Re-treatable corneal lenticular incisions with re-treatment options using a femtosecond ophthalmic laser system

1 . An ophthalmic laser system comprising:

a laser device configured to generate a pulsed laser beam;

an optical delivery system configured to deliver the pulsed laser beam to a cornea of a patient's eye, including one or more scanners configured to scan a laser beam focal spot of the pulsed laser beam within the cornea; and

a controller configured to control the laser device and the scanners to form a lenticule in the cornea, including to:

(a) scan the laser beam focal spot in the cornea by executing a treatment plan, the treatment plan including a bottom segment defining a bottom lenticule incision and a top segment defining a top bed incision, wherein the bottom lenticule incision includes an optical zone having a shape determined by a defined optical power of the lenticule, the top bed incision has a flat shape, and the top bed incision is located above the bottom lenticule incision; and

either: (b) in response to an interruption while executing the bottom segment of the treatment plan after the bottom lenticule incision is partially formed, revise the treatment plan to define a new bottom lenticule incision which has an identical shape as the bottom lenticule incision and is located below the partially formed bottom lenticule incision without coinciding with or intersecting the partially formed bottom lenticule incision, and scan the laser beam focal spot by executing the revised treatment plan to form the new bottom lenticule incision;

or: (c) in response to an interruption while executing the top segment of the treatment plan after the top bed incision is partially formed, revise the treatment plan to define a new top bed incision which has an identical shape as the top bed incision and is located above the partially formed top bed incision without coinciding with or intersecting the partially formed top bed incision, and scan the laser beam focal spot by executing the revised treatment plan to form the new top bed incision.

2 . The ophthalmic laser system of claim 1 , wherein controller function (b) further includes, before revising the treatment plan, measuring a depth of an apex of the partially formed bottom lenticule incision.

3 . The ophthalmic laser system of claim 2 , wherein an apex of the new bottom lenticule incision is located 5-20 microns below the apex of the partially formed bottom lenticule incision.

4 . The ophthalmic laser system of claim 1 , wherein controller function (c) further includes, before revising the treatment plan, measuring a depth of the partially formed top bed incision.

5 . The ophthalmic laser system of claim 4 , wherein the new top bed incision is located 5-10 microns above the partially formed top bed incision.

6 . The ophthalmic laser system of claim 1 , wherein in the treatment plan, the bottom segment is executed before the top segment.

7 . The ophthalmic laser system of claim 1 , wherein in the treatment plan, the top segment is executed before the bottom segment.

8 . The ophthalmic laser system of claim 1 , wherein the treatment plan further includes an entry segment which defines an entry cut, the entry cut extending upwardly from an outer edge of the bottom lenticule incision to reach an anterior surface of the cornea, and the controller is further configured to:

(d) in response to an interruption while executing the entry segment of the treatment plan after an entry cut is partially formed, revise the treatment plan to define a new entry cut which is aligned with the partially formed entry cut, and scan the laser beam focal spot by executing the revised treatment plan.

9 . The ophthalmic laser system of claim 8 , wherein in the treatment plan, the entry segment is executed before the bottom segment and the top segment.

10 . The ophthalmic laser system of claim 1 , wherein the bottom lenticule incision and the top bed incision intersect each other near their respective peripheries to define an isolated lenticule volume.

11 . The ophthalmic laser system of claim 1 , wherein the treatment plan further includes a ring segment which defines a ring cut, the ring cut having a ring shape and extending between the bottom lenticule incision and the top bed incision, wherein the bottom lenticule incision and the top bed incision both intersect the ring cut near their respective peripheries to define an isolated lenticule volume, and the controller is further configured to:

(d) in response to an interruption while executing the ring segment of the treatment plan after a ring cut is partially formed, revise the treatment plan to define a new ring cut which has a radius larger than a radius of the partially formed ring cut, the new ring cut being aligned concentrically with the partially formed ring cut, and scan the laser beam focal spot by executing the revised treatment plan.

12 . The ophthalmic laser system of claim 11 , wherein the radius of the new ring cut is larger than the radius of the partially formed ring cut by 20-100 microns.

