embodiments and other aspects of the invention described herein , including the system embodiments described below , may be made or used in conjunction with inventions described , in whole or in part , in co - pending u . s . patent application ser . no . 09 / 692 , 483 filed on oct . 20 , 2000 in the name of inventors daniel r . neal , darrell j . armstrong , daniel m . topa and richard j . copland , entitled “ dynamic range extension techniques for a shack - hartman sensor including use in ophthalmic measurement .” [ 0024 ] fig1 shows a functional diagram of an embodiment of an integrated laser treatment system 100 , comprising a laser refractive surgery instrument that is integrated with a wavefront aberrometry system . the system 100 includes a wavefront aberrometer 110 , a laser 130 , an aperture - sharing element 120 , first and second lenses 135 , 140 operating as a microscope , a camera 150 , and a heads - up display ( hud ) 160 . the wavefront aberrometer 110 operates by injecting a beam or pattern near the center of the pupil and then recording and monitoring the resulting light that is scattered from the retina . beneficially , the wavefront aberrometer 110 includes a target for the patient &# 39 ; s eye . the wavefront aberrometer 110 is arranged to monitor the central part of the optical zone . the wavefront aberrometer 110 may be a hartmann - shack sensor , scanning refractometer , tscheming aberrometer or other aberrometer system . the wavefront aberrometer 110 operates with the aperture - sharing element 120 to simultaneously inject the refractive laser beam ( s ) from the laser 130 . beneficially , the aperture - sharing element may comprise a dichroic mirror that passes visible light ( and a scanning beam from the wavefront aberrometer 110 ) straight through while reflecting infrared ( ir ) light from the laser 130 , as shown in fig1 . the laser 130 should , beneficially , be arranged to illuminate the region outside the optical zone . however , it should not be limited to this case , since accurate real - time measurement can be performed even when the laser 130 modifies the optical zone directly , so long as the modification does not result in scattering or other phenomenon that is not consistent with the desired refractive change . the wavefront aberrometer 110 beneficially communicates with the laser 130 through a hardware or software link ( not shown ). the wavefront aberrometer 110 provides a feedback signal to the laser 130 for end - point detection and supports the hud 160 . the feedback signal from the wavefront aberrometer 110 may control the progress of the corrective procedure administered by the laser 130 based upon one or more characteristics of the patent &# 39 ; s eye measured by the wavefront aberrometer 110 . a surgeon can use the hud 160 to evaluate the progress of the procedure . the wavefront aberrometer 110 may operate in conjunction with the laser 130 to terminate the treatment once a desired correction has been obtained and measured by the wavefront aberrometer 110 . [ 0028 ] fig2 shows a functional diagram of another embodiment of an integrated laser treatment system 100 , comprising a laser refractive surgery instrument that is integrated with a wavefront aberrometry system . the major difference between the embodiments of fig1 and fig2 is that the embodiment of fig2 includes a tracking mirror which allows both the laser 130 and the wavefront aberrometer 110 to track movements of a patient &# 39 ; s eye during a procedure . again , a feedback signal from the wavefront aberrometer 110 may control the progress of the corrective procedure administered by the laser 130 based upon one or more characteristics of the patent &# 39 ; s eye measured by the wavefront aberrometer 110 . [ 0029 ] fig3 shows a structural configuration of a laser treatment system including a laser refractive surgery instrument and an objective aberrometer , such as an embodiment having the functional diagram of fig1 . a goal of the wavefront measurement is to monitor the change in the spherical value of the eye during the corrective procedure . it is important that measurement not be confused by changes in the accommodative state of the crystalline lens in the patient &# 39 ; s eye . in the case of the making a hyperopic patient more emmetropic , the change in the sphere value will tend to make the target more blurry during the treatment . in the case of making a myopic patient more emmetropic , the change in sphere will tend to make a fogged target clear . once the target becomes clear , the accommodation of the eye would tend to follow the target . then large changes in the corneal shape could occur while the wavefront aberrometer 110 shows no change in the sphere value . to prevent either of these outcomes , the eye target can be moved during the treatment to maintain the presentation of a fogged eye target to the patient . this movement can be controlled by inputs from wavefront sensor , by predictions from the treatment nomogram , or by inputs from other measurements of the patient &# 39 ; s accommodative state . it is possible to monitor the accommodative state of the patient &# 39 ; s eye by several means . for instance , a camera can be located conjugate to the position of the fogged target of the eye . when the target intensity is very bright , the fogged eye target can be viewed on the retina through the eye lens . if the target becomes clearer , the eye is not longer focused at infinity but instead is focusing on the target . a more practical system results if an additional probe beam is added that has a divergence that corresponds to fogged target . a retinal camera will show a small spot when the patient is focused at infinity . the spot size increases as the eye is focused nearer . additional cameras located a various location on either side of the conjugate location can also be used to measure the accommodative state , with each camera location corresponding to a different distance that the eye is focused . to make a more compact system , a diffractive optic can be made that maps different regions on a single charge coupled device ( ccd ) camera to different accommodative states . the different beam sizes in the different regions can be evaluated to determine at what range the eye is focused . a compact beam viewed on the retina corresponds to the eye adjusted for far vision as the eye tries to focus on the fogged target . it is also possible to monitor the accommodative state of the eye with a retinal camera that is positioned conjugate to the target in its fogged position and that views the primary injected laser beam . an alternative is to paralyze the accommodative response of the eye by pharmaceuticals . [ 0032 ] fig4 and 5 illustrate characteristics obtained from measurements taken by a wavefront aberrometer during ltk procedures using the system of fig3 having the functional diagram of fig1 . fig4 illustrates changes to a first patient &# 39 ; s eye &# 39 ; s spherical characteristics as a series of laser pulses are applied to the eye . a correction of − 2 . 