MXPA01010027A - Offset ablation profiles for treatment of irregular astigmatism - Google Patents

Abstract

The invention provides near-term customized ablation capabilities for treatment of corneal irregularities by ablating laterally offset refractive therapy profiles. These treatment profiles may, when centered on the eye (E), be suitable for treatment of standard refractive errors such as myopia, hyperopia, and cylindrical astigmatism. By selectively offsetting one or more of these ablation profiles at selected points across the corneal surface (C), the laser system (14) can reduce refractive errors resulting from corneal irregularities such as irregular astigmatism, corneal steepening in one quadrant, asymmetrical astigmatism, irregularities inadvertently produced by a prior refractive treatment (such as radial keratotomy incisions, a de-centered ablation, or the like), granular dystrophy, diffuse, asymmetric warpage as a result of post-corneal transplants, bilateral keratoconus, penetrating keratoplasty, or the like.

Description

COMPENSATED ABLATION PROFILES FOR THE TREATMENT OF AN IRREGULAR ASTIGMATISM BACKGROUND OF THE INVENTION 1. Field of the Invention In general, this invention relates to laser eye surgery and, in particular, provides methods, devices and systems to selectively perform an ablation of corneal tissue for the purpose of improving vision of patients with corneal irregularities.

Currently, systems and methods of eye surgery are used to correct vision defects by means of a technique known as ablative photodecomposition. In general, these techniques selectively expose the cornea to laser radiation so that it also selectively removes the cornea and reshapes it, achieving the desired change in the shape of the cornea with the optic defect.

At this time, laser eye surgery is used to treat a variety of visual defects, such as nearsightedness (short sight), hyperopia (long view), and cylindrical symmetric astigmatism. To obtain these results, the known systems of laser eye surgery resort to a variety of mechanisms to selectively expose the corneal tissue to the ablative laser energy in order to change the optical characteristics of the eye uniformly throughout the optically utilized portion of the eye. the cornea. On some occasions, the desired change with respect to the shape is affected by selectively removing the corneal tissue according to the spherical profile of ablation (for example, for the treatment of myopia and hyperopia). Often the cylindrical astigmatism is treated by selectively removing the corneal tissue according to a cylindrical profile, in which the cylinder runs parallel to the optical axis of the eye.

Many of the patients suffer from optical defects that can not be easily treated by using the well-known techniques of spherical or cylindrical ablation. It has been proposed to treat patients suffering from non-symmetrical astigmatism or of any other type when defining a personalized ablation profile. Currently, ophthalmic measurement techniques are being developed that can generate topographic information with a high degree of accuracy with respect to a specific cornea. Unfortunately, the process of integrating these topographic measurements together with new ablation algorithms can take many years, while patients with irregularities in the cornea, which greatly limits their vision, need treatment immediately.

In view of the above, it would be advisable to have better devices, systems and methods of laser eye surgery. It would be very positive if they facilitated the treatment of irregular corneal defects and, in particular, if they could be counted safely in the short term. 2. Description of background The following patents and patent applications may be relevant to the present invention: U.S. Patent No. 5,683,379, issued November 4, 1997, on "Apparatus for Modifying the Surface of the Eye Through Large Beam Laser Polishing and Method of Controlling the Apparatus "; U.S. Patent No. 4,724,522, issued February 9, 1988, on "Method and Apparatus for Modification of Corneal Refractive Properties"; U.S. Patent No. 5,098,426, issued March 24, 1992, on "Method and Apparatus for Precision Laser Surgery"; U.S. Patent No. 5,290,272, issued March 1, 1994, on "Method for the Joining of Ocular Tissues Using Laser Light"; U.S. Patent No. 5,314,422, issued May 24, 1994, on "Equipment for the Correction of Presbyopia by Remodeling the Corneal Surface by Means of Photo-Ablation"; U.S. Patent No. 5,391,165, issued February 21, 1995, on "System for Scanning to Surgical Laser Beam"; U.S. Patent No. 5,439,462, issued August 8, 1995, on "Apparatus for Removing Cataractous Material"; U.S. Patent No. 5,549,596, issued August 27, 1996, on "Selective Laser Targeting of Pigmented Ocular Cells"; U.S. Patent No. 5,549,597, issued August 27, 1996, on "In Situ Astigmatism Axis Alignment"; U.S. Patent No. 5,556,395, issued September 17, 1996, on "Method and System for Laser Treatment of Refractive Error Using an Offset Image of a Rotatable Mask"; U.S. Patent No. 5,634,919, issued June 3, 1997, on "Correction of Strabismus by Laser-Sculpting of the Cornea"; U.S. Patent No. 5,637,109, issued June 10, 1997, on "Apparatus for Operation on a Cornea Using Laser-Beam"; PCT International Application No. PCT / EP95 / 01287, filed on April 7, 1995, on "Method and Apparatus for Providing Precise Location of Points on the Eye"; European Patent Application No. 94303256.5, filed May 5, 1994, on "Method and System for Laser Treatment of Refractive Errors Using Offset Imaging"; and U.S. Patent Application No. 09 / 274,499, filed March 23, 1999, on "Multiple Beam Laser Sculpting System and Method"; whose descriptions are considered reproduced as if they were inserted to the letter.

