Optical properties of fiber optic surgical tips

David Royston, Ronald Waynant, A. Banks, S. Ramee, and C. J. White

The optical emission pattern of experimental sphere-tipped fibers and an assortment of shapes of sapphiretipped fibers has been measured. The emission patterns were recorded in both air and water. These
patterns show that cone and wedge shaped tips unexpectedly

have focusing properties.

The observed

patterns help give an understanding of the results that the tips produce on tissues. The optical analysis
suggests ways of improving tip designs.

1.

Introduction

The use of lasers and fiber optics to detect and

destroy specific tissues such as arterial plaque and
cancer has gained significant attention in the medical
area. The correct medical usage of these optical devices can only be determined with knowledge of their

performance in realistic conditions. This study evaluates several fiber surgery devices in laboratory condi-

tions.
Fiber optic delivery of laser power to irradiate targeted tissue has advantages over other delivery methods because (1) it gives greater maneuvering freedom
to the surgeon than mirrored reflector systems; (2) it
allows power to be delivered endoscopically through
natural body canals without more invasive surgery;
and (3) it may allow the laser to be located outside the
operating room. To predict the results of laser-tissue
interaction, it is necessary to understand the optical
properties of the delivery end of the fiber. Many
different tip shapes are possible. The end of the fiber
may be cut flat and polished or the radiation pattern
may be changed by shaping the end of the fiber into a
sphere or lens element or by attaching an optical element to the end. This paper examines the emission
patterns of several fiber optic tips immersed in air and
water. Previous studies1 -3 have examined the optical
properties of spherical and sapphire tips in air or water
or near contact with tissues.
This study evaluates both experimental spherical
fiber optic tips and four commercial sapphire tips commonly used in laser surgery. These tips have general

David Royston and R. Waynant are with FDA Center for Devices
& Radiological Health, 5600 Fishers Lane, Rockville, Maryland
20857; the other authors are with Walter Reed Medical Center,
Washington, DC 20307.
Received 14 April 1988.

shapes which can be described as spherical, conical

(two different aspect ratios), wedged, and hemispherical. The spherical tip shown schematically in Fig. 1

was made of fused silica and had a diameter of 1.5mm.

It was attached to a step-index multimode silica fiber
of 200-Amdiameter. Transmission measurements indicate that the sphere initially transmits 90% or more
of argon laser radiation (all lines). This fiber system
was intended for laser angioplasty using visible argon
laser radiation.4 The remaining tips shown in Fig. 2
are made of sapphire and were attached to a surgical
handpiece containing a 600-gm diam step-index multimode silica fiber. These sapphire tips were designed
for use with cw Nd:YAG laser radiation. They are
used in laser surgery for incisions, coagulation, ablation and other uses.5 -8
Transmission measurements indicate that the cones
absorb -80% of argon (all lines) laser radiation, and
the remaining tips absorb -60%. For Nd:YAG laser
radiation the absorption drops to -60% for the cones
and 40%for the remaining tips. This absorption indicates that a substantial portion of the laser radiation is
converted to heat. These tips must be used with liquid
or gas cooling.
11. Theoretical Analysis

Some indication of the optical performance of these

tips can be obtained from thick lens theory,9 matrix
optics,10'1' or total internal reflection.'2 The performance of the conical tips can be described with the aid
of Fig. 3 and an analysis of the internal reflections.
The critical angle B, for total internal reflection at A is
determined by arcsin n'/n, where n and n' are indices of
refraction of the tip and the surrounding medium,
respectively. All rays incident at angles >B, will be
totally reflected and contained within the tip. However, at the next reflection of the ray at point B, the
incident angle will have decreased by the cone angle

possibly allowing the ray to escape. Subsequent reflections and their angles of incidence also decrease by
15 February 1989 / Vol. 28, No. 4/ APPLIEDOPTICS

799

</~~~~~>
Nm
t

Fig. 1.

7:

N,

Optical schematic of a spherical tip.

A, which may even reverse the direction of the ray

producing a large amount of randomly scattered light.
For a sapphire (n = 1.77)tip in air (n' = 1), Bc equals
340; for sapphire and water (n' = 1.33),B, equals 48.70.
When the tip is immersed in water, the critical angle
becomes larger and fewer light rays (compared with
the tip in air) are incident at angles greater than the
critical angle. Therefore, in water it would be expected that a larger portion of the tip would emit light.
This would lower the thermal load on the tip and
spread any emission pattern.

Fig. 2.

Various sapphire surgical tips.

