U.S. patent application number 11/456521 was filed with the patent office on 2006-10-26 for ophthalmic lens combinations.
This patent application is currently assigned to Advanced Medical Optics, Inc.. Invention is credited to Daniel G. Brady, Robert E. Glick.
Application Number | 20060238702 11/456521 |
Document ID | / |
Family ID | 38924009 |
Filed Date | 2006-10-26 |
United States Patent
Application |
20060238702 |
Kind Code |
A1 |
Glick; Robert E. ; et
al. |
October 26, 2006 |
OPHTHALMIC LENS COMBINATIONS
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.
Inventors: |
Glick; Robert E.; (Lake
Forest, CA) ; Brady; Daniel G.; (San Juan Capistrano,
CA) |
Correspondence
Address: |
ADVANCED MEDICAL OPTICS, INC.
1700 E. ST. ANDREW PLACE
SANTA ANA
CA
92705
US
|
Assignee: |
Advanced Medical Optics,
Inc.
Santa Ana
CA
|
Family ID: |
38924009 |
Appl. No.: |
11/456521 |
Filed: |
July 10, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10234801 |
Sep 4, 2002 |
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11456521 |
Jul 10, 2006 |
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09390380 |
Sep 3, 1999 |
6616692 |
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10234801 |
Sep 4, 2002 |
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60132085 |
Apr 30, 1999 |
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Current U.S.
Class: |
351/159.11 |
Current CPC
Class: |
A61F 2/1648 20130101;
A61F 2002/009 20130101; G02C 7/00 20130101; A61F 2/1613 20130101;
A61F 2/1602 20130101; A61F 2/1635 20130101; A61F 2/1629 20130101;
A61F 2250/0053 20130101 |
Class at
Publication: |
351/160.00R |
International
Class: |
G02C 7/04 20060101
G02C007/04 |
Claims
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 of claim 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 of claim 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 of claim 1, wherein the base optical power
is within 4 Diopters of the basic prescription.
5. The ophthalmic device of claim 1, wherein the base optical power
is within 2 Diopters of the basic prescription.
6. The ophthalmic device of claim 1, wherein the base optical power
is greater than 20 Diopters.
7. The ophthalmic device of claim 1, wherein the base optical power
is greater than the supplemental optical power by at least 10
Diopters.
8. The ophthalmic device of claim 1, wherein the supplemental
optical power is within the range of about -4 Diopters to about +4
Diopters.
9. The ophthalmic device of claim 1, wherein the supplemental optic
is a diffractive optic.
10. The ophthalmic device of claim 1, wherein the primary optic is
configured to be disposed within a capsular bag of the eye.
11. The ophthalmic device of claim 1, wherein the supplemental
optic is configured to be disposed within an anterior chamber of
the eye.
12. The ophthalmic device of claim 1, wherein the supplemental
optic is configured to be implanted separately from the primary
optic.
13. The ophthalmic device of claim 1, wherein the supplemental
optic is a corneal implant configured to be disposed within a
cornea of the eye.
14. The ophthalmic device of claim 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 of claim 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 of claim 15, wherein the predetermined
amount is at least 500 micrometers.
17. The ophthalmic device of claim 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 of claim 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 within 4
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 of claim 19, wherein the supplemental
optical power that is within a range of -4 Diopters to +4
Diopters
21. The ophthalmic device of claim 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 of claim 22, wherein the optical
corrector is an intraocular lens comprising one or more optical
elements.
24. The ophthalmic device of claim 22, wherein the optical
corrector is at least one surface of the primary optic.
25. The ophthalmic device of claim 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 of claim 22, wherein the optical
corrector is a corneal implant configured to be disposed within a
cornea of the eye.
27. The ophthalmic device of claim 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 of claim 28, wherein the
supplemental optical power is substantially zero.
30. The system of intraocular lenses of claim 28, wherein the
different optical characteristic is a different optical power.
31. The system of intraocular lenses of claim 28, wherein the
different optical characteristic is a different amount of an
optical aberration correction.
32. The system of intraocular lenses of claim 31, wherein the
optical aberration correction is a spherical aberration correction.
Description
RELATED APPLICATION
[0001] 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
[0002] 1. Field of the Invention
[0003] The present invention relates generally to devices and
methods for correcting vision and more particularly to ophthalmic
device combinations for providing accommodative vision.
[0004] 2. Description of the Related Art
[0005] 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.
[0006] 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.
[0007] 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.
[0008] 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.
[0009] 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.
[0010] 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
[0011] 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.
[0012] 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.
[0013] 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.
[0014] The present ILCs provide accommodation, preferably an
acceptable degree of accommodation, in spite of movement and space
limitations in the eye. For example, the maximum theoretical amount
of axial movement for a simple disc lens having an overall diameter
of 11 millimeters (mm) and an optic diameter of 5 mm that undergoes
1 mm of compression in its diameter is about 1.65 mm. The amount of
axial movement required for a plus 15 diopter optic to provide 2.5
diopters of additional power in the spectacle plane is about 2.6
mm. However, a plus 30 diopter optic requires only 1.2 mm of axial
movement to provide 2.5 diopters of additional power in the
spectacle plane. Thus, by increasing the plus power of the second
optic, which is adapted for accommodating movement, a reduced
amount of movement is needed to achieve higher or enhanced degrees
of accommodation. The first or fixed optic may have a minus power
to compensate for the excess plus power in the second optic.
