Treatment of presbyopia and other eye disorders using a scanning laser system

Abstract

Presbyopia is treated by a method which uses ablative lasers to ablate the sclera tissue and increase the accommodation of the ciliary body. Tissue bleeding is prevented by an ablative laser having a wavelength of between 0.15 and 3.2 micron. A scanning system is proposed to perform various patterns on the sclera area of the cornea to treat presbyopia and to prevent other eye disorder such as glaucoma. Laser parameters are determined for accurate sclera expansion. REEXAMINATION RESULTS The questions raised in reexamination request no. 90/006,090, filed Aug. 22, 2001, have been considered and the results thereof are reflected in this reissue patent which constitutes the reexamination certificate required by 35 U.S.C. 307 as provided in 37 CFR 1.570(e), for ex parte reexaminations, or the reexamination certificate required by 35 U.S.C. 316 as provided in 37 CFR 1.997(e) for inter partes reexaminations.

1. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera comprising the steps of:
 selecting a pulsed ablation laser having a pulsed output beam of predetermined wavelength;  
 selecting a beam spot controller mechanism for reducing and focusing said selected ablative laser's output beam onto a predetermined spot size on the surface of the cornea  eye;  
 selecting a scanning mechanism for scanning said ablative laser output beam;  
 coupling said ablative laser beam to a scanning device for scanning said ablative laser over a predetermined area of the corneal  sclera; and  
 controlling said scanning mechanism to deliver said ablative laser beam in a predetermined pattern in said predetermined area onto the surface of the cornea  eye to photoablate the sclera tissue outside the limbus to a depth of  80 - 90 %  of the thickness of the scleral tissue , whereby a presbyopic patient's vision is corrected by expansion of the sclera.  
 
     
     
       2. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the step of selecting a pulsed ablation laser includes selecting a pulsed ablative laser having a predetermined wavelength between 0.15-0.32 microns. 
     
     
       3. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the step of selecting a pulsed ablation laser includes selecting a pulsed ablative laser having a wavelength between 2.6 and 3.2 microns. 
     
     
       4. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the step of selecting a pulsed ablation laser includes selecting a solid state laser. 
     
     
       5. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with claim  1  in which the step of selecting a pulsed ablation laser includes selecting a pulsed gas laser having a pulse duration shorter than 200 nanoseconds. 
     
     
       6. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which said  the step of selecting a beam spot controller includes selecting a pulsed ablative laser having a focusing lens with focal length of between 10 and 100 cm selected to obtain a predetermined laser beam spot size having a diameter of between 0.1 and 0.8 mm on the corneal  eye surface. 
     
     
       7. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the step of selecting a beam spot controller includes selecting a beam spot controller having a focusing lens with cylinder focal length of between 10 and 100 cm to obtain a laser beam spot having a line size of about 0.1-0.8 mm×3-5 mm on the corneal  eye surface. 
     
     
       8. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the step of selecting a scanning mechanism includes selecting a scanning mechanism having a pair of reflecting mirrors mounted to a galvanometer scanning mechanism for controlling said laser output beam into a predetermined pattern. 
     
     
       9. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by an ablating laser beam in accordance with  claim 1  in which said ablative laser is delivered to the surface of the cornea  eye by an optical fiber. 
     
     
       10. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the step of selecting a scanning mechanism includes selecting a hand-held optical fiber coupled to the ablation laser for scanning said laser output beam into a predetermined pattern. 
     
     
       11. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which the predetermined pattern is generated by the steps of:
 selecting a metal mask having at least one slit therein; and  
 positioning the selected mask over the cornea  eye surface for scanning the ablation laser thereover for controlling the ablation slit pattern on the sclera tissue outside the limbus.  
 
     
     
       12. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which said predetermined pattern includes at least 3 radial lines around the area of the cornea outside the limbus. 
     
     
       13. A laser beam ophthalmological surgery method for treating presbyopic  presbyopia in a patient's eye by ablating the sclera in accordance with  claim 1  in which said predetermined pattern includes a ring pattern around the area of the cornea outside the limbus. 
     
     
       14. A method of improving accommodation and/or treating presbyopia, comprising:
   cutting at least three spaced apart, substantially radial lines in the scleral tissue of a patient's eye outside the limbus to a depth of  80 - 90   %  of the thickness of the scleral tissue.     
     
     
       15. A method as in  claim 14  wherein the lines are non- intersecting.   
     
     
       16. A method as in  claim 14  wherein the step of cutting is performed using a pulsed laser. 
     
     
       17. A method as in  claim 16  wherein the laser has a spot size of  0 . 1  mm to  0 . 8  mm. 
     
     
       18. A method as in  claim 14  wherein the step of cutting is performed using a laser having a wavelength of approximately  2 . 6 - 3 . 2  microns. 
     
     
       19. A method as in  claim 14  wherein the step of cutting is performed using a laser having a wavelength of about  308  nanometers. 
     
     
       20. A method as in  claim 14  wherein the step of cutting is performed using a laser having a wavelength of about  193  nanometers. 
     
     
       21. A method as in  claim 14  wherein the step of cutting is performed using a laser having an average power of about  30  mW to  3  W. 
     
     
       22. A method as in  claim 14  wherein the step of cutting includes cutting  8  lines in the sclera. 
     
     
       23. A method as in  claim 14  wherein the step of cutting includes using an optical fiber tip to deliver the laser beam to the sclera.