US20060111776A1 - Intraocular lens combinations - Google Patents

Abstract

Intraocular lens combinations are provided which include an axially movable primary intraocular lens (IOL) and a substantially fixed compensating IOL. In certain embodiments, the compensating IOL has no corrective power and serves only to inhibit or reduce the risk of posterior capsular opacification (PCO). In other embodiments, the primary IOL has higher corrective power than required by the patient's prescription in order to amplify the accommodation obtained from axial movement, and the compensating IOL has negative corrective power to compensate for the excessive diopter value of the primary IOL. In a preferred method, the primary IOL is implanted in the capsular bag of an eye, and centered about the optical axis. The compensating IOL is then implanted in the capsular bag, sulcus, or anterior chamber and axially aligned with the primary IOL. If desired, refractive measurements may be made between insertion of the primary IOL and insertion of the compensating IOL to improve refractive accuracy and outcomes.

Description

CROSS REFERENCE TO RELATED APPLICATION
• This application is a Continuation-in-Part Application of U.S. patent application Ser. No. 09/390,380, filed Sep. 3, 1999, which claims the benefit of U.S. Provisional Application 60/132,085 filed Apr. 30, 1999. The disclosures of both the provisional application and the non-provisional application are incorporated in their entirety by reference herein.
BACKGROUND OF THE INVENTION
• The present invention relates to intraocular lens combinations. More particularly, the invention relates to intraocular lens combinations which are adapted to provide substantial benefits, such as accommodating movement and/or inhibition of posterior capsule opacification (PCO) in the eye.
• The human eye includes an anterior chamber between the cornea and iris, a posterior chamber including a capsular bag containing a crystalline lens, a ciliary muscle, a vitreous chamber behind the lens containing the vitreous humor, and a retina at the rear of this chamber. The human eye has a natural accommodation ability. The contraction and relaxation of the ciliary muscle provides the eye with near, intermediate and distant vision. This ciliary muscle action shapes the natural crystalline lens to the appropriate optical configuration for focusing light rays entering the eye on the retina.
• After the natural crystalline lens is removed, for example, because of cataract or other condition, a conventional, monofocal IOL can be placed in the posterior chamber. Such a conventional IOL has very limited, if any, accommodating ability. However, the wearer of such an IOL continues to require the ability to view both near and far (distant) objects. Corrective spectacles may be employed as a useful solution. Recently, multifocal IOLs without accommodating movement have been used to provide near/far vision correction.
• Attempts have been made to provide IOLs with accommodating movement along the optical axis of the eye as an alternative to shape changing. Examples of such attempts are set forth in Levy U.S. Pat. No. 4,409,691, U.S. Pat. Nos. 5,674,282 and 5,496,366 to Cumming, U.S. Pat. No. 6,176,878 to Gwon et al, U.S. Pat. No. 6,231,603 to Lang et al, and U.S. Pat. No. 6,406,494 to Laguette et al. The disclosure of each of these patents is incorporated herein by reference.
• One problem that exists with such IOLs is that they often cannot move sufficiently to obtain the desired accommodation. The degree of accommodation has been closely related to the lens prescription of the individual patient. In addition, the presence of such lenses can result in cell growth from the capsular bag onto the optics of such lenses. Such cell growth, often referred to as posterior capsule opacification (PCO), can interfere with the clarity of the optic to the detriment of the lens wearer's vision.
• It would be advantageous to provide IOLs adapted for accommodating movement, which can preferably achieve an acceptable amount of accommodation and/or a reduced risk of PCO.
SUMMARY OF THE INVENTION
• New intraocular lens combinations (ILCs) have been disclosed. The present ILCs provide distance, near and intermediate vision through position, preferably axial position, changes in the eye. The present combinations preferably enhance the degree of accommodation achieved in spite of the movement and space limitations within the eye. One advantage of the present ILCs is the ability to standardize the prescription or optical power of the moving or accommodating lens of the ILC. Thus, the required amount of movement in the eye to achieve accommodation can be substantially the same for all patients. This greatly facilitates the design of the moving or accommodating lens. Further, with at least certain of the present ILCs, inhibition of PCO is obtained. The present ILCs are relatively straightforward in construction, can be implanted or inserted into the eye using systems and procedures which are well known in the art and function effectively with little or no additional treatments or medications being required.
• In one broad aspect of the present invention, intraocular lens combinations (ILCs) comprise a first optic body, second optic body and a movement assembly. The first optic body has a negative or plano optical power and is adapted to be placed in a substantially fixed position in a mammalian eye. In those cases where the first optic body has a negative optical power, it is also called the compensating optic body. The second optic body, also called the primary optic body, has a higher optical power than the first optic body. The movement assembly is coupled to the second optic body and is adapted to cooperate with the eye, for example, the zonules, ciliary muscle and capsular bag of the eye, to effect accommodating movement of the second optic body in the eye.
