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US5163934A Expired / Lapsed US ⏱️ 0.0 years remaining

Photorefractive keratectomy

Assignee: AMO Manufacturing USA LLC
•
Filing: 1987-08-05
•
Granted: 1992-11-17
•
Expires: 2007-08-05
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Abstract

Abstract Photorefractive keratectomy is accomplished by an excimer laser beam that ablates away corneal tissue in a photo decomposition process. Before this occurs, the epithelium (21) of the cornea (20) is surgically removed to expose Bowman's layer (22) on the anterior surface of the stroma (23) and to begin the laser ablation at Bowman's layer. An excimer laser beam is preferred for this and is rotated during the ablation to average out energy density variations in the beam. The beam is also variably masked concentrically of its axis, during the ablation, to remove corneal tissue to varying depths as necessary for recontouring the anterior stroma. Afterward, epithelium (21) rapidly regrows and resurfaces the contoured area.

Inventors

  • 👤 Charles R. Munnerlyn

Bibliographic Details

Application Number —
Jurisdiction US
Data Source google_patents
Last Synchronized 2026-10-31 14:11
CPC Classifications
G; G02; G02B; G02B27/00; G02B27/64; G02B27/642; A; A61; A61F; A61F9/00; A61F9/007; A61F9/008; A61F9/00802; A61F9/00804; A61F9/00817; A61F2009/00861; A61F2009/00872

Claims Analysis

Total Claims: 73
Claim 1
Independent Claim 145 words
A photorefractive keratectomy method for operating on an eye having a cornea, said cornea having an anterior surface and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method comprising the steps of: (a) mechanically removing said epithelium from the anterior surface of said cornea to clear said epithelium away from a selected region of said cornea and to expose the anterior surface of said Bowman's layer in said selected region; and (b) after exposing said Bowman's layer, directing a beam of electromagnetic radiation in a wavelength highly absorbed by corneal tissue onto an area of said Bowman's layer in said selected region of said cornea to accomplish ablative photo decomposition to a depth in said selected region, beginning with said Bowman's layer and penetrating into the anterior stroma of said cornea.
Claim 2
Dependent Claim 145 words
A photorefractive keratectomy method for operating on an eye having a cornea, said cornea having an anterior surface and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method comprising the steps of: (a) mechanically removing said epithelium from the anterior surface of said cornea to clear said epithelium away from a selected region of said cornea and to expose the anterior surface of said Bowman's layer in said selected region; and (b) after exposing said Bowman's layer, directing a beam of electromagnetic radiation in a wavelength highly absorbed by corneal tissue onto an area of said Bowman's layer in said selected region of said cornea to accomplish ablative photo decomposition to a depth in said selected region, beginning with said Bowman's layer and penetrating into the anterior stroma of said cornea.
Claim 3
Dependent Claim 34 words
The method of claim 1 including using a series of pulses of said radiation and rotating said beam around an axis of said beam to different angular orientations for successive ones of said pulses.
Claim 4
Dependent Claim 41 words
The method of claim 1 including using a series of pulses of said radiation and variably masking successive pulses so that said pulses of said beam vary in size and are incident on various concentrically overlapping portions of said selected region.
Claim 5
Dependent Claim 19 words
The method of claim 3 including using a variable diameter aperture for varying the diameters of said successive pulses.
Claim 6
Dependent Claim 17 words
The method of claim 3 including using an annular mask having a variable diameter opaque central region.
Claim 7
Dependent Claim 25 words
The method of claim 3 including rotating said beam around an axis of said beam to different angular orientations for successive ones of said pulses.
Claim 8
Dependent Claim 76 words
The method of claim 1 wherein: (a) the area exposed to electromagnetic radiation has a periphery, a center, and an outer dimension; (b) more tissue is removed from the periphery than from the center of the area exposed to electromagnetic radiation; and (c) the outer dimension of the area exposed to electromagnetic radiation is slowly increased during the ablative photo decomposition so that the depth tapers at the periphery of the area exposed to electromagnetic radiation.
Claim 9
Dependent Claim 18 words
The method of claim 7 wherein the outer periphery of the area exposed to electromagnetic radiation is circular.
