Abstract: Heat is generated in corneal fibrils in a cornea of an eye according to a selected pattern. The heat causes the corneal fibrils corresponding to the selected pattern to transition from a first structure to a second structure. The second structure provides a desired reshaping of the cornea. A cross-linking agent is then activated in the region of corneal fibrils according to the selected pattern. The cross-linking agent prevents the corneal fibrils from changing from the second structure. Thus, embodiments stabilize corneal tissue and improve its biomechanical strength after desired structural changes have been achieved in the corneal tissue. Accordingly, the embodiments help to preserve the desired reshaping of the cornea.

Abstract: A method for controlling activation of a cross-linking agent applied to an eye includes applying the cross-linking agent to a selected region of a cornea of the eye and initiating cross-linking activity in the selected region by activating the cross-linking agent with pulsed light illumination. The pulsed light illumination has a selectable wavelength, irradiance, dose, and on/off duty cycle. The wavelength, the irradiance, the dose, and the on/off duty cycle are adjusted in response to a determination of photochemical kinetic pathways for cross-linking activity and to control photochemical efficiency, depth of cross-linking, and density of cross-linking.

Abstract: A system for aligning an eye therapy instrument over a selected area or feature of an eye provides an attachment element that is removably attached to a surface of an eye. A receiving element is coupled to the attachment element and movable relative to the attachment element. The receiving element includes a coupling element configured to operably couple an eye therapy instrument to the receiving element and adjustably move the eye therapy instrument into a selected position with respect to the attachment element. The system makes adjustments to ensure accurate delivery of treatment from the eye therapy device to areas of the eye. In one embodiment, the receiving element allows lateral adjustments to be made along one or more axes. Additionally or alternatively, the receiving element allows angular or rotational adjustments to be made about one or more axes.

Abstract: A system includes a conducting element that conducts energy from an energy source to apply therapy to an eye. The system includes a covering configured to be removably attached to the conducting element. The covering has an interface surface that is positionable at an eye. At least a portion of the interface surface includes one or more dielectric materials. Energy is deliverable to the eye through the interface surface. In one aspect, the covering provides an electrical insulator to minimize the concentration of electrical current in the area of contact with the eye. In another aspect, the covering allows the eye to be cooled during the application of energy without directly applying coolant to the eye. In another aspect, the covering includes a dielectric layer that may provide varying impedances that allow different patterns for energy delivery. In another aspect, the sheath promotes hygienic use of the conducting element.

Abstract: A system for applying therapy to an eye selectively applies coolant to the corneal surface to minimize heat-related damage to the corneal surface during thermokeratoplasty. Embodiments may include an energy source, a conducting element, a coolant supply, and a coolant delivery system. The conducting element is operably connected to the energy source and extends from a proximal end to a distal end. The conducting element directs energy from the energy source to the distal end, which is positionable at the eye. The coolant delivery system is in communication with the coolant supply and is operable to deliver a micro-controlled pulse of coolant to the distal end.

Abstract: In systems and methods for generating cross-linking activity in an eye, a feedback system monitors a biomechanical strength of the eye in response to the photoactivation of a cross-linking agent applied to an eye. The feedback system includes a perturbation system that applies a force to the eye and a characterization system that determines an effect of the force on the eye. The effect of the force provides an indicator of the biomechanical strength of the eye. The characterization system determines the effect of the force on the eye by measuring an amount of deformation caused by the force or a rate of recovery from the deformation.

Abstract: A system for applying therapy to an eye includes an applicator having a conducting element configured to direct energy from an energy source to an application end of the conducting element, where the application end has an eye contact portion. A positioning system receives the applicator and positions the eye contact portion in stable engagement with the surface of an eye. In some embodiments, the conducting element is disposed within a housing for the applicator and an adjustment system is employed to move the conducting element relative to the housing. The adjustment system enables controlled movement of the conducting element and the eye contact portion against the corneal surface. In particular embodiments, sufficient contact between the applicator and the cornea is determined by causing applanation of the cornea. In other embodiments, a physical measurement device, such as a strain gauge, is employed to determine when sufficient contact has been established.

