US20060238702A1 - Ophthalmic lens combinations - Google Patents

Abstract

An ophthalmic device is provided for a patient that has a basic prescription for distant vision, the ophthalmic device including a primary optic and a supplemental optic. The primary optic is configured for placement in the eye and has a base optical power configured to substantially provide the basic prescription. The supplemental optic has an optical power that is less than the optical power of the primary optic and is configured to provide, in combination with the primary optic, a combined optical power that provides the basic prescription of the patient. In addition, at least one surface of the primary optic is configured to deform in response to an ocular force so as to modify the combined optical power by at least 1 Diopter. The ophthalmic device may further include a movement assembly operably coupled to the primary optic that is structured to cooperate with the eye to effect accommodating deformation of the primary optic in response to an ocular force produced by the eye. The movement assembly may also be configured to provide accommodating axial movement of the primary optic.

Description

RELATED APPLICATION
• This application is a Continuation-in-Part Application of U.S. patent application Ser. No. 10/234,801, filed Sep. 4, 2002, which 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 No. 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
• 1. Field of the Invention
• The present invention relates generally to devices and methods for correcting vision and more particularly to ophthalmic device combinations for providing accommodative vision.
• 2. Description of the Related Art
• 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 postelior 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. Multifocal IOLs without accommodating movement have also 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.
• Another problem that can occur is that of providing an intraocular lens that provides a predetermined amount of accommodative power for a wide variety of eyes and with a relatively low amount of aberrations for both near and distant vision. This problem may arise because mechanical stresses used to change the focal length of a lens generally give rise to optical aberrations that reduce visual acuity of the eye. A related problem is that of determining a precise prescription for the aphakic eye prior to the surgical procedure for replacing the natural lens with an accommodative intraocular lens. This may result in implantation of an intraocular lens that is either too strong or too weak for the patient, or that does not produce enough accommodation to provide both near and distant vision. A similar problem may occur when the correct prescription is initially provided, but the patient's prescription changes over time.
• It would be advantageous to provide IOLs adapted for accommodating movement and/or deformation, which can preferably achieve an acceptable amount of accommodation and/or a reduced risk of PCO. It would also be advantageous to provide accommodating intraocular lenses or systems of ophthalmic devices that accurately provide a patient's prescription for distant and/or near vision in a way that produces little or no optical aberrations.
SUMMARY OF THE INVENTION
• New combinations of ophthalmic devices such as intraocular lens combinations (ILCs) have been disclosed. Embodiments of the present invention provide distance, near and/or intermediate vision by axially moving and/or deforming one or more optical elements, for example, by deforming at least one optical surface (e.g., changing a radius of curvature or conic constant of the surface) and/or changing the thickness of the optic. The present combinations may be used to enhance the degree of accommodation achieved in spite of the movement and space limitations within the eye and to produce near and/or distant vision that is relatively low in optical aberrations. One advantage of the present combinations is the ability to standardize the prescription or optical power of the accommodating lens or optic of the combination. Thus, the required amount of movement and/or deformation in the eye to achieve accommodation can be substantially the same for all patients or for a particular class or category of patients. This greatly facilitates the design of the moving or deforming of the accommodating lens or optic. Further, with at least certain of the present combinations, improved inhibition of PCO is obtained. The present combinations may be designed to be relatively straightforward in construction, implanted or inserted into the eye using systems and procedures which are well known in the art, and be made to function effectively with little or no additional treatments or medications being required. In addition to changing the optical power of the eye, combinations of ophthalmic devices according to the present invention may also include a corrector lens or optic that is used in combination with an accommodating lens, wherein the corrector lens or optic is configured to correct monochromatic and/or a chromatic aberrations of a primary intraocular lens and/or of at least a portion of the ocular imaging system.
• 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 and/or accommodating deformation of the second optic body in the eye, for example, in response to one or more ocular forces or naturally occurring actions of 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, aplus 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 may have a minus power to compensate for the excess plus power in the second optic.
• The present ILCs may 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 minus 15 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 minus 15 diopters and plus 30 diopters or plus15 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 may have 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 piano 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 the entire 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, 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. The first and second optics may be made of polymeric materials and, along with the movement assembly and any fixation member(s), 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 that may be 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 piano 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 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.
• In certain embodiments, an accommodating ophthalmic device comprises a primary optic and supplemental optic. The primary optic is configured for placement in an eye of a subject or patient having a basic prescription (e.g., a basic prescription for distant vision or near vision) and has a base optical power that is selected to at least partially provide the basic prescription. In some embodiments, the base optical power is selected to be within 8 Diopters of the basic prescription, preferably within 4 Diopter of the basic prescription, and even more preferably within 2 Diopters of the basic prescription. The supplemental optic has an optical power that is selected to adjust or compensate for the base optical power and may be selected to have an optical power that is within a range of about −4 Diopters to +4 Diopters. The supplemental optic and the primary optic preferably have a combined optical power that is capable of providing the basic prescription of the patient to within 2 Diopters of the basic prescription, even more preferably within1 Diopter of the basic prescription. In addition, at least one surface of the primary optic is configured to deform in response to an ocular force (e.g., contraction or relaxation of the ciliary muscle) so as to modify the combined optical power of the ophthalmic device or eye by at least I Diopter. The ophthalmic device may further comprise a movement assembly operably coupled to the primary optic that is structured to cooperate with the eye to effect accommodating deformation of the primary optic in response to an ocular force produced by the eye. The movement assembly may additionally or alternatively be configured to provide accommodating axial movement of the primary optic.
