Systems and methods for modulating laser treatment on the eye

1 . A laser system, comprising:

a laser which includes radiation which is focusable as a laser illumination light beam;

a non-transitory memory storing instructions; and

one or more processors in communication with the non-transitory memory, wherein the one or more processors execute the instructions to:

scan an eye of a patient to produce a scan result, wherein the scan result comprises at least one of optical coherence tomography (OCT), thermal imaging, or ultrasound data specifically of iris dilator muscle tissue depth and density;

create a mapping of the eye based on the scan result, wherein the mapping includes at least one of a depth map, optical density map, or color map, and wherein the mapping includes a three-dimensional depth map of iris dilator muscle tissue location;

create a modulated treatment of the eye based on the mapping, wherein the modulated treatment is configured to cause a decrease in diameter of a pupil of the eye by targeting at least a subset of iris dilator muscle tissue;

deliver the laser illumination light beam to a first location on the eye of the patient in accordance with the modulated treatment; and

determine an effectiveness of the modulated treatment at the first location in real-time during delivery of the last illumination light beam based on at least one of thermal imaging, optical coherence tomography (OCT), or ultrasound;

wherein determining the effectiveness comprises measuring at least one of thermal uptake, depth and density, or change in optical density specifically of the iris dilator muscle tissue;

wherein determining the effectiveness comprises comparing measurements at the first location against the three-dimensional depth map to verify sufficient laser penetration to the iris dilator muscle tissue; wherein the modulated treatment is automatically updated based on the determined effectiveness at the first location, and wherein the updated modulated treatment is used to guide treatment parameters for one or more second locations on the eye; and wherein the modulated treatment is updated by adjusting at least one of laser power, pulse duration, or focal depth based on whether the measured effectiveness indicates sufficient weakening of the iris dilator muscle's ability to dilate the pupil and based on the comparison of the measurements against the three-dimensional depth map.

2 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to:

receive feedback for the modulated treatment based on the delivering of the laser illumination light beam to the first location on the eye, using the laser scanning system, wherein:

when the feedback aligns with expected results of the modulated treatment, deliver the laser illumination light beam to one or more second locations on the eye of the patient in accordance with the modulated treatment; or

when the feedback conflicts with the expected results of the modulated treatment, update the modulated treatment based on the feedback, and deliver the laser illumination light beam to the one or more second locations on the eye of the patient in accordance with the updated modulated treatment.

3 . The laser system of claim 2 , wherein the laser system is configured such that the feedback includes a muscle response of the eye.

4 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to:

while delivering the laser illumination light beam to the first location on the eye or to the one or more second locations on the eye, track the eye; and

guide the laser illumination light beam based on the tracking.

5 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to:

burn, using the laser illumination light beam, the at least a subset of iris dilator muscle tissue of the eye or at least subset of iris sphincter muscle tissue of the eye, wherein the burning causes a decrease in diameter of a pupil of the eye.

6 . The laser system of claim 1 , wherein the laser system is configured such that the modulated treatment includes at least two of:

a predetermined pattern,

a predetermined depth, or

a color, wherein the color is associated with at least one of: an effective pulse of the laser illumination light beam, an effective depth for the laser illumination light beam, a power, or a duration of pulse associated with laser illumination light beam.

7 . The laser system of claim 1 , wherein the laser system is configured such that the laser is a pulse laser and the laser illumination light beam comprises a sequence of a plurality of light pulses with an average repetition rate between two consecutive light pulses of the plurality of light pulses between 0.5 Hertz and 100 kiloHertz.

8 . The laser system of claim 1 , wherein the laser system is configured such that the laser illumination light beam comprises a sequence of light pulses of average time duration between 10 milliseconds and 100 milliseconds.

9 . The laser system of claim 1 , wherein the laser system is configured such that the laser illumination light beam comprises a sequence of light pulses of average time duration between 1 millisecond and 10 milliseconds.

10 . The laser system of claim 1 , wherein the laser system is configured such that the laser illumination light beam comprises a sequence of light pulses of average time duration between 100 femtoseconds and 1 millisecond.

11 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to:

monitor iris muscle contraction in real-time during delivery of the laser illumination light beam, and adjust laser power or pulse duration based on observed changes in pupil diameter to optimize targeting of the iris dilator muscle tissue;

or create the modulated treatment to include a radial treatment pattern that follows anatomical pathways of the iris dilator muscle tissue, wherein the radial treatment pattern extends from an iris root toward a pupil margin to maximize weakening of the dilator muscle's ability to expand the pupil.

12 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to receive feedback in the form of a muscle response of the iris sphincter muscle, and increase or decrease power or pulse duration of the laser based on whether a visible muscle response is observed.

13 . The laser system of claim 1 , wherein the laser system comprises a first laser beam for treatment and a second laser beam for aiming, wherein the second laser beam is focused on an anterior surface of the iris and the first laser beam converges at a distance of 50 to 250 microns deeper than the focus point of the second laser beam.

14 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to perform modulated treatment on a spot-by-spot basis, wherein an active OCT is used to determine whether a last treatment spot was of appropriate depth and density to produce a desired treatment result.

15 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to correlate each of one or more positions of the modulated treatment with a spot treatment point and correlate the one or more positions with a depth map obtained via an initial scan of the eye, and wherein the laser is calibrated based on the depth map and delivered based on a predetermined pattern and the depth map.

16 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to determine whether the patient's eye has moved, and if the eye has moved, recalibrate the mapping by modifying offset laser points, laser beam angles, power of the laser beam, wattage of the laser beam, or depth of laser point.

17 . The laser system of claim 1 , wherein the laser system is configured to operate in a continuous wave format where a laser burn is initiated and a delivery site is moved to various locations without pulses in a continuous line, providing continuous delivery of the laser beam to the eye.

18 . The laser system of claim 1 , wherein the laser system is configured to apply laser spots in multiple rows, wherein laser spots are applied proximal to an iris root around the eye, and a second row is applied inside proximal to the first row of spots, wherein such treatment occurs at a same treatment session or at a subsequent treatment session.

19 . The laser system of claim 1 , wherein the one or more processors further execute the instructions to:

create the mapping by determining thickness variations of the iris tissue at multiple locations around the eye, wherein an eye-specific pattern is configured to compensate for the thickness variations by adjusting at least one of laser power, pulse duration, or focal depth at each location based on the determined thickness at that location, such that the laser treatment delivered to the iris dilator muscle tissue remains consistent at all locations notwithstanding the thickness variations.

20 . The laser system of claim 1 , wherein:

the scan result comprises optical coherence tomography (OCT) data that measures depth and optical density of iris tissue at a plurality of positions along spatially distributed iris tissues;

the three-dimensional depth map identifies locations of the iris dilator muscle tissue at the plurality of positions;

determining the effectiveness in real-time comprises using OCT to measure a change in optical density at the first location during delivery of the laser illumination light beam; and

the modulated treatment is automatically updated for a second location by adjusting focal depth based on comparing the measured change at the first location against the three-dimensional depth map to determine whether the laser illumination light beam sufficiently penetrated to the iris dilator muscle tissue at the first location.