[0015] 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
plus 15 diopters, the desired prescription for the patient in
question. The powers of the first and second optics are only
approximately additive since the net power of the combination also
depends on other factors including, but not limited to, the
separation of the two optics, the magnitude of the power of each
individual optic body and its location in the eye and the like
factors. Also, by adjusting the optical power of the first optic
body, the net optical power of the ILC can be adjusted or
controlled even though the optical power of the second optic body
is standardized or remains the same, for example, at a plus 30
diopter optical power. By standardizing the optical power of the
second optic body, the amount of movement in the eye required to
obtain a given level of accommodation is substantially the same,
and preferably well within the space limitations in the eye, from
patient to patient.
[0016] 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.
[0017] The second optic body preferably is adapted to be positioned
in the capsular bag of the eye.
[0018] 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.
[0019] 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).
[0020] 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.
[0021] 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.
[0022] 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.
[0023] 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.
[0024] 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.
[0025] 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.
[0026] 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.
[0027] The movement assembly may be structured and functions
similarly to movement assembly of the previously described
ILCS.
[0028] 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.
[0029] 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.
[0030] 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.
[0031] 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.
[0032] 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.
[0033] 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.
[0034] 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.
[0035] 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
within 1 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.
[0036] 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.
[0037] 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).
[0038] 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).
[0039] 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).
[0040] 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.
[0041] 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
[0042] 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:
[0043] FIG. 1 is a front plan view of an ILC in accordance with the
present invention.
[0044] FIG. 2 is a cross-sectional view taken generally along line
2-2 of FIG. 1.
[0045] FIG. 3 is a cross-sectional view of an additional ILC in
accordance with the present invention.
[0046] FIG. 4 is a fragmentary sectional view of an eye in which an
alternate ILC in accordance with the present invention has been
implanted.
[0047] FIG. 5 is a fragmentary sectional view, similar to FIG. 4,
in which the compensating optic body of the ILC is implanted in the
anterior chamber of the eye.
[0048] FIG. 6 is a front plan view of an intraocular lens useful in
an ILC in accordance with the present invention.
[0049] FIG. 7 is a fragmentary sectional view, similar to FIGS. 4
and 5, in which the compensating optic body of the ILC is implanted
in the capsular bag of the eye.
[0050] 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.
[0051] FIG. 9 is a cross-sectional view taken generally along line
9-9 of FIG. 8.
[0052] 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 of FIG. 9 and a
supplemental or corrector optic disposed within the anterior
chamber of the eye.
[0053] FIG. 11 is a cross-sectional view of the ophthalmic device
shown in FIG. 10 in an accommodative state.
[0054] FIG. 12 is block diagram of a method of providing
accommodative vision according to an embodiment of the
invention.
[0055] FIG. 13 is a cross-sectional view of an ophthalmic device
according to an embodiment of the invention including a primary
lens of FIG. 9 and a corrector optic support by the sulcus of the
eye.
DETAILED DESCRIPTION OF THE DRAWINGS
[0056] Referring now to FIGS. 1 and 2, an ILC according to the
present invention, shown generally at 10, includes a first optic or
optic body 12, a second optic or optic body 14, a disc type
fixation member 16 and a disc type movement assembly 18. 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.
[0057] The first optic body 12 has substantially piano optical
power and is adapted to be held in a fixed position, for example,
at least partially by the fixation member 16. When the ILC 10 is
positioned in a human eye, the posterior surface 20 of first optic
body 12 is in contact with the inner posterior wall of the capsular
bag of the eye. This positioning of optic body 12 is very effective
in reducing or inhibiting endothelial cell growth from the capsular
bag onto the first optic body 12. In effect, the positioning of the
first optic body 12 against the posterior surface of the capsular
bag inhibits or reduce the risk of PCO.
[0058] The second optic body 14 includes a distance vision
correction power. The movement assembly 18 extends radially
outwardly from second optic body 14 and fully circumscribes the
second optic body 14. Movement assembly 18 has a proximal end
region 22 which is coupled to the second optic body 14 at first
optic body periphery 24. Movement assembly 18 extends radially
outwardly to a distal end region 26 including a peripheral zone 28,
Fixation member 16 includes a distal end portion 30 including a
peripheral area 32. The movement assembly 18 and fixation member 16
are fused together at the peripheral zone 28 and peripheral area
32. Thus, the entire ILC 10 is a single unitary structure. The
first optic body 12 and fixation member 16 can be manufactured
separately from second optic body 14 and movement assembly 18 and,
after such separate manufacture, the fixation member and movement
assembly can be fused together. Alternately, the entire ILC 10 can
be manufactured together. Also, if desired, the first optic body 12
and fixation member 16 can be inserted into the eye separately from
the second optic body 14 and movement assembly 18. Thus, ILC 10 can
comprise a plurality of separate components.
[0059] Movement assembly 18 extends outwardly from second optic
body 14 sufficiently so that the distal end region 26, and in
particular the peripheral zone 28 of the distal end region 28, is
in contact with the inner peripheral wall of the posterior capsular
bag when the ILC 10 is implanted in the eye.
[0060] As best seen in FIG. 2, when ILC 10 is at rest, the second
optic body 14 is positioned vaulted anteriorly relative to the
distal end region 26 of movement assembly 18. In other words, the
anterior surface 34 of second optic body 14 is anterior of the
anterior surface 36 of movement assembly 18 at distal end region 26
and/or the posterior surface 38 of the second optic body 14 is
anterior of a posterior surface 39 of the movement assembly at the
distal end region 26.