• The primary optic of the accommodating ophthalmic device may be selected in accordance to the structure of the eye into which the primary optic is to be placed. In some embodiments, the supplemental optic is selected to change or adjust the optical power provided by the primary optic. In other embodiments, the supplemental optic is a corrector optic that is selected to correct the primary optic or a portion of the eye and that has either no optical power or an optical power that is within a range of about −4 Diopters to +4 Diopters. The corrector optic may be configured to correct a monochromatic aberration and/or a chromatic aberration of the primary optic and/or at least a portion of the eye (e.g., the cornea of the eye). For example, the corrector optic may be used to correct or compensate for an astigmatic aberration, a spherical aberration, and/or a comatic aberration.
• The supplemental optic may be implanted together with the primary optic or separately from the primary optic (e.g., during a subsequent surgery from that in which the primary optic is implanted). The primary optic is preferably implanted within the capsular bag of the eye, but alternatively may be implanted outside the capsular bag, for example in the vicinity of the sulcus. The supplemental optic may also be implanted in the capsular bag in front of the primary optic; however, may alternatively be implanted anywhere in the anterior or posterior chambers of the eye. The primary and supplemental optic may be configured to maintain a separation between one another upon implantation within the eye or may be configured to contact one another in the eye. In some embodiments, the supplemental optic may be a corneal implant configured to be disposed within the cornea or a surface profile disposed on or within the cornea, the profile being formed by a laser (e.g., using a LASIK, LASEK, or PRK procedure).
• In another aspect of the current invention, the supplemental optic is designed to provide a predetermined refractive outcome in terms of optical performance or image quality. In such embodiments, the supplemental optic may have an overall optical power that may be combined with the optical power of the primary optic to provide near vision, distant vision, or intermediate vision. Alternatively, the supplemental optic may have no or substantially no optical power. In either case, the supplemental optic is a corrector optic that is selected to correct an optical aberration, for example a spherical aberration of the eye and/or at least one surface of an optic of the ophthalmic device. In some embodiments, the supplemental optic is configured to favorably modify the aberrations when the primary optic is in an accommodative and/or disaccommodative state. In other embodiments, the supplemental optic is configured increase the depth of focus of the eye, for example, by changing the optical power or focal length of the supplemental optic as a function of distance from the optical axis thereof. In still other embodiments, the supplemental optic is configured to produce two or more simultaneous foci (e.g., a bifocal or multifocal lens).
• In certain embodiment, the primary optic, the supplemental optic, and/or the corrector optic are part of a system or set of intraocular lenses for insertion into an eye. For example, the set of intraocular lenses may comprise a plurality of supplemental optics, each supplemental optic having a value of an optical characteristic that is different from the other supplemental optics of the plurality, at least one of the supplemental optics configured to provide, in combination with the primary optic, the basic prescription of the patient. The different optical characteristic may be a different optical power and/or a different amount of an optical aberration or some other optical characteristic (e.g., a different first order diffraction efficiency of a multifocal phase plate).
• 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
• Embodiments of the present invention may be better understood from the following detailed description when read in conjunction with the accompanying drawings. Such embodiments, which are for illustrative purposes only, depict the novel and non-obvious aspects of the invention. The drawings include the following figures, with like numerals indicating like parts:
• 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.
• FIG. 8 is a front view of a primary lens according to another embodiment of invention having accommodative ability to provide both distant and near vision.
• FIG. 9 is a cross-sectional view taken generally along line9-9 ofFIG. 8.
• FIG. 10 is a cross-sectional view of an ophthalmic device according to an embodiment of the invention in an disaccommodative state, the device including the primary lens ofFIG. 9 and a supplemental or corrector optic disposed within the anterior chamber of the eye.
• FIG. 11 is a cross-sectional view of the ophthalmic device shown inFIG. 10 in an accommodative state.
• FIG. 12 is block diagram of a method of providing accommodative vision according to an embodiment of the invention.
• FIG. 13 is a cross-sectional view of an ophthalmic device according to an embodiment of the invention including a primary lens ofFIG. 9 and a corrector optic support by the sulcus 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 first optic oroptic body12, a second optic oroptic body14, a disctype fixation member16 and a disctype movement assembly18. As used herein, the term “optic” or “optic body” means an optical element that may be used alone or as part of an optical system to produce an image on the retina the eye of a subject. The terms “optic” and “optic body” are used somewhat interchangeable, with the term “optic” emphasizing more the optical characteristics of an optical element and “optic body” referring more to the use an optical element as part of an intraocular lens that may also include, for example, a base element, a movement assembly, or one or more haptics, fixation members, and/or movement members. An optic or optic body may have an optic power to converge or diverge incident light using the principles of refraction, diffraction, and/or reflection of light. Alternatively, the optic or optic body may have substantially no optical power and/or be used to at least partially correct or compensate for an optical aberration, for example, by varying the optical characteristics of the optical element over the surface (e.g., as a function of radius from the center of the optical element). In addition, the optic or optic body may combine both optical power and aberration correction characteristics into a single optical element. Examples of aberration correction are found in U.S. Pat. Nos. 6,338,559 and 6,948,818, which are herein incorporated by reference.
• The firstoptic body12 has substantially piano 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 thedistal end region28, 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 a posterior surface39 of the movement assembly at thedistal end region26.