Abstract: The cornea is reshaped in multiple steps according to varying amounts of energy in varying patterns and/or at varying locations to achieve a customized reshaping of the cornea to address the specific needs of an individual patient. The varying amounts of energy may be applied via one or more conducting elements, which include an outer conductor and an inner conductor disposed within the outer conductor, a distal end of the outer conductor and the inner conductor defining the varying patterns. For example, one step may form a substantially circular lesion to flatten a first portion of the cornea to treat presbyopia, while another step may form a substantially circular and concentric lesion having a greater diameter to steepen a second portion of the cornea to treat hyperopia. Advantageously, continuous transitional regions are formed relative to the reshaped portions to provide vision for intermediate distances.

Abstract: A method for controlling activation of Riboflavin applied to an eye includes applying the Riboflavin to a selected region of a cornea of the eye and initiating cross-linking activity in the selected region by activating the Riboflavin with pulsed light illumination. The pulsed light illumination has an irradiance, dose, and an on/off duty cycle. The irradiance, the dose, and the on/off duty cycle are adjusted in response to a determination of photochemical kinetic pathways for Riboflavin cross-linking activity and to control photochemical efficiency.

Abstract: In a system for stabilizing a pattern of structural changes in corneal fibrils, an eye treatment system causes corneal fibrils of a cornea of an eye to transition from a first structure to a second structure. An application device applies a cross-linking element to the corneal fibrils. An activating device applies an initiating element to the corneal fibrils and activates the cross-linking element. The cross-linking element causes cross-linking in the corneal fibrils to preserve the second structure of the corneal fibrils. Another application device may apply a cross-linking breaker to the corneal fibrils. The cross-linking breaker halts or reverses at least partially the cross-linking in the corneal fibrils. Another activating device applies an initiating element to the corneal fibrils and activates the cross-linking breaker. Advantageously, the cross-linking breaker provides greater control over the amount and progress of cross-linking that occurs in the corneal fibrils.

Abstract: A system for applying therapy to an eye includes an applicator having a conducting element configured to direct energy from an energy source to an application end of the conducting element, where the application end has at least one eye contact portion. A positioning system positions the at least one eye contact portion in stable engagement with the eye surface. The conducting element is disposed within a housing for the applicator and at least one adjustment system is employed to move the conducting element relative to the housing. The at least one adjustment system enables controlled movement of the conducting element and the at least one eye contact portion against the corneal surface. In particular embodiments, sufficient contact between the applicator and the cornea is determined by causing applanation of the cornea. In other embodiments, at least one measurement device is employed to determine when sufficient contact has been established.

Abstract: Devices and approaches for monitoring time based photo active agent delivery or photo active marker presence in an eye. A monitoring system is provided for measuring the presence of a photo active marker by illuminating the eye so as to excite the photo-active marker and then observing characteristic emission from the photo active marker. Example systems incorporate Scheimpflug optical systems or slit lamp optical systems to observe cross sectional images of an eye to monitor instantaneous distribution, diffusion pattern, and rate of uptake of a photo active agent applied to an eye. Systems and methods further allow for utilizing the monitored distribution of photo active agent in the eye as feedback for a cross-linking system.

Abstract: Systems and methods include a cutting instrument that creates incisions in selected areas of the cornea; an eye therapy system that applies reshaping forces to the cornea; and a controller that determines the selected areas of the cornea for the incisions and the reshaping forces from the eye therapy system, such that the reshaping forces and the incisions combine to achieve corrective reshaping of the cornea. Other systems and methods include measuring an eye to determine a required amount of reshaping of a cornea; determining one or more doses of cross-linking agent and one or more corresponding doses of photoactivating light according to the required amount of reshaping; applying the cross-linking agent to the cornea; and delivering, from a light source, the photoactivating light to the area of the eye, the photoactivating light combining with the cross-linking agent to induce the corrective reshaping of the cornea.