[0061] The first and second optics 12 and 14 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 the optics 12 and
14 to be rolled or folded for insertion through a small incision
into the eye. Although the first and second optics 12 and 14 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.
[0062] As noted previously, first optic body 12 has a substantially
piano or zero optical power. Second optic body 14 is prescribed for
the wearer of ILC 10 with a baseline or far (distance) diopter
power for infinity. Thus, the wearer of ILC 10 is provided with the
vision correction power of second optic body 14 with little or no
contribution from the first optic body 12.
[0063] The fixation member 16 and movement assembly 18, as shown,
are integral (unitary) with and circumscribe the first and second
optics 12 and 14, respectively. Alternately, fixation member 16
and/or movement assembly 18 can be mechanically or otherwise
physically coupled to first optic body 12 and second optic body 14,
respectively. Also, the fixation member 16 and/or movement assembly
18 may only partially circumscribe first and second optics 12 and
14, respectively, and such embodiments are included within the
scope of the present invention. The fixation member 16 and movement
assembly 18 may be constructed from the same or different
biocompatible materials as first and second optics 12 and 14, and
preferably are made of polymeric materials, such as polypropylene
silicone polymeric materials, acrylic polymeric materials, and the
like. Movement assembly 18 has sufficient strength and rigidity to
be effective to transfer the force from the ciliary muscle of the
eye so that the second optic body 14 is movable axially in the eye
to effect accommodation.
[0064] Movement member 18 includes a region of reduced thickness 41
located at the proximal end region 22. This area of reduced
thickness, which completely circumscribes the second optic body 14,
acts as a hinge to provide additional flexibility to the movement
member 18 to extenuate or amplify the accommodating movement of
second optic body 14 in response to the action of the ciliary
muscle and zonules.
[0065] The fixation member 16 and movement assembly 18 preferably
are deformable, in much the same manner as first and second optics
12 and 14 are deformable, to facilitate passing ILC 10 through a
small incision into the eye. The material or materials of
construction from which fixation member 16 and movement assembly 18
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.
[0066] The ILC 10 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. The ILC 10 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.
[0067] The ILC 10 in the eye is located in a position in the
capsular bag so that the posterior surface 20 of first optic body
12 is maintained in contact with the inner posterior wall of the
capsular bag. As noted previously, positioning the first optic body
12 in contact with the posterior wall of the capsular bag reduces
the risk of or inhibits cell growth from the capsular bag onto the
first optic body 12 which, in turn, reduces or inhibits PCO. The
ciliary muscle and zonules of the eye provide force sufficient to
move axially second optic body 14 sufficiently to provide
accommodation to the wearer of ILC 10.
[0068] The ILC 10 should be sized to facilitate the movement of the
second optic body 14 in response to the action of the ciliary
muscle and zonules of the eye in which the ILC is placed.
[0069] If the ILC 10 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 the ILC 10 is too small, the second optic body 14 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 the ILC 10
is to be included in an adult human eye, the first and second
optics 12 and 14 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. The ILC 10 preferably has an overall maximum diameter,
with the movement assembly 18 in the unflexed or rest state, in the
range of about 8 mm to about 11 mm or about 12 mm.
[0070] The present ILC 10 has the ability, in cooperation with the
eye, to move the second optic body 14 both posteriorly and
anteriorly in the eye, to provide for both distance focus and near
focus, respectively. This movement of ILC 10 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. The movement member 18,
as described herein, preferably is effective to facilitate or even
enhance or extenuate the axial movement of the second optic body 14
caused by the action of the ciliary muscle and zonules to provide
increased degree of accommodation.
[0071] FIG. 3 illustrates an additional ILC, shown generally at
110, in accordance with the present invention. Except as expressly
described herein, ILC 110 is structured and functions similar to
ILC 10. Components of ILC 110 which correspond to components of ILC
10 are indicated by the same reference numeral increased by
100.
[0072] One primary difference between ILC 110 and ILC 10 relates to
the substitution of a posterior lens structure 40 for the first
optic body 12 and fixation member 16. Lens structure 40 includes a
posterior face 42 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 the ILC 110 is to be placed. Thus,
the surface 42 which extends around the peripheral area 44 and
across the center region 46 of the lens structure 40 is adapted to
come in contact with and substantially conform to the inner
posterior wall of the capsular bag. Moreover, the lens structure 40
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 the ILC 110. The anterior surface 48 of lens structure 40
is configured to provide the lens structure with a substantially
plano or zero optical power. Second optic body 114 is prescribed
for the wearer of ILC 110 with a baseline or distance or far
(distance) dioptic power for infinity. Thus, the wearer of ILC 110
is provided with a vision correction power of second optic body 114
with little or no contribution from the lens structure 40.
[0073] Alternately, second optic body 114 has a high plus power,
for example, plus 30 diopters. The lens structure 40, and in
particular the region of the lens structure, defined by the
anterior surface 48, which extends substantially across the entire
field of vision of the wearer of ILC 110, has a minus vision
correction power which is controlled to provide the correction
prescription for use in the eye in which the ILC 110 is placed. For
example, if this eye requires a plus 15 diopter power, the lens
structure 40 has a vision correction power of approximately minus
15 diopters so that the net vision correction power of the
combination of lens structure 40 and second optic body 114, is plus
15 diopters.
[0074] The lens structure can be made from materials described
previously with regard to first optic body 12 and fixation member
16.