• 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 piano 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 may be 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 minus 15 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 a movement 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 and movement 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.
• The movement 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. The movement is preferably 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. For example, with a primaryoptic body64 having a corrective power of plus30 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. The movement assembly66 may be configured to provide accommodative movement by producing relative motion between theoptic body64 and at least portion of the movement assembly66. Alternatively, the movement assembly66 may be configured to maintain a fixed or substantially fixed relationship between theoptic body64 and the movement assembly66. In such embodiments, accommodation may be provided when both the movement assembly66 and theoptic body64 move together relative to the retina of the eye as the capsular bag moves and/or changes shape during accommodation.
• 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 toILC60. Components ofILC360 which correspond to components ofILC60 are identified by the same reference numeral increased by 300.
• One primary difference betweenILC360 andILC60 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 primaryoptic 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 toILC60. Components ofILC560 which correspond to components ofILC60 are identified by the same reference numeral increased by 500.
• Again,ILC560 differs fromILC60 primarily in the location of the compensatingIOL561, 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 illustrated, 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 compensatingIOL561.
• If the original incision is still open, the compensatingIOL561 is inserted through the same incision 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.
• FIGS. 8-11 illustrate another embodiment of the present invention in which anophthalmic device600 comprises aprimary optic602 and asupplemental optic604. Theoptics602,604 are configured for placement in aneye607 of a patient or subject having a basic prescription (e.g., a basic prescription for distant or near vision) and are generally disposed about anoptical axis608. Theprimary optic602 has a base optical power P_basethat may be selected to provide or approximately provide the basic prescription of the subject. For example, the base optical power may be selected to be within ±4 Diopters of the basic prescription, preferably within ±2 Diopters of the basic prescription, even more preferably within ±1 Diopter of the basic prescription.
• Thesupplemental optic604 comprises ananterior surface605 and aposterior surface606 that are configured to provide a supplemental optical power P_supplemental. In addition, thesupplemental optic604 may be configured to provide, in combination with theprimary optic602, a combined optical power P_combined(e.g., P_base+P_supplemental) that is capable of providing the basic prescription of the patient. In certain embodiments, the supplemental optical power is selected or configured to modify the vision correction provided by theprimary optic602 by an amount that allows the combination to provide or substantially provide the basic prescription for at least one configuration of theprimary optic602. For example, the supplemental optical power may be selected such that the combined optical power is within1 Diopter of the basic prescription. Generally, theprimary optic602 is configured to provide vision correction that is nearly equal to the patient's basic prescription for distant vision and thesupplemental optic604 is used to modify the vision correction provided by theprimary optic602 so as to more precisely provide the patient's basic prescription. In such cases, the supplemental optical power of thesupplemental optic604 is less than the primary optical power of theprimary optic602. For example, theprimary optic602 may have an optical power that is greater than 20 Diopters and the base optical power is greater than the supplemental optical power by at least 10 Diopters.
• Theophthalmic device600 is configured to produce ocular accommodation, for example, by configuring at least one surface of theprimary optic602 to be adeformable surface610 that is able to deform in response to an ocular force. The resulting deformation may produce a change in the radius of curvature or of a conic constant of at least one surface of theprimary optic602. In addition, the thickness of the optic602 is generally changed as it deforms. Deformation of the optic602 generally results in a change in the optic properties of the optic602, for example, a change in the optical power or aberrations produced by theoptic602.
• Theprimary optic602 is generally configured to produce an add power that modifies the primary optical power and/or the combined optical power by at least about 1 Diopter, preferably by at least 2 Diopters, and more preferably by at least 3 Diopters. The add power is a change in optical power that allows the eye to focus on objects that are at distances from about 30 cm to about 2 meters in addition to distant objects located at distances that are greater than 2 meters. The accommodative capability or add power provided by deformation of thesurface610 may be supplemented by axial motion or travel of theprimary optic602 along theoptical axis608 in response to the ocular force, as discussed in greater detail above.
• As used herein, the term “ocular force” means any force produced by the eye of a subject that stresses, moves, or changes the shape of the natural lens of the eye or of at least a portion of an optic or intraocular lens that is placed in the eye of a subject. The ocular force acting on a lens (either a natural lens or an intraocular lens) may be produced, for example, by the state or configuration of the ciliary body (e.g., contracted or retracted), changes in the shape of the capsular bag of the eye, stretching or contraction of one or more zonules, vitreous pressure changes, and/or movement of some part of the eye such as the ciliary body, zonules, or capsular bag, either alone or in combination.
• As used herein the terms “prescription” or “basic prescription” means an amount of optical power of a lens or an optic that is able to provide normal or functional vision to a subject when viewing objects located at a specified distances from the subject. For example, a “basic prescription for distant vision” is an amount of optical power for a lens or an optic that will allow a subject to resolve distant objects with a predetermined amount of visual acuity (e.g., to resolve the letters on a Snellen eye chart disposed at a distance of20 feet from the subject with a visual acuity of at least 20/20, 20/30, or 20/40, based on the standard Snellen test for visual acuity).