Claim 10
Independent Claim 186 words
A method of using an instrument that produces a pulsed beam of electromagnetic radiation in a wavelength highly absorbed by corneal tissue for performing a photorefractive keratectomy on an eye having a cornea, said cornea having an anterior surface and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method comprising the steps of: (a) preparing a selected region of said cornea for ablative photo decomposition produced by said beam by mechanically removing said epithelium from the anterior surface of said selected region of said cornea to clear said epithelium away from said selected region and to expose the anterior surface of said Bowman's layer in said selected region; and (b) after removing said epithelium and exposing the anterior surface of said Bowman's layer in said selected region, then directing pulses of said beam onto an area of said Bowman's layer in said selected region to accomplish said ablative photo decomposition of corneal tissue in said selected region to a depth, so that said pulses of said beam ablatively photo decompose stromal tissue.
Claim 11
Independent Claim 186 words
A method of using an instrument that produces a pulsed beam of electromagnetic radiation in a wavelength highly absorbed by corneal tissue for performing a photorefractive keratectomy on an eye having a cornea, said cornea having an anterior surface and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method comprising the steps of: (a) preparing a selected region of said cornea for ablative photo decomposition produced by said beam by mechanically removing said epithelium from the anterior surface of said selected region of said cornea to clear said epithelium away from said selected region and to expose the anterior surface of said Bowman's layer in said selected region; and (b) after removing said epithelium and exposing the anterior surface of said Bowman's layer in said selected region, then directing pulses of said beam onto an area of said Bowman's layer in said selected region to accomplish said ablative photo decomposition of corneal tissue in said selected region to a depth, so that said pulses of said beam ablatively photo decompose stromal tissue.
Claim 12
Dependent Claim 29 words
The method of claim 9 including rotating said beam around an axis of said beam to change the angular orientation of said beam in successive pulses of said beam.
Claim 13
Dependent Claim 13 words
The method of claim 10 including using a K-mirror for rotating said beam.
Claim 14
Dependent Claim 14 words
The method of claim 10 including using a dove prism for rotating said beam.
Claim 15
Dependent Claim 42 words
The method of claim 9 including variably masking successive pulses of said beam concentrically of said beam so that said pulses differ in area and cover various overlapping concentric portions of a selected region of said cornea centered on said beam axis.
Claim 16
Dependent Claim 15 words
The method of claim 13 including using a variable diameter aperture for masking said beam.
Claim 17
Dependent Claim 19 words
The method of claim 13 including using an annular mask having a variable inside diameter for masking said beam.
Claim 18
Dependent Claim 76 words
The method of claim 9 wherein: (a) the area exposed to electromagnetic radiation has a periphery, a center, and an outer dimension; (b) more tissue is removed from the periphery than from the center of the area exposed to electromagnetic radiation; and (c) the outer dimension of the area exposed to electromagnetic radiation is slowly increased during the ablative photo decomposition so that the depth tapers at the periphery of the area exposed to electromagnetic radiation.
Claim 19
Dependent Claim 18 words
The method of claim 16 wherein the outer periphery of the area exposed to electromagnetic radiation is circular.
Claim 20
Dependent Claim 198 words
A photorefractive keratectomy method for operating on an eye having a cornea, said cornea having an anterior surface and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method comprising the steps of: (a) mechanically removing said epithelium from the anterior surface of said cornea to clear said epithelium away from a selected region of said cornea to expose the anterior surface of said Bowman's layer in said selection region; (b) forming a beam of electromagnetic radiation in a wavelength highly absorbed by corneal tissue and directing said radiation beam onto an area of said selected region of said Bowman's layer after exposing said Bowman's layer in said selected region for ablatively photo decomposing said selected region of said cornea to a depth; (c) while keeping an axis of said beam centered within said selected region, variably masking said beam concentrically of said axis for varying the area of said beam to vary the ablatively photo decomposed profile of said selected region of said cornea; and (d) rotating said beam around said axis to change the angular orientation of said beam during the photo decomposition.