[0075] One additional feature of lens structure 40 relates to the
anteriorly extending projections 50 which extend from the base
element 52 of lens structure 40. The number of these projections 50
can range from 2 to about 6 or more. Alternately, a continuous
annulus projecting anteriorly can be provided. The purpose of the
projections 50 or the continuous annulus is to limit the posterior
movement of the second optic body 114 and movement assembly 118.
This limitation in the movement provides an additional degree of
control of the ILC 110, and prevent a collapse of the ILC 110 and
maintains an advantageous degree of separation between second optic
body 114 and anterior surface 48 of lens structure 40.
[0076] FIG. 4 illustrates the use of an alternate ILC in accordance
with the present invention. This ILC, shown generally at 60
includes a compensating IOL 61 comprising a first, or compensating,
optic body 62, and a primary IOL 63 comprising a second, or
primary, optic body 64 and a movement assembly 66. The compensating
optic body 62 is coupled to a fixation member 68 which includes a
distal end portion 70 in contact with the periphery 72 of the
sulcus 73 of eye 74. Fixation member 68 is a disk fixation member
which completely circumscribes the compensating optic body 62.
However, it should be noted that the disc fixation member 68 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 assembly 66 is
coupled to the primary optic body 64 and completely circumscribes
the primary optic body. The primary optic body 64 is located in the
capsular bag 76 of eye 74 and is vaulted anteriorly to some extent
to enhance accommodating movement of the primary optic body.
[0077] The primary optic body 64 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, primary optic body 64 might have a corrective power of
plus 30 diopters. The compensating optic body 62 is a negative or
minus lens having a minus vision correction power which is
controlled to provide the correct prescription for use in eye 74.
For the patient described above, the compensating optic body 62 has
a vision correction power of approximately minus 15 diopters so
that the net vision correction power of the combination of
compensating optic body 62 and primary optic body 64 equals the
patient's basic prescription of plus 15 diopters. The compensating
optic body 62, fixation member 68, primary optic body 64 and
movement assembly 66 can be made from materials described
previously with regard to the first optic body 12, fixation member
16, second optic body 14 and movement assembly 18,
respectively.
[0078] The compensating optic body 62 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 compensating optic body 62 could be multifocal or
aspheric to allow for additional accommodation.
[0079] In the configuration shown in FIG. 4, the fixation member 68
is in contact with the periphery 72 of the sulcus 73 of the eye 74.
This is a relatively durable component of the eye and is effective
to support the fixation member 68 in maintaining the compensating
optic body 62 in a fixed position.
[0080] The movement assembly 66 cooperates with the ciliary muscle
78 and zonules 80 of eye 74 to move the second optic body 64
axially along optical axis 82 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 primary optic body 64 having a corrective power of
plus 30 diopters, this amount of movement will be amplified to
create an additional add power, or diopter shift, of about 1.75 to
about 2.5, or possibly as high as 3.5 diopters. A diopter shift in
this range is consistent with the near vision, or add, prescription
of a "typical" presbyopic patient. The movement assembly 66 may be
configured to provide accommodative movement by producing relative
motion between the optic body 64 and at least portion of the
movement assembly 66. Alternatively, the movement assembly 66 may
be configured to maintain a fixed or substantially fixed
relationship between the optic body 64 and the movement assembly
66. In such embodiments, accommodation may be provided when both
the movement assembly 66 and the optic body 64 move together
relative to the retina of the eye as the capsular bag moves and/or
changes shape during accommodation.
[0081] FIG. 5 illustrates another ILC, shown generally at 360, in
accordance with the present invention. Except as expressly
described herein, ILC 360 is structured and functions similarly to
ILC 60. Components of ILC 360 which correspond to components of ILC
60 are identified by the same reference numeral increased by
300.
[0082] One primary difference between ILC 360 and ILC 60 relates to
the positioning of compensating optic body 362. Specifically,
compensating IOL 361 is located in anterior chamber 90 of eye 374.
Fixation member 368 is coupled to the compensating optic body 362
and extends outwardly and comes in contact with the angle 92 of eye
374. The arrangement of compensating optic body 362 and fixation
member 368 is such that the compensating optic body is maintained
in a substantially stationary position in the anterior chamber 90
of eye 374. The primary optic body 364 is adapted to be moved
axially along optical axis 382 of eye 374 by the ciliary muscle 378
and zonules 380 acting on the movement assembly 366.
[0083] Still another embodiment of an ILC according to the present
invention is shown in FIG. 7, indicated generally at 560. Except as
expressly described herein, ILC 560 is structured and functions
similarly to ILC 60. Components of ILC 560 which correspond to
components of ILC 60 are identified by the same reference numeral
increased by 500.
[0084] Again, ILC 560 differs from ILC 60 primarily in the location
of the compensating IOL 561, which is located in the capsular bag
76 with the primary optic body 564, rather than in the sulcus or
anterior chamber. In this configuration, the compensating optic
body 562 would not be truly stationary since the capsular bag 76
itself typically moves about 0.4 mm during accommodation. However,
axial movement of the compensating optic body 562 relative the
capsular bag 76 can be limited by appropriate design of the
fixation member or members 568. Controlling other factors such as
material selection, length, width and angulation of the fixation
member or members 58 relative the compensating optic body 562 can
limit the overall axial movement of the compensating optic body 562
to less than 0.5 mm which, for the purposes of this invention, can
be regarded as "substantially fixed."
