Methods and systems for OCT guided glaucoma surgery

A method for treating glaucoma in an eye, the method comprising:

• inserting a probe into an anterior chamber of an eye, the probe including at least one optical fiber configured to transmit photoablation energy sufficient to photoablate tissue, the probe defining a probe axis that extends from a distal portion of the probe, the probe further configured to perform real-time optical coherence tomography (OCT) data collection from tissue distal to the distal portion of the probe;
• generating an OCT data stream from the real-time OCT data collection of the probe;
• collecting, from the probe when the probe has been inserted into the anterior chamber of the eye and is positioned and repositioned within the anterior chamber, first OCT data from the OCT data stream, the first OCT data representing a tissue structure of the eye, the first OCT data updating in real-time as the probe is repositioned;
• determining, from the first OCT data, locations of a trabecular meshwork of the eye relative to the probe and a Schlemm's canal of the eye relative to the probe, the locations updating in real-time as the probe is repositioned;
• displaying, based on the determined locations, instructions for repositioning the probe such that the distal portion of the probe contacts the trabecular meshwork and the probe axis extends toward the Schlemm's canal, the instructions updating in real-time as the probe is repositioned;
• determining, from the first OCT data, that the probe is positioned such that the distal portion of the probe contacts the trabecular meshwork and the probe axis extends toward the Schlemm's canal;
• collecting, from the probe when the probe is in contact with the trabecular meshwork, second OCT data from the OCT data stream, the second OCT data representing the tissue structure of the eye as a first channel is formed via photoablation through the trabecular meshwork, through a juxtacanalicular trabecular meshwork of the eye, and through an inner wall of the Schlemm's canal, the second OCT data updating in real-time as the first channel is formed;
• determining, from the second OCT data, that the first channel has extended through the inner wall of the Schlemm's canal;
• and
• displaying an indication that the first channel has extended through the inner wall of the Schlemm's canal.

A system for treating glaucoma in an eye, the system comprising:

• a probe that is insertable into an anterior chamber of an eye, the probe including an optical fiber configured to transmit photoablation energy sufficient to photoablate tissue, the probe defining a probe axis that extends from a distal portion of the probe, the probe further configured to perform real-time optical coherence tomography (OCT) data collection, using the optical fiber, from tissue distal to the distal portion of the probe;
• a viewing device;
• and
• at least one processor coupled to the probe and the viewing device, the at least one processor configured to:
• generate an OCT data stream from the real-time OCT data collection of the probe;
• collect, from the probe when the probe has been inserted into the anterior chamber of the eye and is positioned and repositioned within the anterior chamber, first OCT data from the OCT data stream, the first OCT data representing a tissue structure of the eye, the first OCT data updating in real-time as the probe is repositioned;
• determine, from the first OCT data, locations of a trabecular meshwork of the eye relative to the probe and a Schlemm's canal of the eye relative to the probe, the locations updating in real-time as the probe is repositioned;
• display, on the viewing device, based on the determined locations, instructions for repositioning the probe in three dimensions such that the distal portion of the probe contacts the trabecular meshwork and the probe axis extends toward the Schlemm's canal, the instructions for repositioning the probe including graphical visual elements positioned to show relative distances between the distal portion of the probe and at least one of the trabecular meshwork, the juxtacanalicular trabecular meshwork, and the inner wall of the Schlemm's canal, the instructions updating in real-time as the probe is repositioned;
• determine, from the first OCT data, that the probe is positioned such that the distal portion of the probe contacts the trabecular meshwork and the probe axis extends toward the Schlemm's canal;
• collect, from the probe when the probe is in contact with the trabecular meshwork, second OCT data from the OCT data stream, the second OCT data representing the tissue structure of the eye as a first channel is formed via photoablation through the trabecular meshwork, through a juxtacanalicular trabecular meshwork of the eye, and through an inner wall of the Schlemm's canal, the second OCT data updating in real-time as the first channel is formed;
• determine, from the second OCT data, that the first channel has extended through the inner wall of the Schlemm's canal;
• and
• display, on the viewing device, an indication that the first channel has extended through the inner wall of the Schlemm's canal.