13 . The ophthalmic laser system of claim 1 , wherein the one or more scanners of the optical delivery system include a resonant scanner, an XY scanner, and a Z scanner, and the controller is configured to perform controller function (a) by:

controlling the resonant scanner to scan the laser beam to form a laser scan line, the scan line being a straight line having a predefined length and parallel to an XY plane; and

controlling the XY scanner and the Z scanner to form a plurality of sweeps of the scan line which collectively form the bottom lenticule incision, including, for each sweep: placing the scan line tangential to a parallel of latitude of the bottom lenticule incision and scanning the laser scan line along a meridian of longitude of the bottom lenticule incision, wherein the parallel of latitude is a circle on the bottom lenticule incision that is perpendicular to a Z axis and has a defined distance to an apex of the bottom lenticule incision, and the meridian of longitude is a curve that passes through the apex and has a defined angular position around the Z axis.

14 . The ophthalmic laser system of claim 1 , wherein the controller is configured to perform controller function (b) by:

controlling the resonant scanner to scan the laser beam to form a laser scan line, the scan line being a straight line having a predefined length and parallel to an XY plane; and

controlling the XY scanner to form a plurality of parallel sweeps of the scan line which collectively form the top bed incision.

15 . The ophthalmic laser system of claim 1 , wherein the treatment plan further includes an entry segment which defines an entry cut, the entry cut extending upwardly from an outer edge of the bottom lenticule incision to reach an anterior surface of the cornea, and the controller is further configured to:

(d) in response to an interruption while executing the entry segment of the treatment plan after an entry cut is partially formed, revise the treatment plan to define a new entry cut that is located at a different angular position from the partially formed entry cut without coinciding with or intersecting the partially formed entry cut, and scan the laser beam focal spot by executing the revised treatment plan.

16 . An ophthalmic laser system comprising:

a laser device configured to generate a pulsed laser beam;

an optical delivery system configured to deliver the pulsed laser beam to a cornea of a patient's eye, including one or more scanners configured to scan a laser beam focal spot of the pulsed laser beam within the cornea; and

a controller configured to control the laser device and the scanners to form a lenticule in the cornea, including to:

(a) scan the laser beam focal spot in the cornea by executing a treatment plan, the treatment plan including, in a sequence, an entry segment defining an entry cut, a bottom segment defining a bottom lenticule incision, and a top segment defining a top bed incision, wherein the bottom lenticule incision includes an optical zone having a shape determined by a defined optical power of the lenticule, the top bed incision has a flat shape, the top bed incision is located above the bottom lenticule incision, the top bed incision and the bottom lenticule incision intersect each other near their respective peripheries to define an isolated lenticule volume, and the entry cut extends upwardly from an outer edge of the bottom lenticule incision; and

either: (b) in response to an interruption while executing the entry segment of the treatment plan after the entry cut is partially formed, revise the treatment plan to define a new entry cut that is located at a different angular position from the partially formed entry cut without coinciding with or intersecting the partially formed entry cut, a new bottom lenticule incision, and a new top bed incision, and scan the laser bean by executing the revised treatment plan to complete the entry cut and to form the new bottom lenticule incision and the new top bed incision;

or: (c) in response to an interruption while executing the bottom segment of the treatment plan after the entry cut is formed and the bottom lenticule incision is partially formed, revising the treatment plan to define a new bottom lenticule incision which has an identical shape as the bottom lenticule incision and is located below the partially formed bottom lenticule incision without coinciding with or intersecting the partially formed bottom lenticule incision, and a new top bed incision located above the new bottom lenticule incision, and scanning the laser beam focal spot by executing the revised treatment plan to form the new bottom lenticule incision and the new top bed incision;

or: (d) in response to an interruption while executing the top segment of the treatment plan after the entry cut and the bottom lenticule incision are formed and the top bed incision is partially formed, revising the treatment plan to define a new top bed incision which has an identical shape as the top bed incision and is located above the partially formed top bed incision without coinciding with or intersecting the partially formed top bed incision, and scanning the laser beam focal spot by executing the revised treatment plan to form the new top bed incision.

