonal (e.g. about 90 degrees or in a range from about 70 degrees to about 110 degrees) to the first direction (e.g. objective optical axis 106). In an example embodiment, the first rotational axis 210 is defined by the posts 201a, 201b of the lens 113 (e.g. the axis 210 extends through the posts 201a, 201b). In another example embodiment, the second rotational axis 802 is angled (e.g. about orthogonal, such as about 90 degrees or in a range from about 70 degrees to about 110 degrees) relative to the first rotational axis 210 and/or the first direction (e.g. objective optical axis 106). In another example embodiment, the second rotational axis 802 is about orthogonal (e.g. about 90 degrees or in a range from about 70 degrees to about 110 degrees) relative to both the first rotational axis 210 and the first direction (e.g. objective optical axis 106).
In one embodiment, as shown in
As shown in
In one embodiment, the lens 113 is configured to be in contact and concentric with an eye 115 of a subject, such that the translational degree of freedom (e.g. along the first direction, such as along the objective optical axis 106 direction) and the first rotational degree of freedom (e.g. about the first rotation axis 210) is to accommodate movement of the eye in the first direction such that the lens 113 remains in contact and concentric with the eye 115 during this movement in the first direction. As shown in
In another embodiment, the lens 113 is configured to be in contact and concentric with the eye 115 of the subject such that the second rotational degree of freedom (e.g. about the second rotational axis 802) is configured to accommodate lateral movement of the eye 115 in a lateral direction orthogonal to the first direction such that the lens 113 remains in contact and concentric with the eye 115 during this movement in the lateral direction. In an example embodiment,
In an embodiment, the rotation of the lens 113 about the second rotational axis 802 is based on the lens 113 pivoting about the second rotational axis 802 within the lens holder 111 (
In one embodiment, the first surface 820 (e.g. bottom surface contacting the eye 115) is a concave surface with a curvature that is based on a curvature of the eye such that the first surface is configured to be in contact and concentric with the eye. In another embodiment, the bottom/first surface 820 of the lens 113 is concave with a radius of curvature matching the radius of curvature of the cornea (e.g. about 8 mm or in a range from about 7 mm to about 9 mm) such that the lens 113 (e.g. made of a material with a similar index of refraction to the human cornea) minimizes the refractive power of the cornea. In another example embodiment, the second/top surface 822 of the lens 113 can have various designs each used to visualize a different region or anatomical feature within the eye and/or to control the magnification of the image. In one example embodiment, a second/top surface 822 is convex. In yet another example embodiment, the second/top surface 822 is angled by a certain angle (e.g. about 40 degrees or in a range from about 30 degrees to about 50 degrees). In other embodiments the lens 113 is a prismatic lens for gonioscopy. In still other embodiments, the lens 113 is a plano-concave lens, a bi-concave lens, and/or a convex-concave lens with spherical or aspheric surfaces. In some embodiments the lens 113 has an anti-reflective coating. In still other embodiments, the lens 113 is made of a gamma-stable material.
In an embodiment, a safety feature is provided by the apparatus 110, i.e. to allow intended (focusing) or unintended microscope movement without exerting a force onto the eye which could lead to injury. In an embodiment, the motion range of this safety feature should exceed the focus range necessary to view the eye structures to be examined, as well as exceed most expected unintended microscope movements. In an embodiment, this safety feature is achieved by a provision to allow tilt, rotation, and axial movement of the lens 113 to compensate for minor patient and eye movement, and allow lateral misalignment of the eye relative to the optical axis 106 of the microscope, to ensure continuous contact of the lens-cornea interface. The inventors of the present invention realized that this feature provides a constant, minimal contact force, in order to prevent compression of the anterior chamber during the procedure.