Abstract: Devices and approaches for activating cross-linking within at least one eye component of an eye to stabilize and strengthen corneal tissue or other tissues of the eye. Cross-linking is activated within the at least one eye component by conveying a cross-linking agent to regions of the at least one eye component and then activating the cross-linking agent by delivering an initiating element to the at least one eye component. Approaches disclosed herein allow for precisely controlling the three dimensional region of strengthened tissue by conveying the cross-linking agent to regions of the at least one eye component. Approaches allow for conveying the cross-linking agent to a depth below the corneal surface such that cross-linking is activated below the corneal surface.

Abstract: A method for treating an eye includes applying, to an outer protective layer of an area of an eye, one or more initial doses of a cross-linking agent that acts as a photosensitizer. The method also includes delivering, from a light source, one or more initial doses of ultraviolet light to the area of the eye. The cross-linking agent increases absorption of the ultraviolet light by the area of the eye, and the absorption of the ultraviolet light sterilizes the area of the eye before the outer protective layer is penetrated. Additionally, the method includes penetrating the outer protective layer of the eye to provide access to an area below the outer protective layer. Moreover, the method includes applying a treatment to the eye via the access provided by cutting the outer protective layer. In some embodiments, the cross-linking agent is Riboflavin, and the treatment is LASIK surgery.

Abstract: Devices and approaches for activating cross-linking within corneal tissue to stabilize and strengthen the corneal tissue following an eye therapy treatment. A feedback system is provided to acquire measurements and pass feedback information to a controller. The feedback system may include an interferometer system, a corneal polarimetry system, or other configurations for monitoring cross-linking activity within the cornea. The controller is adapted to analyze the feedback information and adjust treatment to the eye based on the information. Aspects of the feedback system may also be used to monitor and diagnose features of the eye. Methods of activating cross-linking according to information provided by a feedback system in order to improve accuracy and safety of a cross-linking therapy are also provided.

Abstract: A system for applying therapy to an eye selectively applies coolant to the corneal surface to minimize heat-related damage to the corneal surface during thermokeratoplasty. Embodiments may include an energy source, a conducting element, a coolant supply, and a coolant delivery system. The conducting element is operably connected to the energy source and extends from a proximal end to a distal end. The conducting element directs energy from the energy source to the distal end, which is positionable at the eye. The coolant delivery system is in communication with the coolant supply and is operable to deliver a micro-controlled pulse of coolant to the distal end.

Abstract: Systems and methods stabilize corneal tissue after treatment of the corneal tissue. For example, thermokeratoplasty may be applied to the corneal tissue to address disorders associated with abnormal shaping of the cornea. To stabilize the desired structural changes caused by the treatment, embodiments apply ophthalmic formulations that help to inhibit wound healing. Wound healing may occur in response to the application of the treatment and may produce further structural changes that mitigate or alter the desired effects of the treatment.

Abstract: Devices and approaches for activating cross-linking within at least one eye component of an eye to stabilize and strengthen corneal tissue or other tissues of the eye. Cross-linking is activated within the at least one eye component by conveying a cross-linking agent to regions of the at least one eye component and then activating the cross-linking agent by delivering an initiating element to the at least one eye component. Approaches disclosed herein allow for precisely controlling the three dimensional region of strengthened tissue by conveying the cross-linking agent to regions of the at least one eye component. Approaches allow for conveying the cross-linking agent to a depth below the corneal surface such that cross-linking is activated below the corneal surface.

Abstract: Devices and approaches for activating cross-linking within corneal tissue to stabilize and strengthen the corneal tissue following an eye therapy treatment. A feedback system is provided to acquire measurements and pass feedback information to a controller. The feedback system may include an interferometer system, a corneal polarimetry system, or other configurations for monitoring cross-linking activity within the cornea. The controller is adapted to analyze the feedback information and adjust treatment to the eye based on the information. Aspects of the feedback system may also be used to monitor and diagnose features of the eye 1. Methods of activating cross-linking according to information provided by a feedback system in order to improve accuracy and safety of a cross-linking therapy are also provided.