• As used herein the phrase “provide a basic prescription” (e.g., for distant, intermediate, or near vision) means to provide a lens or an optic that allows a subject to resolve objects at a specified distance with a predetermined degree of visual acuity (e.g., to resolveobjects 20 feet from a subject with a visual acuity of at least about 20/40, more preferably of at least 20/30, and even more preferably of at least 20/20). As used herein, the phrase “substantially provide a basic prescription” (e.g., for distant vision or for near vision) means to provide an ophthalmic device, intraocular lens, or other internal optic that may be combined with an external lens, such as a spectacle lens or a contact lens, to allow a subject to resolve objects with a predetermined amount of visual acuity. The external lens typically has an optical power that is within a range of ±4 Diopters, preferably within a range of ±3 Diopters, and more preferably within a range of ±1 Diopter.
• In certain embodiments, theprimary optic602 may be deformed by using arigid optic611 that is configured to deform theprimary optic602 in a predetermined manner, so as to produce accommodation or some other desired effect (e.g., changing the aberrations of theprimary optic602 and/or the wavefront that is directed to the retina of the eye607). Theoptics602,611 are configured so that thedeformable surface610 is deformed when theoptics602,611 are pressed together, as illustrated by comparingFIG. 10 withFIG. 11. Thus, themovement assembly620 is structured to cooperate with the eye to effect accommodating axial movement of theprimary optic602 and accommodating deformation of theprimary optic602 in response to an ocular force produced by theeye607.
• Therigid optic611 may be configured as a meniscus lens having no or substantially no optical power. Alternatively, therigid optic611 may be a meniscus or some other type of lens having either a positive or negative optical power and/or may have other optical properties such as the ability to compensate for optical aberrations and/or form a multifocal image on the retina when theeye607 in an accommodative or disaccommodative state. In some embodiments, therigid optic611 has an optical power (and/or some other optical characteristic) and either replaces or supplements thesupplemental optic604. The structure and function of the movement assemblies similar to thatmovement assembly620 in the illustrated embodiment are described in greater detail in U.S. Pat. No. 6,443,985, and U.S. Patent Application Publication Numbers 2004/082994 and 2004/0111153, which are all herein incorporated by reference.
• One advantage of embodiments of the current invention is an increased ability to achieve a predetermined optical power or refractive outcome (e.g., the ability to resolve both distant objects and object at a reading distance of about 30 cm with a resolution of 20/30 or better). It will be appreciated that prior to implantation of an intraocular lens, the basic prescription for an aphakic eye and/or amount of accommodative capability of the eye may not be precisely known, since the precise contribution of the natural lens alone may not be precisely determinate. In certain embodiments of the present invention, the deformableprimary optic602 is implanted into theeye607 to substantially provide the basic prescription for both distant and near vision (for example within ±2 Diopter). The patient may then be refracted in the usual manner to obtain a more accurately determination of the basic prescription for both distant and near vision. The optical power of thesupplemental optic604 may then be selected to provide the predetermined optical power or refractive outcome.
• Another advantage of embodiments of the current invention is that a predetermined performance of an accommodating intraocular lens may be achieved when used in a variety of different eyes requiring intraocular lenses with different amounts of optical power. The inventors have observed that the image quality or amount of aberrations produced by a deformable optic change as the optic is deformed from one shape to another. The inventors have further observed that the amount of change in the image quality and/or aberrations can be controlled by proper selection of design parameters such as the thickness of the optic, the base optical power in an unstressed state, the material, etc. Aprimary optic602 may be produced with a particular geometry and/or base optical power that has an optimized or predetermined optical performance over a range of add powers as compared to other geometries and/or base optical powers. This optimizedprimary optic602 may be used in a variety of patients having different basic prescriptions to provide the same quality of accommodative performance for each. In order to provide each patient with their particular basic prescription, a differentsupplemental optic604 with a different supplemental power for each, thesupplemental optic604 being selected in each case to provide the correct total power when used in combination with theprimary optic602.
• Yet another advantage of embodiments of the current invention is that thesupplemental optic604 is a corrector optic that is selected to provide a predetermined refractive outcome in terms of optical performance or image quality of the eye and/or theophthalmic device600. In such embodiments, thesupplemental optic604 may have no or substantially no optical power or may have an optical power that is combined with the optical power of theprimary optic602 to provide near vision, distant vision, or intermediate vision. In some embodiments, thesupplemental optic604 enhances optical performance or image quality by correcting or reducing an aberration such as a chromatic aberration or a monochromatic aberration of the eye and/orophthalmic device600. For example, one or both of thesurfaces605,606 of the supplemental604 may be aspheric in form in order to reduce or compensate for a spherical aberration of the eye orophthalmic device600. Alternatively or additionally, at least one thesurfaces605,606 be a monofocal or multifocal diffractive phase plate in order to reduce or compensate for a chormatic aberration of the eye orophthalmic device600. Thesupplemental optic604 may be configured to favorably modify the aberrations when theprimary optic602 is in an accommodative and/or disaccommodative state.
• In certain embodiments, thesupplemental optic604 is a corrector optic that is configured increase the depth of focus of the eye, for example, by changing the optical power or focal length of thesupplemental optic604 as a function of distance from the optical axis thereof. In other embodiments, thesupplemental optic604 is configured to produce two or more simultaneous foci (e.g., a bifocal or multifocal lens). In such embodiments, at least one of thesurfaces605,606 of thesupplemental optic604 may comprise a diffractive phase plate that produces two or more diffraction orders. Alternatively, at least one of thesurfaces605,606 may be configured to have an aspheric surface in which the radius of curvature varies with distance from theoptical axis608.
• Theprimary optic602 may be placed within acapsular bag612, as illustrated inFIGS. 10 and 11, so that theophthalmic device600 is responsive to ocular forces produced byciliary muscle614 and/orzonules618. Alternatively, theprimary optic602 may be implanted elsewhere within theeye607. For example, the anterior and posterior capsules of thecapsular bag612 may be allowed to attach to one another and theophthalmic device600 implanted within the sulcus of theeye607 so that theprimary optic602 is disposed in front of thecapsular bag612. In certain embodiments, theprimary optic602 has an optical power of at least about 10 Diopters, at least 20 Diopters, or at least 30 Diopters. In other embodiments, theprimary optic602 has a negative optical power, for example less than −5 Diopters, less than −10 Diopters, or less than −20 Diopters. In yet other embodiments, theprimary optic602 has an optical power within the range of −30 to +40 Diopters, −20 to +30 Diopters, or −10 to +20 Diopters.