[0085] A preferred method of implanting an ILC will now be
discussed. The method is equally effective for the embodiments of
FIGS. 5, 6, and 7, but for purposes of illustration will be
discussed specifically with reference to FIG. 7.
[0086] Initially, the primary IOL 563 is inserted through an
incision in the patient's cornea and positioned in the capsular bag
76 using conventional techniques. Preferably, the incision is less
than 4 mm in length. If the primary optic body 564 and movement
assembly 566 are unitary as illustrated, they are inserted
simultaneously. However, it is also possible to implant an
independent movement assembly 566 first, and then insert the
primary optic body in the movement assembly 566.
[0087] After the primary IOL 563 is placed in the capsular bag 76,
a measurement is taken to determine the location of the primary
optic body 564 relative to the optical axis 82. If desired,
refractive measurements may also be made at this time to accurately
determine an appropriate prescription for the compensating IOL
561.
[0088] If the original incision is still open, the compensating IOL
561 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 or members 568 such that
compensating optic body 562 and the primary optic body 564 are
axially aligned with the optical axis 82 and one another. If
necessary, the primary optic body 564 may also be repositioned at
this time.
[0089] Alignment of the two optic bodies 562 and 564 is a crucial
aspect of this invention, since any decentration of images will be
amplified by the high diopter power of the primary optic body 564.
Visual confirmation of alignment can be facilitated by providing
the compensating optic body 562 with a diameter D.sub.CB equal to
the diameter D.sub.PB of the primary optic body 564.
[0090] In addition, the ILC 560 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 the IOLs 561 and 563. 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.sub.PZ and
D.sub.CZ in IOLS 561 and 563, 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.sub.PZ or D.sub.CZ should be in the range of about 6.5 mm to
about 8 mm. Although, as mentioned previously, the diameters
D.sub.PB and D.sub.CB of the optic bodies 562 and 564 are
preferably equal, the diameters D.sub.PZ and D.sub.CZ of the optic
zones need not be.
[0091] Another factor influencing centration is the flexibility of
fixation member or members 568, Preferably the member or members
568 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.
[0092] FIG. 6 illustrates a still further embodiment of an
intraocular lens in accordance with the present invention. This
intraocular lens, shown generally at 400 includes an optic body 401
and four (4) equally spaced apart movement members 403. Each of the
movement members 403 includes a distal region 405 and a proximal
region 407 which is coupled to the optic body 401. A hinge, for
example, a linear hinge, such as a reduced thickness area 409, is
located near the proximal end 407 of each of the movement members
403, A linear hinge is particularly advantageous to achieve
enhanced, or even substantially maximum theoretical, axial
movement.
[0093] The IOL 400 can be used in place of the various second
optic/movement assembly subcombinations noted above. One
distinction between IOL 400 and these other subcombinations is the
use of four (4) individual movement members 403 which do not
totally circumscribe the optic body 401 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.
[0094] FIGS. 8-11 illustrate another embodiment of the present
invention in which an ophthalmic device 600 comprises a primary
optic 602 and a supplemental optic 604. The optics 602, 604 are
configured for placement in an eye 607 of a patient or subject
having a basic prescription (e.g., a basic prescription for distant
or near vision) and are generally disposed about an optical axis
608. The primary optic 602 has a base optical power P.sub.base that
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.
[0095] The supplemental optic 604 comprises an anterior surface 605
and a posterior surface 606 that are configured to provide a
supplemental optical power P.sub.supplemental. In addition, the
supplemental optic 604 may be configured to provide, in combination
with the primary optic 602, a combined optical power P.sub.combined
(e.g., P.sub.base+P.sub.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 the primary optic 602 by an amount
that allows the combination to provide or substantially provide the
basic prescription for at least one configuration of the primary
optic 602. For example, the supplemental optical power may be
selected such that the combined optical power is within 1 Diopter
of the basic prescription. Generally, the primary optic 602 is
configured to provide vision correction that is nearly equal to the
patient's basic prescription for distant vision and the
supplemental optic 604 is used to modify the vision correction
provided by the primary optic 602 so as to more precisely provide
the patient's basic prescription. In such cases, the supplemental
optical power of the supplemental optic 604 is less than the
primary optical power of the primary optic 602. For example, the
primary optic 602 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.
[0096] The ophthalmic device 600 is configured to produce ocular
accommodation, for example, by configuring at least one surface of
the primary optic 602 to be a deformable surface 610 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 the primary optic 602. In
addition, the thickness of the optic 602 is generally changed as it
deforms. Deformation of the optic 602 generally results in a change
in the optic properties of the optic 602, for example, a change in
the optical power or aberrations produced by the optic 602.
[0097] The primary optic 602 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 the surface 610 may be supplemented by
axial motion or travel of the primary optic 602 along the optical
axis 608 in response to the ocular force, as discussed in greater
detail above.
[0098] 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.
[0099] 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 of 20 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).
[0100] 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 resolve objects 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.
[0101] In certain embodiments, the primary optic 602 may be
deformed by using a rigid optic 611 that is configured to deform
the primary optic 602 in a predetermined manner, so as to produce
accommodation or some other desired effect (e.g., changing the
aberrations of the primary optic 602 and/or the wavefront that is
directed to the retina of the eye 607). The optics 602, 611 are
configured so that the deformable surface 610 is deformed when the
optics 602, 611 are pressed together, as illustrated by comparing
FIG. 10 with FIG. 11. Thus, the movement assembly 620 is structured
to cooperate with the eye to effect accommodating axial movement of
the primary optic 602 and accommodating deformation of the primary
optic 602 in response to an ocular force produced by the eye
607.
