The present invention relates to ophthalmological instruments and, more particularly, to an intraocular lens having a posterior aspheric surface with mechanically-modifiable curvature and a continuously alterable focal length.
The invention will be more fully understood by referring to the following Detailed Description in conjunction with the generally not-to-scale Drawings, of which:
Embodiments of the invention provide a pseudophakic lens that includes a first rotationally symmetric optical portion having an optical axis and a first optical power, a second rotationally-symmetric optical portion co-axial with the first rotationally symmetric portion and having a second optical power, and first and second flexible haptic wings, each having proximal and distal sides. A first volume, being the volume of the first rotationally symmetric optical portion is defined by a posterior curved plate having a first perimeter and a flexible membrane, the first volume is filled with a first fluid having a first refractive index. A second volume—being the volume of the second rotationally-symmetric optical portion, is defined by an anterior rigid curved plate having a second perimeter and the flexible membrane. The second volume is filled with a second fluid having a second refractive index. The posterior and anterior plates are integrated with one another along said first and second perimeters. The flexible and deformable membrane is sealingly affixed to at least one of the posterior and anterior plates at least one of the first and second perimeters such as to prevent leakage or escape of any of the first and second fluids from a respectively corresponding volume of the first and second volumes. The proximal sides of the first and second haptic wings are integrated with at least the anterior plate at least along the first perimeter. The first and second optical portions are structured to be operable such as to gradually change at least one of the first and second optical powers in response to deformation of the flexible and deformable membrane while the anterior and posterior plates substantially maintain their corresponding shapes.
The presudophakis lens is dimensioned to be placed, in operation, in mechanical cooperation with a ciliary body muscle of an eye of a subject such that, in response to tension applied to at least one of zonules and capsular membrane of a natural lens of the eye by the ciliary body muscle, an anteriorly-vectored force is administered to said posterior plate, causing deformation of the flexible membrane by transferring of pressure thereto from the posterior plate through the second fluid. The deformation of the membrane can be spherical. In a specific implementation, the lens may additionally include a rotationally symmetric stabilizing plate made from an optically transparent material. Such stabilizing plate has a surface congruent with that of the posterior plate and is integrated with said posterior plate along an outer surface thereof.
Embodiments additionally provide a pseudophakic lens having an optical power and including a bicameral chamber defined by rigid and foldable anterior and posterior curved layers of material integrated with one another along corresponding perimeters of such layers. This embodiment also includes a flexible and deformable membrane disposed between the anterior and posterior layers to form first and second cameras or sub-chambers, of said chamber, filled respectively with first and second fluids that have different indices of refraction. The flexible membrane is sealingly and directly affixed to said corresponding perimeters to prevent leakage of any of said first and second fluids from corresponding sub-chambers. The lens is structured to be operable to transfer pressure, applied anteriorly to the posterior layer, to the membrane such as to change the optical power in response to spherical deformation of membrane caused by such pressure transfer transfer. In a specific case, the lens is operable to change the optical power in response to such spherical deformation while the deformation is accompanied by at least one of (i) the anterior and posterior layers substantially maintaining their corresponding shapes, and (ii) the anterior and posterior layers substantially maintaining their corresponding axial positions. Additionally or alternatively, the posterior plate in unstressed state has a prolate aspheric shape.
Embodiments of the invention additionally provide a method for correcting vision with the use of an intraocular lens (IOL). Such method includes a step of implanting the IOL in an eye of the patient. The IOL as issue has a bicameral chamber defined by rigid and foldable anterior and posterior curved layers of material integrated with one another along corresponding perimeters of such anterior and posterior curved layer. The IOL also has a flexible and deformable membrane disposed between the anterior and posterior layers such as to form first and second cameras or sub-chambers, of said chamber, that are filled respectively with first and second fluids having different indices of refraction. The IOL also includes first and second flexible haptic wings, each having proximal and distal sides. The proximal sides of the haptic wings are integrated with at least the anterior layer at least along a perimeter of this layer. The flexible and deformable membrane is sealingly and directly affixed to said corresponding perimeters to prevent leakage of any of said first and second fluids from corresponding sub-chambers. The lens is operable to transfer pressure (when it's applied to the posterior layer towards the front of the lens), to the membrane such as to change the optical power in response to spherical deformation of membrane caused by such pressure transfer.