• Advantageously, the second optic body has a high plus optical power to reduce the amount of movement, for example, axial movement, in the eye needed to provide accommodation for intermediate and near vision. The negative or minus optical power of the first optic body compensates for the excess plus or positive optical power in the first optic body. The use of such a compensating lens, that is the first optic body having a negative optical power, can allow for standardization of the optical power correction in the second optic body. In other words, the optical power of the second optic body, that is the primary or movable optic body, can be approximately equal from optic body to optic body, while the optical power of the first optic body, that is the compensating or fixed optic body, is adjusted from optic body to optic body to meet the specific vision correction needs (prescription) of each individual patient. Consequently, the required amount of movement of the second optic body in the eye can be approximately the same for all patients.
• The present ILCs provide accommodation, preferably an acceptable degree of accommodation, in spite of movement and space limitations in the eye. For example, the maximum theoretical amount of axial movement for a simple disc lens having an overall diameter of 11 millimeters (mm) and an optic diameter of 5 mm that undergoes 1 mm of compression in its diameter is about 1.65 mm. The amount of axial movement required for a plus 15 diopter optic to provide 2.5 diopters of additional power in the spectacle plane is about 2.6 mm. However, a plus 30 diopter optic requires only 1.2 mm of axial movement to provide 2.5 diopters of additional power in the spectacle plane. Thus, by increasing the plus power of the second optic, which is adapted for accommodating movement, a reduced amount of movement is needed to achieve higher or enhanced degrees of accommodation. The first or fixed optic preferably has a minus power to compensate for the excess plus power in the second optic.
• The present ILCs preferably include first and second optics with optical powers which provide a net plus optical power. To illustrate, assume that the patient requires a plus 15 diopter correction. The first optic body is provided with a minus15 diopter optical power and the second optic body with a plus 30 diopter optical power. The net optical power of this ILC is approximately the sum of minus15 diopters and plus 30 diopters or plus 15 diopters, the desired prescription for the patient in question. The powers of the first and second optics are only approximately additive since the net power of the combination also depends on other factors including, but not limited to, the separation of the two optics, the magnitude of the power of each individual optic body and its location in the eye and the like factors. Also, by adjusting the optical power of the first optic body, the net optical power of the ILC can be adjusted or controlled even though the optical power of the second optic body is standardized or remains the same, for example, at a plus 30 diopter optical power. By standardizing the optical power of the second optic body, the amount of movement in the eye required to obtain a given level of accommodation is substantially the same, and preferably well within the space limitations in the eye, from patient to patient.
• In one very useful embodiment, the movement assembly comprises a member including a proximal end region coupled to the second optic body and a distal end region extending away from the second optic body and adapted to contact a capsular bag of the eye. Such movement assembly may completely circumscribe the second optic body or may be such as to only partially circumscribe the second optic body.
• The second optic body preferably is adapted to be positioned in the capsular bag of the eye.
• The first optic body may be coupled to a fixation member, or a plurality of fixation members, adapted to assist in fixating the first optic body in the eye. Each fixation member preferably has a distal end portion extending away from the first optic body. In one embodiment, the distal end portion of the fixation member is adapted to be located in the capsular bag of the eye. Alternately, the distal end portion of the fixation member may be located in contact with a sulcus of the eye. As a further alternate, the distal end portion of the fixation member may be adapted to be located in an anterior chamber of the eye.
• The first optic body may be located posterior in the eye relative to the second optic body or anterior in the eye relative to the second optic body. In a useful embodiment, the first optic body is adapted to be positioned in contact with the posterior wall of the capsular bag of the eye. This positioning of the first optic body provides for effective compensation of the plus or positive vision correction power of the second optic body. In addition, by having the first optic body in contact with the posterior wall of the capsular bag, cell growth from the capsular bag onto the ILC, and in particular onto the first and second optics of the ILC, is reduced. This, in turn, reduces the risk of or inhibits posterior capsule opacification (PCO).
• In one embodiment, the fixation member or members and the movement assembly are secured together, preferably permanently secured together. Thus, when inserting the ILC into the eye, a single combined structure can be inserted. This reduces the need to position the first and second optics relative to each other. Put another way, this feature allows the surgeon to very effectively and conveniently position the ILC in the eye with reduced surgical trauma to the patient.
• The fixation member and movement assembly may be secured, for example, fused, together at the distal end portion of the fixation member and the distal end region of the movement assembly.