[0102] The rigid optic 611 may be configured as a meniscus lens
having no or substantially no optical power. Alternatively, the
rigid optic 611 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 the
eye 607 in an accommodative or disaccommodative state. In some
embodiments, the rigid optic 611 has an optical power (and/or some
other optical characteristic) and either replaces or supplements
the supplemental optic 604. The structure and function of the
movement assemblies similar to that movement assembly 620 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.
[0103] 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 deformable primary optic
602 is implanted into the eye 607 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
the supplemental optic 604 may then be selected to provide the
predetermined optical power or refractive outcome.
[0104] 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. A primary optic
602 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 optimized primary optic 602 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 different supplemental optic 604 with a different
supplemental power for each, the supplemental optic 604 being
selected in each case to provide the correct total power when used
in combination with the primary optic 602.
[0105] Yet another advantage of embodiments of the current
invention is that the supplemental optic 604 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 the
ophthalmic device 600. In such embodiments, the supplemental optic
604 may have no or substantially no optical power or may have an
optical power that is combined with the optical power of the
primary optic 602 to provide near vision, distant vision, or
intermediate vision. In some embodiments, the supplemental optic
604 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/or ophthalmic device 600.
For example, one or both of the surfaces 605, 606 of the
supplemental 604 may be aspheric in form in order to reduce or
compensate for a spherical aberration of the eye or ophthalmic
device 600. Alternatively or additionally, at least one the
surfaces 605, 606 be a monofocal or multifocal diffractive phase
plate in order to reduce or compensate for a chormatic aberration
of the eye or ophthalmic device 600. The supplemental optic 604 may
be configured to favorably modify the aberrations when the primary
optic 602 is in an accommodative and/or disaccommodative state.
[0106] In certain embodiments, the supplemental optic 604 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 the supplemental optic 604 as a function of distance from the
optical axis thereof. In other embodiments, the supplemental optic
604 is configured to produce two or more simultaneous foci (e.g., a
bifocal or multifocal lens). In such embodiments, at least one of
the surfaces 605, 606 of the supplemental optic 604 may comprise a
diffractive phase plate that produces two or more diffraction
orders. Alternatively, at least one of the surfaces 605, 606 may be
configured to have an aspheric surface in which the radius of
curvature varies with distance from the optical axis 608.
[0107] The primary optic 602 may be placed within a capsular bag
612, as illustrated in FIGS. 10 and 11, so that the ophthalmic
device 600 is responsive to ocular forces produced by ciliary
muscle 614 and/or zonules 618. Alternatively, the primary optic 602
may be implanted elsewhere within the eye 607. For example, the
anterior and posterior capsules of the capsular bag 612 may be
allowed to attach to one another and the ophthalmic device 600
implanted within the sulcus of the eye 607 so that the primary
optic 602 is disposed in front of the capsular bag 612. In certain
embodiments, the primary optic 602 has an optical power of at least
about 10 Diopters, at least 20 Diopters, or at least 30 Diopters.
In other embodiments, the primary optic 602 has a negative optical
power, for example less than -5 Diopters, less than -10 Diopters,
or less than -20 Diopters. In yet other embodiments, the primary
optic 602 has an optical power within the range of -30 to +40
Diopters, -20 to +30 Diopters, or -10 to +20 Diopters.
[0108] In certain embodiments, a patient has a basic prescription
for distant vision that is expressed in terms of an optical power
P.sub.distant. The difference between the optical power
P.sub.distant and the base optical power P.sub.base of the primary
optic 602 may be calculated and based on the ability of a surgeon
or other practitioner to estimate the required basic prescription
for distant vision, the primary optic 602 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.sub.base to
be within .+-.4 Diopters of the basic prescription (e.g., abs
(P.sub.distant-P.sub.base).ltoreq.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.sub.base is 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.
[0109] By selecting the optical power P.sub.base of the primary
optic 602 to be within at least one of these ranges, the primary
optic 602 is able to provide normal vision over at least some
distances. For example, if (P.sub.distant-P.sub.base) is equal to
-3 Diopters after implantation of the primary optic 602, 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 optic 604) and/or
external lenses (e.g., spectacles or contact lenses). In certain
embodiments, the optical power P.sub.supplemental of the
supplemental optic 604 is selected so that the combined optical
power P.sub.combined is equal to or approximately equal to the
basic prescription for distant vision (e.g., so that
(P.sub.distant-P.sub.combined) is approximately equal to zero).
[0110] The supplemental optic 604 may be configured to be implanted
together with the primary optic 602 or separately therefrom. In
some embodiments, the supplemental optic 604 is only optionally
implanted into the eye 607 when the actual vision provided by the
primary optic 602 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 the primary optic 602 and/or supplemental optic
604. The supplemental optic 604 may be disposed in front of the
iris or in the anterior chamber of the eye 607, as illustrated for
example in FIGS. 10 and 11. Alternatively, the supplemental optic
604 may be disposed within the vicinity of the sulcus of the eye
607, together with the primary optic 602 within capsular bag 612,
or slightly protruding from the capsular bag 612. In other
embodiments, the supplemental optic 604 may be disposed within a
cornea 619 of the eye as a corneal implant. In yet other
embodiments, the supplemental optic 604 may be a corneal implant
disposed configured to be disposed within the cornea 619 or a
surface profile disposed on or within the cornea 619, the profile
being formed by a laser (e.g., using a LASIK, LASEK, or PRK
procedure).