• In certain embodiments, a patient has a basic prescription for distant vision that is expressed in terms of an optical power P_distant. The difference between the optical power P_distantand the base optical power P_baseof theprimary optic602 may be calculated and based on the ability of a surgeon or other practitioner to estimate the required basic prescription for distant vision, theprimary optic602 alone may be sufficient to restore both the distant and/or near vision of a patient to a degree that allows normal vision to be provided at least by the use of an external lens. In certain embodiments, the surgeon or practitioner is able to select the base optical power P_baseto be within ±4 Diopters of the basic prescription (e.g., abs (P_distant−P_base)≦4 Diopters), preferably within ±2 Diopter of the basic prescription, more preferably within +1 Diopter of the basic prescription. In other embodiments, the base optical power P_baseis within a range of zero to −4 Diopters of the basic prescription for distant vision, preferably within a range of zero to −2 Diopters, more preferably within a range of zero to −1 Diopters.
• By selecting the optical power P_baseof theprimary optic602 to be within at least one of these ranges, theprimary optic602 is able to provide normal vision over at least some distances. For example, if (P_distant−P_base) is equal to −3 Diopters after implantation of theprimary optic602, the patient would have blurred distant vision, but a high degree of visual acuity at normal reading distances without the need for additional internal lenses (e.g. the supplemental optic604) and/or external lenses (e.g., spectacles or contact lenses). In certain embodiments, the optical power P_supplementalof thesupplemental optic604 is selected so that the combined optical power P_combinedis equal to or approximately equal to the basic prescription for distant vision (e.g., so that (P_distant−P_combined) is approximately equal to zero).
• Thesupplemental optic604 may be configured to be implanted together with theprimary optic602 or separately therefrom. In some embodiments, thesupplemental optic604 is only optionally implanted into theeye607 when the actual vision provided by theprimary optic602 differs by a predetermined amount from an expected refractive outcome and/or the prescription of the patient changes by predetermined amount over time after initial implantation of theprimary optic602 and/orsupplemental optic604. Thesupplemental optic604 may be disposed in front of the iris or in the anterior chamber of theeye607, as illustrated for example inFIGS. 10 and 11. Alternatively, thesupplemental optic604 may be disposed within the vicinity of the sulcus of theeye607, together with theprimary optic602 withincapsular bag612, or slightly protruding from thecapsular bag612. In other embodiments, thesupplemental optic604 may be disposed within acornea619 of the eye as a corneal implant. In yet other embodiments, thesupplemental optic604 may be a corneal implant disposed configured to be disposed within thecornea619 or a surface profile disposed on or within thecornea619, the profile being formed by a laser (e.g., using a LASIK, LASEK, or PRK procedure).
• The primary andsupplemental optics602,604 may be configured and disposed within theeye607 so as to maintain a separation therebetween that is greater than a predetermined minimum, for example 200 micrometer, 500 micrometers, or about 1 millimeter. Alternatively, the primary andsupplemental optics602,604 may be configured and disposed within theeye607 so as to press against one another while theeye607 is in an accommodative and/or disaccommodative state and/or between an accommodative and a disaccommodative state.
• At least one surface of theprimary optic602, for example thedeformable surface610, is configured to deform in response to an ocular force so as to modify the optical power of at least one of (1) theprimary optic602, (2) the combined optical power of theoptics602,604, and/or (3) the total or effective optical power of theentire eye607. The deformation may be the result of change in the radius of curvature as theprimary optic602 changes from an accommodative state and disaccommodative state, which results in a change in the optical power or focal length of theprimary optic602. Alternatively or additionally, at least one surface of theprimary optic602 may change from a spherical profile to an aspheric profile or from a more spherical profile to a less spherical profile as theprimary optic602 changes from an accommodative state and disaccommodative state, or visa versa, wherein the profile change produces a change in optical power or in some other optical characteristic of theprimary optic602. In other embodiments, theprimary optic602 may change from a monofocal lens to a multifocal lens (either refractive or diffractive) as theprimary optic602 changes from an accommodative state and disaccommodative state, or visa versa. Alternatively, theprimary optic602 may be a multifocal lens, wherein the optical power or some other optical characteristic of the zones changes as theprimary optic602 changes between accommodative state and disaccommodative states.
• In certain embodiments, theprimary optic602 has a center thickness t_ialong theoptical axis608 when in a substantially unstressed state and a center thickness t_fin the response to or in the absence of an ocular force. In such embodiments, theprimary optic602 may be adapted to change the center thickness by a factor of at least 1.1 (e.g., the quotient t_f/t_iis at least 1.1), typically when the ocular force is in the range of about 1 to 10 grams, preferably in the range of about 5 to 10 grams. In other embodiments, theprimary optic602 is adapted to change the center thickness by a factor of at least 1.05 or at least 1.2 or more. In yet other embodiments, theprimary optic602 is adapted to change the center thickness by a factor of at least 1.05, 1.1, or 1.2 when the ocular force is in the range of about 1 to 5 gram or about 1 to 3 grams. In still other embodiments, theprimary optic602 has a center thickness along theoptical axis608 when theprimary optic602 is in a substantially unstressed state, the deformable optic adapted to change the center thickness by at least about 50 micrometers, preferably at least 100 micrometers, when the ocular force is in the range of about 1 to 9 grams, in the range of about 6 to 9 grams, or in the range of about 1 to 3 grams. Within the art, an understanding of the physiology of the eye is still developing. Thus, other ranges of ocular forces able to provide the above ranges of relative and/or absolute thickness change are anticipated as the physiology of the eye is better understood. Such ranges of ocular forces are also consistent with embodiments of the present invention as disclosed herein.
• The modification in optical power as theprimary optic602 deforms is preferably at least 1 Diopter, more preferably at least 2 Diopters or 3 Diopters, and even more preferably at least 2 to 4 Diopters or 3 to 5 Diopters. The amount of change in optical power ofprimary optic602 is generally an effective Diopter change in the optical power, for example, from a principal plane of the primary optic602 (e.g., somewhere between the anterior and posterior surfaces of primary optic602). In general, and as illustrated inFIGS. 10 and 11, the Diopter change may be a positive change as theciliary muscle614 contracts and thezonules618 relax; however, other directions and/or types of Diopter change are allowable (e.g., multifocal and/or aberration changes).
