WO2020026950A1 - Ophthalmic laser treatment apparatus - Google Patents
Ophthalmic laser treatment apparatus Download PDFInfo
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- WO2020026950A1 WO2020026950A1 PCT/JP2019/029304 JP2019029304W WO2020026950A1 WO 2020026950 A1 WO2020026950 A1 WO 2020026950A1 JP 2019029304 W JP2019029304 W JP 2019029304W WO 2020026950 A1 WO2020026950 A1 WO 2020026950A1
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- eye
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- observation
- optical system
- patient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
Definitions
- the present disclosure relates to an ophthalmic laser treatment apparatus that irradiates a treatment laser beam to an affected part of a patient's eye.
- Patent Document 1 There is known a laser treatment apparatus that displays parameters related to irradiation conditions of treatment laser light in an observation field (for example, Patent Document 1). Also, a laser treatment apparatus that synthesizes a wide-area image of a patient's eye and a slit photographed image of the patient's eye is known (for example, Patent Document 2).
- the laser treatment apparatus disclosed in Patent Document 1 information other than the observation image obtained by the observation optical system is limited to character information on irradiation conditions of the treatment laser light. Therefore, there is a possibility that it takes time to align the device with the site to be treated.
- the laser treatment apparatus disclosed in Patent Literature 2 connects the laser treatment apparatus to a network and acquires a wide-area image of the patient's eye on a recording medium in order to acquire a wide-area image of a patient's eye (treatment target) used for generating a composite image. It was imperative that the storage or laser treatment device include at least a portion of another modality (eg, a fundus camera).
- another modality eg, a fundus camera
- the laser treatment apparatus disclosed in Patent Literature 2 is based on the premise that wide-area imaging is performed before the treatment is started. Therefore, work is performed in the order of imaging for preparing a wide-area image and treatment using the wide-area image, and there is a possibility that the operation is prolonged.
- an object of the present disclosure is to provide an ophthalmic laser treatment apparatus that can appropriately perform treatment laser beam irradiation by presenting a reference image different from a captured image of a patient's eye to an operator during observation of the patient's eye.
- An ophthalmic laser treatment apparatus for irradiating a treatment laser beam to an affected part of a patient's eye is a laser irradiation optical system for irradiating a treatment laser beam to a patient's eye, and an illumination for illuminating the patient's eye with slit light.
- a reference image different from the photographed image of the patient's eye is presented to the operator during observation of the patient's eye, so that irradiation of the treatment laser light can be performed appropriately.
- FIG. 11 is a diagram in which an irradiation scheduled area is drawn on the reference image of FIG. 10. It is a reference image of a transformation example. It is a reference image of a transformation example. It is a live screen displayed on a monitor.
- the ophthalmic laser treatment apparatus 1 of the present embodiment can perform treatment of the patient's eye E by irradiating the patient's eye E with treatment laser light.
- the ophthalmic laser treatment apparatus 1 of the present embodiment includes a delivery unit 2, a laser light source unit 10, and an optical fiber 20.
- the delivery section 2 includes a laser irradiation optical system 40 (see FIG. 2).
- the laser light source unit 10 includes a treatment laser light source 11 (see FIG. 2).
- the delivery unit 2 and the laser light source unit 10 are connected by an optical fiber 20 or the like.
- a control unit 70 (see FIG. 2) is housed in the housing of the laser light source unit 10.
- An operation unit 80, a foot switch 81, a 3D mouse 84, and the like are connected to the laser light source unit 10.
- the ophthalmic laser treatment apparatus 1 of the present embodiment further includes a slit lamp microscope unit 3 (slit lamp) and a table unit 4.
- the slit lamp microscope unit 3 includes an observation optical system 30 and an illumination optical system 60 (see FIG. 2).
- the slit lamp microscope section 3 includes a main body section 5, and the delivery section 2 is connected to (combined with) the main body section 5.
- the table section 4 places the main body section 5 to which the delivery section 2 is connected.
- the aspect of the ophthalmic laser treatment apparatus 1 is not limited to the present disclosure.
- the slit lamp microscope unit 3, the delivery unit 2, and the laser light source unit 10 may be integrated.
- the delivery unit 2 and the slit lamp microscope unit 3 may be integrated.
- the slit lamp microscope section 3 of the present embodiment includes the main body section 5 and the headrest section 22.
- the main body unit 5 includes a microscope unit 7, an illumination unit 6, a joystick unit 9, and a displacement mechanism 8.
- the microscope section 7 includes an eyepiece 36 for an operator to look through.
- the observation optical system 30 (see FIG. 2) is housed in the microscope unit 7.
- the illumination optical system 60 (see FIG. 2) is housed in the illumination unit 6.
- the displacement mechanism 8 is a displacement means, and moves the main body 5 (laser irradiation optical system 40 and the like) placed on the table 4 in a vertical direction (Y direction in FIG. 1) and a horizontal direction (X direction in FIG. 1). Or in the front-back direction (Z direction in FIG. 1).
- the displacement mechanism 8 can rotate the observation optical system 30 in the horizontal direction about the axis extending in the vertical direction as the rotation center.
- the surgeon can operate the joystick 9 to move the main body 5 in the up-down direction, the left-right direction, or the front-back direction.
- the laser light source unit 10 of this embodiment includes a treatment laser light source 11 (see FIG. 2) for emitting treatment laser light, an aiming light source 12 for emitting visible aiming laser light (hereinafter referred to as aiming light), and a treatment laser light. It includes a beam splitter 13 (combiner) that combines aiming light and a condenser lens 14.
- the treatment laser light source 11 can emit laser beams having different wavelengths according to the purpose of treatment.
- the treatment laser light source 11 of the present embodiment emits laser light of a wavelength in a visible region (for example, 532 nm (green), 577 nm (yellow), 647 nm (yellow), etc. so that the fundus Er absorbs the energy of the laser light.
- any one of three types (green / yellow / red) of treatment laser light can be selectively emitted from the treatment laser light source 11.
- the treatment laser light source 11 may be able to emit only one kind of treatment laser light, or may be capable of emitting treatment laser light having a wavelength in the infrared region.
- the aiming light source 12 emits aiming light for causing the operator to recognize the irradiation position of the treatment laser light.
- the wavelength of the aiming light is in the visible range so that the operator can visually recognize the aiming light reflected by the patient's eye E with the naked eye.
- a different wavelength from the treatment laser light may be used as the aiming light.
- a wavelength of 670 nm (red) may be used as the wavelength of the aiming light.
- a laser diode (LD) that emits red laser light may be used as the aiming light source 12.
- the beam splitter 13 of the present embodiment reflects most of the treatment laser light emitted from the treatment laser light source 11 and transmits part of the aiming light emitted from the aiming light source 12.
- the laser light multiplexed by the beam splitter 13 is condensed by the condenser lens 14 and is incident on the incident end face of the optical fiber 20.
- a shutter 15 for blocking treatment laser light is provided between the treatment laser light source 11 and the beam splitter 13, a shutter 15 for blocking treatment laser light is provided.
- a shutter 16 is provided in an optical path through which the aiming light or the treatment laser light is guided.
- the shutter 16 of the present embodiment is a safety shutter that is closed when an abnormality occurs in the ophthalmic laser treatment apparatus 1.
- the laser irradiation optical system 40 (irradiation means) of the present embodiment has an optical axis L2, and is used to irradiate the treatment laser light emitted from the treatment laser light source 11 to the patient's eye E.
- the laser irradiation optical system 40 is shared by the treatment laser light and the aiming light.
- the laser irradiation optical system 40 of the present embodiment can also be said to be an aiming optical system for forming a spot of aiming light based on a predetermined pattern on the tissue of the patient's eye E.
- the above-mentioned predetermined pattern includes a single spot (single-shot irradiation).
- the treatment laser light emitted from the emission end face of the optical fiber 20 passes through the lens 41, the zoom lens 42, and the mirror 43 in this order, and then passes through the scanning unit 50 (scanning means), the objective lens 46, the reflection mirror 49, and the contact lens CL. It is then irradiated to the treatment site.
- the zoom lens 42 is a spot size changing unit for changing the spot size of the laser beam.
- the zoom lens 42 is movable in the optical axis direction. In the present embodiment, the operator holds the contact lens CL.
- the scanning unit 50 of the present embodiment is provided in the laser irradiation optical system 40.
- the scanning unit 50 is used to two-dimensionally scan the spot (irradiation position) of the treatment laser beam on the tissue of the patient's eye E (on the fundus Er).
- the scanning unit 50 of the present embodiment is a scanning optical system that two-dimensionally moves the irradiation position (irradiation direction) of the laser light.
- the scanning unit 50 of the present embodiment includes a scanner mirror.
- the scanning unit 50 of the present embodiment includes a galvanometer mirror 51 (first galvanometer mirror) and a galvanometer mirror 55 (second galvanometer mirror).
- the galvanometer mirror may be referred to as a galvanometer scanner.
- each of the galvanometer mirror 51 and the galvanometer mirror 55 includes a mirror that reflects laser light and an actuator.
- the actuator is a driving unit that drives (rotates) the mirror.
- JP-A-2011-156290 has been referred to.
- the treatment laser light that has passed through each optical element of the laser irradiation optical system 40 is reflected by the reflection mirror 49, and then, through the contact lens CL, the tissue (the fundus Er) of the patient's eye E, which is the target surface. Is irradiated.
- the zoom lens 42 is held by a lens cam (not shown). When the lens cam rotates, each zoom lens 42 moves in the optical axis direction. The position of the zoom lens 42 can be detected by an encoder 42a attached to the lens cam.
- the control unit 70 of the present embodiment can receive the position information (detection signal) of each lens from the encoder 42a and acquire the spot size of the treatment laser beam.
- the scanning unit 50 is controlled based on a command signal from the control unit 70 so that the spot of the treatment laser beam is formed as a two-dimensional pattern on the target surface.
- the reflection mirror 49 of the present embodiment includes a mechanism for inclining the optical axis L2 of the laser beam two-dimensionally by the operation of the operator.
- the control unit 70 includes: starting driving of the scanning unit 50, stopping driving of the scanning unit 50, starting irradiation of the treatment laser light from the treatment laser light source 11, and stopping irradiation of the treatment laser light from the treatment laser light source 11. By repeating the order, spots of a predetermined pattern can be formed on the tissue of the patient's eye E. That is, the control unit 70 of the present embodiment controls the driving of the scanning unit 50 and the irradiation of the treatment laser light, and performs pattern irradiation of the treatment laser light.
- the ophthalmic laser treatment apparatus 1 of the present embodiment has a pattern irradiation unit that forms a spot of a predetermined pattern using the laser irradiation optical system 40 and the scanning unit 50.
- each spot constituting the spot is separated.
- the spots may be connected to each other.
- the pattern irradiation unit of the present embodiment can form a spot of a predetermined pattern even for aiming light. Using the observation optical system 30 and the aiming light, the surgeon can grasp the irradiation site of the treatment laser light before the start of the treatment laser light irradiation.
- the present disclosure is an example, and the ophthalmic laser treatment apparatus 1 may not include the pattern irradiation unit.
- the observation optical system 30 of the present embodiment is observation means for observing the patient's eye E, and includes an optical axis L3.
- the observation optical system 30 of the present embodiment includes an optical axis L3R for presenting an observation image to the operator's right eye EoR and an optical axis L3L for presenting an observation image to the operator's left eye EoL. .
- the observation optical system 30 of the present embodiment may be called binoculars.
- the observation optical system 30 of the present embodiment includes an objective lens 31, a variable power optical system 32 (32R, 32L), a protection filter 33 (33R, 33L), a half mirror 37, an erecting prism group 34 (34R, 34L), a field of view.
- An aperture 35 (35R, 35L), an eyepiece 36 (36R, 36L) and the like are provided.
- the surgeon can look into the eyepiece 36 to check the observation site of the patient's eye E, the spot of the aiming light (in other words, the reflected light (return light) where the aiming light is reflected by the patient's eye E), and the like.
- the observation surface (object surface) provided at the front of the objective lens 31 and the field stop 35 disposed inside the apparatus have an optically conjugate positional relationship via the objective lens 31. That is, at the position of the field stop 35, the observation image of the patient's eye E is formed as an aerial image.
- an observation image formed by observation light passing through the observation optical system 30 may be referred to as an optical observation image 111a (or a through observation image).
- the optical observation image 111a is an observation image with no time lag generated by the observation optical system 30 without using the light receiving element.
- the observation optical system 30 downstream of the half mirror 37 is provided with a presentation optical system (first presentation optical system or first presentation means) for presenting information on treatment (the optical observation image 111a of the patient's eye E) to the operator. ).
- the observation optical system 30 of the present embodiment includes the light receiving element 39, and can capture an observation image of the patient's eye E as a moving image or a still image. That is, the observation optical system 30 of the present embodiment includes an imaging unit for imaging the patient's eye E (in other words, electronic imaging). In the present embodiment, an image sensor is used as the light receiving element 39. In the present embodiment, an observation image acquired by using the light receiving element 39 may be referred to as an electronic observation image 111b (or an electronic observation image).
- the half mirror 37 is a branching member for branching the observation optical path, and in the present embodiment, is provided obliquely on one observation optical path (on the optical axis L3L side). The half mirror 37 of the present embodiment is arranged between the protection filter 33L and the erecting prism group 34L.
- a lens 38 and a light receiving element 39 are arranged in this order.
- the optical path from the observation surface (the observation site of the patient's eye E) to the light receiving element 39 may be referred to as a photographing optical system (photographing means) for photographing the patient's eye E.
- the observation light reflected by the half mirror 37 passes through a lens 38 and is received by a light receiving element 39. That is, an observation image of the patient's eye E is formed on the light receiving element 39.
- the observation surface (object surface) provided ahead of the objective lens 31 and the light receiving element 39 have an optically conjugate positional relationship via the objective lens 31.
- a color CMOS image sensor having sensitivity in the visible band and the infrared band is used as the light receiving element 39.
- the control unit 70 of the present embodiment can display the electron observation image 111b acquired using the light receiving element 39 on the monitor 82, the display 93, and the like. Note that the ophthalmic laser treatment apparatus 1 may not include the light receiving element 39.
- the protection filter 33 of the present embodiment can be inserted into and removed from the observation optical path, and an actuator is connected to the protection filter 33.
- the control unit 70 can insert and remove the protection filter 33 in the observation optical path.
- the control unit 70 of the present embodiment inserts the protection filter 33 into the observation optical path during irradiation of the treatment laser light, and retracts the protection filter 33 from the observation optical path in other cases.
- the display unit 90 of the present embodiment can present information on the treatment to the operator. For example, as information on treatment (presentation information), irradiation conditions of treatment laser light, a schematic diagram of the eye, an electronic observation image 111b, and the like may be presented. In other words, in other words, the display unit 90 of the present embodiment can present the operator with information regarding treatment different from the optical observation image 111a.
- the display unit 90 of the present embodiment is provided in the observation optical system 30.
- the display unit 90 of the present embodiment includes a display 93, a lens 92, a half mirror 91, and the like.
- the display 93 displays presentation information to be presented to the operator. In this embodiment, an LCD (with a backlight) is used as the display 93.
- a color LCD capable of displaying 1600 (H) ⁇ 1200 (V) is used as the display 93.
- the half mirror 91 of the present embodiment is arranged on the optical axis L3R. Specifically, the half mirror 91 is disposed between the protection filter 33R and the erecting prism group 34L.
- the presentation light (display light) emitted from the indicator 93 travels along the optical axis L5.
- the presentation light emitted from the display 93 is reflected by the half mirror 91 in the direction of the erecting prism group 34 after passing through the lens 92.
- the half mirror 91 of the present embodiment is a synthesizing unit for synthesizing the optical observation image 111a and the presentation information displayed on the display 93.
- the half mirror 91 of the present embodiment makes the optical axis L5 and the optical axis L3R coaxial.
- the presentation light reflected by the half mirror 91 travels through the erecting prism group 34, the field stop 35, and the eyepiece 36 in this order, and converges on the fundus of the operator looking through the eyepiece 36.
- the optical path from the display 93 to the operator's fundus may be referred to as a presentation optical system (second presentation optical system or second presentation means) for presenting information on treatment to the operator.
- the display 93 and the field stop 35 are in an optically conjugate positional relationship. That is, at the position of the field stop 35, the display image of the display 93 is formed as an aerial image.
- a method of presenting information regarding treatment different from the optical observation image 111a to the operator is not limited to the present disclosure.
- an LCD liquid crystal panel
- the control unit 70 controls the transmittance of each cell constituting the LCD to control the operator. May be presented.
- the LCD is a synthesizing unit for synthesizing the optical observation image 111a and the presentation information displayed on the LCD.
- the illumination optical system 60 of the present embodiment is illumination means for projecting illumination light to the patient's eye E, and has an optical axis L1.
- the illumination optical system 60 of the present embodiment is a slit illumination unit, and can illuminate a part of the patient's eye E with slit light.
- the illumination optical system 60 of the present embodiment includes an illumination light source 61, a condenser lens 62, a slit plate 63, a filter, a projection lens 64, a correction lens, and a split mirror.
- the slit plate 63 of the present embodiment includes a variable circular aperture and a variable slit plate. The variable circular aperture can change the opening diameter, and the variable slit plate can change the slit width.
- the illumination optical system 60 of the present embodiment includes a deformation unit for deforming the illumination shape (slit shape) of the patient's eye E.
- the illumination optical system 60 of the present embodiment can generate not only slit-shaped slit light but also circular illumination light.
- the operator can change the opening diameter of the variable circular aperture or the slit width of the variable slit plate by operating an operation member (not shown). That is, the illumination optical system 60 of the present embodiment is provided with operation means for an operator to change the illumination shape.
- the illumination light source 61 of the present embodiment can emit visible light.
- a halogen lamp or an LED may be used.
- the illumination light emitted from the illumination light source 61 passes through the opening of the slit plate 63 after passing through the condenser lens 62.
- the illumination light formed in a slit shape by the slit plate 63 advances through the filter, the projection lens 64, and the correction lens in this order, and is reflected by the split mirror in the direction of the patient's eye E.
- the illumination light reflected by the split mirror illuminates the patient's eye E (the fundus Er in this embodiment).
- the surgeon can observe the patient's eye E illuminated by the illumination optical system 60 using the observation optical system 30.