[0111] The primary and supplemental optics 602, 604 may be
configured and disposed within the eye 607 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 and supplemental optics 602,
604 may be configured and disposed within the eye 607 so as to
press against one another while the eye 607 is in an accommodative
and/or disaccommodative state and/or between an accommodative and a
disaccommodative state.
[0112] At least one surface of the primary optic 602, for example
the deformable surface 610, is configured to deform in response to
an ocular force so as to modify the optical power of at least one
of (1) the primary optic 602, (2) the combined optical power of the
optics 602, 604, and/or (3) the total or effective optical power of
the entire eye 607. The deformation may be the result of change in
the radius of curvature as the primary optic 602 changes from an
accommodative state and disaccommodative state, which results in a
change in the optical power or focal length of the primary optic
602. Alternatively or additionally, at least one surface of the
primary optic 602 may change from a spherical profile to an
aspheric profile or from a more spherical profile to a less
spherical profile as the primary optic 602 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 the primary optic 602. In
other embodiments, the primary optic 602 may change from a
monofocal lens to a multifocal lens (either refractive or
diffractive) as the primary optic 602 changes from an accommodative
state and disaccommodative state, or visa versa. Alternatively, the
primary optic 602 may be a multifocal lens, wherein the optical
power or some other optical characteristic of the zones changes as
the primary optic 602 changes between accommodative state and
disaccommodative states.
[0113] In certain embodiments, the primary optic 602 has a center
thickness t.sub.i along the optical axis 608 when in a
substantially unstressed state and a center thickness t.sub.f in
the response to or in the absence of an ocular force. In such
embodiments, the primary optic 602 may be adapted to change the
center thickness by a factor of at least 1.1 (e.g., the quotient
t.sub.f/t.sub.i is 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, the primary optic 602 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, the primary
optic 602 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, the primary optic 602 has a center thickness along the
optical axis 608 when the primary optic 602 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.
[0114] The modification in optical power as the primary optic 602
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
of primary optic 602 is generally an effective Diopter change in
the optical power, for example, from a principal plane of the
primary optic 602 (e.g., somewhere between the anterior and
posterior surfaces of primary optic 602). In general, and as
illustrated in FIGS. 10 and 11, the Diopter change may be a
positive change as the ciliary muscle 614 contracts and the zonules
618 relax; however, other directions and/or types of Diopter change
are allowable (e.g., multifocal and/or aberration changes).
[0115] In the illustrated embodiment, the ophthalmic device 600
comprises a movement assembly 620 that is operably coupled to the
primary optic 602 and a fixation member 622 that is operably
coupled to the supplemental optic 604. Alternatively, the
supplemental optic 604 may be coupled to the movement assembly 620
or comprise its own, separate movement assembly. The movement
assembly 620 comprises an anterior portion 624 that engages the
anterior capsule of the capsular bag 612 and a posterior portion
628 that engages the posterior capsule of the capsular bag 612. The
anterior and posterior portions 624, 628 together form an enclosure
that fills or substantially fills the capsular bag 612. The
movement assembly 620 may further comprise a plurality of arms 630
that are configured to pivot, rotate, bend and/or otherwise deform
in response to deformation of the movement assembly 620, whereby
the primary optic 602 may be moved and/or deformed to provide
accommodation. The anterior and posterior portions 624, 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 the movement assembly 620 conforms and remains in contact with
the capsular bag 612 during accommodative movement thereof.
[0116] The embodiment illustrated in FIGS. 8-11 of the primary
optic 602, the supplemental optic 604, and structures connected to
the optics 602, 604 is exemplary only and is not meant to limit the
scope of the invention. For example, the primary optic 602 may be
configured to have a posterior vault rather than the anterior vault
illustrated in FIGS. 10 and 11, in which case the deformable
surface 610 is pressed against the posterior capsule of the
capsular bag 612 when the ciliary muscle 614 contracts and the
shape of the capsular bag 612 changes. In certain embodiments, the
ILC illustrated in FIG. 7 is used to provide such a configuration,
wherein the posteriorly vaulted primary IOL 563 is made of a
material that is sufficiently soft to deform in response to ocular
forces and the compensating IOL 561 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.
[0117] The ophthalmic device 600 may be used in a surgical
procedure to restore both distant vision and accommodative ability
for providing near vision. Referring to FIG. 12, in some
embodiments, a method 700 of providing accommodative vision
comprises an operational block 702, making a first estimate of a
basic prescription of a subject. The method 700 also comprises an
operational block 704, inserting the primary optic 602 into the eye
607 of the subject. The method 700 further comprises an operational
block 706, which includes making a second estimate of the basic
prescription of the subject based on the presence of the primary
optic 602. The method additionally comprises an operational block
708, implanting the supplemental optic 604 into the eye 607.
[0118] In the operational block 702, 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.
[0119] 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.
[0120] In the operational block 704, the surgeon implants the
primary optic 602 into the eye 607. In certain embodiments, the
primary optic 602 is selected to have a base optical power
P.sub.base that substantially provides the basic prescription and
is within at least .+-.4 Diopters of the basic prescription. Since
the primary optic 602 substantially provides a basic prescription
and in addition has the ability to provide accommodation, the
primary optic 602 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 the primary optic 602, without the need of
implanting the supplemental optic 604 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 the primary optic 602 provides accommodative
ability. Alternatively, the supplemental optic 604 may be implanted
to restore full vision of both distant and near objects. In
addition, because the primary optic 602 is able to substantially
provides the basic prescription, a more accurate estimate of the
aberrations of eye 607 may be made and subsequently corrected or
compensated for using either an external optic and/or the
supplemental optic 604.