Claim 21
Dependent Claim 198 words
A photorefractive keratectomy method for operating on an eye having a cornea, said cornea having an anterior surface and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method comprising the steps of: (a) mechanically removing said epithelium from the anterior surface of said cornea to clear said epithelium away from a selected region of said cornea to expose the anterior surface of said Bowman's layer in said selection region; (b) forming a beam of electromagnetic radiation in a wavelength highly absorbed by corneal tissue and directing said radiation beam onto an area of said selected region of said Bowman's layer after exposing said Bowman's layer in said selected region for ablatively photo decomposing said selected region of said cornea to a depth; (c) while keeping an axis of said beam centered within said selected region, variably masking said beam concentrically of said axis for varying the area of said beam to vary the ablatively photo decomposed profile of said selected region of said cornea; and (d) rotating said beam around said axis to change the angular orientation of said beam during the photo decomposition.
Claim 22
Dependent Claim 16 words
The method of claim 18 including using a variable diameter aperture for variably masking said beam.
Claim 23
Dependent Claim 20 words
The method of claim 18 including using an annular mask having a variable inside diameter for variably masking said beam.
Claim 24
Dependent Claim 26 words
The method of claim 18 including pulsing said beam, and applying said variable masking and said rotating of said beam to successive pulses of said beam.
Claim 25
Dependent Claim 81 words
The method of claim 18 wherein: (a) the area exposed to electromagnetic radiation has a periphery, a center, and an outer dimension; (b) more tissue is removed from the periphery than from the center of the area exposed to electromagnetic radiation; and (c) the outer dimension of the area exposed to electromagnetic radiation is slowly increased while ablatively photo decomposing said selected region of said cornea so that the depth tapers at the periphery of the area exposed to electromagnetic radiation.
Claim 26
Dependent Claim 18 words
The method of claim 22 wherein the outer periphery of the area exposed to electromagnetic radiation is circular.
Claim 27
Independent Claim 91 words
The method of changing optical properties of an eye by operating solely upon the optically used area of the anterior surface of the cornea of an eye, which comprises the preliminary step of removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then within said area subjecting the cornea to selective tissue-ablating laser radiation to selectively ablate the anterior surface of the cornea in a volumetric removal of corneal tissue and with depth penetration into the stroma to achieve a predetermined corneal profile.
Claim 28
Independent Claim 91 words
The method of changing optical properties of an eye by operating solely upon the optically used area of the anterior surface of the cornea of an eye, which comprises the preliminary step of removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then within said area subjecting the cornea to selective tissue-ablating laser radiation to selectively ablate the anterior surface of the cornea in a volumetric removal of corneal tissue and with depth penetration into the stroma to achieve a predetermined corneal profile.
Claim 29
Dependent Claim 32 words
The method of claim 24 including using a series of pulses of said laser radiation and rotating the beam of laser radiation to different angular orientation for successive ones of said pulses.
Claim 30
Dependent Claim 60 words
The method of claim 24 wherein: (a) more tissue is removed from the periphery than from the center of the area exposed to laser radiation and (b) the outer dimension of the area exposed to laser radiation is slowly increased during the ablation so that the ablation depth tapers at the outer periphery of the area exposed to laser radiation.
Claim 31
Dependent Claim 18 words
The method of claim 26 wherein the outer periphery of the area exposed to laser radiation is circular.
Claim 32
Dependent Claim 41 words
The method of claim 24 including using a series of pulses of said laser radiation and variably masking successive pulses so that said pulses of said laser radiation vary in size and are incident on various overlapping portions of said area.
Claim 33
Dependent Claim 19 words
The method of claim 28 including using a variable diameter aperture for varying the diameter of said successive pulses.
Claim 34
Dependent Claim 16 words
The method claim 28 including using an annular mask having a variable diameter opaque central region.
Claim 35
Dependent Claim 23 words
The method of claim 28 including rotating said laser radiation around an axis to different angular orientation for successive ones of said pulses.
