Scleral translocation elasto-modulation methods and apparatus

Abstract

A laser delivery system is configured to delivery light energy to soften and realign the tissue of the eye in order to increase accommodation and treat glaucoma. The laser system can be configured to increase a circumlental space of the eye and increase movement of a posterior vitreous zonule in order to increase accommodation. The light energy may comprise wavelengths strongly absorbed by collagen of the sclera. In many embodiments a heat sink is provided to couple to the conjunctiva and the heat sink comprises a material transmissive to the light energy absorbed by collagen, for example Zinc Selenide. The heat sink can be chilled to inhibit damage to the conjunctiva of the eye. In many embodiments, one or more layers of the epithelium of the eye remain substantially intact above the zone where the eye has been treated when the heat sink has been removed.

1 . An apparatus to treat glaucoma of an eye, the apparatus comprising:
 a source of a laser energy to irradiate a conjunctival tissue and a scleral tissue beneath the conjunctival tissue with the laser energy, wherein the laser energy comprises at least one wavelength within a range from 1.4 μm to 10 μm;   a processor comprising instructions to treat one or more treatment regions the eye with the laser energy in order to heat the scleral tissue beneath the conjunctival tissue and effect ocular tissue beneath the scleral tissue, the one or more treatment regions located posterior to a limbus of the eye.   
     
     
         2 .- 3 . (canceled) 
     
     
         4 . An apparatus as in  claim 1 , further comprising:
 a cooling structure to contact an outer surface of the eye, wherein the processor comprises instructions to treat the eye with the source of energy when the cooling structure contacts the outer surface of the eye.   
     
     
         5 . An apparatus as in  claim 4 , wherein the cooling structure comprises one or more of a heat sink or a chiller. 
     
     
         6 . (canceled) 
     
     
         7 . An apparatus as in  claim 4 , wherein the cooling structure is shaped to contact a conjunctiva of the eye. 
     
     
         8 . An apparatus as in  claim 4 , wherein the cooling structure comprises a material transmissive to energy of the source. 
     
     
         9 . An apparatus as in  claim 4 , wherein the energy source comprises a laser beam and the cooling structure comprises a material transmissive to the laser beam. 
     
     
         10 .- 14 . (canceled) 
     
     
         15 . An apparatus as in  claim 1 , wherein the processor comprises instructions to treat the eye such that energy is transmitted through a conjunctiva of the eye to irradiate the sclera. 
     
     
         16 . An apparatus as in  claim 1 , wherein the processor comprises instructions to treat the eye such that a conjunctiva of the eye comprises at least one layer of viable cells under a location of the conjunctiva irradiated with the energy source and a corresponded heated region comprising scleral tissue. 
     
     
         17 .- 19 . (canceled) 
     
     
         20 . An apparatus as in  claim 1 , wherein the processor comprises instructions to treat the eye such that at least about half of an electromagnetic light energy is absorbed with the conjunctiva of the eye and wherein a scleral stroma of the eye is heated more than the conjunctiva of the eye. 
     
     
         21 . An apparatus as in  claim 1 , wherein the processor comprises instructions to treat the eye such that an outer epithelial layer of the conjunctiva is heated to a temperature of no more than about 43 degrees Celsius. 
     
     
         22 . (canceled) 
     
     
         23 . An apparatus as in  claim 1 , further comprising:
 a display;   wherein the processor is configured to show a ring sized to mark the limbus of the eye on the display in order to align the limbus of the eye with the ring.   
     
     
         24 . An apparatus as in  claim 23 , wherein the processor is configured to display one or more one or more rings outward from the ring, the one or more rings corresponding to one or more treatment regions outward from the limbus. 
     
     
         25 . An apparatus as in  claim 24 , wherein the one or more treatment regions treatment regions correspond to the one or more outer rings with the ring aligned with the limbus of the eye and the processor is configured to irradiate the one or more treatment regions corresponding to the one or more outer rings. 
     
     
         26 . An apparatus as in  claim 1 , wherein the at least one wavelength comprises a wavelength within a range from 1.4 μm to 1.5 μm. 
     
     
         27 . An apparatus an in  claim 1 , further comprising a laser scanner to scan a beam of the laser energy on the annular treatment region. 
     
     
         28 . An apparatus as in  claim 1 , wherein the processor is configured with instructions to repeatedly treat the one or more annular treatment regions with the laser energy. 
     
     
         29 . An apparatus as in  claim 1 , wherein the one or more treatment regions comprise predetermined annular treatment regions presented to a user prior to treating the one or more annular treatment regions with the laser beam. 
     
     
         30 . An apparatus as in  claim 1 , further comprising a lens sized and shaped to be placed on the eye during treatment, wherein the contract lens comprises a material transmissive to the laser energy.