Retinal laser surgery

1. A system comprising:

an image processing subsystem to identify retina blood vessels in first image of a retina;

a laser subsystem to apply a therapeutic shot to the retina;

a laser control subsystem to determine a retina therapeutic location needing therapy, determine whether the therapeutic location substantially intersects an identified retina blood vessel, and if the therapeutic location substantially intersects an identified retina blood vessel, then determine a different therapeutic location that does not substantially intersect an identified retina blood vessel, the laser control subsystem configured to generate a command to activate the laser subsystem for the therapeutic location when a beam from the laser subsystem is aligned with the therapeutic location that does not substantially intersect an identified retina blood vessel; and

an imaging subsystem to obtain a second image of the retina, wherein the second image of the retina is a real-time retina image;

wherein the image processing subsystem is configured to determine reflectivity of a retina location during a therapeutic laser shot;

wherein the laser control subsystem is configured to adjust the therapeutic laser shot based on the determined reflectivity and a variability limit established by a user for a laser setting; and

wherein the image processing subsystem is configured to register the retina blood vessels of the second image with the retinal blood vessels of the first image.

2. The system of claim 1 , further comprising an imaging subsystem to obtain the second image of the retina, wherein the second image of the retina is a real-time retina image, and wherein the real-time retina image is the retina image from which the retina blood vessels are identified.

3. The system of claim 1 , further comprising a first imaging subsystem to obtain the first image of the retina.

4. The system of claim 3 , further comprising a second imaging subsystem to obtain the second image of the retina.

5. The system of claim 3 , wherein the first imaging subsystem comprises a scanning laser ophthalmoscope and the second imaging subsystem comprises a fundus camera.

6. The system of claim 3 , wherein the image processing subsystem is configured to locate the retina blood vessels in the first image of the retina.

7. The system of claim 6 , wherein the second imaging subsystem is configured to obtain a third image of the retina after one or more therapeutic laser shots; and

the image processing subsystem is configured to register the retina blood vessels with the third image of the retina.

8. The system of claim 1 , wherein the laser subsystem comprises a coagulation laser.

9. The system of claim 1 , wherein:

the image processing subsystem is configured to determine reflectivity of a retina location needing therapy before application of a therapeutic laser shot; and

the laser control subsystem is configured to adjust the laser shot based on the determined reflectivity.

10. The system of claim 1 , further comprising a beam guidance subsystem to adjust the alignment of the beam from the laser subsystem.

11. The system of claim 10 , wherein the beam guidance subsystem is controlled by the laser control subsystem.

12. The system of claim 11 , wherein the beam guidance subsystem comprises a galvanometer mirror and associated drive.

13. The system of claim 10 , wherein the beam guidance system comprises a rotatable glass prism.

14. The system of claim 1 , wherein the system is configured to determine the reflectivity of the retina location using a scanning laser ophthalmoscope (SLO) at a lower power and a different wave band than the therapeutic laser shot.

15. A method comprising:

identifying retina blood vessels in an image of a retina;

determining a retina therapeutic location needing therapy;

determining whether the therapeutic location substantially intersects an identified retina blood vessel, and if the therapeutic location substantially intersects an identified retina blood vessel, then determine a different therapeutic location that does not substantially intersect an identified retina blood vessel;

generating a command to activate a retinal laser when a beam from the retinal laser is aligned with the therapeutic location that does not substantially intersect an identified retina blood vessel;

determining reflectivity of a retina location during a laser shot;

adjusting the laser shot based on the determined reflectivity and a variability limit established by a user for a laser setting;

obtaining the first image of the retina;

obtaining a second image of the retina; and

registering the retina blood vessels identified in the first image of the retina with the second image of the retina.

16. The method of claim 15 , further comprising:

obtaining a third image of the retina after one or more therapeutic laser shots; and

registering the retina blood vessels with the third image of the retina.

17. The method of claim 15 , further comprising:

determining reflectivity of a retina location needing therapy before application of a laser shot; and

adjusting the laser shot based on the determined reflectivity.

18. The method of claim 15 , further comprising adjusting the alignment of the laser beam from the retinal laser.

19. The method of claim 15 , further comprising generating a laser shot for the therapeutic location.

20. The method of claim 15 , wherein second image is a real-time image of the retina.

21. The method of claim 15 , further comprising:

obtaining a real-time image of the retina; and

registering the retina blood vessels with the real-time retina image.

22. The method of claim 15 , wherein determining the reflectivity is done with a scanning laser ophthalmoscope (SLO) at a lower power and a different wave band than the laser shot.

23. A computer program product for retinal laser surgery, the computer program product comprising:

a non-transitory computer readable storage medium;

program instructions to identify retina blood vessels from a first retina image;

program instructions to determine a retina therapeutic location needing therapy;

program instructions to determine whether the therapeutic location substantially intersects an identified retina blood vessel, and if the therapeutic location substantially intersects an identified retina blood vessel, then determine a different therapeutic location that does not substantially intersect an identified retina blood vessel;

program instructions to generate a command to activate a retinal laser when a beam from the retinal laser will be aligned with the therapeutic location that does not substantially intersect an identified retina blood vessel;

program instructions to determine reflectivity of a retina location during a laser shot;

program instructions to adjust the laser shot based on the determined reflectivity and a variability limit established by a user for a laser setting;

program instructions to obtain a second retina image after one or more laser shots; and

program instructions to register the retina blood vessels of the second retina image with the retina blood vessels of the first retina image;

wherein said program instructions are stored on said non-transitory computer readable storage medium.

24. The computer program product of claim 23 , wherein the program instructions to identify retina blood vessels from the first retina image are adapted to identify the retina blood vessels from a real-time retina image.

25. The computer program product of claim 24 , further comprising program instructions for obtaining the real-time image of the retina.

26. The computer program product of claim 23 , further comprising program instructions to:

determine reflectivity of a retina location needing therapy before application of a laser shot; and

adjust the laser shot based on the determined reflectivity.

27. The computer program product of claim 23 , further comprising program instructions to adjust the alignment of the laser beam.

28. The computer program product of claim 23 , wherein the reflectivity of the retina location is determined using a scanning laser ophthalmoscope (SLO) at a lower power and a different wave band than the therapeutic laser shot.