N'

Figure 1 shows the general case for a spherical-

tipped fiber with index n2 immersed in a medium of

index nm. Using matrix optics theory, the paraxial ray
path through the refractive surfaces shown in Fig. 1
can be traced to produce the matrices below. In this
case, the flat fiber tip is assumed to be in contact with
the spherical surfaces on index n and of radius R.
Matrix optics relates the angle and height of a paraxial
ray above the y axis at location 1 to the same parameters at location 2. The four components of a 2 X 2
matrix are given the letters A, B, C, and D:
Oout

Yut

QOi

_A

ICDX

Yi|

and transversal through several interfaces is determined by the product of the matrices. For the fiber tip
of Fig. 1 the product of the matrices shown below

describes the path taken by a paraxial ray. By multiplying these matrices, the focal point can be calculated
as a function of the index of refraction of the medium:
0

2R/nl

1 0 1

Fig. 3.

Optical schematic of a conical tip.

Equation (2) gives results for cases of interest.

In

air, nm = 1, and the focal length of either the sphere or

hemisphere is equal to R/(ni - 1). The two cases are
the same because it is assumed that the fiber touches
the sphere. If the medium is water, then nm = 1.33,
and the focal lengths are equal to Rnm/(nl - nm). For
fused silica spheres, n1 = 1.46 (515 nm), which pro-

At each inter,face a new matrix must be determined,

1 x/nm 1
10 1
I (nm-li)/R

1
(n 1 -n 2 )/R

0o
1

duces a focal length of 2.17R in air and 10.2R in water.

These tips possess less focusing power in water and,
therefore, have a larger spot size than the same tips in
air. Since tissue is composed primarily of water, it is
likely that somewhat similar focusing patterns will
result. It must be remembered that matrix optics
assumes paraxial rays. The angular composition of
the rays impinging on the focusing element, after traversing the fiber, may not be primarily paraxial.

Matrix multiplication gives the terms of the overall

ABCD matrix, and the focal point for parallel rays can
be found by setting the resulting A term equal to zero.
This gives the focal length x in terms of the indices of
refraction and the radius of curvature of the sphere,

III.

i.e.,

argon laser. It was operated at 515 nm in the TEMoo

mode with a beam diameter of 1.6 mm (1/e2 points).
The laser power level was set at 1 W and controlled to
<0.2%rms. Both the fiber optic launching microscope
objective and the imaging microscope objective were

nmi(n, -n2)/R -1
-(n-nl)/R[1

- (n,- n2)/R]- (n -n2)R

(1)

Assuming that the index of the sphere tip matches the

index of the fiber, then n2 = ni and
x = nmR/(nl

nm).

(2)

If the fiber tip does not contact the sphere, a translation matrix must be added for the separation distance.
The position of the image of the fiber can be found by
setting the resulting B term equal to zero.
800

APPLIEDOPTICS / Vol. 28, No. 4 / 15 February 1989

Experimental Analysis and Results

Spatial beam profiles were measured in 0.5-mm increments beginning at tip contact and extending to 3
mm in front of most tips. The experimental setup is
shown in Fig. 4. The ion laser was a Lexel model 295

1oX power with 0.25 N.A. The cuvette was a standard

fluorescence cell with a 10-mm light path and a clear

bottom. The detector array was a Spiricon model
16X16-81 pyroelectric matrix array. The array consisted of 256 pyroelectric elements, each 750,gmsquare
with 800-gm spatial periods. The beam profiles detected by the array were analyzed by Spiricon Color

( L

)i

PC

M=Mlror
A=Arry
PC=Compster
C =Chopper
ND =Nestral DensityFilters
MO=Microscope Objective 0X
CU =Csvet
F =Fiber
SMA=SMA Connector
T =Spherical Tip

Fig. 5.

Typical beam profile.

Fig. 4. Experimental arrangement for measuring the emissionpatterns from tips and probes.
2.5

Quantitative 3D software. A typical beam profile is

2.0

shown in Fig. 5.
The imaging microscope objective was focused on

the inside bottom surface of the cuvette. This point

coincided with the zero or initial position of the tip
being tested. The tips were raised in increments of 0.5
mm, and the beam profiles were recorded for each
position, first in air, then in water. The results are
presented graphically. The ratio of the irradiance at
each incremental position Ii to the initial position Io
was plotted as a function of position. The irradiance is
calculated as the total array power divided by the beam
diameter at the full width at half-maximum points.
Both array power and beam diameter were determined
by the software. The optical patterns produced by the
sapphire tips at 515 nm is representative of their response at 1060 nm, since the calculated difference in

.2.
0

1.5

ram
1.0,

:5
Cu

0.5_v
r
oF6

Fig. 6.