In yet another embodiment, a length 805 (
In an embodiment, the second surface 822 is angled at about 50 degrees (or in a range from about 40 degrees to about 60 degrees) relative to the first surface 820 to accommodate a wide range of microscope angles and eye anatomies in the visualization of the iridocorneal angle 901 (
In an embodiment, in step 1301 a sterile barrier is positioned between the microscope 101 and the optical attachment (e.g. viewing attachment and/or lens holder). In one embodiment, in step 1301 a sterility disc 1401 (
In an embodiment, in step 1303 a sterile cap 1403 is placed on a knurled screw (
In an embodiment, in step 1305 the lens 113 and lens holder 111 are secured to the viewing attachment. In one embodiment, in step 1305 the lens holder 111 is secured to the viewing attachment 107, 601 using various features 401, 403 as discussed in the embodiment of
In an embodiment, in step 1307 the viewing attachment is attached to the microscope 101. In one embodiment, in step 1307 a portion of the viewing attachment 107 (
In an embodiment, in step 1309 the objective lens 103 of the microscope 101 is focused to the proper distance. In one embodiment, in step 1309 the objective lens 103 is focused on the iris of the eye 115.
In an embodiment, in step 1311 the viewing attachment is moved to a working position (e.g. a position where the surgeon can view the eye for purposes of performing one or more surgical procedures and/or can diagnose one or more conditions of the eye). In one embodiment, in step 1311 the viewing attachment 107, 601 (e.g. and the lens 113 and lens holder 111) is rotated in a direction 1413 (
In an embodiment, in step 1313 the viewing attachment is adjusted to move the lens 113 to establish contact with the eye 115 (e.g. cornea). In one embodiment, in step 1313 the viewing attachment 107 is adjusted by rotating the knob 109 in a second direction 1420 (
In an embodiment, in step 1313 the viewing attachment is adjusted to move the lens 113 such that the posts 201a, 201b of the lens 113 are positioned within the slots 203 of the lens holder 111 to facilitate axial movement of the lens 113 relative to the lens holder 111 (and viewing attachment). In an example embodiment, in step 1313 the viewing attachment is adjusted until the posts 201a, 201b of the lens 113 are positioned at about a midpoint 1417 (
In an embodiment, in step 1315 relative movement between the lens 113 and the lens holder 111 and/or viewing attachment is facilitated, in one or more degrees of freedom while still ensuring that the lens 113 remains in contact with and/or concentric with the cornea. In one embodiment, in step 1315 relative translational movement between the lens 113 and the lens holder 111 (and/or viewing attachment) is facilitated based on translational movement of the posts 201 within the slot 203 of the lens holder 111. In still other embodiments, in step 1315 relative rotational movement between the lens 113 and the lens holder 111 and/or viewing attachment is facilitated about the first rotational axis 210 (e.g. to facilitate front/rear pivot of the lens 113). In still other embodiments, in step 1315 relative rotational movement between the lens 113 and the lens holder 111 and/or viewing attachment is facilitated about the second rotational axis 802 (e.g. to facilitate side-to-side tilt of the lens 113).
In an embodiment, in step 1317 the viewing attachment (and lens 113) is rotated relative to the microscope 101. In one embodiment, in step 1317 the viewing attachment 107 is rotated about the optical axis 106 of the microscope objective lens 103. In an example embodiment, the viewing attachment 107 is rotated in a counterclockwise direction 705 (
In an embodiment, in step 1319 the viewing attachment is moved out of the working position. In one embodiment, step 1319 is performed after the procedure (e.g. eye surgery). In an embodiment, in step 1319 the viewing attachment 107 (and lens 113) are moved out of the working position. In an example embodiment, step 1319 is a reverse of step 1311, where the viewing attachment 107 is adjusted to move the lens 113 in the upward direction 1409 and/or is rotated about a direction 1413′ (
In the foregoing specification, the invention has been described with reference to specific embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention. The specification and drawings are, accordingly, to be regarded in an illustrative rather than a restrictive sense. Throughout this specification and the claims, unless the context requires otherwise, the word “comprise” and its variations, such as “comprises” and “comprising,” will be understood to imply the inclusion of a stated item, element or step or group of items, elements or steps but not the exclusion of any other item, element or step or group of items, elements or steps. Furthermore, the indefinite article “a” or “an” is meant to indicate one or more of the item, element or step modified by the article.
This application claims benefit of U.S. Provisional Application No. 63/081,469, filed Sep. 22, 2020, under 35 U.S.C. § 119(e).
Filing Document | Filing Date | Country | Kind |
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PCT/US2021/051508 | 9/22/2021 | WO |
Number | Date | Country | |
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63081469 | Sep 2020 | US |