- the control unit 70 of the present embodiment is control means for controlling the ophthalmic laser treatment apparatus 1, and includes a CPU 71 (processor), a ROM 72, a RAM 73, a nonvolatile memory 74, and the like.
- the CPU 71 controls each unit in the ophthalmic laser treatment apparatus 1.
- the ROM 72 stores various programs, various parameters, initial values, and the like.
- the RAM 73 can temporarily store various information.
- the non-volatile memory 74 is a non-transitory storage medium capable of retaining stored contents even when power supply is cut off. For example, a USB memory, a flash ROM, or the like removably attached to the control unit 70 may be used as the nonvolatile memory 74.
- the control unit 70 of the present embodiment includes a treatment laser light source 11, an aiming light source 12, an encoder 42a, a galvanomirror 51, a galvanomirror 55, a display 93, a light receiving element 39, a protection filter 33, a dimming plate 94, a foot switch 81, A data input / output unit 95 (acquisition unit), a 3D mouse 84, a touch panel 83, and a monitor 82 are connected.
- the foot switch 81 of the present embodiment is a trigger input unit for starting irradiation of the treatment laser beam.
- the monitor 82 of the present embodiment is a display means for displaying various parameters related to the irradiation condition of the treatment laser beam, an observation image of the patient's eye E, and the like.
- the touch panel 83 of the present embodiment is a setting unit (first setting unit) for setting various parameters related to the irradiation condition of the treatment laser beam.
- a touch panel 83 is attached to the monitor 82, and an operation unit 80 is formed by a combination of the monitor 82 and the touch panel 83. By operating (touching) the touch panel 83, the operator can set various parameters related to the irradiation condition of the treatment laser light.
- the 3D mouse 84 is a setting unit (second setting unit) for setting various parameters related to the irradiation condition of the treatment laser light.
- the operator operates the 3D mouse 84 to set various irradiation conditions of the treatment laser light (for example, the currently set output value 134 ° of the treatment laser light) while looking through the eyepiece 36.
- the control unit 70 of the present embodiment is also a display control unit that controls display contents of the monitor 82 or the display 93.
- the control unit 70 can selectively drive each of the pair of protection filters 33 (33R, 33L).
- the control unit 70 irradiates the treatment laser light so as to form a pattern (one or a plurality of spots) of the treatment laser light on the target surface based on the setting of various parameters. I do. That is, the control unit 70 of the present embodiment is an irradiation control unit that controls irradiation of the treatment laser beam to the patient's eye E.
- the control unit 70 of the present embodiment controls the treatment laser light source 11 and also controls the scanning unit 50 based on the set pattern, so that the treatment laser is placed on the tissue of the patient's eye E (on the fundus Er) which is the target surface.
- the control unit 70 of this embodiment forms a pattern (one or a plurality of spots) of aiming light on the target surface using a pattern for treatment laser light.
- a pattern for treatment laser light For the pattern irradiation of the aiming light and the treatment laser light, refer to, for example, JP-A-2011-156290.
- status information 137 indicating whether or not irradiation of the treatment laser light is possible, the spot size value 133 of the treatment laser light currently set, the output value 134 of the treatment laser light currently set, and the treatment currently set.
- the irradiation time value 135 of the laser beam, the currently set irradiation pattern 131 of the treatment laser light, the currently set spot interval value 136 of the treatment laser light, and the like are displayed.
- the main screen of the present embodiment is in the form of a GUI (graphical user interface), and the operator can set laser irradiation conditions by touching elements (such as buttons) displayed on the main screen.
- FIG. 5 shows information displayed on the display 93 after the initial setting of the ophthalmic laser treatment apparatus 1.
- the display 93 displays reference information 120 for irradiating the treatment laser light and irradiation conditions 130 for the treatment laser light.
- the optical observation image 111a observation image
- the presentation information eg, an eye schematic diagram as a reference image
- the eyepiece 36 is viewed.
- the surgeon visually recognizes the composite image (superimposed image) as shown in FIG.
- FIG. 6 is an image in a state where the positioning of the observation optical system 30 with respect to the patient's eye E is completed.
- This embodiment is an example, and only the presentation information (the reference information 120 and the irradiation condition 130) may be guided to the operator's right eye, and only the observation image may be guided to the operator's left eye. That is, the composite image of FIG. 6 may be presented to the operator using the fusion image of the operator.
- the observation information 110 includes the optical observation image 111a (through observation image) generated by the observation optical system 30.
- the optical observation image 111a illustrated in FIG. 6 includes an illumination area 112 of the patient's eye E illuminated using the illumination optical system 60, a light-shielded area 113 of the patient's eye E not directly illuminated by the illumination light, and a patient's eye E. Includes reflected aiming light 115.
- the shape of the illumination area 112 or the light shielding area 113 is based on the shape of the slit plate 63 of the illumination optical system 60.
- the light shielding region 113 is indicated by hatching.
- the glare of the patient that is, the burden on the patient
- the thinner the slit the less the glare of the patient, but, on the other hand, the smaller the illumination area 112, and the more difficult it is to grasp which part of the patient's eye E is being observed.
- the burden on the patient and the grasp of the observation site tend to be in a trade-off relationship.
- the reference information 120 includes a reference image (an image related to the structure of the eye).
- FIGS. 5 and 6 show an eye schematic diagram 121 which is an image relating to the structure of the eye as an example of the reference image.
- the papillae and the retinal vascular arcade are drawn as black lines on the white base portion as characteristic portions.
- the fovea or macula may be included as the characteristic portion.
- an equatorial portion (equatorial position) of the fundus may be drawn.
- the schematic eye diagram 121 of the present embodiment may be called an illustration of the structure of the eye or a schematic diagram of the structure of the eye.
- the schematic eye diagram 121 of the present embodiment is an example, and for example, the base portion may be transparent (transmission).
- the above-described characteristic portion may be drawn in a raster format or in a vector format.
- the reference image may be, for example, other than a captured image of the patient's eye E or an analysis image of the patient's eye E.
- the captured image may be obtained by capturing an eye other than the patient's eye E with another device.
- the reference image (eye schematic diagram 121 in FIGS. 5 and 6) of the present embodiment is stored in the storage unit (nonvolatile memory 74) in advance when the ophthalmic laser treatment apparatus 1 is manufactured. Therefore, for example, the reference image can be used without importing the reference image into the ophthalmic laser treatment apparatus 1 at the operation site.
- the eye schematic diagram 121 and the photographed image 125 can be selectively presented as reference images.
- the left and right eye information 124 is further included as the reference information 120.
- the left and right eye information 124 of the present embodiment can be set on a reference setting screen described later.
- the displacement mechanism 8 includes a left and right eye detector, and the control unit 70 uses the output signal of the left and right eye detector to generate the left and right eye information 124. It may be set automatically. Until the setting on the later-described reference setting screen is completed, control may be performed so that the reference information 120 is not displayed on the display 93.
- use of the reference image may be prohibited (that is, display on the display 93 is prohibited) until the left and right eye information 124 is set by an operation by the operator or the left and right detectors described above.
- the reference image for the left eye is displayed during the observation of the right eye of the patient's eye E, and it is possible to suppress an event that the operator gets lost in the operation of aligning the observation optical system 30 with the right eye.
- a photographed image (actual photographed image) of the patient's eye E in which fundus bleeding has occurred is used as a reference image
- blood floating in the vitreous body may be reflected in the photographed image. Therefore, there may be a case where it is difficult to grasp the blood vessel running of the fundus even by looking at the photographed image.
- the floating position of the blood in the vitreous body is likely to be different between the time of imaging and the time of observation, the operator may be confused by referring to the reference image.
- the reference image It is highly possible that the image of the patient's eye E differs greatly from the observed image. In other words, the captured image (actual image) of the patient's eye E used as the reference image and the observed image of the patient's eye E actually observed may be different from each other, which may cause confusion for the operator.
- the reference image (the ophthalmic schematic diagram 121 and a real image 125 described later) of the present embodiment is an image having no direct relationship with the patient's eye E, for example, even the patient's eye E in which fundus bleeding has occurred The operator can easily align the observation optical system 30 (or aiming light).
- an operator who looks through the eyepiece 36 displays an observation image (optical observation image 111a) of the patient's eye E and a reference image (eye schematic diagram 121) that is different from the observation image.
- the surgeon observes the observation image while referring to the reference image (the schematic diagram of the eye 121), so that the observation optical system 30 for the patient's eye E can be observed, for example, even in an observation state using slit light with a small illumination area. It becomes easier to determine the alignment state.
- the observation image (optical observation image 111a) and the reference image (schematic eye diagram 121) are presented in the field of view looking through the eyepiece 36, the surgeon can refer without removing the eye from the eyepiece 36.
- An image (eye schematic diagram 121) can be confirmed.
- the reference image may be presented to the operator so that the optical observation image 111a and the reference image (the schematic diagram of the eye 121) do not overlap.
- the currently set irradiation pattern 131 of the treatment laser light the currently set treatment laser light type 132 (presented by the color of the selected wavelength), and the currently set treatment laser light.
- Current treatment laser light spot size value 133, currently set treatment laser light output value 134, currently set treatment laser light irradiation time value 135, currently set treatment laser light for pattern irradiation Are displayed, and status information 137 indicating whether or not the treatment laser beam can be irradiated is displayed.
- each element of the irradiation condition information 130 described above can be individually changed using the 3D mouse 84.
- the surgeon can change the irradiation condition of the treatment laser light without removing the eye from the eyepiece 36.
- the size of the currently presented reference image (the schematic diagram of the eye 121) may be changed by operating the 3D mouse 84 (operation means) by the operator. That is, the ophthalmic laser treatment apparatus 1 may include a change unit that changes the size of the reference image currently being presented.
- the size of the reference image can be reduced when staring at the observation image, and the reference image can be enlarged when staring at the reference image.
- the size of the reference image may increase for a predetermined time.
- a 3 ⁇ 3 pattern is displayed, but the display changes according to the set irradiation pattern 131.
- a pattern illustrated in FIG. 9 may be displayed as the irradiation pattern 131.
- the irradiation pattern 131 in FIG. 9 is a pattern suitable for treating a macula, for example.
- the irradiation pattern of FIG. 9 when the foot switch 81 is depressed for the first time, the pattern of the hatched spot group 131a is irradiated as treatment laser light.
- the remaining spot group 131b is divided, and pattern irradiation is performed such that each time the foot switch 81 is depressed, the spot group is rotated clockwise. That is, the irradiation pattern 131 of FIG.
- the pattern shown in FIG. 9 may be called an auto-forward pattern. Since all the spots to be irradiated are displayed as the irradiation pattern 131 in this manner, it becomes easier to determine the aiming light (state of the aiming light) reflected in the observation image. Therefore, it becomes easier to position the aiming light to the nearest treatment target site.
- the operator touches the reference button 142 when the setting of the laser irradiation conditions is completed.
- the control unit 70 switches the screen displayed on the monitor 82 from the main screen to the reference setting screen (see FIG. 7).
- the reference setting screen (see FIG. 7) of the present embodiment includes a reference image (eye schematic diagram 121), a main button 146, a live button 147, left and right eye information 124, a reference image selection button 143, and a template selection button 144. .
- the live button 147 and the template selection button 144 will be described later as modified examples.
- the operator can operate (touch) the location of the left and right eye information 124 to set whether the treatment target eye is the right eye or the left eye.
- the reference image eye schematic diagram 121 automatically changes based on the setting of the left and right eye information 124. For example, when the operator changes the setting of the left and right eye information 124 from the right eye to the left eye, the drawing of the schematic eye diagram 121 is mirror-reversed in the left and right direction.
- the reference image selection button 143 of the present embodiment is a display selection unit for selectively displaying the photographed image 125 or the eye schematic diagram 121 on the display 93.
- the reference image selection button 143 may be used to make a selection that can simultaneously present the photographed image 125 and the eye schematic diagram 121 to the operator.
- the ophthalmic schematic diagram 121 is stored in the storage unit (the non-volatile memory 74) in advance when the ophthalmic laser treatment apparatus 1 is manufactured.
- the photographed image 125 is imported into the ophthalmic laser treatment apparatus 1 via a wired LAN, a wireless LAN, a USB memory, or the like, using the data input / output unit 95 provided in the ophthalmic laser treatment apparatus 1.
- the eye schematic diagram 121 may be imported into the ophthalmic laser treatment apparatus 1 using the data input / output unit 95.
- the real image 125 of the present embodiment is an image obtained by photographing the patient's eye E using a device other than the observation optical system 30, that is, for example, the patient's eye E photographed by a device other than the ophthalmic laser treatment device 1 (for example, a fundus camera). It is a photographed image.
- a color fundus image, a fluorescent fundus image, a color anterior segment image, a fundus OCT image, an anterior segment OCT image, or the like may be used as the real image 125.
- a plurality of different eye schematic diagrams 121 may be stored in the non-volatile memory 74 and may be selectable by the surgeon.
- the reference image displayed on the reference setting screen (see FIG. 7) is switched from the eye schematic diagram 121 to the photographed image 125.
- the reference information 120 displayed on the display 93 changes based on the settings on the reference setting screen.
- the operator sets the status information 137 to irradiation enabled.
- the operation of the foot switch 81 becomes effective.
- the surgeon operates the joystick 9 while looking through the eyepiece 36 to adjust the position of the observation optical system 30 (laser irradiation optical system 40) with respect to the patient's eye E. More specifically, the surgeon performs positioning of the aiming light 115 (in other words, the laser irradiation optical system 40) to the part to be treated (the first part to be treated) while referring to the reference image (the schematic ocular diagram 121). .
- the operator depresses the foot switch 81 to irradiate the treatment laser beam. Subsequently, the operator aligns the aiming light with another part to be treated (the second part to be treated) and depresses the foot switch 81 to irradiate the treatment laser beam. In this way, the irradiation of the treatment laser beam is performed on one or a plurality of treatment target sites while changing the aiming position of the aiming light.
- FIGS. 10 to 12 show reference images of the modification example.
- a template 122 is superimposed (combined) on a schematic eye diagram 121.
- the control unit 70 has a function of an image processing unit that generates a combined image obtained by combining the eye image (the eye schematic diagram 121 or the real image 125) and the template 122.
- the template 122 according to the present embodiment is a graphic obtained by dividing a predetermined area (in other words, a segment map).
- the center of the template 122 corresponds to the fovea, and a region dividing line extends radially from the center of the template 122.
- a macular region, a region between the macula and a retinal vascular arcade, and the like are also divided.
- the operator can superimpose the template 122 on the eye image (the schematic eye image 121 or the photographed image 125).
- the plurality of templates 122 are stored in the storage unit (non-volatile memory 74) when the laser treatment apparatus for ophthalmology 1 is manufactured.
- the eye schematic diagram 121 is automatically changed according to the type of the template 122 (for example, trimming, simplification, and precision) so that the eye schematic diagram 121 in FIG. 10 is different from the eye schematic diagram 121 in FIG. Etc.).
- FIGS. 10 and 12 are examples of the template 122.
- the operator can select a template 122 suitable for the purpose of treatment from a plurality of templates 122 included in the ophthalmic laser treatment apparatus 1.
- the operator can set the treatment laser beam irradiation scheduled area 123 by touching (selecting) an arbitrary area (segment) on the selected template 122.
- the irradiation scheduled area 123 is wider than the irradiation area defined by the irradiation pattern 131. That is, in the present embodiment, the operator can use the template 122 to define the irradiation scheduled area with less work than arranging the plurality of irradiation patterns 131 on the schematic eye diagram 121. Therefore, it is possible to quickly shift to the start of the treatment laser beam.
- the irradiation scheduled area 123 is indicated by hatching. Note that a composite image obtained by compositing only the eye image (the eye schematic diagram 121 or the real image 125) and the scheduled irradiation region 123 may be displayed on the display 93.
- the operator may be able to set the irradiation prohibited area of the treatment laser light by using the template 122 (marking on the eye schematic diagram 121).
- the irradiation scheduled area 123 may be painted out with an arbitrary color corresponding to the wavelength of the treatment laser beam to be irradiated on the irradiation scheduled area 123.
- the irradiation scheduled area 123 may be filled with semi-transmission.
- the marking may be performed only as the irradiation scheduled area 123.
- the irradiation pattern 131 illustrated using FIG. 9 is superimposed on the schematic eye diagram 121.
- the arrangement of the irradiation pattern 131 on the eye schematic diagram 121 can be performed on the reference setting screen (see FIG. 7).
- the irradiation pattern 131 that can be superimposed on the schematic eye diagram 121 can be arbitrarily determined.
- the number of irradiation patterns 131 that can be superimposed on the schematic eye diagram 121 is not limited to one.
- Arbitrary irradiation patterns may be arranged at a plurality of positions on the schematic eye diagram 121, respectively.
- a graphic representing a coagulation spot may be superimposed on the ocular schematic diagram 121.
- the eye schematic diagram 121 is used as the base image, but a real image 125 may be used.
- FIG. 14 is a live image displayed on the monitor 82.
- the description of the same reference numerals in FIGS. 6 and 14 is omitted.
- the optical observation image 111a is used as the observation image in the composite image shown in FIG. 6
- the electronic observation image 111b is used as the observation image in the live image shown in FIG.
- the electronic observation image 111b in FIG. 14 is a moving image.
- the electron observation image 111b is obtained using the light receiving element 39.
- the control unit 70 combines the electronic observation image 111b and the presentation information (reference information 120, irradiation condition information 130) in a manner similar to the combined image shown in FIG.
- the monitor 82 of the present embodiment is a third presenting unit for presenting information regarding the treatment (the electronic observation image 111b, the reference image, and the like) to the operator.
- the layout relationship among the observation information 110, the reference information 120, and the irradiation condition information 130 is the same between the composite image and the live image shown in FIG.
- the operator can easily confirm or change the irradiation condition information 130 quickly.
- the positional relationship between the observation image and the reference information 120 be the same in the irradiation condition information 130 between the first observation method that looks at the eyepiece 36 and the second observation method that looks at the monitor 82.
- the positional relationship between the observation image and the reference information 120 may differ depending on the observation method. For example, in a live image using the monitor 82, the reference information 120 may be arranged outside the electronic observation image 111b.
- the display on the monitor 82 is switched from the main screen to the live screen (see FIG. 14).
- the display on the monitor 82 switches from the live screen to the main screen.
- a synthetic image is presented to the surgeon looking through the eyepiece 36.