SUMMARY OF THE INVENTION The present invention describes improved devices, systems and methods of laser eye surgery, as well as providing short-term personalized ablation capabilities in the treatment of corneal irregularities through standard refractive therapy profiles in a position that is compensated from the pupillary center. These treatment profiles can, once centered in the eye, be suitable for the treatment of standard refractive errors such as myopia, hyperopia and cylindrical symmetric astigmatism. By selectively compensating one or more of these ablation profiles at specific points on the entire corneal surface, the laser system can reduce refractive errors derived from corneal irregularities such as irregular astigmatism, corneal increase in a quadrant, asymmetric astigmatism, irregularities Inadvertently produced by a previous refractive treatment (such as radial keratotomy incisions, decentered ablation, asymmetric deformation as a result of corneal transplants, penetrating keratoplasty or similar), granular dystrophy, diffuse reflection, bilateral keratoconus or the like.

In a first embodiment, the invention provides a method for treating a patient's eye composed of a cornea and pupil having a center. The method comprises aligning a laser delivery system with respect to the pupil of the eye. The designation of the treatment center with respect to the cornea is due to the search to compensate laterally the treatment center (in the X and / or Y direction) from the center of the pupil. A region of the cornea is ablated by directing the laser energy according to a therapy profile focused at the treatment center, which may be located some distance from the pupillary center.

In addition, the therapy may comprise the selection of the treatment profile from a library that includes a myopic treatment profile, a hypermetropic treatment profile and a cylindrical treatment profile. These treatment profiles can be scaled by size and power, and even more so the profiles of the therapy can be included in the library. A more complete library may include myopic ablations with spherical, cylindrical and / or elliptical shape; spherical and cylindrical ablations for hyperopia, which provide soft transition zones; and optionally therapeutic ablations such as the clefts of phototherapeutic keratectomy and / or phototherapeutic keratectomy circles of various sizes and with different transition zones.

Frequently, corneal irregularities will benefit from a combination of two or more therapy profiles focused on different corneal treatment centers. By providing a diversity of different treatment profiles that can be scaled and compensated for each other selectively, often at least by overlapping on the corneal surface a wide range of personalized modeled ablations can be carried out without having to generate algorithms of custom ablation to perform the desired general treatment profile.

Normally, the particular profile or profiles applied to the patient's eye will be identified or planned using a map of the cornea. Altitude maps, such as those that can be developed based on advanced wave technology now in development, are very useful in the selection, scaling and compensation of treatment profiles on the corneal surface in order to reduce the corneal irregularity. Fortunately, it is not necessary (although it is possible) to link these experimental topography systems with the ablation system in order to generate personalized therapies. In this way, the system operator can select the size, shape, location and power of the ablation based on the topographic map and, thus, plan the combined treatment as a whole, optionally stimulating the effect of the proposed ablation before be done. In fact, although the results of altitude map data are preferred due to their accuracy and location, depth and size of the irregular corneal elements, it is possible to use tangential and / or axial maps combined separately and conveniently to provide the desired information.

In another embodiment, the invention provides a system for the treatment of a patient's eye composed of a cornea and pupil having a center. The system features a laser that produces a laser beam capable of ablating the cornea. The release optics are adapted to the laser and the alignment optics align with the first in order to maintain alignment between the laser and the pupil of the eye. An entry to designate at least one treatment center is adapted to the discharge optics. The center of the treatment is compensated laterally from the center of the pupil at the same time as it is aligned with the alignment optics.

