A further component of the system is the laser patient interface 207. This interface should provide that the x, y, z position between the natural lens and the laser remains fixed during the procedure, which includes both the measurement steps of determining the x y z position and the delivery step of delivering the laser to the lens in a shot pattern. The interface device may contain an optically transparent applanator. One example of this interface is a suction ring applanator that is fixed against the outer surface of the eye and is then positioned against the laser optical housing, thus fixing the distance between the laser, the eye and the natural lens. Reference marks for the 3-dimensional viewing and measuring apparatus may also be placed on this applanator. Moreover, the interface between the lower surface of the applanator and the cornea may be observable and such observation may function as a reference. A further example of a laser patient interface is a device having a lower ring, which has suction capability for affixing the interface to the eye. The interface further has a flat bottom, which presses against the eye flattening the eye's shape. This flat bottom is constructed of material that transmits the laser beam and also preferably, although not necessarily, transmits optical images of the eye within the visible light spectrum. The upper ring has a structure for engaging with the housing for the laser optics and/or some structure that is of known distance from the laser along the path of the laser beam and fixed with respect to the laser. Further examples of such devices are generally disclosed in U.S. Pat. No. D462442, U.S. Pat. No. D462443, and U.S. Pat. No. D459807S, the disclosures of which are hereby incorporated by reference.

It is preferred that the interface may be a corneal shaped transparent element whereby the cornea is put into direct contact with the interface or contains an interface fluid between. Examples of patient interfaces devices are disclosed and taught in US Patent Application Publication Nos. 2010/0022994, 2011/0022035 and 2015/0088175, the entire disclosures of each of which are incorporated herein by reference.

Systems methods and apparatus for performing laser operations on the eye are disclosed and taught in US patent application Publication Nos. 2016/0302971, 2015/0105759, 2014/0378955, and U.S. Pat. Nos. 8,262,646 and 8,708,491, the entire disclosures of each of which are incorporated herein by reference.

An embodiment of a network system for performing the alignment nub capsulotomies of the present inventions is provided in FIG. 7. This embodiment is a network, wherein the laser surgery system 701 is in communication with a Wi-Fi router 702. This may be by either an Ethernet connection 701a or Wi-Fi connection 702a or both. The router 702 is in turn in communication with a Cassini Topographer 703, A QNAP server 704, a printer 705, and an OR Microscope 706. The router is linked to these devices along communication pathways 703a, 704a, 705a, and 706a, respectively. This communication may be done either via a Wi-Fi connection, Ethernet link, other automation or data communication systems and combinations and variations of these. Data may be exchanged between the laser 701 and the Cassini Topographer 703 and the OR Microscope 706 via the use of USB Memory Sticks 707 or flash drive 708. This network may optionally include other devices useful in a hospital or a medical office, including personal computers or mobile devices. The network may download and/or upload a patient's medical history to a remote server. This information may include previously-acquired data regarding the patient's iris, and may be used by the system to ensure that the scanned iris belongs to the patient for whom the current treatment plan was developed. Other embodiments of combinations of the devices in this network are contemplated by the present inventions.

Laser systems have predetermined laser shot patterns for providing a laser beam in a capsulotomy shot pattern to the anterior capsule of the natural human crystalline lens. The laser shot pattern can be stored in the laser system memory or associated laser system control system. The laser beam shot delivery pattern, is delivered to the anterior surface of the lens capsule to cut an opening in the capsule, forming a capsulotomy.

The capsulotomy is typically and generally circular, however, it should be understood that elliptical and other shapes may be used in conjunction with the alignment nubs.

The astigmatic axis of the eye is provided to the laser system. The axis can be determined by the laser system, having integral systems to determine the astigmatic axis, by a separate device to make this determination, or prior to laser surgery at a remote device where the information about the astigmatic axis of the eye is provided to the laser system, and combinations and variations of these. The astigmatic axis (e.g., the axis of astigmatism) can be determined before, during, or after, the removal of lens material by, for example, topographically mapping the structures of an eye.