- the layout relationship between the observation information 110, the reference information 120, and the irradiation condition information 130 is substantially the same between the live screen and the composite image shown in FIG. Even when switching from the observation method of looking through the lens 36 to the observation method of looking at the monitor 82, it is easy to observe without discomfort.
- an observation method of looking through the eyepiece 36 may be employed, and otherwise, an observation method using a live screen (the monitor 82) may be employed.
- the degree of freedom of the posture of the operator is increased, so that the burden on the operator during treatment is reduced.
- the contact lens CL is easily applied to the patient's eye E. Since the image 35R 'of the field stop 35 is not reflected in the electron observation image 111b, the controller 70 may superimpose an electronic mask imitating the field stop 35 on the electron observation image 111b by image processing.
- the electronic mask is used so that the combined image using the optical observation image 111a illustrated using FIG. 6 and the combined image using the electronic observation image 111b illustrated using FIG. May be used.
- the ophthalmic laser treatment apparatus 1 of the present disclosure includes the laser irradiation optical system 40 for irradiating the treatment eye to the patient's eye E and the illumination optical system for illuminating the patient's eye E with the slit light. 60, an observation optical system 30 for obtaining an observation image of the patient's eye E illuminated by the slit light, a display unit 90 for displaying an eye schematic diagram 121, and an observation image and the eye schematic diagram 121 to an operator. There are provided presentation means for presenting, and display control means for displaying the eye schematic diagram 121 on the display unit 90.
- irradiation of the treatment laser beam is preferably performed using the observation image of the patient's eye E and the eye schematic diagram 121 without acquiring a captured image (actual image 125) of the patient's eye E captured by another device. Can be done.
- the ophthalmic laser treatment apparatus is provided in the observation optical system 30 and includes the eyepiece 36 for observing the optical observation image 111a, and the display unit 90 is provided in the observation optical system 30.
- the observation optical system 30 further includes a synthesizing unit for synthesizing the optical observation image and the eye schematic diagram.
- the observation optical system 30 further includes a synthesizing unit for synthesizing the optical observation image and the eye schematic diagram.
- the ophthalmic laser treatment apparatus of the present embodiment is provided in the observation optical system 30 and includes a light receiving element 39 for obtaining an electronic observation image 111b of the patient's eye E, and the display control means displays the electronic observation image 111b on the display unit 90. And the eye schematic diagram 121 are displayed at the same time.
- the posture of the surgeon has a margin, the frequency of irradiation of the treatment laser beam is large, and the surgeon is hardly tired even if the treatment time is prolonged.
- the ophthalmic laser treatment apparatus of the present embodiment has an acquisition unit for acquiring a real image 125 of the patient's eye E photographed using an optical system different from the observation optical system 30, and an eye schematic diagram on the display unit 90.
- a display selection unit for selectively displaying the image 121 and the photographed image 125 is provided. Thereby, for example, when the photographed image 125 of the patient's eye E already exists, irradiation of the treatment laser beam using the observation image and the photographed image 125 is performed, and when the photographed image 125 of the patient's eye E does not exist, the observation image is displayed. Irradiation of treatment laser light using the schematic ocular diagram 121 may be performed. That is, the treatment can be performed promptly without depending on the presence or absence of the real image 125.
- the ophthalmic laser treatment apparatus includes a template 122 for selectively determining an irradiation scheduled region 123 of the treatment laser beam, and an image processing for generating a composite image of the eye schematic diagram 121 and the template 122.
- the display control means can display the composite image on the display unit 90.
- the surgeon can determine the irradiation scheduled area by a simple operation using the template, and the determined irradiation scheduled area is presented to the operator, thereby enabling prompt treatment.
- the ophthalmic laser treatment apparatus 1 of the present embodiment is an example.
- an ocular unit (the erecting prism group 34, the field stop 35, and the ocular lens 36) for an operator to look into and observe is used. It is not necessary to prepare. That is, the technology of the present disclosure may be applied to an ophthalmic laser treatment apparatus that presents an observation image to the patient's eye E only by combining an observation image using a light receiving element and a display unit that does not pass through an eyepiece.
- the ophthalmic laser treatment apparatus 1 that photocoagulates the affected part of the fundus Er of the patient's eye E is used as an example of the ophthalmic laser treatment apparatus.
- the application of the present disclosure is not limited to the photocoagulation device.
- the technology of the present disclosure may be applied to an ophthalmic laser treatment apparatus that treats a secondary cataract by irradiating a patient's eye E with treatment laser light.
- the technology of the present disclosure may be applied to another ophthalmic laser treatment apparatus that observes a patient's eye and performs treatment using treatment laser light.
- the technology of the present disclosure is more preferably applied to an ophthalmic laser treatment apparatus that uses slit light as illumination light for observation.
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Abstract
This ophthalmic laser treatment apparatus which irradiates an affected site in a patient's eye with a therapeutic laser beam is provided with: a laser irradiation optical system for irradiating the patient's eye with a therapeutic laser beam; an illumination optical system for illuminating the patient's eye with slit light; an observation optical system for obtaining an observation image of the patient's eye illuminated with the slit light; a display unit for displaying an ophthalmic diagram; a presentation means for presenting the observation image and the ophthalmic diagram to a practitioner; and a display control means for displaying the ophthalmic diagram on the display unit. The ophthalmic laser treatment apparatus is further provided with an eyepiece lens which is provided to the observation optical system and which is for observing the observation image; meanwhile, the display unit is disposed in the observation optical system. The observation image is an optical observation image of the patient's eye. There is also provided a synthesis means which is provided to the observation optical system so as to synthesize the optical observation image and the ophthalmic diagram.
Description
本開示は、患者眼の患部に治療レーザ光を照射する眼科用レーザ治療装置に関する。
The present disclosure relates to an ophthalmic laser treatment apparatus that irradiates a treatment laser beam to an affected part of a patient's eye.
治療レーザ光の照射条件に関するパラメータを、観察視野内に表示するレーザ治療装置が知られている(例えば特許文献1)。また患者眼の広域画像と患者眼のスリット撮影画像とを合成するレーザ治療装置が知られている(例えば特許文献2)。
(2) There is known a laser treatment apparatus that displays parameters related to irradiation conditions of treatment laser light in an observation field (for example, Patent Document 1). Also, a laser treatment apparatus that synthesizes a wide-area image of a patient's eye and a slit photographed image of the patient's eye is known (for example, Patent Document 2).
しかし特許文献1のレーザ治療装置では、観察光学系で得られる観察像以外の情報は、治療レーザ光の照射条件に関する文字情報に限られていた。従って治療予定部位への装置の位置合わせに手間取る可能性があった。また特許文献2のレーザ治療装置は、合成画像の生成に利用する患者眼(治療対象)の広域画像を取得するため、レーザ治療装置のネットワークへの接続、記録媒体への患者眼の広域画像の保存、又はレーザ治療装置が他のモダリティ(例えば眼底カメラ)の少なくとも一部を備えることが必須であった。つまり、特許文献2のレーザ治療装置は、治療を開始する前に広域画像用の撮影が行われていることが前提であった。従って、広域画像を用意するための撮影、広域画像を用いた治療の順で作業が行われ、手術が長引く可能性があった。
However, in the laser treatment apparatus disclosed in Patent Document 1, information other than the observation image obtained by the observation optical system is limited to character information on irradiation conditions of the treatment laser light. Therefore, there is a possibility that it takes time to align the device with the site to be treated. In addition, the laser treatment apparatus disclosed in Patent Literature 2 connects the laser treatment apparatus to a network and acquires a wide-area image of the patient's eye on a recording medium in order to acquire a wide-area image of a patient's eye (treatment target) used for generating a composite image. It was imperative that the storage or laser treatment device include at least a portion of another modality (eg, a fundus camera). In other words, the laser treatment apparatus disclosed in Patent Literature 2 is based on the premise that wide-area imaging is performed before the treatment is started. Therefore, work is performed in the order of imaging for preparing a wide-area image and treatment using the wide-area image, and there is a possibility that the operation is prolonged.
そこで、本開示は患者眼の観察中に患者眼の撮影画像とは異なる参照画像を術者に呈示することで、治療レーザ光の照射を好適に行える眼科用レーザ治療装置を提供することを目的とする。
Therefore, an object of the present disclosure is to provide an ophthalmic laser treatment apparatus that can appropriately perform treatment laser beam irradiation by presenting a reference image different from a captured image of a patient's eye to an operator during observation of the patient's eye. And
上記課題を解決するために、本開示は以下のような構成を備えることを特徴とする。
(1)患者眼の患部に治療レーザ光を照射する眼科用レーザ治療装置は、患者眼に治療レーザ光を照射するためのレーザ照射光学系と、前記患者眼をスリット光で照明するための照明光学系と、前記スリット光で照明された前記患者眼の観察像を得るための観察光学系と、眼模式図を表示するための表示部と、前記観察像と前記眼模式図を術者に呈示するための呈示手段と、前記表示部に前記眼模式図を表示するための表示制御手段と、を備えることを特徴とする。 In order to solve the above problem, the present disclosure is characterized by including the following configuration.
(1) An ophthalmic laser treatment apparatus for irradiating a treatment laser beam to an affected part of a patient's eye is a laser irradiation optical system for irradiating a treatment laser beam to a patient's eye, and an illumination for illuminating the patient's eye with slit light. An optical system, an observation optical system for obtaining an observation image of the patient's eye illuminated with the slit light, a display unit for displaying an eye schematic diagram, and an operator displaying the observation image and the eye schematic diagram to an operator. It is characterized by comprising presentation means for presenting, and display control means for displaying the eye schematic diagram on the display unit.
(1)患者眼の患部に治療レーザ光を照射する眼科用レーザ治療装置は、患者眼に治療レーザ光を照射するためのレーザ照射光学系と、前記患者眼をスリット光で照明するための照明光学系と、前記スリット光で照明された前記患者眼の観察像を得るための観察光学系と、眼模式図を表示するための表示部と、前記観察像と前記眼模式図を術者に呈示するための呈示手段と、前記表示部に前記眼模式図を表示するための表示制御手段と、を備えることを特徴とする。 In order to solve the above problem, the present disclosure is characterized by including the following configuration.
(1) An ophthalmic laser treatment apparatus for irradiating a treatment laser beam to an affected part of a patient's eye is a laser irradiation optical system for irradiating a treatment laser beam to a patient's eye, and an illumination for illuminating the patient's eye with slit light. An optical system, an observation optical system for obtaining an observation image of the patient's eye illuminated with the slit light, a display unit for displaying an eye schematic diagram, and an operator displaying the observation image and the eye schematic diagram to an operator. It is characterized by comprising presentation means for presenting, and display control means for displaying the eye schematic diagram on the display unit.
本開示の眼科用レーザ治療装置によれば、患者眼の観察中に患者眼の撮影画像とは異なる参照画像が術者に呈示されるため、治療レーザ光の照射を好適に行える。
According to the ophthalmic laser treatment apparatus of the present disclosure, a reference image different from the photographed image of the patient's eye is presented to the operator during observation of the patient's eye, so that irradiation of the treatment laser light can be performed appropriately.
以下、本開示における典型的な実施形態を図面に基づいて説明する。本実施形態の眼科用レーザ治療装置1は、患者眼Eに治療レーザ光を照射して、患者眼Eの治療等を行なえる。
Hereinafter, typical embodiments of the present disclosure will be described with reference to the drawings. The ophthalmic laser treatment apparatus 1 of the present embodiment can perform treatment of the patient's eye E by irradiating the patient's eye E with treatment laser light.
図1~3を用いて説明する。本実施形態の眼科用レーザ治療装置1は、デリバリー部2、レーザ光源ユニット10、及び光ファイバー20を備える。デリバリー部2はレーザ照射光学系40(図2参照)を含む。レーザ光源ユニット10は治療レーザ光源11(図2参照)を含む。本実施形態では、デリバリー部2とレーザ光源ユニット10が光ファイバー20等で接続されている。レーザ光源ユニット10の筐体内には制御部70(図2参照)が収容されている。レーザ光源ユニット10には、操作ユニット80、フットスイッチ81、3Dマウス84等が接続されている。
説明 This will be described with reference to FIGS. The ophthalmic laser treatment apparatus 1 of the present embodiment includes a delivery unit 2, a laser light source unit 10, and an optical fiber 20. The delivery section 2 includes a laser irradiation optical system 40 (see FIG. 2). The laser light source unit 10 includes a treatment laser light source 11 (see FIG. 2). In the present embodiment, the delivery unit 2 and the laser light source unit 10 are connected by an optical fiber 20 or the like. A control unit 70 (see FIG. 2) is housed in the housing of the laser light source unit 10. An operation unit 80, a foot switch 81, a 3D mouse 84, and the like are connected to the laser light source unit 10.
本実施形態の眼科用レーザ治療装置1は更に、細隙灯顕微鏡部3(スリットランプ)とテーブル部4を備える。細隙灯顕微鏡部3は観察光学系30と照明光学系60を含む(図2参照)。細隙灯顕微鏡部3は本体部5を備え、デリバリー部2は本体部5に接続(合体)される。テーブル部4は、デリバリー部2が接続された本体部5を載置する。なお、眼科用レーザ治療装置1の態様は本開示に限るものでは無い。例えば、細隙灯顕微鏡部3とデリバリー部2とレーザ光源ユニット10とが一体化されていてもよい。また例えば、デリバリー部2と細隙灯顕微鏡部3が一体化されていてもよい。
眼 The ophthalmic laser treatment apparatus 1 of the present embodiment further includes a slit lamp microscope unit 3 (slit lamp) and a table unit 4. The slit lamp microscope unit 3 includes an observation optical system 30 and an illumination optical system 60 (see FIG. 2). The slit lamp microscope section 3 includes a main body section 5, and the delivery section 2 is connected to (combined with) the main body section 5. The table section 4 places the main body section 5 to which the delivery section 2 is connected. Note that the aspect of the ophthalmic laser treatment apparatus 1 is not limited to the present disclosure. For example, the slit lamp microscope unit 3, the delivery unit 2, and the laser light source unit 10 may be integrated. Further, for example, the delivery unit 2 and the slit lamp microscope unit 3 may be integrated.
本実施形態の細隙灯顕微鏡部3は、本体部5とヘッドレスト部22を備える。本体部5は、顕微鏡部7、照明部6、ジョイスティック部9、及び変位機構8を備える。顕微鏡部7には術者が覗くための接眼レンズ36が含まれる。観察光学系30(図2参照)は顕微鏡部7に収容される。照明光学系60(図2参照)は照明部6に収容される。変位機構8は変位手段であり、テーブル部4上に載置された本体部5(レーザ照射光学系40等)を、上下方向(図1ではY方向)、左右方向(図1ではX方向)、又は前後方向(図1ではZ方向)に移動できる。変位機構8は更に、上下方向に伸びる軸を回動中心として、観察光学系30を水平方向に回動できる。術者はジョイスティック部9を操作して、本体部5を上下方向、左右方向、又は前後方向に移動できる。
隙 The slit lamp microscope section 3 of the present embodiment includes the main body section 5 and the headrest section 22. The main body unit 5 includes a microscope unit 7, an illumination unit 6, a joystick unit 9, and a displacement mechanism 8. The microscope section 7 includes an eyepiece 36 for an operator to look through. The observation optical system 30 (see FIG. 2) is housed in the microscope unit 7. The illumination optical system 60 (see FIG. 2) is housed in the illumination unit 6. The displacement mechanism 8 is a displacement means, and moves the main body 5 (laser irradiation optical system 40 and the like) placed on the table 4 in a vertical direction (Y direction in FIG. 1) and a horizontal direction (X direction in FIG. 1). Or in the front-back direction (Z direction in FIG. 1). Further, the displacement mechanism 8 can rotate the observation optical system 30 in the horizontal direction about the axis extending in the vertical direction as the rotation center. The surgeon can operate the joystick 9 to move the main body 5 in the up-down direction, the left-right direction, or the front-back direction.
<レーザ光源ユニット>
本実施形態のレーザ光源ユニット10は、治療レーザ光を出射する治療レーザ光源11(図2参照)、可視の照準レーザ光(以降では照準光と呼ぶ)を出射する照準光源12、治療レーザ光と照準光を合波するビームスプリッタ13(コンバイナ)、及び集光レンズ14を備える。治療レーザ光源11は、治療目的に応じた異なる波長のレーザ光を出射できる。本実施形態の治療レーザ光源11は、レーザ光のエネルギーを眼底Erが吸収するように、可視域の波長(例えば、532nm(緑色)、577nm(黄色)、647nm(黄色)等)のレーザ光を出射できる。本実施形態では制御部70が治療レーザ光源11を制御することで、3種類(緑色/黄色/赤色)の治療レーザ光のいずれかを、治療レーザ光源11から選択的に出射できる。なお本実施形態は一例であり、例えば治療レーザ光源11が1種類の治療レーザ光のみを出射できてもよいし、赤外域の波長の治療レーザ光を出射できてもよい。 <Laser light source unit>
The laserlight source unit 10 of this embodiment includes a treatment laser light source 11 (see FIG. 2) for emitting treatment laser light, an aiming light source 12 for emitting visible aiming laser light (hereinafter referred to as aiming light), and a treatment laser light. It includes a beam splitter 13 (combiner) that combines aiming light and a condenser lens 14. The treatment laser light source 11 can emit laser beams having different wavelengths according to the purpose of treatment. The treatment laser light source 11 of the present embodiment emits laser light of a wavelength in a visible region (for example, 532 nm (green), 577 nm (yellow), 647 nm (yellow), etc. so that the fundus Er absorbs the energy of the laser light. Can be emitted. In the present embodiment, by controlling the treatment laser light source 11 by the control unit 70, any one of three types (green / yellow / red) of treatment laser light can be selectively emitted from the treatment laser light source 11. Note that the present embodiment is an example, and for example, the treatment laser light source 11 may be able to emit only one kind of treatment laser light, or may be capable of emitting treatment laser light having a wavelength in the infrared region.