[0121] In operational block 706, 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 primary
ophthalmic device 600. 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 the primary optic 602 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
optic 602 (perhaps for causes unrelated to the surgical procedure),
thereby necessitating a second estimate and correction of the
subject's vision. In cases where an implanted supplemental optic
604 must be explanted in order to restore proper vision, the
difficulty of explanting is advantageously reduced using the
ophthalmic device 600, since the supplemental optic 604 may be made
relatively thin and is disposed in front of the primary optic 602
and nearer to the front of the eye 607 (e.g., in the anterior
chamber in the illustrated embodiment).
[0122] In certain embodiments, the primary optic 602 and/or the
supplemental optic 604 belong to a system or set of intraocular
lenses. In some embodiments, the set of optics comprises a single
primary optic 602 and a set or plurality S1 of supplemental optics
604. The single primary optic 602 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 the supplemental optic
604 is selected from the set S1 of supplemental optics 604 to
provide a more precise correction for a particular individual
within the population. The primary optic 602 may have a base
optical power selected to be at or near the average basic
prescription for a particular population. Alternatively or
additionally, the primary optic 602 may be configured to provide a
predetermined optical quality over a range of expected amounts of a
particular optical aberration for a particular population.
[0123] Each of the supplemental optics 604 from the set S1 of
supplemental optics 604 may be configured to vary from one another
in optical power by a predetermined amount. For example, the
supplemental optics 604 may be configured to vary by 1/2 Diopter,
1/4 Diopter, or less than 1/4 Diopters from one another. In this
manner, the primary optic 602 is implanted to provide and
approximate correction of vision for the patient and a
predetermined optical performance over range of accommodation add
powers.
[0124] In other embodiments, the primary optic 602 is selected from
plurality or set P2 of primary optics 602 and the supplemental
optic 604 is selected from a set or plurality S2 of supplemental
optics 604. Since there is more one primary optic 602 for providing
an approximate correction of the eyes in a given population, the
number of optics in the set S2 of supplemental optics 604 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 of primary optics 602 and in the set S2 of supplemental
optics 604 may be configured to provide visual correction for
populations having variations in basic prescription that are too
large to be covered using only a single primary optic 602, as in
the previous embodiment.
[0125] Referring to FIG. 13, in certain embodiments, the ophthalmic
device 600 comprises a corrector optic 604c configured to correct
the optical power of the primary optic 602, wherein the primary
optic 602 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 optic 604c may be configured to correct a monochromatic
aberration and/or a chromatic aberration of, for example, the
primary optic 602, the cornea 619, and/or an overall aberration of
the eye 607. The corrector optic 604c may 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 optic 604c may be a multifocal lens
and/or provide cylinder correction. Alternatively, the corrector
optic 604c may have no or substantially no overall optical power
and be used primary to correct an aberration of primary optic 602
or the eye 607. When the corrector optic 604c has no or
substantially no optical power, the primary optic 602 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.
[0126] The corrector optic 604c may be disposed in the sulcus, as
illustrated in FIG. 11. Alternatively, the corrector optic 604c may
be disposed in the anterior chamber, similar to the location of the
supplemental optic 604 in FIGS. 9 and 10. In other embodiments, the
corrector optic 604c may be a corneal implant configured to be
disposed within the cornea 619 or a surface profile disposed on or
within the cornea 619, the profile being formed by a laser (e.g.,
using a LASIK, LASEK, or PRK procedure). In yet other embodiments,
the corrector optic 604c is the rigid optic 611 configured to
deform the primary optic 602 in a predetermined manner. In such
embodiments, the optics 602, 604c are configured such that the
deformable surface 610 of the primary optic 602 is deformed when
the optics 602, 604c are pressed together.
[0127] The corrector optic 604c may be used to correct
monochromatic and/or chromatic aberrations of the ophthalmic device
600, the eye 607 of an individual, or a population of eyes. The
corrector optic 604c may 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 optic 604c is
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 optic 604c include, 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.
[0128] In some embodiments, the primary optic 602 is a corrector
optic that may be used to correct or compensate for an optical
aberration of the eye 607 and/or the supplemental optic 604. In
other embodiments, the primary optic 602 and the supplemental optic
604 together correct or compensate for an optical aberration of at
least a portion of the eye 607. For example, the primary optic 602
may be configured to correct astigmatism produced by the cornea
619, while the supplemental optic 604 is selected to correct a
spherical aberration of the cornea 619. Alternatively or
additionally, the primary optic 602 may be configured to correct a
spherical aberration of the cornea 619 based on a preliminary
estimate before the primary optic 602 is implanted into the eye
607. The supplemental optic 604 may then be select to have a
spherical aberration that compensates for any remaining spherical
aberrations resulting from implantation of the primary optic
602.
[0129] In certain embodiments, the corrector optic 604c is selected
from a plurality or set S3 of corrector optics 604c, wherein each
of the corrector optics 604c from 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 optics 604c
within the set S3. At least one of the corrector optics 604c in the
set S3 is configured to provide, in combination with the primary
optic 602, the basic prescription of the patient for at least one
of distant vision, near vision, or intermediate vision.
[0130] 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.
* * * * *