• In an alternate embodiment, there is no connection between the fixation member or members of the compensating lens and the movement assembly of the primary lens. That is, the compensating lens and primary lens are completely separate from and independent of one another, enabling them to be implanted consecutively, rather than simultaneously. This allows the lenses to be inserted through a smaller incision than would be possible with a combined structure. In the case of separate lenses, however, special care must be taken to axially align the two lenses in order to avoid decentration issues.
• In another broad aspect of the present invention, ILCs are provided which comprise a first optic body having a posterior surface adapted to be positioned in contact with a posterior wall of the capsular bag of the eye; a second optic body adapted to focus light toward a retina of the eye; and a movement assembly coupled to the second optic body and adapted to cooperate with the eye to effect accommodating movement of the second optic body in the eye. The first optic body has a substantially plano optical power or a negative optical power. These ILCs are particularly adapted to inhibit PCO.
• The first optic body of these combinations preferably is adapted to be placed in a substantially fixed position in the eye. The posterior surface of the first optic body advantageously is configured to substantially conform to a major portion, that is, at least about 50%, of the posterior wall of the capsular bag of the eye in which the combination is placed. More preferably, the posterior surface of the first optic body is configured to substantially conform to substantially all of the posterior wall of the capsular bag. Such configuration of the first optic body is very useful in inhibiting cell growth from the eye onto the first and second optics and in inhibiting PCO.
• In one embodiment, the first optic body, which contacts the posterior wall of the capsular, has a substantially plano optical power and the second optic body has a far vision correction power. In an alternate embodiment, the first optic body has a negative optical power and the second optic body has a positive optical power, more preferably, so that the optical powers of the first and second optics provide a net plus optical power in the eye in which the combination is placed. In this latter embodiment, the second, or primary, optic body is preferably placed in the capsular bag, while the first, or compensating, optic body, may be placed in the bag, the sulcus or the anterior chamber, or attached to the iris.
• In a very useful embodiment, the first optic body includes an anterior surface and at least one projection extending anteriorly from this anterior surface. The at least one projection is positioned to limit the posterior movement of the second optic body in the eye. Thus, the movement of the second optic body is effectively controlled to substantially maintain the configuration of the combination and/or to substantially maintain an advantageous spacing between the first and second optics.
• The movement assembly may be structured and functions similarly to movement assembly of the previously described ILCs.
• The first optic body may have a fixation member or members coupled thereto. The fixation member or members are adapted to assist in fixating the first optic body in the eye, that is in contact with the posterior wall of the capsular bag of the eye. In one embodiment, the first optic body itself is configured and/or structured so that no fixation member or members are needed to maintain the first optic body in contact with the posterior wall of the capsular bag of the eye. The first optic body and the movement assembly of these ILCs may be secured together.
• In general, the first and second optics of the present ILCs may be made of any suitable materials. Preferably, the first and second optics are made of polymeric materials. More preferably, the first and second optics and the movement assembly, and the fixation member(s), if any, are deformable for insertion through a small incision in the eye.
• The present movement assemblies are sufficiently flexible to facilitate movement of the second optic body in the eye upon being acted upon by the eye. In one very useful embodiment, the movement assembly includes a hinge assembly, preferably adapted and positioned to facilitate the accommodating movement of the second optic body.
• In those embodiments in which the first optic body has a substantially plano optic body power, the second optic body preferably has a far vision correction power, more preferably such a power for infinity, in the unaccommodated state.
• In a further broad aspect of the present invention, methods for inserting an ILC in an eye are provided. Such methods comprise providing an ILC in accordance with the present invention, as described herein. The ILC is placed into the eye, for example, in the capsular bag of the eye or partly in the capsular bag of the eye, using equipment and techniques which are conventional and well known in the art. The ILC is placed in a rest position in the eye, for example, a position so that the eye, and in particular the ciliary muscle and zonules of the eye, effectively cooperate with the movement assembly to move the second optic body of the ILC anteriorly in the eye from the rest position to provide for positive accommodation. No treatments or medications, for example, to paralyze the ciliary muscle, to facilitate fibrosis or otherwise influence the position of the ILC in the eye, are required.
• In one embodiment, the primary and compensating lenses are connected by the fixation member or members and the movement assembly, and are thus simultaneously implanted in the eye. In another embodiment, the primary lens is implanted first and centered about the optical axis. The the compensating lens is then inserted anteriorly of the primary lens and optically aligned with the primary lens. This latter embodiment may require a smaller incision than that required for the unitary combination of the former embodiment. In addition, this embodiment allows for refractive measurements to be made after the primary lens has been implanted, so that any new refractive errors that may have been introduced as a result of the surgery itself can be taken into account, and a more accurate prescription for the compensating lens can be obtained.