In a standard symmetric ablation, the alignment optics are rectified with the discharge optics so that the discharged laser beam is coincident and concentric with respect to the alignment lattice. In general, the patient's pupil is aligned to the reticle of the alignment optics. If a treatment is desired in which the beam does not focus on the pupil, the operator can specify the distance and the direction of beam displacement from the center of alignment. Traditionally, a controller will direct the optics to deflect the beam laterally in order to perform a treatment profile focused on the designated treatment center. Frequently, the treatment profile will be obtained by directing a large number of individual laser pulses on different overlapping regions of the cornea. The controller and the optics of discharge can resort to techniques of tracking of small luminous points, techniques of ablation of large areas with different degree of blocking of the energy of the laser, and / or overlapping luminous points of medium size that deviate laterally by means of mirrors, lenses and others. The controller can perform the treatment profiles by moving the tracking mechanisms, selecting openings, varying the size of the iris or slot, often according to a treatment table or a position calculation algorithm. However, the controller of preference will have to use a tangible data storage medium as a library of alternative refractive therapies that can be selected and / or scaled individually or in combinations Traditionally, the library will comprise suitable profiles for the treatment of myopia, hyperopia and cylindrical astigmatism once that treatment has been centered on the optic axis of the eye.When compensating one or more of these therapies, it is possible to treat a wide variety of corneal irregularities.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 schematically illustrates a custom ablation system that applies refractive therapy profiles in a location laterally offset with respect to the optical axis of the shaft.

Figures 2 and 3 illustrate schematically an optical train for selectively directing a laser beam towards the corneal tissue.

Fig. 4 is a functional schematic diagram showing control of the tracking architecture of the personalized ablation system of Fig. 1.

Figures 5-8 illustrate by means of a scheme the use of refractive ablation profiles outside the center for the treatment of corneal irregularities.

Figure 9 is a flow diagram showing the steps for treating an irregularity in the cornea when using the compensated ablation profiles.

Figure 10 shows the therapy profiles and scale parameters included within an exemplary library.

Figures HA and B show the data entry screens for selecting, compensating, scaling and combining the standard ablation profiles to treat corneal irregularities.

Figures 12A-C provide an outline of the alternative maps for the planning of a custom combined ablation.

Figure 13 presents the information displayed for the planning and simulation of a combined ablation in order to verify the proposed combination of the ablation profiles before the treatment of the eye.

DESCRIPTION OF THE SPECIFIC MODALITIES Referring to FIG. 1, a system 10 for the treatment of corneal irregularities focuses a laser beam 12 from a laser 14 to an eye E with a cornea C. A pupil P has a center defining a optical axis A.

An optical train 16 variably directs the laser beam 12 on the surface of the cornea C according to a treatment profile. Instead of treating the cornea C with a profile centered on the axis A, an operator designates a treatment center 18 that is laterally compensated (often described as the X-Y plane) from the center of the pupil P.

The operator designates the treatment center 18 using an input 20 adapted to the controller 22, the input is schematized as a joystick. The orientation of the E eye is stabilized by having the patient direct his gaze on a fixation target 24 through alignment optics 26. The operator often directs the procedure while viewing the E eye through a microscope 28.

With respect to Figure 2, the laser discharge optic 16 for directing the laser beam 12 to the eye E will often comprise several mirrors 30, as well as one or more integrators 32 that can even [sic] (or in any other way adapted) the distribution of energy through the laser beam. Normally, the laser 14 has an excimer laser or a solid-state laser of multiple frequencies that generates laser energy at a frequency appropriate for ablation of the corneal tissue with minimal thermal damage to the underlying tissue. The laser system may include, but is not limited to, Excimer lasers such as Excimer lasers of argon fluoride (which produce laser energy with a wavelength of about 193 nm), solid-state lasers, including lasers. Solid state of multiple frequencies such as flash lamp and solid-state lasers pumped by diodes. Solid state lasers include lasers of UV solid states (approximately 193-215 nm) such as those described in U.S. Patent Nos. 5,144,630 and 5,742,626, Borsuztky et al., "Tunable UV Radiation at Short Wavelengths (188-240 nm) Generated by Sum Frequency Mixing in Lithium Borate ", Appl. Phys. 61: 529-532 (1995) and others. The laser energy may comprise a beam in the form of a series of discrete laser pulses. It is possible to use other alternative lasers.