Claim 36
Independent Claim 127 words
The method of changing the anterior surface of the cornea of an eye from an initial curvature in an optically used area having defective optical properties to a subsequent curvature having correctively improved optical properties within said optically used area, which method comprises the preliminary step of removing only the epithelial layer from said area, whereby within said area Bowman's membrane is the externally exposed anterior surface of the cornea, and then directionally and within said area impacting said externally exposed surface with tissue-ablating laser radiation to selectively ablate the anterior surface of the cornea with penetration into the stroma and within volumetric sculpturing removal of corneal tissue to such penetration depth and profile as to characterize the anterior surface of the cornea with said subsequent curvature.
Claim 37
Independent Claim 127 words
The method of changing the anterior surface of the cornea of an eye from an initial curvature in an optically used area having defective optical properties to a subsequent curvature having correctively improved optical properties within said optically used area, which method comprises the preliminary step of removing only the epithelial layer from said area, whereby within said area Bowman's membrane is the externally exposed anterior surface of the cornea, and then directionally and within said area impacting said externally exposed surface with tissue-ablating laser radiation to selectively ablate the anterior surface of the cornea with penetration into the stroma and within volumetric sculpturing removal of corneal tissue to such penetration depth and profile as to characterize the anterior surface of the cornea with said subsequent curvature.
Claim 38
Dependent Claim 32 words
The method of claim 32 including using a series of pulses of said laser radiation and rotating the beam of laser radiation to different angular orientation for successive ones of said pulses.
Claim 39
Dependent Claim 75 words
The method of claim 32 wherein: (a) the area exposed to laser radiation has a periphery, a center, and an outer dimension; (b) more tissue is removed from the periphery than from the center of the area exposed to laser radiation; and (c) the outer dimension of the area exposed to laser radiation is slowly increased during the ablation so that the ablation depth tapers at the periphery of the area exposed to laser radiation.
Claim 40
Dependent Claim 18 words
The method of claim 34 wherein the outer periphery of the area exposed to laser radiation is circular.
Claim 41
Dependent Claim 41 words
The method of claim 32 including using a series of pulses of said laser radiation and variably masking successive pulses so that said pulses of said laser radiation vary in size and are incident on various overlapping portions of said area.
Claim 42
Dependent Claim 23 words
The method of claim 36 including rotating said laser radiation around an axis to different angular orientation for successive ones of said pulses.
Claim 43
Dependent Claim 17 words
The method of claim 36 including using an annular mask having a variable diameter opaque central region.
Claim 44
Dependent Claim 19 words
The method of claim 36 including using a variable diameter aperture for varying the diameter of said successive pulses.
Claim 45
Independent Claim 85 words
The method of changing optical properties of an eye by operating solely upon the optically used area of the anterior surface of the cornea of an eye, which comprises the preliminary step of removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then within said area subjecting the cornea to selective ultraviolet radiation and attendant ablative photodecomposition in a volumetric removal of corneal tissue and with depth penetration into the stroma to achieve a predetermined corneal profile.
Claim 46
Independent Claim 85 words
The method of changing optical properties of an eye by operating solely upon the optically used area of the anterior surface of the cornea of an eye, which comprises the preliminary step of removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then within said area subjecting the cornea to selective ultraviolet radiation and attendant ablative photodecomposition in a volumetric removal of corneal tissue and with depth penetration into the stroma to achieve a predetermined corneal profile.
Claim 47
Dependent Claim 32 words
The method of claim 40 including using a series of pulses of said laser radiation and rotating the beam of laser radiation to different angular orientation for successive ones of said pulses.
Claim 48
Dependent Claim 75 words
The method of claim 40 wherein: (a) the area exposed to ultraviolet radiation has a periphery, a center, and an outer dimension; (b) more tissue is removed from the periphery than from the center of the area exposed to ultraviolet radiation and (c) the outer dimension of the area exposed to ultraviolet radiation is slowly increased during the ablation so that the ablation depth tapers at the periphery of the area exposed to ultraviolet radiation.
Claim 49
Dependent Claim 18 words
The method of claim 42 wherein the outer periphery of the area exposed to laser radiation is circular.
Claim 50
Dependent Claim 41 words
The method of claim 40 including using a series of pulses of said laser radiation and variably masking successive pulses so that said pulses of said laser radiation vary in size and are incident on various overlapping portions of said area.