• In the illustrated embodiment, theophthalmic device600 comprises amovement assembly620 that is operably coupled to theprimary optic602 and afixation member622 that is operably coupled to thesupplemental optic604. Alternatively, thesupplemental optic604 may be coupled to themovement assembly620 or comprise its own, separate movement assembly. Themovement assembly620 comprises ananterior portion624 that engages the anterior capsule of thecapsular bag612 and aposterior portion628 that engages the posterior capsule of thecapsular bag612. The anterior andposterior portions624,628 together form an enclosure that fills or substantially fills thecapsular bag612. Themovement assembly620 may further comprise a plurality ofarms630 that are configured to pivot, rotate, bend and/or otherwise deform in response to deformation of themovement assembly620, whereby theprimary optic602 may be moved and/or deformed to provide accommodation. The anterior andposterior portions624,628 are generally made of a resilient material (e.g., a silicone or acrylic material) that deforms in response to an ocular force in such a way that themovement assembly620 conforms and remains in contact with thecapsular bag612 during accommodative movement thereof.
• The embodiment illustrated inFIGS. 8-11 of theprimary optic602, thesupplemental optic604, and structures connected to theoptics602,604 is exemplary only and is not meant to limit the scope of the invention. For example, theprimary optic602 may be configured to have a posterior vault rather than the anterior vault illustrated inFIGS. 10 and 11, in which case thedeformable surface610 is pressed against the posterior capsule of thecapsular bag612 when theciliary muscle614 contracts and the shape of thecapsular bag612 changes. In certain embodiments, the ILC illustrated inFIG. 7 is used to provide such a configuration, wherein the posteriorly vaultedprimary IOL563 is made of a material that is sufficiently soft to deform in response to ocular forces and the compensatingIOL561 is configured as a supplemental optic. Other examples of devices and means for producing a predetermined amount of accommodation in response to an ocular force may be found, for example, in U.S. patent application Ser. No. 11/241,586, which is herein incorporated by reference.
• Theophthalmic device600 may be used in a surgical procedure to restore both distant vision and accommodative ability for providing near vision. Referring toFIG. 12, in some embodiments, amethod700 of providing accommodative vision comprises anoperational block702, making a first estimate of a basic prescription of a subject. Themethod700 also comprises anoperational block704, inserting theprimary optic602 into theeye607 of the subject. Themethod700 further comprises anoperational block706, which includes making a second estimate of the basic prescription of the subject based on the presence of theprimary optic602. The method additionally comprises anoperational block708, implanting thesupplemental optic604 into theeye607.
• In theoperational block702, the surgeon make a first estimate of the basic prescription of the patient by, for example, measuring physical characteristic of the eye such as the axial length (AL) and the anterior chamber depth (ACD). Other dimensional parameters may also be measured including, but are not limited to, the corneal radius (CR), the corneal power (K), and crystalline lens thickness (LT). The first estimate may also include other parameters of the eye such as the refractive indices and/or estimated refractive indices of the various portions of the eye. The estimate may additionally or alternatively include performing one or more interactive vision tests with the subject, for example using the standard Snellen test for visual acuity. Generally, the first estimate is determined while the natural lens or a previously implanted intraocular lens is still in the eye. In some embodiments, the first estimate may be made after removal of the natural lens and/or explanting a previously implanted intraocular lens.
• In some embodiments, the estimates of the basic prescription are made using ophthalmic instruments designed to measure physical properties of the eye or wavefront aberrations produced by the eye, for example using biometry or keratometry. Corneal surface measurements according to well-known topographical measurement methods may be used that express surface irregularities of the cornea. Corneal measurements for this purpose can be performed by the ORBSCAN.RTM. videokeratograph available from Orbtech or by corneal topography methods, such as EyeSys.RTM available from Premier Laser Systems. The corneal measurements may also include the measurement of the corneal refractive power. In addition, wavefront sensors such as the Hartmann-Shack sensor (J. Opt. Soc. Am., 1994, Vol. 11(7), pp. 1949-57) may also be used to determine aberrations of the eye. The wavefront sensor may be used in combination with topographic sensors to determine other physical characteristics of the eye such as its length.
• In theoperational block704, the surgeon implants theprimary optic602 into theeye607. In certain embodiments, theprimary optic602 is selected to have a base optical power P_basethat substantially provides the basic prescription and is within at least ±4 Diopters of the basic prescription. Since theprimary optic602 substantially provides a basic prescription and in addition has the ability to provide accommodation, theprimary optic602 advantageously allows a surgeon to use a single implanted optic to provide a patient both distant and near vision. In some cases, satisfactory distant vision and near vision may be restored using only theprimary optic602, without the need of implanting thesupplemental optic604 or using other external lenses. In other cases, the basic prescription is provided only for certain distances or the vision provided is within an acceptable range to allow a more accurate estimate of a patient's prescription for both near and distant vision. In such cases, both distant and near vision may be restored using a single prescription spectacle or contact lens, since theprimary optic602 provides accommodative ability. Alternatively, thesupplemental optic604 may be implanted to restore full vision of both distant and near objects. In addition, because theprimary optic602 is able to substantially provides the basic prescription, a more accurate estimate of the aberrations ofeye607 may be made and subsequently corrected or compensated for using either an external optic and/or thesupplemental optic604.
• Inoperational block706, the surgeon may make the second estimate of the basic prescription either at the time of the surgery or at a time shortly after the implantation of the primaryophthalmic device600. Alternatively, the second estimate may be made at a later time by the surgeon or by another practitioner, such as an optometrist, after the subject has more fully recovered from the surgical procedure. In some instances, the time between the implantation of theprimary optic602 and the second estimate is an extended period of time in order to allow the eye to recover from the surgical procedure. The period of time may be one week, one month, or even several months (from at least about three months to at least about 6 months). Also, in some cases, the basic prescription may change some time after implantation of the primary optic602 (perhaps for causes unrelated to the surgical procedure), thereby necessitating a second estimate and correction of the subject's vision. In cases where an implantedsupplemental optic604 must be explanted in order to restore proper vision, the difficulty of explanting is advantageously reduced using theophthalmic device600, since thesupplemental optic604 may be made relatively thin and is disposed in front of theprimary optic602 and nearer to the front of the eye607 (e.g., in the anterior chamber in the illustrated embodiment).