22d is obtained after 14 pulses are applied . if , for example , a correction of only − 2 . 00 was desired , the data provided by the wavefront aberrometer would have indicated that the procedure should be terminated after only 9 pulses . in that case , a feedback control signal from the wavefront aberrometer may operate to shut of the energy source ( laser ) applying the corrective procedure aft6er the ninth pulse . meanwhile , fig5 illustrates changes to a second patient &# 39 ; s eye &# 39 ; s cylindrical characteristics as a series of laser pulses are applied to the eye . the following are some features that may be provided by a system and method as disclosed herein . ( 1 ) the refractive surgery laser and the diagnostic system are beneficially provided in the same instrument . ( 2 ) a signal may be used for refractive adjustment end - point detection . ( 3 ) the laser pattern may be adjusted based on information received from the diagnostic instrument ( 4 ) the laser exposure may be adjusted based on the information received from the diagnostic instrument . ( 5 ) a higher order aberration may be controlled by a signal from the diagnostic instrument to the laser . ( 6 ) an eye target may be incorporated that the patient views during the treatment . ( 7 ) an eye target may be adjusted to maintain proper patient accommodation state during treatment . ( 8 ) an accommodation state of a patient &# 39 ; s eye may be measured during treatment . ( 9 ) two video cameras may be used to set an angle to the optical axis of eye . when imaged pupils appear at correct places in the cameras , the eye will be at the proper distance from the optical system . ( 10 ) a heads - up display may be included to provide a real - time update of display of the sphere , cylinder and axis . a treating physician may view these values through the oculars when the patient is lined up to the optical system . ( 11 ) an indication may be provided on the heads - up display if the patient is not properly lined up for good wavefront measurements to be performed . ( 12 ) algorithms and electronics may be provided to synchronize the firing of the pulses of the ltk laser in between sample times of the wavefront aberrometer . ( 13 ) algorithms and electronics may be provided to move the optical stage of the wavefront aberrometer at optimal times during laser pulses so that the wavefront sensor will have the best measurements and the wavefront sensor will stay in range while the treatment progresses from beginning to end . ( 14 ) algorithms may be provided to match particular zernike polynomials to the firing of the pulses of the laser and the influence functions . ( 15 ) an eye tracker may use the video signal of infrared light that fills the pupil as it comes from the eye and appears on a camera that images the iris . ( 16 ) an eye tracker may use the light disk that appears to fill the entire pupil of the eye and is projected onto a high speed quad cell to follow the eye at a kilohertz rate . ( 17 ) an eye tracker arrangement may use a fold mirror such that both the wavefront sensor and the treatment laser follow any small motions of the eye . ( 18 ) a wavefront aberrometer with a wide field of view may be used that can obtain good wavefront measurements even if the tracking mirror only directs the treatment beam and not the wavefront aberrometer field of view . ( 19 ) a small pickoff mirror situated in between the field of view of the two oculars may be used to send the beam to a wavefront aberrometer . ( 20 ) relay telescopes may be incorporated to image pupil into a wavefront abberometer . ( 21 ) a fixture that acts as a model eye may be automatically inserted and measured by the wavefront aberrometer before each treatment to verify proper operation of the aberrometer before each patient procedure . ( 22 ) a model eye test fixture may be automatically varied to verify proper operation of control loop operation of the aberrometer and treatment laser control system before each patient procedure . ( 23 ) a stabilized laser diode ( sld ) illumination beam may be aligned off - center from the optical axis to reduce stray reflections off lenses from coming back onto the wavefront sensor . ( 24 ) a sld beam may be aligned on the optical axis with polarizing elements used to reduce stray reflections off lenses from coming back onto the wavefront sensor . ( 25 ) although the above - described embodiments describe correction procedures involving lasers , other energy sources and wavelengths may be employed . for example , it has been discovered that certain corrective procedures ( e . g ., presbyopic corrections — both ciliary and lenticular pliancy modifications ) may be achieved through the application of ultrasound energy to the eye . in such cases , it is still possible to employ the principles described herein to perform a procedure to modify the refraction of the eye and , while the procedure is being performed , measure the refraction and / or an aberration of the eye , and terminate the procedure when a change the measured refraction and / or the measured aberration reaches a desired value . ( 26 ) an adaptive algorithm may be employed to automate the corrective procedure based upon a feedback signal derived from the wavefront measurements . in that case , an initial wavefront measurement of a patient &# 39 ; s eye may be taken prior to the start of corrective procedures . based upon one or more measured characteristics of the eye , an adaptive algorithm may begin the corrective procedure . a dynamic nomogram may be obtained from real - time sampled wavefront errors measured during the corrective procedure . from the nomogram , a minimized aberration profile endpoint may be determined during the corrective procedure . while preferred embodiments are disclosed herein , many variations are possible which remain within the concept and scope of the invention . such variations would become clear to one of ordinary skill in the art after inspection of the specification , drawings and claims herein . the invention therefore is not to be restricted except within the spirit and scope of the appended claims .
a real - time refractory control system includes a laser refractive surgery instrument for modifying the refraction of the eye , an objective diagnostic apparatus for measuring the refraction and aberrations of the eye , and an aperture - sharing element to inject a refractive surgery beam and a monitoring diagnostic beam . an associated method of adjusting a refraction of an eye , includes : performing a procedure to modify the refraction of the eye ; while the procedure is being performed , measuring the refraction and / or an aberration of the eye ; and terminating the procedure when a change in the measured refraction and / or the measured aberration reaches a desired value .