Distance From Tip (mm)

Irradiance ratios from spherical tips as a function of dis-

tance from the tip.

index is only 0.018.

5.0

IV.

Spherical Tips

Two sphere-tipped fibers were tested as described.

The results are shown in Fig. 6. The beam emitted in
air from sphere-tipped fiber 2 is essentially collimated
while that emitted from sphere-tipped fiber 3 is focused as predicted by paraxial theory. The decrease
in the irradiance levels experienced in water is due to
the larger spot size, which was also predicted by the
matrix analysis. Both sphere-tipped fibers exhibit
decreasing irradiance when immersed in water due to
the spreading of the beam. This difference in performance between two similar sphere-tipped fibers may
be due to their fabrication.
In a separate experiment the distance between the
end of an illuminating fiber and a sphere was varied.
An image plane could not be found visually when the
fiber tip was located inside the focal point of the
sphere.

However, an image plane was readily ob-

served when the fiber tip was located outside and near
the focal point of the sphere. This may indicate that
the angular spread of energy delivered to the ball is not
at all paraxial and cannot be focused. As the fiber is
moved outside the focal length of the ball an image of
the end of the fiber is produced at the conjugate plane.
V.

Hemispherical Tip

The hemispherical tip shown in Fig. 7 performed

similarly to the 3 sphere. It also had a real focal point

._

0
'a

It

0.5

1.0

1.5

2.0

2.5

3.0

DistanceFrom Tip (mm)

Fig. 7.

Irradiance ratios from the hemispherical tip as a function of

distance from the tip.

in air. In water the reduced power of the tip-water

interface was not sufficient to focus the radiation.
VI.

Cone Tips

Two cone shaped tips (of two different sizes) produced the results shown in Figs. 8 and 9. Both gener-

ated higher irradiance levels in water than in air, and

both showed a maximum intensity at some distance
away from the tip (a focal point). Observation of a
focal point from a cone most likely comes from those
rays not making an internal reflection but refracting at
15 February 1989 / Vol. 28, No. 4/ APPLIEDOPTICS

801

1.50

1.25

1.00

.9

cr: 0.75
Cu
a,
C
.U
CU
..

Fig. 10. Wedge tip beam profile.

0.50

0.25

0.25

0.50

0.75

1.00

Fig. 8.

Distance From Tip (mm)

Irradiance ratios from the small cone tip as a function of

distance from the tip.

t

4.0
3.5
3.0
Z_
0.5

2.5
At
cc
a,
C,)
C

:5

Cu

2.0

Fig. 11.

2.5

3.0

Irradiance

ratios from the wedge tip as

function of

mm from the tip-tissue interface. Again, the focusing

is likely due to axicon-like focusing action.
0.5

1.0

1.5

2.0

Distance From Tip (mm)

Irradiance ratios from large cone tip as a function of dis-

tance from the tip.

an angle near the cone surface much as the case of the

focusing axicon. The light from the large cone tip was
spread over a greater angle and focused at a longer
distance. These two tips have been designed as laser
scalpels and are intended to provide tactile sensation
through tip contact. However, these results suggest
that the radiation ahead of the tip may contribute
most to cutting. Furthermore, the heat that is transmitted from the tip may be of value in coagulation of
blood.
Wedge Tip

The wedge tip produces a rectangular beam profile

parallel to the direction of the wedge (see Fig. 10).
The radiation is refracted in one direction much like a
chisel and is used for shaving off tissue. This tip also
produces a higher irradiance in water than in air as
shown in Fig. 11. Also, the maximum irradiance out-

side the tip occurred some distance away from the tip
for both air and water. When the tip is in contact with
the tissue, the highest irradiance would occur at -1.0
802

2.0

1.0'

VII.

1.5

distance from the tip.

1.5

0.5

Fig. 9.

1.0

DistanceFrom Tip (mm)

APPLIEDOPTICS / Vol. 28, No. 4 / 15 February 1989

Vil.