Claim 51
Dependent Claim 23 words
The method of claim 44 including rotating said laser radiation around an axis to different angular orientation for successive ones of said pulses.
Claim 52
Dependent Claim 16 words
The method claim 44 including using an annular mask having a variable diameter opaque central region.
Claim 53
Dependent Claim 38 words
The method of claim 44: (a) wherein the selective tissue-ablating laser radiation is provided in the form of a beam having a diameter and (b) including using a variable diameter aperture for varying the diameter of the beam.
Claim 54
Independent Claim 176 words
The method of changing the anterior surface of the cornea of an eye having a cornea, said cornea having an anterior surface and an optically used area and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method changing the anterior surface of said cornea from an initial curvature in said optically used area having defective optical properties to a depth and a subsequent curvature having correctively improved optical properties within said optically used area, which method comprises the preliminary step of removing only said epithelium from said area, whereby within said area Bowman's layer is the externally exposed anterior surface of said cornea, and then directionally and within said area impacting said externally exposed surface with ultraviolet radiation to selectively ablate the anterior surface of said cornea by photo decomposition with penetration into said stroma and with volumetric sculpturing removal of corneal tissue to such penetration depth and profile as to characterize the anterior surface of said cornea with said subsequent curvature.
Claim 55
Independent Claim 176 words
The method of changing the anterior surface of the cornea of an eye having a cornea, said cornea having an anterior surface and an optically used area and comprising an epithelium, a Bowman's layer, and stroma, said epithelium, said Bowman's layer, and said stroma each having an anterior surface, said method changing the anterior surface of said cornea from an initial curvature in said optically used area having defective optical properties to a depth and a subsequent curvature having correctively improved optical properties within said optically used area, which method comprises the preliminary step of removing only said epithelium from said area, whereby within said area Bowman's layer is the externally exposed anterior surface of said cornea, and then directionally and within said area impacting said externally exposed surface with ultraviolet radiation to selectively ablate the anterior surface of said cornea by photo decomposition with penetration into said stroma and with volumetric sculpturing removal of corneal tissue to such penetration depth and profile as to characterize the anterior surface of said cornea with said subsequent curvature.
Claim 56
Dependent Claim 32 words
The method of claim 48 including using a series of pulses of said laser radiation and rotating the beam of laser radiation to different angular orientation for successive ones of said pulses.
Claim 57
Dependent Claim 41 words
The method of claim 48 including using a series of pulses of said laser radiation and variably masking successive pulses so that said pulses of said laser radiation vary in size and are incident on various overlapping portions of said area.
Claim 58
Dependent Claim 38 words
The method of claim 50: (a) wherein the selective tissue-ablating laser radiation is provided in the form of a beam having a diameter and (b) including using a variable diameter aperture for varying the diameter of the beam.
Claim 59
Dependent Claim 16 words
The method claim 50 including using an annular mask having a variable diameter opaque central region.
Claim 60
Dependent Claim 75 words
The method of claim 48 wherein: (a) the area exposed to ultraviolet radiation has a periphery, a center, and an outer dimension; (b) more tissue is removed from the periphery than from the center of the area exposed to ultraviolet radiation; and (c) the outer dimension of the area exposed to ultraviolet radiation is slowly increased during the photo decomposition so that the depth tapers at the periphery of the area exposed to ultraviolet radiation.
Claim 61
Dependent Claim 18 words
The method of claim 53 wherein the outer periphery of the area exposed to laser radiation is circular.
Claim 62
Dependent Claim 23 words
The method of claim 53 including rotating said laser radiation around an axis to different angular orientation for successive ones of said pulses.
Claim 63
Dependent Claim 33 words
The method of claim 48 or claim 40, or claim 32 or claim 24 in which the radiation exposure is such as to develop anterior-surface curvature correction with depth penetration of several microns.
Claim 64
Dependent Claim 23 words
The method of claim 48 or claim 40, or claim 32 or claim 24 in which epithelial-layer removal is via gentle mechanical scraping.
Claim 65
Dependent Claim 22 words
The method of claim 48 or claim 40, or claim 32 or claim 24 in which the area of radiation is circular.