本実施形態のレーザ光源ユニット10は、治療レーザ光を出射する治療レーザ光源11(図2参照)、可視の照準レーザ光(以降では照準光と呼ぶ)を出射する照準光源12、治療レーザ光と照準光を合波するビームスプリッタ13(コンバイナ)、及び集光レンズ14を備える。治療レーザ光源11は、治療目的に応じた異なる波長のレーザ光を出射できる。本実施形態の治療レーザ光源11は、レーザ光のエネルギーを眼底Erが吸収するように、可視域の波長(例えば、532nm(緑色)、577nm(黄色)、647nm(黄色)等)のレーザ光を出射できる。本実施形態では制御部70が治療レーザ光源11を制御することで、3種類(緑色/黄色/赤色)の治療レーザ光のいずれかを、治療レーザ光源11から選択的に出射できる。なお本実施形態は一例であり、例えば治療レーザ光源11が1種類の治療レーザ光のみを出射できてもよいし、赤外域の波長の治療レーザ光を出射できてもよい。 <Laser light source unit>
The laser
照準光源12は、治療レーザ光の照射予定位置を術者に認識させるための照準光を出射する。本実施形態では、患者眼Eで反射した照準光を術者が肉眼で視認できるように、照準光の波長は可視域とされている。治療レーザ光とは異なる波長を、照準光として用いてもよい。例えば照準光の波長として、波長670nm(赤色)を用いてもよい。照準光源12として例えば、赤色のレーザ光を出射するレーザダイオード(LD)を用いてもよい。
The aiming light source 12 emits aiming light for causing the operator to recognize the irradiation position of the treatment laser light. In the present embodiment, the wavelength of the aiming light is in the visible range so that the operator can visually recognize the aiming light reflected by the patient's eye E with the naked eye. A different wavelength from the treatment laser light may be used as the aiming light. For example, a wavelength of 670 nm (red) may be used as the wavelength of the aiming light. For example, a laser diode (LD) that emits red laser light may be used as the aiming light source 12.
本実施形態のビームスプリッタ13は、治療レーザ光源11が出射する治療レーザ光の大部分を反射し、照準光源12が出射する照準光の一部を透過する。ビームスプリッタ13で合波されたレーザ光は集光レンズ14で集光され、光ファイバー20の入射端面に入射する。治療レーザ光源11とビームスプリッタ13の間には、治療レーザ光を遮断するためのシャッター15が設けられている。照準光又は治療レーザ光が導光される光路には、シャッター16が設けられている。本実施形態のシャッター16は、眼科用レーザ治療装置1の異常時に閉じられる安全シャッターである。
The beam splitter 13 of the present embodiment reflects most of the treatment laser light emitted from the treatment laser light source 11 and transmits part of the aiming light emitted from the aiming light source 12. The laser light multiplexed by the beam splitter 13 is condensed by the condenser lens 14 and is incident on the incident end face of the optical fiber 20. Between the treatment laser light source 11 and the beam splitter 13, a shutter 15 for blocking treatment laser light is provided. A shutter 16 is provided in an optical path through which the aiming light or the treatment laser light is guided. The shutter 16 of the present embodiment is a safety shutter that is closed when an abnormality occurs in the ophthalmic laser treatment apparatus 1.
<レーザ照射光学系>
次いで本実施形態のレーザ照射光学系40を説明する。本実施形態のレーザ照射光学系40(照射手段)は光軸L2を備え、治療レーザ光源11から出射される治療レーザ光を患者眼Eに照射するために用いられる。本実施形態では、治療レーザ光と照準光とでレーザ照射光学系40を共用する。本実施形態のレーザ照射光学系40は、所定のパターンに基づく照準光のスポットを、患者眼Eの組織上に形成するための照準光学系とも言える。本説明では便宜上、前述した所定のパターンにシングルスポット(単発照射)を含めている。 <Laser irradiation optical system>
Next, the laser irradiationoptical system 40 of the present embodiment will be described. The laser irradiation optical system 40 (irradiation means) of the present embodiment has an optical axis L2, and is used to irradiate the treatment laser light emitted from the treatment laser light source 11 to the patient's eye E. In the present embodiment, the laser irradiation optical system 40 is shared by the treatment laser light and the aiming light. The laser irradiation optical system 40 of the present embodiment can also be said to be an aiming optical system for forming a spot of aiming light based on a predetermined pattern on the tissue of the patient's eye E. In this description, for the sake of convenience, the above-mentioned predetermined pattern includes a single spot (single-shot irradiation).
次いで本実施形態のレーザ照射光学系40を説明する。本実施形態のレーザ照射光学系40(照射手段)は光軸L2を備え、治療レーザ光源11から出射される治療レーザ光を患者眼Eに照射するために用いられる。本実施形態では、治療レーザ光と照準光とでレーザ照射光学系40を共用する。本実施形態のレーザ照射光学系40は、所定のパターンに基づく照準光のスポットを、患者眼Eの組織上に形成するための照準光学系とも言える。本説明では便宜上、前述した所定のパターンにシングルスポット(単発照射)を含めている。 <Laser irradiation optical system>
Next, the laser irradiation
以降では治療レーザ光に対して説明するが、照準光も同様である。光ファイバー20の出射端面から出射される治療レーザ光は、レンズ41、ズームレンズ42、ミラー43の順で介した後、走査部50(走査手段)、対物レンズ46、反射ミラー49、コンタクトレンズCLを経て治療部位に照射される。ズームレンズ42はレーザ光のスポットサイズを変更するためのスポットサイズ変更手段である。ズームレンズ42は光軸方向に移動可能である。本実施形態ではコンタクトレンズCLは術者が把持する。
(4) Although the treatment laser light will be described below, the same applies to the aiming light. The treatment laser light emitted from the emission end face of the optical fiber 20 passes through the lens 41, the zoom lens 42, and the mirror 43 in this order, and then passes through the scanning unit 50 (scanning means), the objective lens 46, the reflection mirror 49, and the contact lens CL. It is then irradiated to the treatment site. The zoom lens 42 is a spot size changing unit for changing the spot size of the laser beam. The zoom lens 42 is movable in the optical axis direction. In the present embodiment, the operator holds the contact lens CL.
本実施形態の走査部50はレーザ照射光学系40に設けられる。走査部50は、治療レーザ光のスポット(照射位置)を患者眼Eの組織上(眼底Er上)で2次元的に走査するために用いられる。本実施形態の走査部50は、レーザ光の照射位置(照射方向)を2次元的に移動させる走査光学系である。本実施形態の走査部50はスキャナミラーを備える。本実施形態の走査部50は、ガルバノミラー51(第1ガルバノミラー)とガルバノミラー55(第2ガルバノミラー)を備える。ガルバノミラーをガルバノスキャナと換言してもよい。本実施形態ではガルバノミラー51とガルバノミラー55の各々は、レーザ光を反射するミラーとアクチュエータとを備える。アクチュエータは、ミラーを駆動(回動)する駆動部である。なお走査部50については、例えば特開2011-156290号公報を参照されたし。
走 査 The scanning unit 50 of the present embodiment is provided in the laser irradiation optical system 40. The scanning unit 50 is used to two-dimensionally scan the spot (irradiation position) of the treatment laser beam on the tissue of the patient's eye E (on the fundus Er). The scanning unit 50 of the present embodiment is a scanning optical system that two-dimensionally moves the irradiation position (irradiation direction) of the laser light. The scanning unit 50 of the present embodiment includes a scanner mirror. The scanning unit 50 of the present embodiment includes a galvanometer mirror 51 (first galvanometer mirror) and a galvanometer mirror 55 (second galvanometer mirror). The galvanometer mirror may be referred to as a galvanometer scanner. In the present embodiment, each of the galvanometer mirror 51 and the galvanometer mirror 55 includes a mirror that reflects laser light and an actuator. The actuator is a driving unit that drives (rotates) the mirror. For the scanning unit 50, for example, JP-A-2011-156290 has been referred to.
本実施形態では、レーザ照射光学系40の各光学素子を通った治療レーザ光は、反射ミラー49で反射された後、コンタクトレンズCLを介してターゲット面である患者眼Eの組織(眼底Er)に照射される。ズームレンズ42は、不図示のレンズカムで保持されている。レンズカムが回転すると、各ズームレンズ42は光軸方向に移動する。ズームレンズ42の位置は、レンズカムに取り付けられたエンコーダ42aで検出できる。本実施形態の制御部70は、各レンズの位置情報(検出信号)をエンコーダ42aから受け取り、治療レーザ光のスポットサイズを取得できる。詳細は後述するが、治療レーザ光のスポットがターゲット面で2次元のパターンとして形成されるように、走査部50は制御部70からの指令信号に基づいて制御される。図示は略すが、本実施形態の反射ミラー49は、術者の操作により、レーザ光の光軸L2を2次元的に傾斜させる機構を備える。
In the present embodiment, the treatment laser light that has passed through each optical element of the laser irradiation optical system 40 is reflected by the reflection mirror 49, and then, through the contact lens CL, the tissue (the fundus Er) of the patient's eye E, which is the target surface. Is irradiated. The zoom lens 42 is held by a lens cam (not shown). When the lens cam rotates, each zoom lens 42 moves in the optical axis direction. The position of the zoom lens 42 can be detected by an encoder 42a attached to the lens cam. The control unit 70 of the present embodiment can receive the position information (detection signal) of each lens from the encoder 42a and acquire the spot size of the treatment laser beam. Although details will be described later, the scanning unit 50 is controlled based on a command signal from the control unit 70 so that the spot of the treatment laser beam is formed as a two-dimensional pattern on the target surface. Although not shown, the reflection mirror 49 of the present embodiment includes a mechanism for inclining the optical axis L2 of the laser beam two-dimensionally by the operation of the operator.
本実施形態の制御部70は、走査部50の駆動開始、走査部50の駆動停止、治療レーザ光源11からの治療レーザ光の照射開始、治療レーザ光源11からの治療レーザ光の照射停止、の順を繰り返して、患者眼Eの組織上に所定パターンのスポットを形成できる。つまり、本実施形態の制御部70は、走査部50の駆動と治療レーザ光の照射とを制御して、治療レーザ光のパターン照射を行う。換言するなら、本実施形態の眼科用レーザ治療装置1は、レーザ照射光学系40と走査部50を用いて、所定パターンのスポットを形成するパターン照射手段を有する。本実施形態では、スポットを構成する各スポットは分離している。しかし、各スポット同士が連結されていてもよい。前述したように、本実施形態のパターン照射手段は、照準光に対しても、所定パターンのスポットを形成できる。術者は観察光学系30と照準光を用いて、治療レーザ光の照射開始前に、治療レーザ光の照射予定部位を把握できる。なお本開示は一例であり、眼科用レーザ治療装置1がパターン照射手段を備えなくてもよい。
The control unit 70 according to the present embodiment includes: starting driving of the scanning unit 50, stopping driving of the scanning unit 50, starting irradiation of the treatment laser light from the treatment laser light source 11, and stopping irradiation of the treatment laser light from the treatment laser light source 11. By repeating the order, spots of a predetermined pattern can be formed on the tissue of the patient's eye E. That is, the control unit 70 of the present embodiment controls the driving of the scanning unit 50 and the irradiation of the treatment laser light, and performs pattern irradiation of the treatment laser light. In other words, the ophthalmic laser treatment apparatus 1 of the present embodiment has a pattern irradiation unit that forms a spot of a predetermined pattern using the laser irradiation optical system 40 and the scanning unit 50. In the present embodiment, each spot constituting the spot is separated. However, the spots may be connected to each other. As described above, the pattern irradiation unit of the present embodiment can form a spot of a predetermined pattern even for aiming light. Using the observation optical system 30 and the aiming light, the surgeon can grasp the irradiation site of the treatment laser light before the start of the treatment laser light irradiation. The present disclosure is an example, and the ophthalmic laser treatment apparatus 1 may not include the pattern irradiation unit.
<観察光学系>
本実施形態の観察光学系30は患者眼Eを観察するための観察手段であり、光軸L3を備える。なお本実施形態の観察光学系30は、術者の右眼EoRに観察像を呈示するための光軸L3Rと、術者の左眼EoLに観察像を呈示するための光軸L3Lとを備える。本実施形態の観察光学系30を双眼鏡と呼んでもよい。本実施形態の観察光学系30は、対物レンズ31、変倍光学系32(32R,32L)、保護フィルタ33(33R,33L)、ハーフミラー37、正立プリズム群34(34R,34L)、視野絞り35(35R,35L)、接眼レンズ36(36R,36L)等を備える。術者は接眼レンズ36を覗いて、患者眼Eの観察部位、照準光のスポット(換言するなら照準光が患者眼Eで反射した反射光(戻り光))等を確認できる。なお本実施形態では、対物レンズ31の先に設けられる観察面(物体面)と装置内部に配置されている視野絞り35とが対物レンズ31を介して光学的に共役な位置関係にある。つまり視野絞り35の位置で、患者眼Eの観察像が空中像として結像される。なお以降の説明では、観察光学系30を通過する観察光で形成される観察像のことを光学観察像111a(又はスルー観察像)と呼ぶことがある。光学観察像111aを換言するなら、受光素子を用いず観察光学系30にて生成されるタイムラグの無き観察像である。なお、ハーフミラー37よりも下流の観察光学系30を、治療に関する情報(患者眼Eの光学観察像111a)を術者に呈示するための呈示光学系(第1呈示光学系又は第1呈示手段)と呼んでもよい。 <Observation optical system>
The observationoptical system 30 of the present embodiment is observation means for observing the patient's eye E, and includes an optical axis L3. The observation optical system 30 of the present embodiment includes an optical axis L3R for presenting an observation image to the operator's right eye EoR and an optical axis L3L for presenting an observation image to the operator's left eye EoL. . The observation optical system 30 of the present embodiment may be called binoculars. The observation optical system 30 of the present embodiment includes an objective lens 31, a variable power optical system 32 (32R, 32L), a protection filter 33 (33R, 33L), a half mirror 37, an erecting prism group 34 (34R, 34L), a field of view. An aperture 35 (35R, 35L), an eyepiece 36 (36R, 36L) and the like are provided. The surgeon can look into the eyepiece 36 to check the observation site of the patient's eye E, the spot of the aiming light (in other words, the reflected light (return light) where the aiming light is reflected by the patient's eye E), and the like. In the present embodiment, the observation surface (object surface) provided at the front of the objective lens 31 and the field stop 35 disposed inside the apparatus have an optically conjugate positional relationship via the objective lens 31. That is, at the position of the field stop 35, the observation image of the patient's eye E is formed as an aerial image. In the following description, an observation image formed by observation light passing through the observation optical system 30 may be referred to as an optical observation image 111a (or a through observation image). In other words, the optical observation image 111a is an observation image with no time lag generated by the observation optical system 30 without using the light receiving element. It should be noted that the observation optical system 30 downstream of the half mirror 37 is provided with a presentation optical system (first presentation optical system or first presentation means) for presenting information on treatment (the optical observation image 111a of the patient's eye E) to the operator. ).
本実施形態の観察光学系30は患者眼Eを観察するための観察手段であり、光軸L3を備える。なお本実施形態の観察光学系30は、術者の右眼EoRに観察像を呈示するための光軸L3Rと、術者の左眼EoLに観察像を呈示するための光軸L3Lとを備える。本実施形態の観察光学系30を双眼鏡と呼んでもよい。本実施形態の観察光学系30は、対物レンズ31、変倍光学系32(32R,32L)、保護フィルタ33(33R,33L)、ハーフミラー37、正立プリズム群34(34R,34L)、視野絞り35(35R,35L)、接眼レンズ36(36R,36L)等を備える。術者は接眼レンズ36を覗いて、患者眼Eの観察部位、照準光のスポット(換言するなら照準光が患者眼Eで反射した反射光(戻り光))等を確認できる。なお本実施形態では、対物レンズ31の先に設けられる観察面(物体面)と装置内部に配置されている視野絞り35とが対物レンズ31を介して光学的に共役な位置関係にある。つまり視野絞り35の位置で、患者眼Eの観察像が空中像として結像される。なお以降の説明では、観察光学系30を通過する観察光で形成される観察像のことを光学観察像111a(又はスルー観察像)と呼ぶことがある。光学観察像111aを換言するなら、受光素子を用いず観察光学系30にて生成されるタイムラグの無き観察像である。なお、ハーフミラー37よりも下流の観察光学系30を、治療に関する情報(患者眼Eの光学観察像111a)を術者に呈示するための呈示光学系(第1呈示光学系又は第1呈示手段)と呼んでもよい。 <Observation optical system>
The observation
なお本実施形態の観察光学系30は受光素子39を備え、患者眼Eの観察像を動画又は静止画で撮影できる。つまり本実施形態の観察光学系30は患者眼Eを撮影(換言するなら電子的に撮影)するための撮影部を備える。本実施形態では受光素子39として撮像素子を用いている。本実施形態では受光素子39を用いて取得した観察像を電子観察像111b(又は電子観察画像)と呼ぶことがある。ハーフミラー37は観察光路を分岐するための分岐部材であり、本実施形態では一方の観察光路(光軸L3L側)上に斜設されている。本実施形態のハーフミラー37は保護フィルタ33Lと正立プリズム群34Lの間に配置されている。
The observation optical system 30 of the present embodiment includes the light receiving element 39, and can capture an observation image of the patient's eye E as a moving image or a still image. That is, the observation optical system 30 of the present embodiment includes an imaging unit for imaging the patient's eye E (in other words, electronic imaging). In the present embodiment, an image sensor is used as the light receiving element 39. In the present embodiment, an observation image acquired by using the light receiving element 39 may be referred to as an electronic observation image 111b (or an electronic observation image). The half mirror 37 is a branching member for branching the observation optical path, and in the present embodiment, is provided obliquely on one observation optical path (on the optical axis L3L side). The half mirror 37 of the present embodiment is arranged between the protection filter 33L and the erecting prism group 34L.
患者眼Eを撮影するための観察光路(支流)には、レンズ38、受光素子39の順で部材が配置されている。観察面(患者眼Eの観察部位)から受光素子39までの光路を、患者眼Eを撮影するための撮影光学系(撮影手段)と呼んでもよい。ハーフミラー37で反射した観察光は、レンズ38を介した後、受光素子39で受光される。つまり患者眼Eの観察像が受光素子39上に結像される。本実施形態では対物レンズ31の先に設けられる観察面(物体面)と受光素子39とが対物レンズ31を介して光学的に共役な位置関係にある。本実施形態では受光素子39として、可視帯域と赤外帯域の感度を有するカラーCMOSイメージセンサーを用いている。本実施形態の制御部70は、受光素子39を用いて取得した電子観察像111bを、モニタ82、表示器93等に表示できる。なお眼科用レーザ治療装置1が受光素子39を備えなくてもよい。
(4) In the observation optical path (branch) for photographing the patient's eye E, a lens 38 and a light receiving element 39 are arranged in this order. The optical path from the observation surface (the observation site of the patient's eye E) to the light receiving element 39 may be referred to as a photographing optical system (photographing means) for photographing the patient's eye E. The observation light reflected by the half mirror 37 passes through a lens 38 and is received by a light receiving element 39. That is, an observation image of the patient's eye E is formed on the light receiving element 39. In the present embodiment, the observation surface (object surface) provided ahead of the objective lens 31 and the light receiving element 39 have an optically conjugate positional relationship via the objective lens 31. In this embodiment, a color CMOS image sensor having sensitivity in the visible band and the infrared band is used as the light receiving element 39. The control unit 70 of the present embodiment can display the electron observation image 111b acquired using the light receiving element 39 on the monitor 82, the display 93, and the like. Note that the ophthalmic laser treatment apparatus 1 may not include the light receiving element 39.