• In certain embodiments, theprimary optic602 and/or thesupplemental optic604 belong to a system or set of intraocular lenses. In some embodiments, the set of optics comprises a singleprimary optic602 and a set or plurality S1 ofsupplemental optics604. The singleprimary optic602 may configured to provide an approximate correction for predetermined population, for example a population of patients with eyes having a particular range of axial lengths or type or shape of cornea, while thesupplemental optic604 is selected from the set S1 ofsupplemental optics604 to provide a more precise correction for a particular individual within the population. Theprimary optic602 may have a base optical power selected to be at or near the average basic prescription for a particular population. Alternatively or additionally, theprimary optic602 may be configured to provide a predetermined optical quality over a range of expected amounts of a particular optical aberration for a particular population.
• Each of thesupplemental optics604 from the set S1 ofsupplemental optics604 may be configured to vary from one another in optical power by a predetermined amount. For example, thesupplemental optics604 may be configured to vary by ½ Diopter, ¼ Diopter, or less than ¼ Diopters from one another. In this manner, theprimary optic602 is implanted to provide and approximate correction of vision for the patient and a predetermined optical performance over range of accommodation add powers.
• In other embodiments, theprimary optic602 is selected from plurality or set P2 ofprimary optics602 and thesupplemental optic604 is selected from a set or plurality S2 ofsupplemental optics604. Since there is more oneprimary optic602 for providing an approximate correction of the eyes in a given population, the number of optics in the set S2 ofsupplemental optics604 may be relatively small, for example as compared to the number of optics in the set S1 previously discussed. Alternatively, the optics in the sets P2 ofprimary optics602 and in the set S2 ofsupplemental optics604 may be configured to provide visual correction for populations having variations in basic prescription that are too large to be covered using only a singleprimary optic602, as in the previous embodiment.
• Referring toFIG. 13, in certain embodiments, theophthalmic device600 comprises a corrector optic604cconfigured to correct the optical power of theprimary optic602, wherein theprimary optic602 may be configured to have a base optical power that is selected to provide a patient's basic prescription for at least one of distant vision, intermediate vision, or near vision. The corrector optic604cmay be configured to correct a monochromatic aberration and/or a chromatic aberration of, for example, theprimary optic602, thecornea619, and/or an overall aberration of theeye607. The corrector optic604cmay have an overall positive or negative optical power, for example, within a range of about −4 Diopters to +4 Diopters or in a range of −2 Diopters to +2 Diopters. Also, the corrector optic604cmay be a multifocal lens and/or provide cylinder correction. Alternatively, the corrector optic604cmay have no or substantially no overall optical power and be used primary to correct an aberration ofprimary optic602 or theeye607. When the corrector optic604chas no or substantially no optical power, theprimary optic602 generally has a base optical power that provides the patient's basic prescription. In some embodiments, the basic prescription will be the basic prescription for distant vision; however, the basic prescription may alternatively the basic prescription for intermediate or near vision.
• The corrector optic604cmay be disposed in the sulcus, as illustrated inFIG. 11. Alternatively, the corrector optic604cmay be disposed in the anterior chamber, similar to the location of thesupplemental optic604 inFIGS. 9 and 10. In other embodiments, the corrector optic604cmay be a corneal implant configured to be disposed within thecornea619 or a surface profile disposed on or within thecornea619, the profile being formed by a laser (e.g., using a LASIK, LASEK, or PRK procedure). In yet other embodiments, the corrector optic604cis therigid optic611 configured to deform theprimary optic602 in a predetermined manner. In such embodiments, theoptics602,604care configured such that thedeformable surface610 of theprimary optic602 is deformed when theoptics602,604care pressed together.
• The corrector optic604cmay be used to correct monochromatic and/or chromatic aberrations of theophthalmic device600, theeye607 of an individual, or a population of eyes. The corrector optic604cmay be a purely refractive optical element or may additionally or alternatively comprise a diffractive element, for example, as discussed in U.S. Pat. Nos. 4,642,112, 4,881,805, and 5,144,483, which are herein incorporated by reference. Diffractive elements may be especially useful for correcting chromatic aberrations and may be configured to provide either monofocal or multifocal lens. When the corrector optic604cis purely refractive, it may be configured to correct a chromatic aberration by combining a plurality of optical elements that are each made of a different material having different optical characteristics (e.g., different refractive indices and/or Abbe numbers). Monochromatic aberrations that may be corrected by the corrector optic604cinclude, but are not limited to, astigmatic, spherical, and/or comatic. Correction of such aberrations is discussed in greater detail, for example, in U.S. Pat. Nos. 5,777,719, 6,609,793, and 6,830,332, which are herein incorporated by reference.
• In some embodiments, theprimary optic602 is a corrector optic that may be used to correct or compensate for an optical aberration of theeye607 and/or thesupplemental optic604. In other embodiments, theprimary optic602 and thesupplemental optic604 together correct or compensate for an optical aberration of at least a portion of theeye607. For example, theprimary optic602 may be configured to correct astigmatism produced by thecornea619, while thesupplemental optic604 is selected to correct a spherical aberration of thecornea619. Alternatively or additionally, theprimary optic602 may be configured to correct a spherical aberration of thecornea619 based on a preliminary estimate before theprimary optic602 is implanted into theeye607. Thesupplemental optic604 may then be select to have a spherical aberration that compensates for any remaining spherical aberrations resulting from implantation of theprimary optic602.
• In certain embodiments, the corrector optic604cis selected from a plurality or set S3 of corrector optics604c, wherein each of the corrector optics604cfrom the set S3 has a predetermined value of an optical characteristic that is different from the value of that optical characteristic for the other corrector optics604cwithin the set S3. At least one of the corrector optics604cin the set S3 is configured to provide, in combination with theprimary optic602, the basic prescription of the patient for at least one of distant vision, near vision, or intermediate vision.
• 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 (32)