Claim 66
Independent Claim 87 words
The method of changing the optical properties of an eye by operating solely upon the optically used area of the anterior surface of the cornea of an eye, which comprises the preliminary step of mechanically removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then within said area subjecting the cornea to selective tissue-ablating laser radiation to selectively ablate the exposed surface of the cornea in a volumetric removal of corneal tissue and with depth penetration into the cornea.
Claim 67
Independent Claim 87 words
The method of changing the optical properties of an eye by operating solely upon the optically used area of the anterior surface of the cornea of an eye, which comprises the preliminary step of mechanically removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then within said area subjecting the cornea to selective tissue-ablating laser radiation to selectively ablate the exposed surface of the cornea in a volumetric removal of corneal tissue and with depth penetration into the cornea.
Claim 68
Independent Claim 92 words
The method of changing the optical properties of an eye by operating solely upon the optically used area of the anterior surface of an eye which comprises: (a) the preliminary step of mechanically removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then (b) within said area subjecting the cornea to selective tissue-ablating laser radiation to selectively ablate the exposed surface of the cornea in a volumetric removal of corneal tissue and with depth penetration into the cornea to achieve a predetermined stroma profile.
Claim 69
Independent Claim 92 words
The method of changing the optical properties of an eye by operating solely upon the optically used area of the anterior surface of an eye which comprises: (a) the preliminary step of mechanically removing only the epithelial layer from said area, whereby within said area the cornea is epithelium-free, and then (b) within said area subjecting the cornea to selective tissue-ablating laser radiation to selectively ablate the exposed surface of the cornea in a volumetric removal of corneal tissue and with depth penetration into the cornea to achieve a predetermined stroma profile.
Claim 70
Independent Claim 105 words
The method of improving optical properties of an eye by operating essentially only upon the optically used area of the anterior surface of the cornea of the eye, which method comprises a one-step procedure of tissue-ablating laser radiation of the anterior surface of the cornea in a volumetric removal of corneal tissue to a predetermined curvature profile after the epithelium has been mechanically removed, said step being one of selectively distributing the tissue-ablating radiation to exposed corneal tissue within said area to achieve the predetermined curvature profile essentially only by volumetric removal of corneal tissue, and terminating said procedure upon achieving the predetermined curvature profile.
Claim 71
Independent Claim 105 words
The method of improving optical properties of an eye by operating essentially only upon the optically used area of the anterior surface of the cornea of the eye, which method comprises a one-step procedure of tissue-ablating laser radiation of the anterior surface of the cornea in a volumetric removal of corneal tissue to a predetermined curvature profile after the epithelium has been mechanically removed, said step being one of selectively distributing the tissue-ablating radiation to exposed corneal tissue within said area to achieve the predetermined curvature profile essentially only by volumetric removal of corneal tissue, and terminating said procedure upon achieving the predetermined curvature profile.
Claim 72
Independent Claim 115 words
The method of changing the anterior surface of the cornea of an eye from an initial curvature in an optically used area having defective optical properties to a subsequent curvature having correctively improved properties within said optically used area, which method comprises: (a) mechanically removing only the epithelial layer from said area, whereby within said area Bowman's membrane is the externally exposed anterior surface of the cornea; and (b) then directionally within said area impacting said exposed surface with tissue-ablating laser radiation to ablate the exposed surface of the cornea with volumetric removal of corneal tissue to such penetration depth and profile as to characterize the anterior surface of the cornea with said subsequent curvature.
Claim 73
Independent Claim 115 words
The method of changing the anterior surface of the cornea of an eye from an initial curvature in an optically used area having defective optical properties to a subsequent curvature having correctively improved properties within said optically used area, which method comprises: (a) mechanically removing only the epithelial layer from said area, whereby within said area Bowman's membrane is the externally exposed anterior surface of the cornea; and (b) then directionally within said area impacting said exposed surface with tissue-ablating laser radiation to ablate the exposed surface of the cornea with volumetric removal of corneal tissue to such penetration depth and profile as to characterize the anterior surface of the cornea with said subsequent curvature.

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