• Preferably, the first and second optics and the movement assembly are deformed prior to being placed into the eye. Once the ILC is placed in the eye, and after a normal period of recovery from the surgical procedure, the ILC, in combination with the eye, provides the mammal or human wearing the ILC with effective accommodation, preferably with reduced risk of PCO. In the unaccommodated state, the ILC preferably provides the mammal or human wearing the ILC with far vision correction.
• Any and all features described herein and combinations of such features are included within the scope of the present invention provided that the features of any such combination are not mutually inconsistent.
• Further aspects and advantages of the present invention are set forth in the following detailed description and claims, particularly when considered in conjunction with the accompanying drawings in which like parts bear like reference numerals.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a front plan view of an ILC in accordance with the present invention.
• FIG. 2 is a cross-sectional view taken generally along line2-2 ofFIG. 1.
• FIG. 3 is a cross-sectional view of an additional ILC in accordance with the present invention.
• FIG. 4 is a fragmentary sectional view of an eye in which an alternate ILC in accordance with the present invention has been implanted.
• FIG. 5 is a fragmentary sectional view, similar toFIG. 4, in which the compensating optic body of the ILC is implanted in the anterior chamber of the eye.
• FIG. 6 is a front plan view of an intraocular lens useful in an ILC in accordance with the present invention.
• FIG. 7 is a fragmentary sectional view, similar toFIGS. 4 and 5, in which the compensating optic body of the ILC is implanted in the capsular bag of the eye.
DETAILED DESCRIPTION OF THE DRAWINGS
• Referring now toFIGS. 1 and 2, an ILC according to the present invention, shown generally at10, includes a firstoptic body12, a secondoptic body14, a disctype fixation member16 and a disctype movement assembly18.
• The firstoptic body12 has substantially plano optical power and is adapted to be held in a fixed position, for example, at least partially by thefixation member16. When theILC10 is positioned in a human eye, theposterior surface20 of firstoptic body12 is in contact with the inner posterior wall of the capsular bag of the eye. This positioning ofoptic body12 is very effective in reducing or inhibiting endothelial cell growth from the capsular bag onto the firstoptic body12. In effect, the positioning of the firstoptic body12 against the posterior surface of the capsular bag inhibits or reduce the risk of PCO.
• The secondoptic body14 includes a distance vision correction power. Themovement assembly18 extends radially outwardly from secondoptic body14 and fully circumscribes the secondoptic body14.Movement assembly18 has aproximal end region22 which is coupled to the secondoptic body14 at firstoptic body periphery24.
• Movement assembly18 extends radially outwardly to adistal end region26 including aperipheral zone28.
• Fixation member16 includes adistal end portion30 including aperipheral area32. Themovement assembly18 andfixation member16 are fused together at theperipheral zone28 andperipheral area32. Thus, theentire ILC10 is a single unitary structure. The firstoptic body12 andfixation member16 can be manufactured separately from secondoptic body14 andmovement assembly18 and, after such separate manufacture, the fixation member and movement assembly can be fused together. Alternately, theentire ILC10 can be manufactured together. Also, if desired, the firstoptic body12 andfixation member16 can be inserted into the eye separately from the secondoptic body14 andmovement assembly18. Thus,ILC10 can comprise a plurality of separate components.
• Movement assembly18 extends outwardly from secondoptic body14 sufficiently so that thedistal end region26, and in particular theperipheral zone28 of the distal end region, is in contact with the inner peripheral wall of the posterior capsular bag when theILC10 is implanted in the eye.
• As best seen inFIG. 2, whenILC10 is at rest, the secondoptic body14 is positioned vaulted anteriorly relative to thedistal end region26 ofmovement assembly18. In other words, theanterior surface34 of secondoptic body14 is anterior of theanterior surface36 ofmovement assembly18 atdistal end region26 and/or theposterior surface38 of the secondoptic body14 is anterior of theposterior surface40 of the movement assembly at the distal end region.
• The first andsecond optics12 and14 may be constructed of rigid biocompatible materials, such as polymethyl methacrylate (PMMA), or flexible, deformable materials, such as silicone polymeric materials, acrylic polymeric materials, hydrogel polymeric materials, and the like, which enable theoptics12 and14 to be rolled or folded for insertion through a small incision into the eye. Although the first andsecond optics12 and14 as shown are refractive lens bodies, the present ILCs can include at least one diffractive lens body, and such embodiment is included within the scope of the present invention.
• As noted previously, firstoptic body12 has a substantially plano or zero optical power. Secondoptic body14 is prescribed for the wearer ofILC10 with a baseline or far (distance) diopter power for infinity. Thus, the wearer ofILC10 is provided with the vision correction power of secondoptic body14 with little or no contribution from the firstoptic body12.