As part of the capsulotomy, alignment indicators or “nubs” are formed in the capsular rim. The capsular rim is the rim or edge of the opening formed by the section of lens capsule remaining after the capsulotomy is performed. Thus, the laser beam shots are delivered in the laser beam pattern to perform the capsulotomy cut through the lens capsule. These nubs are preferably placed on opposite sides of the capsular rim along the determined axis of astigmatism. However, it is understood that the nubs can be placed in any known and predetermined relationship to the astigmatic axis. In this manner the nubs form reference points for the alignment of implants into the lens of the eye, IOLs and in particular toric IOLs.

These nubs can be viewed as appendages having predetermined shapes and sizes that extend inwardly from the circular capsulotomy rim and provide reference points to assist surgeons in accurately aligning toric IOL marks along the axis of astigmatism. The shape and size of the nubs can provide both qualitative reference, i.e., is the IOL aligned with the astigmatic axis, and quantitative reference, i.e., within how many degrees of the astigmatic axis is the IOL aligned.

In an embodiments the orientation of the alignment indicators is automatically computed using, in part, data regarding the topographic mapping of a patient's eye, an iris registration method, as well as calculations based on the average surgically-induced astigmatism for a patient's demographic. For example, this demographic information may include, but is not limited to, Nichamin, Johnson and Woodcock monograms.

Before surgery, the system may generate a 3-D model of the eye using, in part, data collected from the eye. This model includes the location of structures including the lens, the astigmatic axis, and any cataracts that may be present. Then, the system may use planning tables, demographic data regarding the patient, including Burd modeling, and the 3-D model to calculate a post-surgical axis of astigmatism, biometry, and topography of the eye. Alternatively, the post-surgical axis of astigmatism may be calculated using the 3-D modeling techniques mentioned above. The system may then automatically align the appendages along the axis of astigmatism. A surgeon may choose to factor either the pre-surgical or post-surgical axis of astigmatism when deciding where to place the alignment indicators.

FIG. 1A shows a schematic plan view of the lens 2320 of the eye, having an embodiment of a laser alignment nub capsulotomy 2304 and its laser delivery pattern 2304-1 (which are coincident in the drawing). The capsulotomy rim 2304a is formed by the remaining lens capsule material 2304b; and the rim 2304a forms or borders the opening 2304c (e.g., the capsular opening) that is formed when the lens capsular material is removed after the laser cut from delivery of the laser beam shot pattern is performed. (In later figures it being understood that the laser beam shot delivery pattern, the capsulotomy and the capsular rim are coincident, and for ease of reference, will only be referred to with a single reference number and line)

Alignment nubs 2301a and 2301b are part of the laser beam delivery pattern 2304-1 and are formed in the capsulotomy 2304, and thus, also from a part of the capsulotomy rim 2304a. The nubs 2301a, 2301b are aligned with the astigmatic axis 2308 of the eye, and are on opposite sides of the points where that axis crosses the capsulotomy. The nubs have apexes, 2361, 2362.

In this embodiment the nubs 2301a, 2301b, are formed from remaining lens capsule material 2304b, and extend inwardly from the generally circular shape of the opening 2304c, and into the lens capsule opening 2304c. Thus, the laser shot pattern provides a cut that results in the remaining lens capsule material 2304b extending into the capsular opening 2304c forming the alignment nubs 2301a, 2301b. In this embodiment the alignment nubs also extend toward the center of the eye and toward the optical axis of the eye.

The center or center point, of the capsulotomy patterns in FIGS. 1A and 1B are located at the 0 point on the x-axis and y-axis of those figures, i.e., where the two axes cross.

The geometries of each nub can be the same or they can be different. One nub may be used, two nubs at the points where the the astigmatic axis crosses the capsulotomy cut is preferred, and additional nubs, 3, 4 etc., may be used, and may be positioned in other predetermined locations with respect to the astigmatic axis. Additionally, one or more of the nubs can extend into the opening or away from the opening. A surgeon may select the geometries of each alignment indicator, e.g., nub, these geometries may be automatically selected by the system, these geometries can be based, in part, on preferred geometries, they can be based in part on the patient's age, and they can be based on combinations and variations of these and other factors.

