Piezo motion-based precision mechanisms provide a number of features that are highly sought after in medical applications, such as lubricant-free design and sterile, ceramic actuation. Ceramics are also non-magnetic, an advantage in high-energy imaging/scanning based on strong magnetic fields.

Improving Vision

In contrast to many animals, humans strongly rely on their visual sense, i.e., they acquire most information visually. Successful correction of vision defects reaches back into the 13th century, when optical glasses became precise enough to make a difference. The first clinical studies investigating surgical methods to shape the cornea started in the 1930s. With the advent of the laser, the steel scalpel has been replaced by high-energy photons, and a number of different laser methods have become established that correspondingly influence the curvature of the cornea to correct visual acuity. They all have one decisive factor in common: laser beam control and focusing that requires high-precision positioning systems. Piezo-based mechanisms usually have an advantage here. They work with the necessary precision, are fast, reliable, and can be integrated well in today’s laser systems due to different and compact designs, and they offer gimbal actuation in a compact package.

Precision Shaping and Cutting

Fig. 1 – In order to compensate for ametropia, the shape of the cornea is modeled in the optical axis by removing small cornea particles with laser beams so that the resulting refractive power of the cornea (epithelium) matches the length of the eyeball again.
Today, ametropia—a disorder in which images do not come to a proper focus on the retina—can be corrected up to high diopter ranges with refractive surgery techniques. For this purpose, the shape of the cornea is modeled in the optical axis by removing small cornea particles with laser energy, so that the resulting refractive power of the cornea (epithelium) matches the length of the eyeball again. (See Figure 1)

With Epi-LASIK (epithelial laser in situ keratomileusis), the epithelium is first prepared with a microkeratome (mechanical preparation scalpel) or a laser. The resulting thin corneal flap is then lifted to the side. The top cell layer of the cornea in the treatment area can also be removed using a small special instrument in the form of a PRK scraper (photorefractive keratectomy).

In the case of so-called LASEK (laserassisted sub-epithelial keratomileusis), the surface of the cornea is perforated with a scratch ring, then briefly moistened with a weak alcohol solution for ablation, and carefully pushed to the side by hand. Only then does the actual laser treatment take place. A video animation is available at http://youtu.be/FVneEQZVjm8 .

Femtosecond and Excimer Lasers

Two different laser types are used for these refractive operations: excimer lasers and femtosecond lasers. The latter work in the infrared range and send light pulses with a duration in the femtosecond range (one femtosecond is equal to 10-15 sec). The laser energy is not discharged on the surface of the cornea but inside at a predetermined depth for a duration of several femtoseconds. In this way, tissue can be cut with extreme precision and practically without generating heat. This can be used in the above-mentioned LASIK method to remove the thin corneal flap. Femtolasers can also be used to prepare corneal tunnels for intracorneal implants, for example, for artificial lenses.

Fig. 2 – Controlling a laser beam requires maximum precision. Piezo-based nanopositioning systems are ideal for all these applications.
The femtolaser does not correct the ametropia, however. This is where excimer lasers come into play. They emit UV light, whereby the energy of the laser beam is discharged directly on the surface of the cornea. The laser beam only penetrates a micrometer-wide tissue layer of the cornea and vaporizes the tissue there. The cornea is shaped very precisely so that myopia, hyperopia, or astigmatism can be corrected.

Highly precise beam control is absolutely crucial for both lasers used. With the excimer laser process, an integrated eye tracker monitors the position of the eye and correspondingly adjusts the placement of the light beam with a reaction time of less than 1/100 of a second. The laser beam also has to be correspondingly guided for this, as well. (See Figure 2)

Piezo High-Speed Laser Steering Mirrors

Common deflection techniques, such as galvo scanners, are basically suitable for such high-precision applications on the human eye, but they have limitations. To be able to position in two axes, two systems have to be stacked. This results in a pivot point shift, polarization rotation and additional space and alignment requirements for integration.

Medical Design Briefs Magazine

This article first appeared in the September, 2015 issue of Medical Design Briefs Magazine.

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