• Thefixation member16 andmovement assembly18, as shown, are integral (unitary) with and circumscribe the first andsecond optics12 and14, respectively. Alternately,fixation member16 and/ormovement assembly18 can be mechanically or otherwise physically coupled to firstoptic body12 and secondoptic body14, respectively. Also, thefixation member16 and/ormovement assembly18 may only partially circumscribe first andsecond optics12 and14, respectively, and such embodiments are included within the scope of the present invention. Thefixation member16 andmovement assembly18 may be constructed from the same or different biocompatible materials as first andsecond optics12 and14, and preferably are made of polymeric materials, such as polypropylene silicone polymeric materials, acrylic polymeric materials, and the like.Movement assembly18 has sufficient strength and rigidity to be effective to transfer the force from the ciliary muscle of the eye so that the secondoptic body14 is movable axially in the eye to effect accommodation.
• Movement member18 includes a region of reduced thickness41 located at theproximal end region22. This area of reduced thickness, which completely circumscribes the secondoptic body14, acts as a hinge to provide additional flexibility to themovement member18 to extenuate or amplify the accommodating movement of secondoptic body14 in response to the action of the ciliary muscle and zonules.
• Thefixation member16 andmovement assembly18 preferably are deformable, in much the same manner as first andsecond optics12 and14 are deformable, to facilitate passingILC10 through a small incision into the eye. The material or materials of construction from whichfixation member16 andmovement assembly18 are made are chosen to provide such members with the desired mechanical properties, e.g., strength and/or deformability, to meet the needs of the particular application involved.
• TheILC10 can be inserted into the capsular bag of a mammalian eye using conventional equipment and techniques, for example, after the natural crystalline lens of the eye is removed, such as by using a phacoemulsification technique. TheILC10 preferably is rolled or folded prior to insertion into the eye, and is inserted through a small incision into the eye and is located in the capsular bag of the eye.
• TheILC10 in the eye is located in a position in the capsular bag so that theposterior surface20 of firstoptic body12 is maintained in contact with the inner posterior wall of the capsular bag. As noted previously, positioning the firstoptic body12 in contact with the posterior wall of the capsular bag reduces the risk of or inhibits cell growth from the capsular bag onto the firstoptic body12 which, in turn, reduces or inhibits PCO. The ciliary muscle and zonules of the eye provide force sufficient to move axially secondoptic body14 sufficiently to provide accommodation to the wearer ofILC10.
• TheILC10 should be sized to facilitate the movement of the secondoptic body14 in response to the action of the ciliary muscle and zonules of the eye in which the ILC is placed.
• If theILC10 is too large, the ciliary muscle and zonules will be inhibited from effectively contracting/relaxing so that the amount of accommodating movement will be unduly restricted. Of course, if theILC10 is too small, the secondoptic body14 will be ineffective to focus light on the retina of the eye, may cause glare and/or the movement member may not cooperate with the eye to effect the desired amount of accommodating movement. If theILC10 is to be included in an adult human eye, the first andsecond optics12 and14 preferably have diameters in the range of about 3.5 mm to about 7 mm, more preferably in the range of about 5 mm to about 6 mm. TheILC10 preferably has an overall maximum diameter, with themovement assembly18 in the unflexed or rest state, in the range of about 8 mm to about 11 mm or about 12 mm.
• Thepresent ILC10 has the ability, in cooperation with the eye, to move the secondoptic body14 both posteriorly and anteriorly in the eye, to provide for both distance focus and near focus, respectively. This movement ofILC10 advantageously occurs in response to action of the ciliary muscle and zonules, which action is substantially similar to that which effects accommodation in an eye having a natural crystalline lens. Thus, the ciliary muscle and zonules require little, if any, retraining to function in accordance with the present invention. Themovement member18, as described herein, preferably is effective to facilitate or even enhance or extenuate the axial movement of the secondoptic body14 caused by the action of the ciliary muscle and zonules to provide increased degree of accommodation.
• FIG. 3 illustrates an additional ILC, shown generally at110, in accordance with the present invention. Except as expressly described herein,ILC110 is structured and functions similar toILC10. Components ofILC110 which correspond to components ofILC10 are indicated by the same reference numeral increased by100.
• One primary difference betweenILC110 andILC10 relates to the substitution of aposterior lens structure40 for the firstoptic body12 andfixation member16.Lens structure40 includes aposterior face42 which is configured to come in contact with and substantially conform to the inner posterior surface of the capsular bag of the eye in which theILC110 is to be placed. Thus, thesurface42 which extends around theperipheral area44 and across thecenter region46 of thelens structure40 is adapted to come in contact with and substantially conform to the inner posterior wall of the capsular bag. Moreover, thelens structure40 is adapted to remain in contact with this inner posterior wall of the capsular bag and to be fixed in the eye. This configuration has been found to be very effective in inhibiting cell growth from the eye onto theILC110. Theanterior surface48 oflens structure40 is configured to provide the lens structure with a substantially plano or zero optical power. Secondoptic body114 is prescribed for the wearer ofILC110 with a baseline or distance or far (distance) dioptic power for infinity. Thus, the wearer ofILC110 is provided with a vision correction power of secondoptic body114 with little or no contribution from thelens structure40.