Turning to FIG. 1B, there is provided a plan view of a lens 2320 of an eye having an alignment nub laser capsulotomy 2304, having nubs 2302 and 2303. The alignment nubs 2302, 2303 are aligned with the astigmatic axis 2308 of the eye. The nub's have a predetermined geometry (i.e., size and shape), which includes a depth shown by double arrow 2307, sweep (defined by a sweep angle 2306 and double arrow 2306a), and fillet (e.g., tightness) defined by the shape and distance of the cut or nub shape between arrows 2309.

The cut's depth is the measurement of difference between the nub's apex and the radius of the capsular rim, as illustrated by double arrow 2307. The depth can be between about 0.1mm-about 1mm, can be from 0.1 mm to 0.4 mm, and can be from 0.2 mm to 0.7 mm. In preferred embodiments the depth is 0.3 mm, about 0.3 mm, and is from 0.25 mm to 0.35 mm. Although, greater and smaller distances are contemplated, as well. (As used herein the term “about” would include 10% of the stated value, the instrumental error associated with measuring or determining that value, or the larger of the two.)

The nub's sweep is the angle 2306 as measured by double arrow 2306a formed by the nub, between the points where the nub, or nub's cut, initially extends away from the general pattern (typically circular) of the capsulotomy 2304. The nub's sweep can be from about 5° to about 35°. Although larger and smaller sweeps are contemplated. The nub's sweep can be from 5° to 20°, can be from 10° to 40°, can be from 15° to 25°, can be about 5°, can be about 3° to about 7°, and can be about 10°.

The nub, and in particular, the apex of the nub is a predetermined distance, typically as measured by degrees along the curve of the circular capsulotomy, from an astigmatic axis of the eye. The nub, and the nub apex, can be on an axis of astigmatism 2308 (i.e., the nub apex is less than about 1° away from the axis), within about 5° to about 10° of an axis of astigmatism, within about 5° of an axis of astigmatism, within about 7° of an axis of astigmatism, and within about 10° of an axis of astigmatism. Most preferably, the nub is within 10° of the post-surgical axis of astigmatism. Although different predetermined or known, distances and degrees from the axis are contemplated.

The tightness of the cut, e.g., the “fillet”, is the linear length between the alignment indicator's apex and the capsular rim (i.e., the distance or length of the cut segment between arrows 2309). The cut's tightness, or fillet, influences the stability of the capsular region and the overall capsule stability. The fillet can be between about 0.1 mm to about 0.5 mm, can be between 0.1 mm to 0.5 mm, can be about 0.2 to about 0.7 mm, can be about 0.1 mm, about 0.2 mm, about 0.25 mm and about 0.4 mm. Preferably the cut's fillet is 0.2 mm.

The geometry for an embodiment of a cut having a depth of about 0.3 mm, a sweep of about 5° to 10°, and a fillet of about 0.2 mm, is an example of a shape and size of a nub that balances the needs, for an alignment indicator of the proper geometry for IOL alignment with the need to preserve optimal capsular strength. The cut's filleting also decreases sharp edges, which minimizes stress focal points and helps preserve capsular strength while minimizing the risk of tissue tearing during implantation and manipulation of an IOL. Also, the alignment indicators, e.g., nubs, are preferably symmetrical, with the same depth, sweep, and fillet, and both within 10° of the axis of astigmatism, with the axis of astigmatism acting as an axis of symmetry. Alignment indicators of differing geometries are contemplated.

FIG. 2A shows a plan for a capsulotomy 2404 with nub 2401 with cut sweep of 5° as defined by angle 2401a and arc 2401b, and nub 2402 with cut sweep of 10° as defined by angle 2402a and arc 2402b. Nub 2402 is a 10° cut that allows for insertion of an IOL, when the nub apex is on the astigmatic axis, within 5° of the axis of astigmatism (not shown in the figure), based upon the typical size of the markings on the IOL. Thus, the sweep of the nub provides, what can be viewed as the width of a runway, or runway markers where the axis indicators of the toric IOL can be landed, or aligned. In this manner a 10° sweep nub can typically provide an accuracy of about 5° (e.g., the nub is providing quantitative measurement of, or information about, the placement of the IOL). In this manner a 5° sweep nub can typically provide an accuracy of about 1° or more. Upon delivering the laser beam shot pattern as provided in the laser beam plan, e.g.,