The method additionally includes a step of juxtaposing the haptic wings and the posterior layer against an interior surface of a capsule membrane of a natural lens of the eye such as to place distal side of each of the haptic wings in mechanical cooperation with said capsule membrane. Alternatively or in addition, the method may include a step of spherically deforming the flexible membrane by applying, to the posterior layer, force that is directed anteriorly (towards the anterior layer).
The clouding of the natural lens of an eye, which is often age-related, is referred to as cataract. Visual loss, caused by the cataract, occurs because opacification of the lens obstructs light from traversing the lens and being properly focused on to the retina. The cataract causes progressive decreased vision along with a progressive decrease in the individual's ability to function in his daily activities. This decrease in function with time can become quite severe, and may lead to blindness. The cataract is the most common cause of blindness worldwide and is conventionally treated with cataract surgery, which has been the most common type of surgery in the United States for more than 30 years and the frequency of use of which is increasing. As a result of cataract surgery, the opacified, clouded natural crystalline lens of an eye is removed and replaced with a synthetic and clear, optically transparent substitute lens (often referred to as an intraocular lens or IOL) to restore the vision.
The use of such customized synthetic IOLs that are properly sized for a given individual—often referred to as intraocular lenses—has been proven very successful at restoring vision for a predetermined, fixed focal distance. The most common type of IOL for cataract treatment is known as pseudophakic IOL that is used to replace the clouded over crystalline lens. (Another type of IOL, more commonly known as a phakic intraocular lens (PIOL), is a lens which is placed over the existing natural lens used in refractive surgery to change the eye's optical power as a treatment for myopia or nearsightedness.) An IOL usually includes of a small plastic lens with plastic side struts (referred to as “haptics”), which hold the IOL in place within the capsular bag inside the eye. IOLs were traditionally made of an inflexible material (such as PMMA, for example), although this is being superseded by the use of flexible materials. Such lenses, however, are not adapted to restore the eye's ability to accommodate, as most IOLs fitted to an individual patient today are monofocal lenses that are matched to “distance vision”.
Accommodation is the eye's natural ability to change the shape of its lens and thereby change the lens' focal distance. The accommodation of the eye allows an individual to focus on an object at any given distance within the field-of-view (FOV) with a feedback response of an autonomic nervous system. Accommodation of an eye occurs unconsciously, without thinking, by innervating a ciliary body muscle in the eye. The ciliary muscle adjusts radial tension on the natural lens and changes the lens' curvature which, in turn, adjusts the focal distance of the eye's lens.
Without the ability to accommodate one's eye, a person has to rely on auxiliary, external lenses (such as those used in reading glasses, for example) to focus his vision on desired objects. Typically, cataract surgery will leave an individual with a substantially fixed focal distance, usually greater than 20 feet. This allows the individual to participate in critical activities, such as driving, without using glasses. For activities such as computer work or reading (which require accommodation of eye(s) at much shorter distance), the individual then needs a separate pair of glasses.
Several attempts have been made to restore eye accommodation as corollary to cataract surgery. The most successful of used methodologies relies on using a substitute lens that has two or three discrete focal lengths to provide a patient with limited visual accommodation in that optimized viewing is provided at discrete distances—optionally, both for distance vision and near vision. Such IOLs are sometimes referred to as a “multifocal IOLs”. The practical result of using such IOLs has been fair, but the design compromises the overall quality of vision. Indeed, such multifocal IOLs use a biconvex lens combined with a Fresnel prism to create two or more discreet focal distances. The focal distance to be utilized is in focus while there is a superimposed defocused image from the other focal distances inherent in the lens. Also, the Fresnel prism contains a series of imperfect dielectrical boundary-related discontinuities, which create scatter perceived as glare by the patient. Some patients report glare and halos at night time with these lenses.
Another methodology may employ altering the position of a fixed-focal-length substitute lens (often referred to as an “accommodating IOL”) with contraction of a ciliary muscle to achieve a change in the working distance of the eye. These “accommodating IOLs” interact with ciliary muscles and zonules, using hinges at both ends to “latch on” and move forward and backward inside the eye using the same natural accommodation mechanism. In other words, while the fixed focal length of such IOL does not change in operation, the focal point of an “accommodating IOL” is repositioned (due to a back-and-forth movement of the IOL itself) thereby changing the working distance between the retina and the IOL and, effectively, changing the working distance of the IOL. Such IOL typically has an approximately 4.5-mm square-edged optical portion and a long hinged plate design with polyimide loops at the end of the haptics. The hinges are made of an advanced silicone (such as BioSil). While “accommodating IOLs” have the potential to eliminate or reduce the dependence on glasses after cataract surgery and, for some, may be a better alternative to refractive lens exchange (RLE) and monovision, this design has diminished in popularity due to poor performance and dynamic range of movement that is not sufficient for proper physiological performance of the eye.