• Alternately, secondoptic body114 has a high plus power, for example, plus 30 diopters. Thelens structure40, and in particular the region of the lens structure, defined by theanterior surface48, which extends substantially across the entire field of vision of the wearer ofILC110, has a minus vision correction power which is controlled to provide the correction prescription for use in the eye in which theILC110 is placed. For example, if this eye requires a plus 15 diopter power, thelens structure40 has a vision correction power of approximately minus15 diopters so that the net vision correction power of the combination oflens structure40 and secondoptic body114, is plus 15 diopters.
• The lens structure can be made from materials described previously with regard to firstoptic body12 andfixation member16.
• One additional feature oflens structure40 relates to theanteriorly extending projections50 which extend from thebase element52 oflens structure40. The number of theseprojections50 can range from 2 to about 6 or more. Alternately, a continuous annulus projecting anteriorly can be provided. The purpose of theprojections50 or the continuous annulus is to limit the posterior movement of the secondoptic body114 andmovement assembly118. This limitation in the movement provides an additional degree of control of theILC110, and prevent a collapse of theILC110 and maintains an advantageous degree of separation between secondoptic body114 andanterior surface48 oflens structure40.
• FIG. 4 illustrates the use of an alternate ILC in accordance with the present invention. This ILC, shown generally at60 includes a compensating IOL61 comprising a first, or compensating,optic body62, and aprimary IOL63 comprising a second, or primary,optic body64 and amovement assembly66. The compensatingoptic body62 is coupled to afixation member68 which includes adistal end portion70 in contact with theperiphery72 of thesulcus73 ofeye74.Fixation member68 is a disk fixation member which completely circumscribes the compensatingoptic body62. However, it should be noted that thedisc fixation member68 can be replaced by two or more filament fixation members or plate fixation members or other types of fixation members, many of which are conventional and well known in the art.Movement assembly66 is coupled to the primaryoptic body64 and completely circumscribes the primary optic body. The primaryoptic body64 is located in thecapsular bag76 ofeye74 and is vaulted anteriorly to some extent to enhance accommodating movement of the primary optic body.
• The primaryoptic body64 has a plus power higher than the power required by the basic prescription of a presbyopic patient. For instance for a patient requiring plus 15 diopters of far vision correction, primaryoptic body64 might have a corrective power of plus 30 diopters. The compensatingoptic body62 is a negative or minus lens having a minus vision correction power which is controlled to provide the correct prescription for use ineye74. For the patient described above, the compensatingoptic body62 has a vision correction power of approximately minus15 diopters so that the net vision correction power of the combination of compensatingoptic body62 and primaryoptic body64 equals the patient's basic prescription of plus 15 diopters. The compensatingoptic body62,fixation member68, primaryoptic body64 andmovement assembly66 can be made from materials described previously with regard to the firstoptic body12,fixation member16, secondoptic body14 andmovement assembly18, respectively.
• The compensatingoptic body62 is shown here as a meniscus style optic body; that is, the anterior surface of the optic body is convex and the posterior surface is concave. However, other negative diopter configurations could also be used, such as plano/concave or biconcave. In addition, one or both of the surfaces of the compensatingoptic body62 could be multifocal or aspheric to allow for additional accommodation.
• In the configuration shown inFIG. 4, thefixation member68 is in contact with theperiphery72 of thesulcus73 of theeye74. This is a relatively durable component of the eye and is effective to support thefixation member68 in maintaining the compensatingoptic body62 in a fixed position.
• Themovement assembly66 cooperates with theciliary muscle78 andzonules80 ofeye74 to move the secondoptic body64 axially alongoptical axis82 of the eye. The amount of axial movement achieved will vary from patient to patient depending on such parameters as capsular bag dimensions. However, the movement should be at least about 0.5 mm, and more preferably, at least about 0.75 mm. In a very useful embodiment, the accommodation assembly should allow about 1 mm to about 1.2 mm of movement. With a primaryoptic body64 having a corrective power of plus 30 diopters, this amount of movement will be amplified to create an additional add power, or diopter shift, of about 1.75 to about 2.5, or possibly as high as 3.5 diopters. A diopter shift in this range is consistent with the near vision, or add, prescription of a “typical” presbyopic patient.
• FIG. 5 illustrates another ILC, shown generally at360, in accordance with the present invention. Except as expressly described herein,ILC360 is structured and functions similarly to ILC60. Components ofILC360 which correspond to components of ILC60 are identified by the same reference numeral increased by300.
• One primary difference betweenILC360 and ILC60 relates to the positioning of compensatingoptic body362. Specifically, compensatingIOL361 is located inanterior chamber90 ofeye374.Fixation member368 is coupled to the compensatingoptic body362 and extends outwardly and comes in contact with theangle92 ofeye374. The arrangement of compensatingoptic body362 andfixation member368 is such that the compensating optic body is maintained in a substantially stationary position in theanterior chamber90 ofeye374. The primary optic body364 is adapted to be moved axially alongoptical axis382 ofeye374 by theciliary muscle378 andzonules380 acting on themovement assembly366.