本実施形態の保護フィルタ33は観察光路上に挿脱可能であり、保護フィルタ33にはアクチュエータが接続されている。制御部70は保護フィルタ33を観察光路に挿脱できる。本実施形態の制御部70は、治療レーザ光の照射中は保護フィルタ33を観察光路に挿入し、それ以外では保護フィルタ33を観察光路から退避させる。
保護 The protection filter 33 of the present embodiment can be inserted into and removed from the observation optical path, and an actuator is connected to the protection filter 33. The control unit 70 can insert and remove the protection filter 33 in the observation optical path. The control unit 70 of the present embodiment inserts the protection filter 33 into the observation optical path during irradiation of the treatment laser light, and retracts the protection filter 33 from the observation optical path in other cases.
<表示部>
本実施形態の表示部90は、治療に関する情報を術者に呈示できる。例えば、治療に関する情報(呈示情報)として、治療レーザ光の照射条件、眼模式図、電子観察像111b等を呈示できてもよい。つまり換言するなら、本実施形態の表示部90は、光学観察像111aとは異なる治療に関する情報を術者に呈示できる。本実施形態の表示部90は観察光学系30に設けられる。本実施形態の表示部90は、表示器93、レンズ92、ハーフミラー91等を備える。表示器93には術者に呈示するための呈示情報が表示される。本実施形態では表示器93としてLCD(バックライト付き)を用いている。詳細には、本実施形態では表示器93として、1600(H)×1200(V)を表示可能なカラーLCDを用いている。本実施形態のハーフミラー91は、光軸L3R上に配置されている。詳細にはハーフミラー91は、保護フィルタ33Rと正立プリズム群34Lの間に配置されている。 <Display unit>
Thedisplay unit 90 of the present embodiment can present information on the treatment to the operator. For example, as information on treatment (presentation information), irradiation conditions of treatment laser light, a schematic diagram of the eye, an electronic observation image 111b, and the like may be presented. In other words, in other words, the display unit 90 of the present embodiment can present the operator with information regarding treatment different from the optical observation image 111a. The display unit 90 of the present embodiment is provided in the observation optical system 30. The display unit 90 of the present embodiment includes a display 93, a lens 92, a half mirror 91, and the like. The display 93 displays presentation information to be presented to the operator. In this embodiment, an LCD (with a backlight) is used as the display 93. Specifically, in the present embodiment, a color LCD capable of displaying 1600 (H) × 1200 (V) is used as the display 93. The half mirror 91 of the present embodiment is arranged on the optical axis L3R. Specifically, the half mirror 91 is disposed between the protection filter 33R and the erecting prism group 34L.
本実施形態の表示部90は、治療に関する情報を術者に呈示できる。例えば、治療に関する情報(呈示情報)として、治療レーザ光の照射条件、眼模式図、電子観察像111b等を呈示できてもよい。つまり換言するなら、本実施形態の表示部90は、光学観察像111aとは異なる治療に関する情報を術者に呈示できる。本実施形態の表示部90は観察光学系30に設けられる。本実施形態の表示部90は、表示器93、レンズ92、ハーフミラー91等を備える。表示器93には術者に呈示するための呈示情報が表示される。本実施形態では表示器93としてLCD(バックライト付き)を用いている。詳細には、本実施形態では表示器93として、1600(H)×1200(V)を表示可能なカラーLCDを用いている。本実施形態のハーフミラー91は、光軸L3R上に配置されている。詳細にはハーフミラー91は、保護フィルタ33Rと正立プリズム群34Lの間に配置されている。 <Display unit>
The
表示器93から発せられる呈示光(表示光)は、光軸L5に沿って進む。詳細には表示器93から発せられる呈示光は、レンズ92を介した後、ハーフミラー91で正立プリズム群34の方向に反射される。本実施形態のハーフミラー91は光学観察像111aと表示器93に表示される呈示情報とを合成するための合成手段である。本実施形態のハーフミラー91は、光軸L5と光軸L3Rとを同軸にする。ハーフミラー91で反射した呈示光は、正立プリズム群34、視野絞り35、接眼レンズ36の順で介して進み、接眼レンズ36を覗いた術者の眼底に集光する。なお表示器93から術者の眼底にかけての光路を、治療に関する情報を術者に呈示するための呈示光学系(第2呈示光学系又は第2呈示手段)と呼んでもよい。
The presentation light (display light) emitted from the indicator 93 travels along the optical axis L5. In detail, the presentation light emitted from the display 93 is reflected by the half mirror 91 in the direction of the erecting prism group 34 after passing through the lens 92. The half mirror 91 of the present embodiment is a synthesizing unit for synthesizing the optical observation image 111a and the presentation information displayed on the display 93. The half mirror 91 of the present embodiment makes the optical axis L5 and the optical axis L3R coaxial. The presentation light reflected by the half mirror 91 travels through the erecting prism group 34, the field stop 35, and the eyepiece 36 in this order, and converges on the fundus of the operator looking through the eyepiece 36. The optical path from the display 93 to the operator's fundus may be referred to as a presentation optical system (second presentation optical system or second presentation means) for presenting information on treatment to the operator.
本実施形態では表示器93と視野絞り35とが光学的に共役な位置関係にある。つまり視野絞り35の位置で、表示器93の表示像が空中像として結像される。なお光学観察像111aとは異なる治療に関する情報の、術者への呈示方法は本開示に限るものでは無い。例えば表示部90としてバックライトを備えないLCD(液晶パネル)を視野絞り35の位置(光軸L3R上)に配置し、制御部70がLCDを構成する各セルの透過率を制御して術者に呈示情報を呈示してもよい。なおこの場合、LCDは光学観察像111aとLCDに表示される呈示情報とを合成するための合成手段である。
で は In the present embodiment, the display 93 and the field stop 35 are in an optically conjugate positional relationship. That is, at the position of the field stop 35, the display image of the display 93 is formed as an aerial image. It should be noted that a method of presenting information regarding treatment different from the optical observation image 111a to the operator is not limited to the present disclosure. For example, an LCD (liquid crystal panel) having no backlight as the display unit 90 is arranged at the position of the field stop 35 (on the optical axis L3R), and the control unit 70 controls the transmittance of each cell constituting the LCD to control the operator. May be presented. In this case, the LCD is a synthesizing unit for synthesizing the optical observation image 111a and the presentation information displayed on the LCD.
<照明光学系>
本実施形態の照明光学系60は患者眼Eに照明光を投光するための照明手段であり、光軸L1を備える。詳細には本実施形態の照明光学系60はスリット照明手段であり、患者眼Eの部位をスリット光で照明できる。本実施形態の照明光学系60は、照明用光源61、コンデンサーレンズ62、スリット板63、フィルタ、投影レンズ64、補正レンズ、及び分割ミラーを備える。本実施形態のスリット板63は、可変円形アパーチャと可変スリット板を含む。可変円形アパーチャは開口径を変更でき、可変スリット板はスリット幅を変更できる。つまり本実施形態の照明光学系60は、患者眼Eの照明形状(スリット形状)を変形するための変形手段を備える。なお本実施形態の照明光学系60はスリット形状のスリット光のみならず、円形の照明光も生成できる。本実施形態では、術者は不図示の操作部材を操作して、可変円形アパーチャの開口径又は可変スリット板のスリット幅を変更できる。つまり本実施形態の照明光学系60は、術者が照明形状を変形するための操作手段を備える。 <Illumination optical system>
The illuminationoptical system 60 of the present embodiment is illumination means for projecting illumination light to the patient's eye E, and has an optical axis L1. In detail, the illumination optical system 60 of the present embodiment is a slit illumination unit, and can illuminate a part of the patient's eye E with slit light. The illumination optical system 60 of the present embodiment includes an illumination light source 61, a condenser lens 62, a slit plate 63, a filter, a projection lens 64, a correction lens, and a split mirror. The slit plate 63 of the present embodiment includes a variable circular aperture and a variable slit plate. The variable circular aperture can change the opening diameter, and the variable slit plate can change the slit width. That is, the illumination optical system 60 of the present embodiment includes a deformation unit for deforming the illumination shape (slit shape) of the patient's eye E. The illumination optical system 60 of the present embodiment can generate not only slit-shaped slit light but also circular illumination light. In the present embodiment, the operator can change the opening diameter of the variable circular aperture or the slit width of the variable slit plate by operating an operation member (not shown). That is, the illumination optical system 60 of the present embodiment is provided with operation means for an operator to change the illumination shape.
本実施形態の照明光学系60は患者眼Eに照明光を投光するための照明手段であり、光軸L1を備える。詳細には本実施形態の照明光学系60はスリット照明手段であり、患者眼Eの部位をスリット光で照明できる。本実施形態の照明光学系60は、照明用光源61、コンデンサーレンズ62、スリット板63、フィルタ、投影レンズ64、補正レンズ、及び分割ミラーを備える。本実施形態のスリット板63は、可変円形アパーチャと可変スリット板を含む。可変円形アパーチャは開口径を変更でき、可変スリット板はスリット幅を変更できる。つまり本実施形態の照明光学系60は、患者眼Eの照明形状(スリット形状)を変形するための変形手段を備える。なお本実施形態の照明光学系60はスリット形状のスリット光のみならず、円形の照明光も生成できる。本実施形態では、術者は不図示の操作部材を操作して、可変円形アパーチャの開口径又は可変スリット板のスリット幅を変更できる。つまり本実施形態の照明光学系60は、術者が照明形状を変形するための操作手段を備える。 <Illumination optical system>
The illumination
本実施形態の照明用光源61は可視光を出射できる。照明用光源61として、例えば、ハロゲンランプ又はLEDを用いてもよい。照明用光源61から発せられる照明光は、コンデンサーレンズ62を介した後にスリット板63の開口部を通過する。スリット板63にてスリット状に形成された照明光は、フィルタ、投影レンズ64、補正レンズの順で介して進み、分割ミラーで患者眼Eの方向に反射される。分割ミラーで反射した照明光は患者眼E(本実施形態では眼底Er)を照明する。術者は、照明光学系60により照明された患者眼Eを、観察光学系30を用いて観察できる。
照明 The illumination light source 61 of the present embodiment can emit visible light. As the illumination light source 61, for example, a halogen lamp or an LED may be used. The illumination light emitted from the illumination light source 61 passes through the opening of the slit plate 63 after passing through the condenser lens 62. The illumination light formed in a slit shape by the slit plate 63 advances through the filter, the projection lens 64, and the correction lens in this order, and is reflected by the split mirror in the direction of the patient's eye E. The illumination light reflected by the split mirror illuminates the patient's eye E (the fundus Er in this embodiment). The surgeon can observe the patient's eye E illuminated by the illumination optical system 60 using the observation optical system 30.
<制御部>
本実施形態の制御部70は眼科用レーザ治療装置1を制御する制御手段であり、CPU71(プロセッサ)、ROM72、RAM73、及び不揮発性メモリ74等を備える。CPU71は、眼科用レーザ治療装置1における各部の制御を司る。ROM72には、各種プログラム、各種パラメータ、初期値等が記憶されている。RAM73は、各種情報を一時的に記憶できる。不揮発性メモリ74は、電源の供給が遮断されても記憶内容を保持できる非一過性の記憶媒体である。例えば、制御部70に着脱可能に装着されるUSBメモリ、フラッシュROM等を、不揮発性メモリ74として使用してもよい。 <Control unit>
Thecontrol unit 70 of the present embodiment is control means for controlling the ophthalmic laser treatment apparatus 1, and includes a CPU 71 (processor), a ROM 72, a RAM 73, a nonvolatile memory 74, and the like. The CPU 71 controls each unit in the ophthalmic laser treatment apparatus 1. The ROM 72 stores various programs, various parameters, initial values, and the like. The RAM 73 can temporarily store various information. The non-volatile memory 74 is a non-transitory storage medium capable of retaining stored contents even when power supply is cut off. For example, a USB memory, a flash ROM, or the like removably attached to the control unit 70 may be used as the nonvolatile memory 74.
本実施形態の制御部70は眼科用レーザ治療装置1を制御する制御手段であり、CPU71(プロセッサ)、ROM72、RAM73、及び不揮発性メモリ74等を備える。CPU71は、眼科用レーザ治療装置1における各部の制御を司る。ROM72には、各種プログラム、各種パラメータ、初期値等が記憶されている。RAM73は、各種情報を一時的に記憶できる。不揮発性メモリ74は、電源の供給が遮断されても記憶内容を保持できる非一過性の記憶媒体である。例えば、制御部70に着脱可能に装着されるUSBメモリ、フラッシュROM等を、不揮発性メモリ74として使用してもよい。 <Control unit>
The
本実施形態の制御部70には、治療レーザ光源11、照準光源12、エンコーダ42a、ガルバノミラー51、ガルバノミラー55、表示器93、受光素子39、保護フィルタ33、減光板94、フットスイッチ81、データ入出力部95(取得手段)、3Dマウス84、タッチパネル83、及びモニタ82が接続されている。
The control unit 70 of the present embodiment includes a treatment laser light source 11, an aiming light source 12, an encoder 42a, a galvanomirror 51, a galvanomirror 55, a display 93, a light receiving element 39, a protection filter 33, a dimming plate 94, a foot switch 81, A data input / output unit 95 (acquisition unit), a 3D mouse 84, a touch panel 83, and a monitor 82 are connected.
本実施形態のフットスイッチ81は、治療レーザ光の照射を開始するためのトリガ入力手段である。本実施形態のモニタ82は、治療レーザ光の照射条件に係わる各種パラメータ、患者眼Eの観察像等を表示するための表示手段である。また本実施形態のタッチパネル83は、治療レーザ光の照射条件に係わる各種パラメータ等を設定するための設定手段(第1設定手段)である。モニタ82にはタッチパネル83が貼り付けられており、モニタ82とタッチパネル83との組み合わせで操作ユニット80が形成されている。術者はタッチパネル83を操作(タッチ)することで、治療レーザ光の照射条件に係わる各種パラメータを設定できる。3Dマウス84は、治療レーザ光の照射条件に係わる各種パラメータ等を設定するための設定手段(第2設定手段)である。一例として、本実施形態では術者は3Dマウス84を操作することで、接眼レンズ36を覗いたまま治療レーザ光の各種照射条件(例えば現在設定されている治療レーザ光の出力値134 )を設定できる。なお本実施形態の制御部70は、モニタ82又は表示器93の表示内容を制御する表示制御手段でもある。
The foot switch 81 of the present embodiment is a trigger input unit for starting irradiation of the treatment laser beam. The monitor 82 of the present embodiment is a display means for displaying various parameters related to the irradiation condition of the treatment laser beam, an observation image of the patient's eye E, and the like. Further, the touch panel 83 of the present embodiment is a setting unit (first setting unit) for setting various parameters related to the irradiation condition of the treatment laser beam. A touch panel 83 is attached to the monitor 82, and an operation unit 80 is formed by a combination of the monitor 82 and the touch panel 83. By operating (touching) the touch panel 83, the operator can set various parameters related to the irradiation condition of the treatment laser light. The 3D mouse 84 is a setting unit (second setting unit) for setting various parameters related to the irradiation condition of the treatment laser light. As an example, in this embodiment, the operator operates the 3D mouse 84 to set various irradiation conditions of the treatment laser light (for example, the currently set output value 134 ° of the treatment laser light) while looking through the eyepiece 36. it can. Note that the control unit 70 of the present embodiment is also a display control unit that controls display contents of the monitor 82 or the display 93.
制御部70は、一対の保護フィルタ33(33R,33L)の各々を選択的に駆動できる。本実施形態では術者がフットスイッチ81を踏むと、制御部70は各種パラメータの設定に基づき、治療レーザ光のパターン(1又は複数のスポット)をターゲット面に形成するように治療レーザ光を照射する。つまり本実施形態の制御部70は、患者眼Eへの治療レーザ光の照射を制御する照射制御手段である。本実施形態の制御部70は、治療レーザ光源11を制御すると共に、設定されたパターンに基づいて走査部50を制御し、ターゲット面である患者眼Eの組織上(眼底Er上)に治療レーザ光のパターンを形成する。本実施形態の制御部70は、フットスイッチ81が踏まれる前は、治療レーザ光用のパターンを用いて、ターゲット面上に照準光のパターン(1又は複数のスポット)を形成する。照準光および治療レーザ光のパターン照射については、例えば特開2011-156290号公報を参照されたし。
The control unit 70 can selectively drive each of the pair of protection filters 33 (33R, 33L). In this embodiment, when the operator steps on the foot switch 81, the control unit 70 irradiates the treatment laser light so as to form a pattern (one or a plurality of spots) of the treatment laser light on the target surface based on the setting of various parameters. I do. That is, the control unit 70 of the present embodiment is an irradiation control unit that controls irradiation of the treatment laser beam to the patient's eye E. The control unit 70 of the present embodiment controls the treatment laser light source 11 and also controls the scanning unit 50 based on the set pattern, so that the treatment laser is placed on the tissue of the patient's eye E (on the fundus Er) which is the target surface. Form a light pattern. Before the foot switch 81 is depressed, the control unit 70 of this embodiment forms a pattern (one or a plurality of spots) of aiming light on the target surface using a pattern for treatment laser light. For the pattern irradiation of the aiming light and the treatment laser light, refer to, for example, JP-A-2011-156290.