Conclusions

The spatial patterns of the laser radiation from five

types of laser surgical tip were measured in air and
water. One spherical tip and the hemispherical sapphire tip showed focusing properties in air, as expected
from the analysis. However, neither showed focusing
properties in water. Other sapphire tips emitted higher irradiances in water than in air and unexpectedly
exhibited focusing properties. The focusing ability of
cones and wedges most likely comes from a dominance

of rays that approach the cone surface with sufficient

angle to escape but which are bent to travel close to the
cone and focus just beyond it. The ability of the
spherical tips to focus laser radiation appears to depend on the angular distribution of rays emerging from
the fiber and on the tip-fiber construction. The analysis for parallel rays does not adequately handle the
focusing (or lack of it) given the likelihood of a variable

amount of cement or air in the path. A better approach might be to set the matrix B equal to zero to
find the conjugate image plane for the end of the fiber.
When spherical-tipped fibers are immersed in water,
their focal length and spot size increase due to the
reduced optical power and even the focusing of paraxial rays would not occur for a substantial distance from

the tip.

These measurements were made at relatively low

power levels. Laboratory working levels for the spherical tipped fibers are normally 5-10 W while the clinical levels for the sapphire tips are normally 20-40 W.

At these levels the temperature of the tip will be much

higher. This may affect the index of refraction, the
transmission properties of the fiber and its focusing
element, the integrity of any adhesive joints, and the
tip-tissue interaction.
Other tip materials with higher indices of refraction
could be used to increase the focusing power of the tips.
Diamond, for example, has an index of -2.4 and might

produce a more durable tip with a shorter focal length,

smaller spot size, broader transmission bandwidth,
and higher irradiance capabilities than sapphire.
Tests of other material for surgical fiber tips are in
progress.
(The mention of commercial products or their use in

connection with material reported here is not to be

construed as either an actual or implied endorsement
of such products by the Food and Drug Administra-

2. R. Verdaasdonk, F. Cross, and C. Borst, "Physical Properties of

Sapphire Fibertips for Laser Angioplasty," Lasers Med. Sci. 2,
183 (1987).
3. H. Ward, "Molding of Laser Energy by Shaped Optic Fiber
Tips," Lasers Surg. Med. 7, 405 (1987).
4. J. Michaels, F. Cross, T. Bowker, and S. Bown, "Effect of Angle
of Incidence upon Arterial Wall Damage with the Ball-Tipped
Fiber for Laser Angioplasty," Am. Soc. Laser Med. Surg. Abstr.
8, 154 (1988).
5. S. Joffe, "Progress in Nd:YAG Laser Surgery," in Technical

Digest, Conference on Lasers and Electro-Optics (Optical Society of America, Washington, DC, 1986), paper WA1.
6. S. Joffe, "Contact Nd:YAG Laser Surgery in Gastroenterology:
A Preliminary Report," Lasers Surg. Med. 6, 155 (1986).

7. S. Landau, T. Wood, and J. Smith, Jr., "Evaluation of Sapphire

Tip Nd:YAG Laser Fibers in Partial Nephrectomy," Lasers
Surg. Med. 7, 426 (1987).
8. H. Washida, H. Watanabe,

H. Sakagami, S. Sasaki, and N.

Daikuzono, "The Contact Nd:YAGLaser System in the Treatment of Bladder Cancer: A Preliminary Report in 48 Patients,"
Lasers Surg. Med. 7, 524 (1987).

9. F. A. Jenkins and H. E. White, Fundamentals of Optics

(McGraw-Hill, New York, 1976).

tion.)

10. W. Brower, Matrix Methods in Optical Instrument Design

References
1. E. Barbieri, T. Roxey, A. Khoury, and G. Abela, "Evaluation of
Optical Properties and Laser Effects on Arterial Tissue Using a
Microlens Tipped Optical Fiber," Proc. Soc. Photo-Opt. Instrum. Eng. 713, 166 (1986).

11. A. Gerrard and J. M. Burch, Introduction to Matrix Methods in

(Benjamin, New York, 1964).

Optics (Wiley, New York, 1975).
12. W. P. Siegmund, "Fiber Optics," in Handbook of Optics, W. G.
Driscoll and W. Vaughn, Eds. (McGraw-Hill, New York, 1978),
pp. 13-18.

FREE ELECTRON LASERS

The Free Electron Laser (FEL) offers the unparalleled potential of
high efficiency, high power, and tunability from microwaves to xrays. These features make this laser a highly attractive candidate
for numerous commercial, medical and strategic defense

applications, such as a ground-based, directed energy weapon to

counter ballistic missiles during their boost trajectory.
ENGINEERING TECHNOLOGY INSTITUTE
P.O. Box 8859
Waco, TX 76714-8859
1 -800-367-4238

3 Days
Cost: $680.00
March 13-15, 1989
Huntsville, AL

15 February 1989 / Vol. 28, No. 4/ APPLIEDOPTICS

803