Therefore, there remains an unresolved need in an IOL that is structured to be, in operation, continuously accommodating, with gradually, non-discretely and/or monotonically adjustable focal length.
According to an embodiment of the invention, the problem of accommodating the focal length of an IOL is solved by utilizing a force mechanism supplied by the eye's ciliary muscle. The IOL is provided with a flexible aspherical surface and is juxtaposed in such spatial relation with respect to the ciliary muscle that force, transferred to the IOL by the muscle, applies pressure on the posterior surface of the accommodating IOL to changes the curvature of the posterior surface and, thereby, the power of the IOL as well. Specifically, according to an idea of the invention, an embodiment of the accommodating IOL is structured to utilize, when implanted into an eye, gradually-changing radial tension caused by the relaxing ciliary muscle thus creating an anteriorly-directed force applied to alter the posterior curvature of the IOL and, as a result, the overall lens' power. The change in radial tension associated with the implanted IOL enables the patient who has undergone cataract surgery to gradually vary the focal length of the IOL through the eye's natural mechanism of ciliary body muscle tension, i.e. in substantially the same way as the focal length of the natural, crystalline lens of an eye is varied. Such variation of the focal length is achieved without repositioning of the IOL itself.
The optical portion may be optionally enhanced and complemented with a stabilizing plate 118 (made, for example, with Acrylic) disposed in front of the first lenticle 116 (as viewed from the apex 112a of the anterior surface 112) such as to share an optical interface 114 with the first lenticle 116. The plate 118 is defined by the anteriorly intermediate surface 114, which it shared with the first lenticle 116, and a front outer or posterior surface 119. It is appreciated, that in a specific implementation and depending on the curvatures of the surfaces 114, 119, the stabilizing plate 118 may be structured as a second lenticle or lenslet 118 disposed in front of the first lenticle 116. The elements 116, 118 aggregately define an optical portion 110 of the IOL 100.
As shown, both the first lenslet 116 and the plate 118 are radially extended, on the outboard side of the optical portion 110, by at least two haptics 120, 122 that are interconnected by the stabilizing plate 118. In the embodiment 100, the haptics 120, 122 are shown integrated with the plate 118 and, in particular, with the front outer surface 119 such as to form a spatially-continuous structure formed by the elements 120, 118, 122. This spatially-continuous structure, which carries the lenslet 116, is configured as a lenslet 116 supporting structure that contains a central optical portion 118 and the haptic wings 120, 122. In one implementation the haptics are symmetric about an optical axis 126 of the lenticle 116. In a related implementation (not shown in
In further reference to
As shown in
The centripetal tightening in the x-y plane of both the zonules 220 and/or the capsule 250which have been placed under slight tonic tension by the IOL/haptics displacing the capsule posteriorly in the +z direction. The conical displacement of the capsule 250 and zonules 220 with its apex in the +z direction (posteriourly) causes any additional centripetal tension supplied by relaxation of the ciliary muscle 214 provides pressure, through the zonules and capsule, to the deformable surface 112 of the IOL 110. The net vector of this applied pressure, shown in
Consequently to flattening of the surface 112, optical imaging conditions are formed that correspond to a distant object within the FOV of the IOL 100 becoming an optical conjugate of the retina (not shown in
During the contraction of the ciliary muscle 214, on the other hand, the tension on the zonules 220 and the membrane of the capsule 250 is being reduced, thereby causing decrease in pressure on the posterior surface 112 and restoring the posterior surface 112 from its flattened condition towards a more curved one and towards that of a prolate asphere corresponding to the relaxed condition of the muscle 214. As a result, the overall power of the optical portion 110 of the IOL 100 is increased, thereby defining the retina and a near-by object located within the FOV of the IOL 100 as optical conjugates. As the degree of steepening of the curvature of the surface 112 and, therefore, increase of the optical power of the lenticle 110 depend on the gradually and continuously varying degree of contraction of the ciliary muscle 214, the accommodation of the vision at near-by objects is also gradual and continuous.