17 . The ophthalmic laser system of claim 16 , wherein controller function (c) further includes, before revising the treatment plan, measuring a depth of an apex of the partially formed bottom lenticule incision, and wherein an apex of the new bottom lenticule incision is located 5-20 microns below the apex of the partially formed bottom lenticule incision.

18 . The ophthalmic laser system of claim 16 , wherein controller function (d) further includes, before revising the treatment plan, measuring a depth of the partially formed top bed incision, and wherein the new top bed incision is located 5-10 microns above the partially formed top bed incision.

19 . An ophthalmic laser system comprising:

a laser device configured to generate a pulsed laser beam;

an optical delivery system configured to deliver the pulsed laser beam to a cornea of a patient's eye, including one or more scanners configured to scan a laser beam focal spot of the pulsed laser beam within the cornea; and

a controller configured to control the laser device and the scanners to form a lenticule in the cornea, including to:

(a) scan the laser beam focal spot in the cornea by executing a treatment plan, the treatment plan including, in a sequence, an entry segment defining an entry cut, a ring segment defining a ring cut, a bottom segment defining a bottom lenticule incision, and a top segment defining a top bed incision, wherein the bottom lenticule incision includes an optical zone having a shape determined by a defined optical power of the lenticule, the top bed incision has a flat shape, the top bed incision is located above the bottom lenticule incision, the ring cut has a ring shape and extends between the top bed incision and the bottom lenticule incision, both the top bed incision and the bottom lenticule incision intersect the ring cut near their respective peripheries to define an isolated lenticule volume, and the entry cut extends upwardly from an outer edge of the bottom lenticule incision; and

either: (b) in response to an interruption while executing the entry segment of the treatment plan after the entry cut is partially formed, revising the treatment plan to define a new entry cut that is located at a different angular position from the partially formed entry cut without coinciding with or intersecting the partially formed entry cut, a new ring cut, a new bottom lenticule incision, and a new top bed incision, and scanning the laser bean by executing the revised treatment plan to complete the entry cut and to form the new ring cut, the new bottom lenticule incision and the new top bed incision;

or: (c) in response to an interruption while executing the ring segment of the treatment plan after the entry cut is formed and the ring cut is partially formed, revising the treatment plan to define a new ring cut that has a radius larger than a radius of the partially formed ring cut and is aligned concentrically with the partially formed ring cut and without coinciding with or intersecting the partially formed ring cut, a new bottom lenticule incision, and a new top bed incision, and scanning the laser bean by executing the revised treatment plan to form the new ring, the new bottom lenticule incision and the new top bed incision;

or: (d) in response to an interruption while executing the bottom segment of the treatment plan after the entry cut and the ring cut are formed and the bottom lenticule incision is partially formed, revising the treatment plan to define a new bottom lenticule incision which has an identical shape as the bottom lenticule incision and is located below the partially formed bottom lenticule incision without coinciding with or intersecting the partially formed bottom lenticule incision, and a new top bed incision located above the new bottom lenticule incision, and scanning the laser beam focal spot by executing the revised treatment plan to form the new bottom lenticule incision and the new top bed incision;

or: (e) in response to an interruption while executing the top segment of the treatment plan after the entry cut, the ring cut and the bottom lenticule incision are formed and the top bed incision is partially formed, revising the treatment plan to define a new top bed incision which has an identical shape as the top bed incision and is located above the partially formed top bed incision without coinciding with or intersecting the partially formed top bed incision, and scanning the laser beam focal spot by executing the revised treatment plan to form the new top bed incision.

20 . The ophthalmic laser system of claim 19 ,

wherein in controller function (c), the radius of the new ring cut is larger than the radius of the partially formed ring cut by 20-100 microns;

wherein controller function (d) further includes, before revising the treatment plan, measuring a depth of an apex of the partially formed bottom lenticule incision, and wherein an apex of the new bottom lenticule incision is located 5-20 microns below the apex of the partially formed bottom lenticule incision; and

wherein controller function (e) further includes, before revising the treatment plan, measuring a depth of the partially formed top bed incision, and wherein the new top bed incision is located 5-10 microns above the partially formed top bed incision.