In the exemplary embodiment, a variable aperture 34 changes the diameter and / or the width of the slot for profiling the laser beam 12, ideally encompassing both a variable diameter iris and a variable width slot. A prism 36 separates the laser beam 12 into a large number of beams, which can partially overlap in an E-eye in order to smooth the edges of the ablation or "crater" from each of the pulses of the laser beam. Referring to Figures 2 and 3, a compensating module 38 has motors 40 that vary an angular compensation of the compensation lenses 42, and that also change the orientation of the compensation. Thus, the compensation module 38 can discriminate the laser beam 12 to a specific lateral region of the cornea. A structure and method for using the optical train 16 and compensation module 38 are described in more detail in copending US patent applications No. 08 / 968,380, entitled "Method and System for Laser Treatment of Refractive Errors Using Offset Imaging". presented on November 12, 1997; U.S. Patent Application No. 09 / 185,914, entitled "Method and System for Laser Treatment of Refractive Errors Using Offset Imaging" filed November 4, 1998; and U.S. Patent Application No. 09 / 274,499, entitled "Multiple Beam Laser Sculpting System and Method", filed March 23, 1999; whose descriptions are considered as reproduced as if they were inserted to the letter.

With reference to Figure 4, the elements of an excimer laser system VISX Star S2®, commercially available from VISX, a company incorporated in Santa Clara, California, are illustrated as a scheme modified for use in accordance with the principles of the present invention. A computer control system 22 promotes precise control of the laser system 10 to give the surface the shape that is specified in the laser treatment table 302. A controller 22, which usually comprises a PC workstation, uses a computer program stored in a tangible medium 304 in order to generate a treatment table 302. An integrated computer 308 to the laser system 10 is located within an electronic communication with the work station and, consequently, may comprise a part of the general controller. Alternatively, a PC workstation can be integrated into the laser system and function as well as the integrated computer and the PC workstation in order to direct the ophthalmic surgery.

The integrated computer 308 is electronically connected to various sensors 306 and a plurality of motor controllers 310. The motor controllers are adapted to the controller to vary the position and configuration of the various optical components of the discharge optics 16 in accordance with the treatment table 302. For example, the first and second scanning axes 320, 330 control the position of the compensating lenses to move the beams on the surface of the cornea. The iris motor 340 controls the diameter of the general beam and, in certain cases, the length of the light transmitted through a slot of variable width. Similarly, the width controller of the slot 350 controls the width of the variable slot. The angle controller of slot 360 controls the rotation of the slot with respect to its axis. The beam angle controller 370 controls beam reconnection, while the laser 14 is pressed to generate the laser beam 12 after the various optical elements have been placed in position to create a specific crater in the E eye. Treatment table 302 may contain a list of all the specific craters that will be combined in order to perform a treatment therapy.

In order to customize the ablations to treat irregular corneas, the controller 22 will preferably include a library with a large number of different photorefractive and / or phototherapeutic profiles. It is very usual that these ablation profiles are used in the treatment of spherical and / or cylindrical refractive errors of the eye by coaxially locating the treatment center 18 in the center of the pupil P. In order to treat the irregular corneas, these same Ablation profiles can be addressed to laterally compensate the treatment center 18 by making use of the input device 20. It is also a great advantage that the controller can modify the treatment table to compensate for the treatment profile by adjusting each of the ablations in coordination with the compensation determined.

While the input device 20 is schematized in the present invention, it should be understood that various input mechanisms may be used. Among the appropriate input mechanisms for compensation we can find trackballs, touch screens or a wide variety of alternative pointer devices. Other alternative input mechanisms are numeric keyboards, data transmission mechanisms such as ethernet, intranet, internet, a modem or the like. These or other input mechanisms can be used to identify the treatment center 18 of a compensation that is offset laterally from the center of the eye pupil.

The use of standard ablation profiles to treat an irregular cornea can be understood in relation to Figures 5-8. The cornea C of Figure 6A exhibits a projecting irregularity 46 of the corneal tissue which is laterally offset from the axis A. In order to treat this condition, a series of laser pulses (illustrated in the scheme as pulses I2a-d) of varying size are directed to a treatment region 48 which is concentrated in the compensation treatment center 18. Such pulse patterns with a gradually varying diameter could be applied coaxially with the optical axis in order to smooth a central part of the cornea and thus eliminate myopia. However, by compensating this same treatment profile laterally, the protruding corneal tissue 46 may undergo ablation in such a way as to give a more spherical shape to the cornea, as illustrated in Figure 6.