1. An ophthalmic device, comprising:

a primary optic having a base optical power and configured for placement in an eye of a patient with a basic prescription for distant vision, at least one surface of the primary optic being configured to deform in response to an ocular force so as to modify the base optical power by at least 1 Diopter; and

a supplemental optic having an supplemental optical power and configured to provide, in combination with the primary optic, a combined optical power capable of providing the basic prescription when disposed in the eye, the supplemental optic power being less than the primary optic power.

2. The ophthalmic device ofclaim 1, wherein to deform comprises at least one of to change the radius of curvature of at least one surface of the primary optic, to change a conic constant of at least one surface of the primary optic, and to change a thickness of the primary optic.

3. The ophthalmic device ofclaim 1, wherein the primary optic is configured to modify the combined optical power by at least 2 Diopter in response to an ocular force.

4. The ophthalmic device ofclaim 1, wherein the base optical power is within 4 Diopters of the basic prescription.

5. The ophthalmic device ofclaim 1, wherein the base optical power is within 2 Diopters of the basic prescription.

6. The ophthalmic device ofclaim 1, wherein the base optical power is greater than 20 Diopters.

7. The ophthalmic device ofclaim 1, wherein the base optical power is greater than the supplemental optical power by at least 10 Diopters.

8. The ophthalmic device ofclaim 1, wherein the supplemental optical power is within the range of about −4 Diopters to about +4 Diopters.

9. The ophthalmic device ofclaim 1, wherein the supplemental optic is a diffractive optic.

10. The ophthalmic device ofclaim 1, wherein the primary optic is configured to be disposed within a capsular bag of the eye.

11. The ophthalmic device ofclaim 1, wherein the supplemental optic is configured to be disposed within an anterior chamber of the eye.

12. The ophthalmic device ofclaim 1, wherein the supplemental optic is configured to be implanted separately from the primary optic.

13. The ophthalmic device ofclaim 1, wherein the supplemental optic is a corneal implant configured to be disposed within a cornea of the eye.

14. The ophthalmic device ofclaim 1, wherein the supplemental optic is a surface profile disposed on or within the cornea and is formed by a laser.

15. The ophthalmic device ofclaim 1, wherein the primary optic and the supplemental optic are configured to maintain separation between one another within the eye that is greater than a predetermined amount.

16. The ophthalmic device ofclaim 15, wherein the predetermined amount is at least 500 micrometers.

17. The ophthalmic device ofclaim 1, further comprising a movement assembly operably coupled to the primary optic and a fixation member operably coupled to the supplemental optic.

18. The ophthalmic device ofclaim 17, wherein the movement assembly is structured to cooperate with the eye to effect accommodating axial movement of the primary optic and accommodating deformation of the primary optic in response to an ocular force produced by the eye.

19. An ophthalmic device, comprising;

a primary optic having a base optical power and configured for placement in an eye of a patient with a basic prescription for distant vision, the base optical power selected to provide vision correction that is within4 Diopters of the basic prescription; and

a supplemental optic having a supplemental optical power and configured to modify the vision correction provided by the primary optic so as to provide the basic prescription;

at least one surface of the primary optic being configured to deform in response to an ocular force so as to provide an add power at least 1 Diopter.

20. The ophthalmic device ofclaim 19, wherein the supplemental optical power that is within a range of −4 Diopters to +4 Diopters

21. The ophthalmic device ofclaim 19, wherein at least one surface of the primary optic is configured to deform in response to an ocular force so as to provide an add power of at least 3 Diopters.

22. An ophthalmic device, comprising:

a primary optic having a base optical power and configured for placement in an eye of a patient with a basic prescription for distant vision, the base optical power selected to provide the basic prescription when disposed in the eye for at least one of distant vision, intermediate vision, or near vision when disposed within the eye, at least one surface of the primary optic being configured to deform in response to an ocular force so as to modify the base optical power by at least 1 Diopter; and

an optical corrector configured to correct at least one of a monochromatic aberration and a chromatic aberration of the primary optic and/or the eye.

23. The ophthalmic device ofclaim 22, wherein the optical corrector is an intraocular lens comprising one or more optical elements.

24. The ophthalmic device ofclaim 22, wherein the optical corrector is at least one surface of the primary optic.

25. The ophthalmic device ofclaim 22, wherein the optical corrector is a surface profile disposed on or within the cornea and is formed by a laser.

26. The ophthalmic device ofclaim 22, wherein the optical corrector is a corneal implant configured to be disposed within a cornea of the eye.

27. The ophthalmic device ofclaim 22, wherein the monochromatic aberration is at least one of an astigmatic aberration, a spherical aberration, and a comatic aberration.

28. A system of intraocular lenses, comprising:

a primary optic having a base optical power and configured for placement in an eye of a patient with a basic prescription for distant vision, at least one surface of the primary optic being configured to deform in response to an ocular force so as to modify the base optical power by at least 1 Diopter; and

a plurality of supplemental optics each having a supplemental optical power that is less than the primary optical power, each supplemental optic being configured for placement within the eye and having a value of an optical characteristic that is different from that of the other supplemental optics of the plurality, at least one of the supplemental optics configured to provide, when disposed in the eye and in combination with the primary optic, at least one of the basic prescription and a reduced optical aberration.

29. The system of intraocular lenses ofclaim 28, wherein the supplemental optical power is substantially zero.

30. The system of intraocular lenses ofclaim 28, wherein the different optical characteristic is a different optical power.

31. The system of intraocular lenses ofclaim 28, wherein the different optical characteristic is a different amount of an optical aberration correction.

32. The system of intraocular lenses ofclaim 31, wherein the optical aberration correction is a spherical aberration correction.

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