• Still another embodiment of an ILC according to the present invention is shown inFIG. 7, indicated generally at560. Except as expressly described herein,ILC560 is structured and functions similarly to ILC60. Components ofILC560 which correspond to components of ILC60 are identified by the same reference numeral increased by500.
• Again,ILC560 differs from ILC60 primarily in the location of the compensating IOL561, which is located in thecapsular bag76 with the primaryoptic body564, rather than in the sulcus or anterior chamber. In this configuration, the compensatingoptic body562 would not be truly stationary since thecapsular bag76 itself typically moves about 0.4 mm during accommodation. However, axial movement of the compensatingoptic body562 relative thecapsular bag76 can be limited by appropriate design of the fixation member ormembers568. Controlling other factors such as material selection, length, width and angulation of the fixation member or members58 relative the compensatingoptic body562 can limit the overall axial movement of the compensatingoptic body562 to less than 0.5 mm which, for the purposes of this invention, can be regarded as “substantially fixed.”
• A preferred method of implanting an ILC will now be discussed. The method is equally effective for the embodiments ofFIGS. 5, 6, and7, but for purposes of illustration will be discussed specifically with reference toFIG. 7.
• Initially, theprimary IOL563 is inserted through an incision in the patient's cornea and positioned in thecapsular bag76 using conventional techniques. Preferably, the incision is less than 4 mm in length. If the primaryoptic body564 andmovement assembly566 are unitary as illlustrated, they are inserted simultaneously. However, it is also possible to implant anindependent movement assembly566 first, and then insert the primary optic body in themovement assembly566.
• After theprimary IOL563 is placed in thecapsular bag76, a measurement is taken to determine the location of the primaryoptic body564 relative to theoptical axis82. If desired, refractive measurements may also be made at this time to accurately determine an appropriate prescription for the compensating IOL561.
• If the original incision is still open, the compensating IOL561 is inserted through the same incsion using conventional techniques. If the incision has closed, a new one, preferably also measuring less than 4 mm, is made before insertion. A keratoscope or similar instrument is then used to guide the surgeon in positioning the fixation member ormembers568 such that compensatingoptic body562 and the primaryoptic body564 are axially aligned with theoptical axis82 and one another. If necessary, the primaryoptic body564 may also be repositioned at this time.
• Alignment of the twooptic bodies562 and564 is a crucial aspect of this invention, since any decentration of images will be amplified by the high diopter power of the primaryoptic body564. Visual confirmation of alignment can be facilitated by providing the compensatingoptic body562 with a diameter D_CBequal to the diameter D_PBof the primaryoptic body564.
• In addition, theILC560 can be made less sensitive to decentration by increasing the diameter of the optic zone, that is the portion of the optic body which has corrective power, in one or both of theIOLs561 and563. For instance, while the optic zones of prior art IOLs typically have a diameter in the range of about 3.5 mm to about 7 mm, the diameters of the optic zones D_PZand D_CZinIOLS561 and563, respectively, should be in the high end of that range or even higher, i.e. preferably from 5 mm to 8 mm. Even more preferably, at least one of the optic zone diameters D_PZor D_CZshould be in the range of about 6.5 mm to about 8 mm. Although, as mentioned previously, the diameters D_PBand D_CBof theoptic bodies562 and564 are preferably equal, the diameters D_PZand D_CZof the optic zones need not be.
• Another factor influencing centration is the flexibility of fixation member ormembers568. Preferably the member ormembers568 are sufficiently flexible to allow the surgeon to reposition them as needed during the implantation process, but stiff enough to remain in a substantially fixed axial and radial position once implanted.
• FIG. 6 illustrates a still further embodiment of an intraocular lens in accordance with the present invention. This intraocular lens, shown generally at400 includes anoptic body401 and four (4) equally spaced apartmovement members403. Each of themovement members403 includes adistal region405 and aproximal region407 which is coupled to theoptic body401. A hinge, for example, a linear hinge, such as a reducedthickness area409, is located near theproximal end407 of each of themovement members403. A linear hinge is particularly advantageous to achieve enhanced, or even substantially maximum theoretical, axial movement.
• TheIOL400 can be used in place of the various second optic/movement assembly subcombinations noted above. One distinction betweenIOL400 and these other subcombinations is the use of four (4)individual movement members403 which do not totally circumscribe theoptic body401 relative to the movement assemblies noted previously which fully circumscribe the second optics. It should be noted that the movement assemblies of the present ILCs can have other configurations, for example, which are effective to facilitate or even enhance the movement of the second optics.
• While this invention has been described with respect to various specific examples and embodiments, it is to be understood that the invention is not limited thereto and that it can be variously practiced within the scope of the following claims.