Standard photorefractive therapies can also be applied, as shown in Figure 7. Initially the cornea C has a flat region 50 without sufficient curvature. A hypermetropic profile of ablation 52, which is very often used to increase the curvature of the central cornea, is compensated laterally in order to focus on the compensation center 18 thereby increasing the curvature of the corneal surface with respect to the flat 50 region.

In FIG. 8, an ablation previously separated from the center is illustrated in schematic form by first using a hypermetropic ablation profile 52 centered on the compensated treatment center 18a, followed by a myopic profile of ablation 54 focused on another center of ablation. compensated treatment 18b in such a way as to decrease the irregularity of the cornea through an optically used region 56. It should be understood that the examples shown in Figures 6A to 8 have a schematic character, that the treatment center can be compensated for. in both directions X and Y, and that the multiple treatment centers will be compensated in general with respect to each one of them. In addition, it should be understood that refractive treatment profiles will generally be graduated by size and energy. Algorithms and techniques for general therapeutic ablation profiles in combination with individual ablation pulse craters are described in patents mentioned in the present invention.

In Figure 9 there is shown a flow diagram 60 illustrating the independent steps to perform a personalized ablation strategy. Preferably, a map of the cornea will be made 62 by means of any commercially available ophthalmic measurement technique. In particular, favorable surveying measurements may be accessible by resorting to the advanced wave technology that is being developed. As described hereinafter, corneal maps that are based on the axial or tangential curvature of the cornea can also be used independently and / or combined to support the calculation of the micro elevation data.

Based on the corneal map 62, a standard ablation profile 64 is chosen with a proposed scale and compensation 66. In case a single ablation profile is sufficient, the proposed ablation 68 can be simulated, with the resulting corneal characteristics presented to verify the proposed ablation parameters. In many cases, one or more additional ablation profiles can be added 70, or if necessary, removed from the previous ablation plan before the ablation process is completely simulated. In case the ablation simulation 68 indicates that it would be favorable to do another refinement in the ablation plan, this can be revised by incorporating and / or eliminating ablation profiles, varying the compensation and the scale of individual ablation profiles or others. On the contrary, if another revision 72 is not recommended, the ablation plan of combined profiles can be implemented to fill the cornea 74.

Figure 10 shows a model library of myopic, hypermetropic and therapeutic ablation profiles. The standard ablation profiles can be scaled in both dimensions and power according to the maximum and minimum scale parameters that are listed. In general, the photorefractive profiles refer to both the myopic profiles (or surfaces) and the hypermetropic profiles (or surfaces) as mentioned, while the therapeutic ablation profiles refer to the corresponding forms that are listed in the column entitled "therapeutic surface" ***.

In Figures HA and 11B, the model data entry screens for selection of ablation profiles, which designate compensations and scales, and incorporate or eliminate profiles are presented. As illustrated in Figure HA, a variety of ablations can be entered for sequential and / or simultaneous ablation with independently designated offsets and escalations. The input of the parameters in the case of a particular ablation profile such as offsets 80, size 82 and power 84 can be performed by means of the standard Windows ™ data entry system comprising a mouse or any other pointing device and / or keyboard.

Referring to Figures 12A-C, the elevation maps offer a great advantage in generating the recommended ablation plan, since they accurately indicate the shape, location, depth, size and irregular features of the cornea, as shown in FIG. Figure 12A. Although the axial curvature maps (Figure 12B) provide good power values, they may not accurately give the location and size of the irregularities. Tangential maps such as those in Figure 12C provide good information about location and size, however they can give less accurate information relative to specific power values. Fortunately, axial and tangential maps can be combined to support the calculation of elevation data, which greatly facilitates the planning of a custom ablation profile.

It is very positive that the proposed ablation plan can be entered into the computer based on a visual revision of the corneal map. The plan can be adjusted for the treatment of asymmetric astigmatism, lower corneal increment, corneal dystrophy, decentered ablations, errors inadvertently induced by refractive procedures or a wide variety of corneal irregularities. Proposed treatments can be generated in order to improve, in general terms, the uncorrected visual acuity or optimize the corrected visual acuity in the case of a particular patient. More generally, the tailored plan can improve the quality of vision and reduce visual aberrations caused by irregularities.