Accommodation of the vision on near-by objects is accompanied with miosis (pupilary constriction). Embodiments of the IOL of the invention are structured to take advantage of this physiological process. With constriction of the pupil and during the optical accommodation of the embodiment of the IOL, the optical performance of the IOL is substantially restricted to the area of the optical portion of the IOL that is located centrally and that is adjacent to the apex 112a of the lenslet 110, because the clear optical aperture defined by the pupil is being reduced in size. As the curvature of the prolate aspheric surface 112 in its central, neighboring the apex 112a portion is higher than in any other portion of the surface 112, the change in the overall resulting optical power of the IOL 100 achieved due to the accommodating of the ciliary muscle 214 during the miosis is larger than during a period of time when the pupil of the eye is not constricted.
Referring again to
It is worth noting that one operational shortcoming of (other) mechanical structures of accommodating IOLs of the related art is that the small force applied by the capsule 116 has to be sufficient to actuate the lens and alter its shape and power. (The small actuating/accommodating force of about 1 gram is applied most effectively to the present design as opposed to other designs). In contradistinction with accommodating IOLs of the related art, embodiments of the present invention are structured to directly transfer the force, caused by flexing of the ciliary body muscle, to a posterior surface 112 of the optical portion of the embodiment to alter its shape, causing substantially no loss of force upon transmission that would otherwise occur if the force were transferred to any other an internal or anterior surface of the optical portion of the embodiment.
It will be understood by those of ordinary skill in the art that modifications to, and variations of, the illustrated embodiments may be made without departing from the inventive concepts disclosed in this application. For example, in reference to
It is appreciated that the design for near/short distance accommodation was set to a 40 mm distance to object (
In reference to
According to a related embodiment of the invention, the problem of accommodating the focal length of an IOL is solved by applying a force mechanism supplied by the eye's ciliary muscle to an IOL structured to include two immediately-adjoining cells or chambers that are formed by outer wall elements (referred to herein as walls) and an internal flexible membrane. The flexible membrane is shared by the chambers is interchangeably referred to herein as an interior wall. The neighboring cells or chambers are filled with fluidic materials having different indices of refraction. For short, this embodiment may be referred to as a “fluidic IOL”. A posterior surface of this embodiment (at the outer wall of the posterior fluid cell) may be additionally reinforced to by a rigid optically transparent plate, which is in optical contact with such posterior surface and the shape of which remains substantially unchanged when the force from the ciliary muscle is passed onto the chamber(s) via flexible haptic(s) of the IOL. A principle of operation of this accommodating IOL, once it's installed in place of a natural eye lens, utilizes radial tension provided by relaxation of the ciliary muscle to create an anteriorly-vectored force on the IOL such as to allow the lens to alter the curvature of the internal flexible membrane and to cause a corresponding change in optical power characterizing at least one of the fluidic chambers.
Just like an embodiment described in reference to
The embodiment 900 includes an optical portion 910 containing a first, posterior lenticle or lenslet 936, defined by a posterior chamber formed by an outer wall or layer 940 and an internal flexible membrane 944. The optical portion 910 additionally includes a second, anterior lenticle or lenslet 946 defined by an anterior chamber formed by the internal flexible membrane 944 and a stabilizing plate (or outer wall or layer) 918 corresponding to the haptic portion of the IOL 900. The perimeter of the interior flexible membrane is integrated with and/or affixed to the peripheral portions of the walls 940, 918 such that the flexible membrane 944 bisects the space between the walls 918, 940 to substantially completely define spatial separation between contents of the anterior and posterior chambers, without the use of any additional rigid chamber-separating portion. The spacings between the housing elements 918, 940, 944 that form the lenslets 936, 946 are filled with fluids, such that the fluid in the anterior chamber has an index of refraction that is higher than that of the fluid in the posterior chamber by, for example, 0.1. Generally, the fluidic materials used in lenslets 936, 940 have refractive indices within the range from about 1.38 and 1.55, with the difference of these refractive indices having a value within the range from about 0.05 and about 0.2.
Non-limiting examples of such fluids are provided by silicon oils and glycerin.
The haptic portion, in addition to the stabilizing plate 918 may include haptic wing(s) 920, 922 between which the plate 918 continuously extends. (In a specific implementation, the stabilizing plate 918 may be structured as a lenslet possessing optical power, for example by analogy with a specific implementation of the element 118 of
It is appreciated that in the case of one specific implementation, the embodiment 900 is structured as a bicameral chamber housed by the semi-rigid walls 918, 940 (that are connected along their respective perimeters and made, for example, from an acrylic material, the constituent sub-chambers of which are separated by the internal (intracameral) flexible membrane 944. The outer wall 940 may be additionally re-enforced by the rigid, optically transparent plate 948 that is substantially congruent with the wall 940 at least in the central, optically operational portion of the lens 900. While generally materials used for construction of the (semi-) rigid plates of an embodiment may differ to optimize the opto-mechanical operational characteristics of a particular embodiment (as a person of ordinary skill in the art will readily understand), in one specific case the outer shell walls of the lens 900 may be made of standard usage foldable acrylic, while the internal flexible membrane may be made of silicone.