Claims (20)

1. An intraocular lens combination configured for implantation into the eye of a patient, the combination comprising:

a primary intraocular lens having a positive optical power and configured to be disposed in the capsular bag of an eye, the primary intraocular lens comprising a primary optic body curved about a first central axis; and

a compensating intraocular lens having a negative optical power and configured to be disposed in the anterior chamber of the eye, the compensating intraocular lens comprising a compensating optic body curved about a second central axis and a fixation member for securing the compensating optic body within the eye; and

a movement assembly adapted to cooperate with the eye to effect accommodating movement of the primary intraocular lens in the eye sufficient to produce an add power of about 1.75 to as high as 3.5 diopters.

2. The combination according toclaim 1, wherein the primary intraocular lens and the compensating intraocular lens are configured to facilitate alignment of the first and second central axes with an optical axis of the eye.

3. The combination according toclaim 1, wherein:

the primary optic body has a first body diameter; and

the compensating optic body has a second body diameter substantially equal to the first body diameter.

4. The combination according toclaim 1, wherein:

the patient has a basic prescription for far vision correction; and

the first optical power combines with the negative optical power to provide a net positive optical power corresponding to the patient's basic prescription.

5. The combination according toclaim 4, wherein:

the patient has a full add power prescription for near vision correction;

the movement assembly is adapted to cooperate with the eye to move the primary optic body a distance corresponding to a diopter shift less than what is required by the patient's full add power prescription; and

the first optical power is selected to amplify the diopter shift sufficiently to obtain substantially full add power.

6. The combination according toclaim 1, wherein:

the patient has a full add power prescription for near vision correction;

the movement assembly is adapted to cooperate with the eye to move the primary optic body a distance corresponding to a diopter shift less than what is required by the patient's full add power prescription; and

the first optical power is selected to amplify the diopter shift sufficiently to obtain substantially full add power.

7. The combination according toclaim 1, wherein the movement assembly is adapted to move the primary optic body axially within the eye.

8. The combination according toclaim 7, wherein the movement assembly is configured to provide at least about 0.5 mm of axial movement.

9. The combination of claim39, wherein the movement assembly is configured to provide at least about 0.75 mm of axial movement.

10. The combination of claim39, wherein the movement assembly is configured to provide about 1 mm to about 1.2 mm of axial movement.

11. The combination according toclaim 1, wherein the compensating optic body is located anteriorly of the primary optic body.

12. The combination according toclaim 1, wherein the combination is configured for implantation into an eye having a capsular bag, and wherein the primary optic body is positioned in the capsular bag.

13. The combination according toclaim 12, wherein the fixation member are configured to maintain the compensating optic body in a substantially fixed axial position relative the capsular bag.

14. An intraocular lens combination configured for implantation into the eye of a patient, the combination comprising:

a primary intraocular lens having a positive optical power and configured to be disposed in the capsular bag of an eye, the primary intraocular lens comprising a primary optic body curved about a first central axis; and

a compensating intraocular lens having a negative optical power and configured to be disposed in the anterior chamber of the eye, the compensating intraocular lens comprising a compensating optic body curved about a second central axis and a fixation member for securing the compensating optic body within the eye; and

a movement assembly adapted to cooperate with the eye to effect accommodating movement of the primary intraocular lens in the eye, the intraocular lens combination is configured to provide a full add power prescription for near vision correction.

15. The combination according toclaim 14, wherein the intraocular lens combination configured to produce an add power of about 1.75 to as high as 3.5 diopters.

16. The combination according toclaim 14, wherein the primary intraocular lens and the compensating intraocular lens are configured to facilitate alignment of the first and second central axes with an optical axis of the eye.

17. An intraocular lens combination configured for implantation into the eye of a patient, the combination comprising:

a primary intraocular lens having a positive optical power and configured to be disposed in the capsular bag of an eye, the primary intraocular lens comprising a primary optic body curved about a first central axis; and

a compensating intraocular lens having a negative optical power and configured to be disposed in the anterior chamber of the eye, the compensating intraocular lens comprising a compensating optic body curved about a second central axis and a fixation member for securing the compensating optic body within the eye; and

a movement assembly adapted to cooperate with the eye to effect accommodating movement of the primary intraocular lens in the eye, the intraocular lens combination configured to provide a diopter shift in a range consistent with near vision prescription of a typical presbyopic patient.

18. The combination according toclaim 17, wherein the intraocular lens combination is configured to provide a full add power prescription for near vision correction.

19. The combination according toclaim 17, wherein the intraocular lens combination configured to produce an add power of about 1.75 to as high as 3.5 diopters.

20. The combination according toclaim 17, wherein the primary intraocular lens and the compensating intraocular lens are configured to facilitate alignment of the first and second central axes with an optical axis of the eye.

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