It is an advantage that it is not necessary to link a topography system directly to an ablation system or ablation algorithm to generate the treatment plan. The operator of the system can control the configurations and combinations of the individual ablation profile, thus offering short-term capabilities to patients suffering from some of these defects. On the other hand, it can be very useful if the topographic information is linked directly with the planning computer of the ablation profile .. In this way, the selection, compensation and scale of the ablation profiles can be done automatically or manually . However, the corneal map and the specific ablation mechanism can be used in various structures that fall within the scope of the present invention.

Referring to Figure 13, after (or optionally during) the selection and scale adjustment of the individual ablation profiles based on corneal map 90, the computer can simulate in mathematical terms the total ablation in order to determine a change in the corneal map 92 and a cornea resulting from the simulated ablation 94, before actually extracting the corneal tissue. This allows the doctor or system operator to compare the anterior and posterior corneal maps to visualize the results and investigate different alternative treatment plans before actual ablation.

Although, as an example and for a better understanding, a modality has been described in detail, various adaptations, changes and modifications will be evident to those skilled in the art. Therefore, the scope of the present invention is limited only by the claims that appear later.

Claims (15)

1. A method to treat one of the eyes of a patient, the eye that is formed by a cornea and a pupil, which has a center, the method consisting of: Aligning the laser release system with the pupil of the eye; Designate a treatment center on the cornea, the center of the treatment that is laterally offset from the center of the pupil; and ablating a region of the cornea by directing the laser energy from the laser alignment system according to the therapy profile focused at the treatment center.

2. The method according to claim 1, further comprising selecting the treatment profile from a library including a myopic treatment profile, a hypermetropic treatment profile and a cylindrical astigmatism treatment profile.

3. The method according to claim 2, which additionally consists of: selecting another therapy profile from the therapies of the library; Designate another treatment center in the cornea, the other treatment center that is compensated from the treatment center and the pupil center; scale the treatment profile and the other therapy profile; and ablating to another region of the cornea with the other refractive therapy profile focused on the other treatment center so that the treatment profiles of the regions undergoing ablation are compensated from each other and from the center of the pupil.

4. The method according to claim 1, wherein the ablation step consists in subjecting the cornea to an ablation with respect to the center of the treatment to give a non-spherical shape to the cornea in relation to the center of the pupil.

5. The method according to claim 4, wherein the step of spherical shape is to reduce the curvature of the cornea adjacent to the center of the treatment according to the myopic profile of ablation.

6. The method according to claim 4, wherein the step of spherical shape is to increase a curvature of the cornea adjacent to the center of the treatment according to the hypermetropic profile of ablation.

7. The method according to claim 1, wherein the ablation step consists in giving a cylindrical shape to the cornea along a cylindrical axis, where the center of the pupil is laterally compensated from the cylindrical axis.

8. The method according to claim 1, wherein the ablation step mitigates the replacement error that a previous ocular treatment inadvertently produced.

9. The method according to claim 8, wherein the pretreatment comprises a previous ablation and where the previous ablation is compensated inadvertently and laterally from the center of the pupil.

10. The method according to claim 1, wherein the step of ablation is performed in order to mitigate a refractive error of the selected eye of the group composed of patients with irregular astigmatism, corneal increase in a quadrant and asymmetric astigmatism.

11. The method according to claim 1, further comprising: Measuring the eye to generate a map of the eye; select the treatment profile in response to the map from a standard therapy library; and select the compensation in response to the map to decrease the refractive error of the eye.

12. The method according to claim 11, wherein the measurement step generates a map of eye elevation.

13. A system for treating one of the eyes of the patient, the eye that is composed of a cornea and a pupil, which has a center, the system comprises: laser that produces a laser beam capable of subjecting the cornea to ablation; optics adapted to the laser; alignment optics with the release optics to maintain alignment between the laser and the pupil of the eye; and entry to designate at least one treatment center adapted to the release optics, the treatment center offset laterally from the center of the pupil of the eye is aligned with the alignment optics.

14. The system according to claim 13, further comprising a controller adapted to the release optics, the controller that directs the optic to laterally deflect the beam in order to carry out a treatment profile focused on the treatment center designated.

15. The system according to claim 13, wherein the controller comprises a library of refractive therapies, individually selectable alternate therapies for ablating the cornea relative to the designated treatment center, the library including a myopic profile of treatment, a profile hypermetropic treatment and a cylindrical astigmatism treatment profile.