<使用方法>
図4~7を用いて、本実施形態の眼科用レーザ治療装置1の使用方法の一例を説明する。術者が眼科用レーザ治療装置1の電源を投入すると、制御部70は眼科用レーザ治療装置1の初期設定を行った後、モニタ82にメイン画面(図4参照)を表示する。なお本実施形態では保護フィルタ33は、眼科用レーザ治療装置1の初期設定中に観察光路の光路外に退避される。 <How to use>
An example of a method of using the ophthalmiclaser treatment apparatus 1 of the present embodiment will be described with reference to FIGS. When the surgeon turns on the power of the ophthalmic laser treatment apparatus 1, the control unit 70 performs an initial setting of the ophthalmic laser treatment apparatus 1, and displays a main screen (see FIG. 4) on the monitor 82. In this embodiment, the protection filter 33 is retracted outside the observation optical path during the initial setting of the ophthalmic laser treatment apparatus 1.
図4~7を用いて、本実施形態の眼科用レーザ治療装置1の使用方法の一例を説明する。術者が眼科用レーザ治療装置1の電源を投入すると、制御部70は眼科用レーザ治療装置1の初期設定を行った後、モニタ82にメイン画面(図4参照)を表示する。なお本実施形態では保護フィルタ33は、眼科用レーザ治療装置1の初期設定中に観察光路の光路外に退避される。 <How to use>
An example of a method of using the ophthalmic
メイン画面には、治療レーザ光の照射可否を示すステータス情報137、現在設定されている治療レーザ光のスポットサイズ値133、現在設定されている治療レーザ光の出力値134、現在設定されている治療レーザ光の照射時間値135、現在設定されている治療レーザ光の照射パターン131、現在設定されている治療レーザ光のスポット間隔値136、等が表示される。本実施形態のメイン画面はGUI(グラフィカル・ユーザー・インターフェース)の態様であり、術者はメイン画面に表示されている要素(ボタン等)にタッチしてレーザ照射条件を設定できる。
On the main screen, status information 137 indicating whether or not irradiation of the treatment laser light is possible, the spot size value 133 of the treatment laser light currently set, the output value 134 of the treatment laser light currently set, and the treatment currently set The irradiation time value 135 of the laser beam, the currently set irradiation pattern 131 of the treatment laser light, the currently set spot interval value 136 of the treatment laser light, and the like are displayed. The main screen of the present embodiment is in the form of a GUI (graphical user interface), and the operator can set laser irradiation conditions by touching elements (such as buttons) displayed on the main screen.
ここで図5と図6を併用し、術者が接眼レンズ36を覗いた際に見える情報(換言するなら接眼レンズ36を覗いた術者に呈示される呈示情報)を説明する。図5は眼科用レーザ治療装置1の初期設定後、表示器93に表示される情報である。表示器93には、治療レーザ光の照射を行うための参照情報120、及び治療レーザ光の照射条件130が表示される。本実施形態では光学観察像111a(観察像)と表示器93が表示する呈示情報(参照画像としての眼模式図等)とが合成(換言するなら重畳)されるため、接眼レンズ36を覗いた術者には、図6で示すように合成像(重畳像)が視認される。なお図6の光学観察像111aは、患者眼Eへの観察光学系30の位置合わせが完了した状態の像である。本実施形態は一例であり、術者の右眼には呈示情報(参照情報120と照射条件130)のみを導き、術者の左眼には観察像のみを導く態様であってもよい。つまり術者の融像を利用して、図6の合成像を術者に呈示してもよい。
Here, with reference to FIGS. 5 and 6, information that is visible when the surgeon looks through the eyepiece 36 (in other words, presentation information presented to the surgeon looking through the eyepiece 36) will be described. FIG. 5 shows information displayed on the display 93 after the initial setting of the ophthalmic laser treatment apparatus 1. The display 93 displays reference information 120 for irradiating the treatment laser light and irradiation conditions 130 for the treatment laser light. In the present embodiment, since the optical observation image 111a (observation image) and the presentation information (eg, an eye schematic diagram as a reference image) displayed by the display 93 are combined (in other words, superimposed), the eyepiece 36 is viewed. The surgeon visually recognizes the composite image (superimposed image) as shown in FIG. The optical observation image 111a in FIG. 6 is an image in a state where the positioning of the observation optical system 30 with respect to the patient's eye E is completed. This embodiment is an example, and only the presentation information (the reference information 120 and the irradiation condition 130) may be guided to the operator's right eye, and only the observation image may be guided to the operator's left eye. That is, the composite image of FIG. 6 may be presented to the operator using the fusion image of the operator.
本実施形態の観察情報110(図6参照)には、観察光学系30により生成された光学観察像111a(スルー観察像)が含まれる。図6で例示する光学観察像111aには、照明光学系60を用いて照明された患者眼Eの照明領域112、照明光が直接当たっていない患者眼Eの遮光領域113、及び患者眼Eで反射した照準光115が含まれる。本実施形態では照明領域112又は遮光領域113の形状は、照明光学系60のスリット板63の形状に基づく。なお図6では遮光領域113をハッチングで示している。観察照明の形状をスリット状にすることで、患者の眩しさ(つまり患者の負担)を低減できる。例えば、細いスリットにするほど患者の眩しさは低減するが、反面、照明領域112が狭くなり患者眼Eのどの部位を観察しているのか把握し難くなる。つまり患者の負担と観察部位(又は治療予定部位)の把握とはトレードオフの関係になり易い。
The observation information 110 (see FIG. 6) of the present embodiment includes the optical observation image 111a (through observation image) generated by the observation optical system 30. The optical observation image 111a illustrated in FIG. 6 includes an illumination area 112 of the patient's eye E illuminated using the illumination optical system 60, a light-shielded area 113 of the patient's eye E not directly illuminated by the illumination light, and a patient's eye E. Includes reflected aiming light 115. In the present embodiment, the shape of the illumination area 112 or the light shielding area 113 is based on the shape of the slit plate 63 of the illumination optical system 60. In FIG. 6, the light shielding region 113 is indicated by hatching. By making the shape of the observation illumination into a slit shape, the glare of the patient (that is, the burden on the patient) can be reduced. For example, the thinner the slit, the less the glare of the patient, but, on the other hand, the smaller the illumination area 112, and the more difficult it is to grasp which part of the patient's eye E is being observed. In other words, the burden on the patient and the grasp of the observation site (or the planned treatment site) tend to be in a trade-off relationship.
図5と図6を用いた説明に戻る。本実施形態の参照情報120には参照画像(眼の構造に関する画像)が含まれる。図5,図6では参照画像の一例として、眼の構造に関する画像である眼模式図121を示している。本実施形態の眼模式図121には白色のベース部分上に、特徴部位として乳頭と網膜血管アーケードとが黒色の線で描かれている。特徴部位として中心窩又は黄斑が含まれてもよい。また眼底の赤道部(赤道位置)が描かれてもよい。本実施形態の眼模式図121を、眼の構造のイラスト、眼の構造の略図と呼んでもよい。本実施形態の眼模式図121は一例であり、例えば、ベース部分が透明(透過)であってもよい。前述した特徴部位が、ラスタ形式で描画されていてもよいし、ベクタ形式で描画されていてもよい。
戻 る Return to the description using FIG. 5 and FIG. The reference information 120 according to the present embodiment includes a reference image (an image related to the structure of the eye). FIGS. 5 and 6 show an eye schematic diagram 121 which is an image relating to the structure of the eye as an example of the reference image. In the schematic eye diagram 121 of this embodiment, the papillae and the retinal vascular arcade are drawn as black lines on the white base portion as characteristic portions. The fovea or macula may be included as the characteristic portion. Further, an equatorial portion (equatorial position) of the fundus may be drawn. The schematic eye diagram 121 of the present embodiment may be called an illustration of the structure of the eye or a schematic diagram of the structure of the eye. The schematic eye diagram 121 of the present embodiment is an example, and for example, the base portion may be transparent (transmission). The above-described characteristic portion may be drawn in a raster format or in a vector format.
参照画像は、例えば、患者眼Eを撮影した撮影画像以外、又は患者眼Eを解析した解析画像以外であればよい。例えば患者眼E以外の眼を他の装置で撮影した撮影画像であってもよい。本実施形態の参照画像(図5,6では眼模式図121)は、眼科用レーザ治療装置1の製造時に予め記憶手段(不揮発性メモリ74)に記憶されている。従って例えば、手術現場で眼科用レーザ治療装置1に参照画像をインポートしなくても参照画像を利用できる。
The reference image may be, for example, other than a captured image of the patient's eye E or an analysis image of the patient's eye E. For example, the captured image may be obtained by capturing an eye other than the patient's eye E with another device. The reference image (eye schematic diagram 121 in FIGS. 5 and 6) of the present embodiment is stored in the storage unit (nonvolatile memory 74) in advance when the ophthalmic laser treatment apparatus 1 is manufactured. Therefore, for example, the reference image can be used without importing the reference image into the ophthalmic laser treatment apparatus 1 at the operation site.
なお詳細は後述するが、本実施形態では参照画像として、眼模式図121と実写画像125とを選択的に呈示できる。本実施形態では参照情報120として更に、左右眼情報124も含まれる。本実施形態の左右眼情報124は後述する参照設定画面で設定できるが、例えば変位機構8が左右眼検出器を備え、制御部70が左右眼検出器の出力信号を用いて左右眼情報124を自動設定してもよい。なお後述する参照設定画面での設定が完了するまで、表示器93に参照情報120を表示させない制御が行なわれてもよい。例えば、術者による操作又は前述した左右検出器で左右眼情報124が設定されるまで、参照画像の利用が禁止(つまり表示器93への表示が禁止)されてもよい。これにより、例えば、患者眼Eの右眼の観察中に左目用の参照画像が表示され、術者が右眼に対する観察光学系30の位置合わせ操作に迷う事象を抑制できる。
Although the details will be described later, in the present embodiment, the eye schematic diagram 121 and the photographed image 125 can be selectively presented as reference images. In the present embodiment, the left and right eye information 124 is further included as the reference information 120. The left and right eye information 124 of the present embodiment can be set on a reference setting screen described later. For example, the displacement mechanism 8 includes a left and right eye detector, and the control unit 70 uses the output signal of the left and right eye detector to generate the left and right eye information 124. It may be set automatically. Until the setting on the later-described reference setting screen is completed, control may be performed so that the reference information 120 is not displayed on the display 93. For example, use of the reference image may be prohibited (that is, display on the display 93 is prohibited) until the left and right eye information 124 is set by an operation by the operator or the left and right detectors described above. Thereby, for example, the reference image for the left eye is displayed during the observation of the right eye of the patient's eye E, and it is possible to suppress an event that the operator gets lost in the operation of aligning the observation optical system 30 with the right eye.
例えば眼底出血が生じた患者眼Eの撮影画像(実写画像)を参照画像として用いる場合、硝子体内を浮遊する血液が撮影画像に写り込む可能性がある。従って、撮影画像を見ても眼底の血管走行を把握し難い場合が考えられる。また撮影時と観察時とで硝子体内の血液の浮遊位置が異なる可能性が高いため、参照画像を参照することで術者が混乱する可能性もある。また患者眼Eの撮影画像を取得するために用いた光学系(照明光学系又は撮影光学系)の特性と観察光学系30(及び照明光学系60)の特性とが異なることで、参照画像と観察像とで同じ患者眼Eの像であっても大きく食い違う可能性も高い。つまり、参照画像として用いる患者眼Eの撮影画像(実写画像)と実際に観察する患者眼Eの観察像とが食い違うことで、術者の混乱を招く可能性がある。しかし本実施形態の参照画像(眼模式図121及び後述する実写画像125)は患者眼Eとの直接的な関係が無い画像であるため、例えば眼底出血が生じている患者眼Eであっても、術者は観察光学系30(又は照準光)を位置合わせし易い。
For example, when a photographed image (actual photographed image) of the patient's eye E in which fundus bleeding has occurred is used as a reference image, blood floating in the vitreous body may be reflected in the photographed image. Therefore, there may be a case where it is difficult to grasp the blood vessel running of the fundus even by looking at the photographed image. In addition, since the floating position of the blood in the vitreous body is likely to be different between the time of imaging and the time of observation, the operator may be confused by referring to the reference image. Further, since the characteristics of the optical system (illumination optical system or imaging optical system) used for acquiring the captured image of the patient's eye E and the characteristics of the observation optical system 30 (and the illumination optical system 60) are different, the reference image It is highly possible that the image of the patient's eye E differs greatly from the observed image. In other words, the captured image (actual image) of the patient's eye E used as the reference image and the observed image of the patient's eye E actually observed may be different from each other, which may cause confusion for the operator. However, since the reference image (the ophthalmic schematic diagram 121 and a real image 125 described later) of the present embodiment is an image having no direct relationship with the patient's eye E, for example, even the patient's eye E in which fundus bleeding has occurred The operator can easily align the observation optical system 30 (or aiming light).
本実施形態では接眼レンズ36を覗いた術者には、患者眼Eの観察像(光学観察像111a)と共に、観察像とは異なる態様である参照画像(眼模式図121)が表示される。これにより、術者は参照画像(眼模式図121)を参照しつつ観察像を観察することで、例えば、照明領域が狭いスリット光を用いた観察状態でも、患者眼Eに対する観察光学系30の位置合わせ状態を判断し易くなる。本実施形態では接眼レンズ36を覗いた視野内に観察像(光学観察像111a)と参照画像(眼模式図121)とが呈示されるため、術者は接眼レンズ36から眼を外すことなく参照画像(眼模式図121)を確認できる。なお光学観察像111aと参照画像(眼模式図121)が重ならないように術者に参照画像を呈示してもよい。
In the present embodiment, an operator who looks through the eyepiece 36 displays an observation image (optical observation image 111a) of the patient's eye E and a reference image (eye schematic diagram 121) that is different from the observation image. Thereby, the surgeon observes the observation image while referring to the reference image (the schematic diagram of the eye 121), so that the observation optical system 30 for the patient's eye E can be observed, for example, even in an observation state using slit light with a small illumination area. It becomes easier to determine the alignment state. In the present embodiment, since the observation image (optical observation image 111a) and the reference image (schematic eye diagram 121) are presented in the field of view looking through the eyepiece 36, the surgeon can refer without removing the eye from the eyepiece 36. An image (eye schematic diagram 121) can be confirmed. Note that the reference image may be presented to the operator so that the optical observation image 111a and the reference image (the schematic diagram of the eye 121) do not overlap.
本実施形態の照射条件情報130には、現在設定されている治療レーザ光の照射パターン131、現在設定されている治療レーザ光の種類132(選択されている波長の色で呈示)、現在設定されている治療レーザ光のスポットサイズ値133、現在設定されている治療レーザ光の出力値134、現在設定されている治療レーザ光の照射時間値135、現在設定されているパターン照射時の治療レーザ光のスポット間隔値136、及び治療レーザ光を照射可能か否かのステータス情報137が表示される。本実施形態では上述した照射条件情報130の各要素を、3Dマウス84を用いて個別に変更できる。従って術者は、接眼レンズ36から眼を外すことなく治療レーザ光の照射条件を変更できる。なお例えば、術者が3Dマウス84(操作手段)を操作することで、現在呈示されている参照画像(眼模式図121)のサイズを変更できてもよい。つまり眼科用レーザ治療装置1が現在呈示中の参照画像のサイズを変更する変更手段を備えてもよい。これにより例えば、観察像を凝視する時は参照画像のサイズを小さくし、参照画像を凝視する時は参照画像を大きくできる。また例えば、3Dマウス84の操作後、参照画像のサイズが所定時間だけ大きくなってもよい。
In the irradiation condition information 130 of the present embodiment, the currently set irradiation pattern 131 of the treatment laser light, the currently set treatment laser light type 132 (presented by the color of the selected wavelength), and the currently set treatment laser light. Current treatment laser light spot size value 133, currently set treatment laser light output value 134, currently set treatment laser light irradiation time value 135, currently set treatment laser light for pattern irradiation Are displayed, and status information 137 indicating whether or not the treatment laser beam can be irradiated is displayed. In the present embodiment, each element of the irradiation condition information 130 described above can be individually changed using the 3D mouse 84. Therefore, the surgeon can change the irradiation condition of the treatment laser light without removing the eye from the eyepiece 36. For example, the size of the currently presented reference image (the schematic diagram of the eye 121) may be changed by operating the 3D mouse 84 (operation means) by the operator. That is, the ophthalmic laser treatment apparatus 1 may include a change unit that changes the size of the reference image currently being presented. Thus, for example, the size of the reference image can be reduced when staring at the observation image, and the reference image can be enlarged when staring at the reference image. Further, for example, after the operation of the 3D mouse 84, the size of the reference image may increase for a predetermined time.
なお図6では3×3のパターンが表示されているが、設定されている照射パターン131に応じて表示は変化する。例えば照射パターン131として図9で例示するパターンが表示されてもよい。図9の照射パターン131は、例えば、黄斑部の治療に適したパターンである。図9の照射パターンは、1回目のフットスイッチ81の踏み込みでは、ハッチングされたスポット群131aのパターンが治療レーザ光として照射される。残りのスポット群131bは分割され、フットスイッチ81を踏み込む度にスポット群が右回転されるようにパターン照射されてゆく。つまり図9の照射パターン131はフットスイッチを踏む度に、治療レーザ光の照射領域がシフト(変位,ずれ)してゆく。図9で示すパターンをオートフォワード用のパターンと呼んでもよい。このように照射予定のスポット全てが照射パターン131として表示されることで、観察像に写り込む照準光(照準光の状態)をより判断し易くなる。従って、直近の治療予定部位への照準光の位置合わせをより行い易くなる。
In FIG. 6, a 3 × 3 pattern is displayed, but the display changes according to the set irradiation pattern 131. For example, a pattern illustrated in FIG. 9 may be displayed as the irradiation pattern 131. The irradiation pattern 131 in FIG. 9 is a pattern suitable for treating a macula, for example. In the irradiation pattern of FIG. 9, when the foot switch 81 is depressed for the first time, the pattern of the hatched spot group 131a is irradiated as treatment laser light. The remaining spot group 131b is divided, and pattern irradiation is performed such that each time the foot switch 81 is depressed, the spot group is rotated clockwise. That is, the irradiation pattern 131 of FIG. 9 shifts (displaces, shifts) the irradiation area of the treatment laser light every time the foot switch is depressed. The pattern shown in FIG. 9 may be called an auto-forward pattern. Since all the spots to be irradiated are displayed as the irradiation pattern 131 in this manner, it becomes easier to determine the aiming light (state of the aiming light) reflected in the observation image. Therefore, it becomes easier to position the aiming light to the nearest treatment target site.
メイン画面(図4参照)を用いた眼科用レーザ治療装置1の使用方法の説明に戻る。術者はレーザ照射条件の設定を完了すると、参照ボタン142をタッチする。制御部70は術者の操作を検出すると、モニタ82に表示する画面をメイン画面から参照設定画面(図7参照)へと切り換える。
Return to the description of the method of using the ophthalmic laser treatment apparatus 1 using the main screen (see FIG. 4). The operator touches the reference button 142 when the setting of the laser irradiation conditions is completed. When detecting the operation of the operator, the control unit 70 switches the screen displayed on the monitor 82 from the main screen to the reference setting screen (see FIG. 7).
本実施形態の参照設定画面(図7参照)には、参照画像(眼模式図121)、メインボタン146、ライブボタン147、左右眼情報124、参照画像選択ボタン143,テンプレート選択ボタン144が含まれる。なおライブボタン147とテンプレート選択ボタン144は変容例として後ほど説明する。
The reference setting screen (see FIG. 7) of the present embodiment includes a reference image (eye schematic diagram 121), a main button 146, a live button 147, left and right eye information 124, a reference image selection button 143, and a template selection button 144. . The live button 147 and the template selection button 144 will be described later as modified examples.
術者は左右眼情報124の箇所を操作(タッチ)して、治療対象眼が右眼又か左眼かを設定できる。なお本実施形態では左右眼情報124の設定に基づいて参照画像(眼模式図121)が自動的に変化する。例えば術者が右眼から左眼へと左右眼情報124の設定を変更すると、眼模式図121の描画は左右方向にミラー反転される。
The operator can operate (touch) the location of the left and right eye information 124 to set whether the treatment target eye is the right eye or the left eye. In the present embodiment, the reference image (eye schematic diagram 121) automatically changes based on the setting of the left and right eye information 124. For example, when the operator changes the setting of the left and right eye information 124 from the right eye to the left eye, the drawing of the schematic eye diagram 121 is mirror-reversed in the left and right direction.
術者は参照画像選択ボタン143の箇所を操作(タッチ)して、参照画像として用いる画像を眼模式図121(図7参照)と実写画像125(図8参照)とで選択できる。つまり本実施形態の参照画像選択ボタン143は、実写画像125又は眼模式図121を表示器93に選択的に表示するための表示選択手段である。なお例えば、参照画像選択ボタン143にて、実写画像125と眼模式図121を術者に同時に呈示できる選択を行なえてもよい。本実施形態では眼模式図121は、眼科用レーザ治療装置1の製造時に記憶手段(不揮発性メモリ74)に予め記憶している。一方、実写画像125は、眼科用レーザ治療装置1が備えるデータ入出力部95を用いて、有線LAN、無線LAN、USBメモリ等を介して眼科用レーザ治療装置1にインポートされる。なお、データ入出力部95を用いて眼科用レーザ治療装置1に眼模式図121をインポートできてもよい。
The operator can operate (touch) the location of the reference image selection button 143 to select an image to be used as a reference image between the eye schematic diagram 121 (see FIG. 7) and the photographed image 125 (see FIG. 8). That is, the reference image selection button 143 of the present embodiment is a display selection unit for selectively displaying the photographed image 125 or the eye schematic diagram 121 on the display 93. Note that, for example, the reference image selection button 143 may be used to make a selection that can simultaneously present the photographed image 125 and the eye schematic diagram 121 to the operator. In the present embodiment, the ophthalmic schematic diagram 121 is stored in the storage unit (the non-volatile memory 74) in advance when the ophthalmic laser treatment apparatus 1 is manufactured. On the other hand, the photographed image 125 is imported into the ophthalmic laser treatment apparatus 1 via a wired LAN, a wireless LAN, a USB memory, or the like, using the data input / output unit 95 provided in the ophthalmic laser treatment apparatus 1. Note that the eye schematic diagram 121 may be imported into the ophthalmic laser treatment apparatus 1 using the data input / output unit 95.
本実施形態の実写画像125は観察光学系30以外で患者眼Eを撮影した画像であり、つまり例えば、眼科用レーザ治療装置1以外の装置(一例として眼底カメラ)で撮影された患者眼Eの撮影画像である。実写画像125として例えば、カラー眼底画像、蛍光眼底画像、カラー前眼部画像、眼底OCT画像、前眼部OCT画像等を用いてもよい。なお不揮発性メモリ74に種類が異なる複数の眼模式図121が記憶されており、術者が選択可能であってもよい。参照画像選択ボタン143にて実写画像125が選択されると、参照設定画面(図7参照)に表示される参照画像は眼模式図121から実写画像125に切り換わる。術者は参照画像(眼模式図121又は実写画像125)と左右眼情報124を適宜設定した後、メインボタン146を押してメイン画面(図4参照)に戻る。なお参照設定画面での設定内容に基づいて、表示器93に表示される参照情報120が変化する。
The real image 125 of the present embodiment is an image obtained by photographing the patient's eye E using a device other than the observation optical system 30, that is, for example, the patient's eye E photographed by a device other than the ophthalmic laser treatment device 1 (for example, a fundus camera). It is a photographed image. For example, a color fundus image, a fluorescent fundus image, a color anterior segment image, a fundus OCT image, an anterior segment OCT image, or the like may be used as the real image 125. Note that a plurality of different eye schematic diagrams 121 may be stored in the non-volatile memory 74 and may be selectable by the surgeon. When the photographed image 125 is selected by the reference image selection button 143, the reference image displayed on the reference setting screen (see FIG. 7) is switched from the eye schematic diagram 121 to the photographed image 125. After appropriately setting the reference image (the schematic eye image 121 or the real image 125) and the left and right eye information 124, the operator presses the main button 146 to return to the main screen (see FIG. 4). The reference information 120 displayed on the display 93 changes based on the settings on the reference setting screen.
メイン画面を用いた説明に戻る。術者は治療レーザ光の照射条件を設定すると、ステータス情報137を照射可に設定する。ステータス情報137の設定が照射可になることで、フットスイッチ81の操作が有効になる。術者は接眼レンズ36を覗きつつジョイスティック9を操作して、患者眼Eに対する観察光学系30(レーザ照射光学系40)の位置合わせを行う。詳細には術者は、参照画像(眼模式図121)を参照しつつ治療予定部位(第1の治療予定部位)への照準光115(換言するならレーザ照射光学系40)の位置合わせを行う。術者は治療予定部位への照準光115の位置合わせが完了すると、フットスイッチ81を踏み込んで治療レーザ光の照射を行う。術者は引き続き、他の治療予定部位(第2の治療予定部位)に照準光を位置合わせし、フットスイッチ81を踏み込んで治療レーザ光の照射を行う。このように照準光の照準位置を変更しつつ1又は複数の治療予定部位への治療レーザ光の照射が行われる。
戻 る Return to the explanation using the main screen. When the operator sets the irradiation condition of the treatment laser beam, the operator sets the status information 137 to irradiation enabled. When the setting of the status information 137 becomes irradiation enabled, the operation of the foot switch 81 becomes effective. The surgeon operates the joystick 9 while looking through the eyepiece 36 to adjust the position of the observation optical system 30 (laser irradiation optical system 40) with respect to the patient's eye E. More specifically, the surgeon performs positioning of the aiming light 115 (in other words, the laser irradiation optical system 40) to the part to be treated (the first part to be treated) while referring to the reference image (the schematic ocular diagram 121). . When the positioning of the aiming light 115 to the part to be treated is completed, the operator depresses the foot switch 81 to irradiate the treatment laser beam. Subsequently, the operator aligns the aiming light with another part to be treated (the second part to be treated) and depresses the foot switch 81 to irradiate the treatment laser beam. In this way, the irradiation of the treatment laser beam is performed on one or a plurality of treatment target sites while changing the aiming position of the aiming light.
<第1の変容例>
次いで図10~12を用いて第1の変容例を説明する。図10~12は変容例の参照画像である。図10で例示する参照画像は、眼模式図121上にテンプレート122が重畳(合成)されている。本実施形態の制御部70は、眼画像(眼模式図121又は実写画像125)とテンプレート122とを合成した合成画像を生成する画像処理手段の機能を有する。本実施形態のテンプレート122は、所定領域を分割したグラフィック(換言するならセグメントマップ)である。テンプレート122の中心は中心窩に対応し、テンプレート122の中心から放射状に領域分割線が伸びる。図10で例示するテンプレート122では、黄斑領域、黄斑と網膜血管アーケードの間の領域等でも分割されている。 <First Transformation Example>
Next, a first modification will be described with reference to FIGS. 10 to 12 show reference images of the modification example. In the reference image illustrated in FIG. 10, atemplate 122 is superimposed (combined) on a schematic eye diagram 121. The control unit 70 according to the present embodiment has a function of an image processing unit that generates a combined image obtained by combining the eye image (the eye schematic diagram 121 or the real image 125) and the template 122. The template 122 according to the present embodiment is a graphic obtained by dividing a predetermined area (in other words, a segment map). The center of the template 122 corresponds to the fovea, and a region dividing line extends radially from the center of the template 122. In the template 122 illustrated in FIG. 10, a macular region, a region between the macula and a retinal vascular arcade, and the like are also divided.
次いで図10~12を用いて第1の変容例を説明する。図10~12は変容例の参照画像である。図10で例示する参照画像は、眼模式図121上にテンプレート122が重畳(合成)されている。本実施形態の制御部70は、眼画像(眼模式図121又は実写画像125)とテンプレート122とを合成した合成画像を生成する画像処理手段の機能を有する。本実施形態のテンプレート122は、所定領域を分割したグラフィック(換言するならセグメントマップ)である。テンプレート122の中心は中心窩に対応し、テンプレート122の中心から放射状に領域分割線が伸びる。図10で例示するテンプレート122では、黄斑領域、黄斑と網膜血管アーケードの間の領域等でも分割されている。 <First Transformation Example>
Next, a first modification will be described with reference to FIGS. 10 to 12 show reference images of the modification example. In the reference image illustrated in FIG. 10, a
術者は参照設定画面(図7参照)のテンプレート選択ボタン144をタッチすることで、眼画像(眼模式図121又は実写画像125)上にテンプレート122を重畳できる。本実施形態では複数のテンプレート122を眼科用レーザ治療装置1の製造時に記憶手段(不揮発性メモリ74)に記憶している。なお図10の眼模式図121と図12の眼模式図121とが異なるように、本実施形態ではテンプレート122の種類に応じて眼模式図121の態様が自動変更(例えばトリミング,簡素化,精密化等)される。図10,図12はテンプレート122の一例であり、術者は眼科用レーザ治療装置1が備える複数のテンプレート122の中から治療目的に好適なテンプレート122を選択できる。
By touching the template selection button 144 on the reference setting screen (see FIG. 7), the operator can superimpose the template 122 on the eye image (the schematic eye image 121 or the photographed image 125). In the present embodiment, the plurality of templates 122 are stored in the storage unit (non-volatile memory 74) when the laser treatment apparatus for ophthalmology 1 is manufactured. In this embodiment, the eye schematic diagram 121 is automatically changed according to the type of the template 122 (for example, trimming, simplification, and precision) so that the eye schematic diagram 121 in FIG. 10 is different from the eye schematic diagram 121 in FIG. Etc.). FIGS. 10 and 12 are examples of the template 122. The operator can select a template 122 suitable for the purpose of treatment from a plurality of templates 122 included in the ophthalmic laser treatment apparatus 1.
術者は選択したテンプレート122上の任意領域(セグメント)をタッチ(選択)することで、治療レーザ光の照射予定領域123を設定できる。照射予定領域123は照射パターン131で定義される照射領域よりも広い。つまり本実施形態では術者はテンプレート122を用いることで、眼模式図121上に複数個の照射パターン131を配置するよりも少ない作業で照射予定領域を定義できる。従って、速やかに治療レーザ光の開始に移行できる。
The operator can set the treatment laser beam irradiation scheduled area 123 by touching (selecting) an arbitrary area (segment) on the selected template 122. The irradiation scheduled area 123 is wider than the irradiation area defined by the irradiation pattern 131. That is, in the present embodiment, the operator can use the template 122 to define the irradiation scheduled area with less work than arranging the plurality of irradiation patterns 131 on the schematic eye diagram 121. Therefore, it is possible to quickly shift to the start of the treatment laser beam.
図11では照射予定領域123をハッチングで示している。なお眼画像(眼模式図121又は実写画像125)と照射予定領域123のみを合成した合成画像を表示器93に表示させてもよい。また照射予定領域123の変容として、術者がテンプレート122を利用して治療レーザ光の照射禁止領域を設定(眼模式図121上にマーキング)できてもよい。また例えば、照射予定領域123に照射する治療レーザ光の波長に対応する任意の色で、照射予定領域123を塗り潰せてもよい。照射予定領域123が半透過で塗り潰されてもよい。照射予定領域123としてマーキングされるだけでもよい。本実施形態のテンプレート122を用いることで、術者は治療レーザ光の照射計画を簡単な操作又は速やかに策定できる。
照射 In FIG. 11, the irradiation scheduled area 123 is indicated by hatching. Note that a composite image obtained by compositing only the eye image (the eye schematic diagram 121 or the real image 125) and the scheduled irradiation region 123 may be displayed on the display 93. In addition, as a modification of the irradiation scheduled area 123, the operator may be able to set the irradiation prohibited area of the treatment laser light by using the template 122 (marking on the eye schematic diagram 121). Further, for example, the irradiation scheduled area 123 may be painted out with an arbitrary color corresponding to the wavelength of the treatment laser beam to be irradiated on the irradiation scheduled area 123. The irradiation scheduled area 123 may be filled with semi-transmission. The marking may be performed only as the irradiation scheduled area 123. By using the template 122 of this embodiment, the operator can easily or quickly formulate a treatment laser beam irradiation plan.
<第2の変容例>
<Second transformation example>
次いで図13を用いて第2の変容例を説明する。図13で例示する参照画像は、図9を用いて例示した照射パターン131が眼模式図121上に重畳されている。眼模式図121上への照射パターン131の配置は参照設定画面(図7参照)で行える。もちろん、眼模式図121上に重畳可能な照射パターン131を任意に決定できる。眼模式図121上に重畳可能な照射パターン131は1個に限らない。眼模式図121上の複数箇所に任意の照射パターンを各々配置できてもよい。なお例えば、照射パターン131の代わりに凝固班を模したグラフィックを眼模式図121上に重畳できてもよい。図13ではベース画像として眼模式図121を用いているが、実写画像125を用いてもよい。
Next, a second modification will be described with reference to FIG. In the reference image illustrated in FIG. 13, the irradiation pattern 131 illustrated using FIG. 9 is superimposed on the schematic eye diagram 121. The arrangement of the irradiation pattern 131 on the eye schematic diagram 121 can be performed on the reference setting screen (see FIG. 7). Of course, the irradiation pattern 131 that can be superimposed on the schematic eye diagram 121 can be arbitrarily determined. The number of irradiation patterns 131 that can be superimposed on the schematic eye diagram 121 is not limited to one. Arbitrary irradiation patterns may be arranged at a plurality of positions on the schematic eye diagram 121, respectively. In addition, for example, instead of the irradiation pattern 131, a graphic representing a coagulation spot may be superimposed on the ocular schematic diagram 121. In FIG. 13, the eye schematic diagram 121 is used as the base image, but a real image 125 may be used.
<第3の変容例>
次いで図14を用いて第3の変容例を説明する。図14はモニタ82に表示するライブ画像である。図6と図14とで同じ符号の箇所の説明は省略する。図6で示した合成像では観察像として光学観察像111aを用いていたが、図14で示すライブ画像では観察像として電子観察像111bを用いる。図14の電子観察像111bは動画である。電子観察像111bは受光素子39を用いて取得される。ライブ画像では制御部70は、図6で示した合成像と類似するように電子観察像111bと呈示情報(参照情報120,照射条件情報130)とを合成する。つまり本実施形態のモニタ82は、治療に関する情報(電子観察像111b,参照画像等)を術者に呈示するための第3呈示手段である。図14では、観察情報110と参照情報120と照射条件情報130とのレイアウト関係は、図6で示した合成像とライブ画像とで同様とされている。 <Third transformation example>
Next, a third modification will be described with reference to FIG. FIG. 14 is a live image displayed on themonitor 82. The description of the same reference numerals in FIGS. 6 and 14 is omitted. While the optical observation image 111a is used as the observation image in the composite image shown in FIG. 6, the electronic observation image 111b is used as the observation image in the live image shown in FIG. The electronic observation image 111b in FIG. 14 is a moving image. The electron observation image 111b is obtained using the light receiving element 39. In the live image, the control unit 70 combines the electronic observation image 111b and the presentation information (reference information 120, irradiation condition information 130) in a manner similar to the combined image shown in FIG. That is, the monitor 82 of the present embodiment is a third presenting unit for presenting information regarding the treatment (the electronic observation image 111b, the reference image, and the like) to the operator. In FIG. 14, the layout relationship among the observation information 110, the reference information 120, and the irradiation condition information 130 is the same between the composite image and the live image shown in FIG.
次いで図14を用いて第3の変容例を説明する。図14はモニタ82に表示するライブ画像である。図6と図14とで同じ符号の箇所の説明は省略する。図6で示した合成像では観察像として光学観察像111aを用いていたが、図14で示すライブ画像では観察像として電子観察像111bを用いる。図14の電子観察像111bは動画である。電子観察像111bは受光素子39を用いて取得される。ライブ画像では制御部70は、図6で示した合成像と類似するように電子観察像111bと呈示情報(参照情報120,照射条件情報130)とを合成する。つまり本実施形態のモニタ82は、治療に関する情報(電子観察像111b,参照画像等)を術者に呈示するための第3呈示手段である。図14では、観察情報110と参照情報120と照射条件情報130とのレイアウト関係は、図6で示した合成像とライブ画像とで同様とされている。 <Third transformation example>
Next, a third modification will be described with reference to FIG. FIG. 14 is a live image displayed on the
これにより術者は、接眼レンズ36を覗く第1観察方法からモニタ82を眺める第2観察方法へと、患者眼Eの観察方法をシームレス(継ぎ目なく)に変更し易い。つまり例えば、患者眼Eの観察方法が接眼レンズ36を覗く第1観察方法とモニタ82を眺める第2観察方法の何れであっても、術者は照射条件情報130を速やかに確認又は変更し易い。なお観察像と参照情報120の位置関係は接眼レンズ36を覗く第1観察方法とモニタ82を眺める第2観察方法とで照射条件情報130とで一致するほど好ましいが、第1観察方法と第2観察方法とで観察像と参照情報120の位置関係が異なってもよい。例えばモニタ82を用いるライブ画像では電子観察像111bの外側に参照情報120が配置されてもよい。
This makes it easy for the operator to seamlessly change the observation method of the patient's eye E from the first observation method that looks at the eyepiece 36 to the second observation method that looks at the monitor 82. That is, for example, regardless of whether the observation method of the patient's eye E is the first observation method of looking at the eyepiece 36 or the second observation method of looking at the monitor 82, the operator can easily confirm or change the irradiation condition information 130 quickly. . It is preferable that the positional relationship between the observation image and the reference information 120 be the same in the irradiation condition information 130 between the first observation method that looks at the eyepiece 36 and the second observation method that looks at the monitor 82. The positional relationship between the observation image and the reference information 120 may differ depending on the observation method. For example, in a live image using the monitor 82, the reference information 120 may be arranged outside the electronic observation image 111b.
術者がメイン画面(図4参照)に表示されているライブボタン141をタッチすると、モニタ82の表示はメイン画面からライブ画面(図14参照)へと切り換わる。なお術者がライブ画面に表示されるボタン151をタッチすると、モニタ82の表示はライブ画面からメイン画面へと切り換わる。モニタ82の表示がメイン画面かライブ画面かに係わらず、接眼レンズ36を覗いた術者には合成像(図6参照)が呈示される。前述したようにライブ画面と図6で示す合成像とは、観察情報110と参照情報120と照射条件情報130とのレイアウト関係が略同一であるため、治療中に術者が観察方法を、接眼レンズ36を覗く観察方法からモニタ82を見る観察方法へと切り換えたとしても、違和感なく観察し易い。
す る と When the surgeon touches the live button 141 displayed on the main screen (see FIG. 4), the display on the monitor 82 is switched from the main screen to the live screen (see FIG. 14). When the operator touches the button 151 displayed on the live screen, the display on the monitor 82 switches from the live screen to the main screen. Regardless of whether the display on the monitor 82 is the main screen or the live screen, a synthetic image (see FIG. 6) is presented to the surgeon looking through the eyepiece 36. As described above, the layout relationship between the observation information 110, the reference information 120, and the irradiation condition information 130 is substantially the same between the live screen and the composite image shown in FIG. Even when switching from the observation method of looking through the lens 36 to the observation method of looking at the monitor 82, it is easy to observe without discomfort.
例えば治療中に、治療予定部位に対して精密な位置合わせが必要な時は接眼レンズ36を覗く観察方法を採用し、それ以外はライブ画面(モニタ82)を用いた観察方法を採用できる。例えばライブ画面(モニタ82)を用いた観察方法では術者の姿勢の自由度が増すため、治療中の術者の負担が低減される。例えばライブ画面(モニタ82)を用いた観察方法では患者眼EにコンタクトレンズCLを当て易くなる。なお電子観察像111bには視野絞り35の像35R’が写り込まないため、制御部70が画像処理により、視野絞り35を模した電子マスクを電子観察像111b上に重畳させてもよい。つまり、図6を用いて例示した光学観察像111aを用いた合成像と、図14を用いて例示した電子観察像111bを用いた合成像とで観察画角を同一になるように、電子マスクが用いられてもよい。これにより、接眼レンズ36を覗く第1観察方法とモニタ82を眺める第2観察方法とで、患者眼Eの観察方法をよりシームレス(継ぎ目なく)に変更し易くなる。
For example, during the treatment, when precise positioning with respect to the part to be treated is required, an observation method of looking through the eyepiece 36 may be employed, and otherwise, an observation method using a live screen (the monitor 82) may be employed. For example, in the observation method using the live screen (monitor 82), the degree of freedom of the posture of the operator is increased, so that the burden on the operator during treatment is reduced. For example, in the observation method using the live screen (the monitor 82), the contact lens CL is easily applied to the patient's eye E. Since the image 35R 'of the field stop 35 is not reflected in the electron observation image 111b, the controller 70 may superimpose an electronic mask imitating the field stop 35 on the electron observation image 111b by image processing. That is, the electronic mask is used so that the combined image using the optical observation image 111a illustrated using FIG. 6 and the combined image using the electronic observation image 111b illustrated using FIG. May be used. This makes it easier to change the observation method of the patient's eye E more seamlessly (without seams) between the first observation method that looks into the eyepiece 36 and the second observation method that looks at the monitor 82.
<まとめ>
以上説明したように、本開示の眼科用レーザ治療装置1は、患者眼Eに治療レーザ光を照射するためのレーザ照射光学系40と、患者眼Eをスリット光で照明するための照明光学系60と、スリット光で照明された患者眼Eの観察像を得るための観察光学系30と、眼模式図121を表示するための表示部90と、観察像と眼模式図121を術者に呈示するための呈示手段と、表示部90に眼模式図121を表示するための表示制御手段と、を備える。これにより、例えば、他の装置で撮影した患者眼Eの撮影画像(実写画像125)を取得しなくても、患者眼Eの観察像と眼模式図121を用いて治療レーザ光の照射を好適に行える。 <Summary>
As described above, the ophthalmiclaser treatment apparatus 1 of the present disclosure includes the laser irradiation optical system 40 for irradiating the treatment eye to the patient's eye E and the illumination optical system for illuminating the patient's eye E with the slit light. 60, an observation optical system 30 for obtaining an observation image of the patient's eye E illuminated by the slit light, a display unit 90 for displaying an eye schematic diagram 121, and an observation image and the eye schematic diagram 121 to an operator. There are provided presentation means for presenting, and display control means for displaying the eye schematic diagram 121 on the display unit 90. Accordingly, for example, irradiation of the treatment laser beam is preferably performed using the observation image of the patient's eye E and the eye schematic diagram 121 without acquiring a captured image (actual image 125) of the patient's eye E captured by another device. Can be done.
以上説明したように、本開示の眼科用レーザ治療装置1は、患者眼Eに治療レーザ光を照射するためのレーザ照射光学系40と、患者眼Eをスリット光で照明するための照明光学系60と、スリット光で照明された患者眼Eの観察像を得るための観察光学系30と、眼模式図121を表示するための表示部90と、観察像と眼模式図121を術者に呈示するための呈示手段と、表示部90に眼模式図121を表示するための表示制御手段と、を備える。これにより、例えば、他の装置で撮影した患者眼Eの撮影画像(実写画像125)を取得しなくても、患者眼Eの観察像と眼模式図121を用いて治療レーザ光の照射を好適に行える。 <Summary>
As described above, the ophthalmic
また本実施形態の眼科用レーザ治療装置は、観察光学系30に設けられ、光学観察像111aを観察するための接眼レンズ36を備え、表示部90は観察光学系30に設けられている。また、観察光学系30に設けられ、前記光学観察像と前記眼模式図を合成するための合成手段を更に備える、これにより、例えば、接眼レンズ36を覗くと観察像と眼模式図121が呈示され、治療レーザ光の照射を好適に行える。接眼レンズ36を覗いて患者眼Eを観察することで、例えば、患者眼Eに対する精密な位置合わせを行い易くなる。また本実施形態の眼科用レーザ治療装置は、観察光学系30に設けられ、患者眼Eの電子観察像111bを得るための受光素子39を備え、表示制御手段は表示部90に電子観察像111bと眼模式図121を同時に表示する。これにより、例えば、術者の姿勢に余裕が生まれ、治療レーザ光の照射回数が多く、治療時間が長引いても術者は疲れ難い。
The ophthalmic laser treatment apparatus according to the present embodiment is provided in the observation optical system 30 and includes the eyepiece 36 for observing the optical observation image 111a, and the display unit 90 is provided in the observation optical system 30. In addition, the observation optical system 30 further includes a synthesizing unit for synthesizing the optical observation image and the eye schematic diagram. Thus, for example, when the eyepiece 36 is viewed, the observation image and the eye schematic diagram 121 are presented. Thus, irradiation of the treatment laser beam can be suitably performed. Observing the patient's eye E by looking through the eyepiece 36 facilitates precise alignment with the patient's eye E, for example. Further, the ophthalmic laser treatment apparatus of the present embodiment is provided in the observation optical system 30 and includes a light receiving element 39 for obtaining an electronic observation image 111b of the patient's eye E, and the display control means displays the electronic observation image 111b on the display unit 90. And the eye schematic diagram 121 are displayed at the same time. Thus, for example, the posture of the surgeon has a margin, the frequency of irradiation of the treatment laser beam is large, and the surgeon is hardly tired even if the treatment time is prolonged.
また本実施形態の眼科用レーザ治療装置は、観察光学系30とは異なる光学系を用いて撮影された患者眼Eの実写画像125を取得するための取得手段と、表示部90に眼模式図121と実写画像125とを選択的に表示するための表示選択手段を備える。これにより、例えば、患者眼Eの実写画像125が既に存在する場合は観察像と実写画像125を用いた治療レーザ光の照射を行い、患者眼Eの実写画像125が存在しない場合は観察像と眼模式図121を用いた治療レーザ光の照射を行えばよい。つまり実写画像125の有無に依存することなく治療を速やかに行える。
Further, the ophthalmic laser treatment apparatus of the present embodiment has an acquisition unit for acquiring a real image 125 of the patient's eye E photographed using an optical system different from the observation optical system 30, and an eye schematic diagram on the display unit 90. A display selection unit for selectively displaying the image 121 and the photographed image 125 is provided. Thereby, for example, when the photographed image 125 of the patient's eye E already exists, irradiation of the treatment laser beam using the observation image and the photographed image 125 is performed, and when the photographed image 125 of the patient's eye E does not exist, the observation image is displayed. Irradiation of treatment laser light using the schematic ocular diagram 121 may be performed. That is, the treatment can be performed promptly without depending on the presence or absence of the real image 125.
また本実施形態の眼科用レーザ治療装置は、治療レーザ光の照射予定領域123を選択的に決定するためのテンプレート122と、眼模式図121とテンプレート122との合成画像を生成するための画像処理手段を備えている。ここで表示制御手段は表示部90に合成画像を表示できる。これにより、例えば、術者はテンプレートを用いることで簡単な操作で照射予定領域を決定でき、且つ、決定した照射予定領域が術者に呈示されることで、速やかな治療が可能になる。
Further, the ophthalmic laser treatment apparatus according to the present embodiment includes a template 122 for selectively determining an irradiation scheduled region 123 of the treatment laser beam, and an image processing for generating a composite image of the eye schematic diagram 121 and the template 122. Means. Here, the display control means can display the composite image on the display unit 90. Thus, for example, the surgeon can determine the irradiation scheduled area by a simple operation using the template, and the determined irradiation scheduled area is presented to the operator, thereby enabling prompt treatment.
<その他>
本実施形態の眼科用レーザ治療装置1は一例であり、例えば術者が覗いて観察するための接眼ユニット(正立プリズム群34,視野絞り35,接眼レンズ36)を、眼科用レーザ治療装置が備えなくてもよい。つまり受光素子を用いた観察像の取得と接眼レンズを介さない表示手段との組合せのみで患者眼Eに観察像を呈示する眼科用レーザ治療装置に本開示の技術を適用してもよい。 <Others>
The ophthalmiclaser treatment apparatus 1 of the present embodiment is an example. For example, an ocular unit (the erecting prism group 34, the field stop 35, and the ocular lens 36) for an operator to look into and observe is used. It is not necessary to prepare. That is, the technology of the present disclosure may be applied to an ophthalmic laser treatment apparatus that presents an observation image to the patient's eye E only by combining an observation image using a light receiving element and a display unit that does not pass through an eyepiece.
本実施形態の眼科用レーザ治療装置1は一例であり、例えば術者が覗いて観察するための接眼ユニット(正立プリズム群34,視野絞り35,接眼レンズ36)を、眼科用レーザ治療装置が備えなくてもよい。つまり受光素子を用いた観察像の取得と接眼レンズを介さない表示手段との組合せのみで患者眼Eに観察像を呈示する眼科用レーザ治療装置に本開示の技術を適用してもよい。 <Others>
The ophthalmic
本実施形態では眼科用レーザ治療装置の一例として、患者眼Eの眼底Erの患部を光凝固する眼科用レーザ治療装置1を用いた。しかし本開示の適用は光凝固装置に限るものでは無い。例えば患者眼Eに治療レーザ光を照射して後発白内障の治療を行う眼科用レーザ治療装置に本開示の技術を適用してもよい。本開示の技術を、患者眼を観察し、治療レーザ光にて治療を行う他の眼科用レーザ治療装置に適用してもよい。本開示の技術は、観察用の照明光としてスリット光を用いる眼科用レーザ治療装置に適用するとより好適である。
In this embodiment, the ophthalmic laser treatment apparatus 1 that photocoagulates the affected part of the fundus Er of the patient's eye E is used as an example of the ophthalmic laser treatment apparatus. However, the application of the present disclosure is not limited to the photocoagulation device. For example, the technology of the present disclosure may be applied to an ophthalmic laser treatment apparatus that treats a secondary cataract by irradiating a patient's eye E with treatment laser light. The technology of the present disclosure may be applied to another ophthalmic laser treatment apparatus that observes a patient's eye and performs treatment using treatment laser light. The technology of the present disclosure is more preferably applied to an ophthalmic laser treatment apparatus that uses slit light as illumination light for observation.
今回開示された実施形態はすべての点で例示であって、制限的なものではないと考えられるべきである。本開示の範囲は、上記した説明ではなく、特許請求の範囲によって示され、特許請求の範囲及びこれと均等の意味及び範囲内でのすべての変更が含まれることが意図される。
The embodiment disclosed this time is an example in all respects, and should not be considered as restrictive. The scope of the present disclosure is defined by the terms of the claims, rather than the description above, and is intended to include the claims, any equivalents, and all modifications within the scope.
1 眼科用レーザ治療装置
30 観察光学系
36 接眼レンズ
39 撮像素子
40 レーザ照射光学系
60 照明光学系
70 制御部
90 表示部
121 眼模式図
E 患者眼
DESCRIPTION OFSYMBOLS 1 Ophthalmic laser treatment apparatus 30 Observation optical system 36 Eyepiece 39 Image sensor 40 Laser irradiation optical system 60 Illumination optical system 70 Control unit 90 Display unit 121 Eye schematic diagram E Patient eye
30 観察光学系
36 接眼レンズ
39 撮像素子
40 レーザ照射光学系
60 照明光学系
70 制御部
90 表示部
121 眼模式図
E 患者眼
DESCRIPTION OF
Claims (5)
- 患者眼に治療レーザ光を照射するためのレーザ照射光学系と、
前記患者眼をスリット光で照明するための照明光学系と、
前記スリット光で照明された前記患者眼の観察像を得るための観察光学系と、
眼模式図を表示するための表示部と、
前記観察像と前記眼模式図を術者に呈示するための呈示手段と、
前記表示部に前記眼模式図を表示するための表示制御手段と、
を備えることを特徴とする眼科用レーザ治療装置。 A laser irradiation optical system for irradiating a treatment laser beam to the patient's eye,
An illumination optical system for illuminating the patient's eye with slit light,
An observation optical system for obtaining an observation image of the patient's eye illuminated with the slit light,
A display unit for displaying an eye schematic diagram,
Presentation means for presenting the observation image and the eye schematic diagram to an operator,
Display control means for displaying the eye schematic diagram on the display unit,
An ophthalmic laser treatment apparatus comprising: - 請求項1に記載の眼科用レーザ治療装置であって、
前記観察光学系に設けられ、前記観察像を観察するための接眼レンズを備え、
前記表示部は前記観察光学系に設けられており、
前記観察像とは患者眼の光学観察像であり、
前記観察光学系に設けられ、前記光学観察像と前記眼模式図を合成するための合成手段を更に備える、
ことを特徴とする眼科用レーザ治療装置。 An ophthalmic laser treatment apparatus according to claim 1,
An eyepiece provided for the observation optical system, for observing the observation image,
The display unit is provided in the observation optical system,
The observation image is an optical observation image of the patient's eye,
It is provided in the observation optical system, further comprising a combining means for combining the optical observation image and the eye schematic diagram,
An ophthalmic laser treatment apparatus characterized by the above-mentioned. - 請求項1に記載の眼科用レーザ治療装置であって、
前記観察光学系に設けられ、前記患者眼の観察画像を得るための受光素子を備え、
前記表示制御手段は前記表示部に、前記観察画像と前記眼模式図を同時に表示する、
ことを特徴とする眼科用レーザ治療装置。 An ophthalmic laser treatment apparatus according to claim 1,
Provided in the observation optical system, comprising a light receiving element for obtaining an observation image of the patient's eye,
The display control means simultaneously displays the observation image and the eye schematic diagram on the display unit,
An ophthalmic laser treatment apparatus characterized by the above-mentioned. - 請求項1~3のいずれか1項に記載の眼科用レーザ治療装置であって、
前記観察光学系とは異なる光学系を用いて撮影された前記患者眼の実写画像を取得するための取得手段と、
前記表示部に前記眼模式図と前記実写画像とを選択的に表示するための表示選択手段と、
を備えることを特徴とする眼科用レーザ治療装置。 The ophthalmic laser treatment apparatus according to any one of claims 1 to 3,
Acquisition means for acquiring a real image of the patient's eye taken using an optical system different from the observation optical system,
Display selection means for selectively displaying the eye schematic diagram and the real image on the display unit,
An ophthalmic laser treatment apparatus comprising: - 請求項1~4のいずれか1項に記載の眼科用レーザ治療装置であって、
前記治療レーザ光の照射予定領域を選択的に決定するためのテンプレートと、
前記眼模式図と前記テンプレートとの合成画像を生成するための画像処理手段と、
を備え、
前記表示制御手段は前記表示部に前記合成画像を表示する、
ことを特徴とする眼科用レーザ治療装置。
The ophthalmic laser treatment apparatus according to any one of claims 1 to 4, wherein
A template for selectively determining the irradiation scheduled region of the treatment laser light,
Image processing means for generating a composite image of the eye schematic diagram and the template,
With
The display control means displays the composite image on the display unit,
An ophthalmic laser treatment apparatus characterized by the above-mentioned.
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JPH08112254A (en) * | 1994-10-18 | 1996-05-07 | Canon Inc | Intraocular observation instrument |
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