In operation, the embodiment 900 is installed behind the cornea in a fashion similar to that described in reference to
The change in opto-geometrical parameters of the lens 900 is caused, in operation, in a fashion similar to that described above with respect to the embodiment 100, by patient's focusing on an object at any given distance within the field-of-view with an autonomic nervous system feedback response. When the ciliary muscle 214 is relaxed (during a distance focusing of the eye), tension is increased on the zonules 220 and the lens capsule 250, similar to the tightening of a drum head. Increasing tension on the lens capsule applies an anteriorly directed force 252 on the capsular membrane 250 and displaces the capsular membrane posteriorly. This movement transfers pressure from the capsular membrane to the posterior surface 912 of the lenticle 936 and anteriorly displaces the posterior lenticle 936 acting as a piston to pressurize the posterior chamber and spherically deform the interior flexible membrane 944 anteriorly. A skilled artisan will readily understand that, due to the differences between the refractive indices of the fluid contents of the lenslets 936, 946, with such deformation and/or repositioning of the membrane 944 and while the walls 918, 940 remain substantially unchanged, the effective optical power of the whole lens 900 is decreased in proportionately (in a specific case—in direct proportion) to the posteriorly-applied pressure. As the flexible membrane 944 is present across the whole clear aperture of the lens 900 (it is affixed internally to the perimeter edge of the outer shell of the lens), the produced change in the effective optical power is substantially the same at any point within the clear aperture of the lens 900.
Such change of the power of the overall lens is accompanied by a change of optical power of at least one of the constituent lenslets 936, 946. Optically, this effect is equivalent to relaxation of the natural lens in an eye that accommodates to focus on a distant object. Conversely, during the accommodation on a near-by object, the ciliary muscle 214 contracts, relaxing the tension on the zonules 220 and/or the capsular membrane 250. The relaxed tension decreases the pressure on the posterior surface 912, allowing it to resume its unstressed shape. This in effect increases the power of the lens 900 just as the natural lens does during accommodation to focus on a near object.
It is appreciated that material composition of IOL embodiments of the invention allows the IOLs to be folded and inserted into the eye through a small incision (which make them a better choice for patients who have a history of uveitis and/or have diabetic retinopathy requiring vitrectomy with replacement by silicone oil or are at high risk of retinal detachment). In the case of IOL 900, for example, it implies that at least one of (i) semi-rigid spatially-continuous haptic(s) 920, 922 integrated with the anterior stabilizing plate 918 along its edge and (ii) the posterior wall 940 and/or plate 948 are structured to be appropriately foldable and/or bendable.
It is appreciated that for the purposes of demonstration of practicality of the proposed design, the design for near/short distance accommodation was set to a 250 mm distance between the lens 900 and the object. The design parameters in Tables 3 and 4, and evidence the effect of the curvature of the flexible membrane on the optical power of the embodiment. These parameters used for the presented operation of lens 900 are not necessarily optimized and, therefore, corresponding spot diagrams (of
References throughout this specification to “one embodiment,” “an embodiment,” “a related embodiment,” or similar language mean that a particular feature, structure, or characteristic described in connection with the referred to “embodiment” is included in at least one embodiment of the present invention. Thus, appearances of the phrases “in one embodiment,” “in an embodiment,” and similar language throughout this specification may, but do not necessarily, all refer to the same embodiment. It is to be understood that no portion of disclosure, taken on its own and in possible connection with a figure, is intended to provide a complete description of all features of the invention.
In addition, it is to be understood that no single drawing is intended to support a complete description of all features of the invention. In other words, a given drawing is generally descriptive of only some, and generally not all, features of the invention. A given drawing and an associated portion of the disclosure containing a description referencing such drawing do not, generally, contain all elements of a particular view or all features that can be presented is this view, for purposes of simplifying the given drawing and discussion, and to direct the discussion to particular elements that are featured in this drawing. A skilled artisan will recognize that the invention may possibly be practiced without one or more of the specific features, elements, components, structures, details, or characteristics, or with the use of other methods, components, materials, and so forth. Therefore, although a particular detail of an embodiment of the invention may not be necessarily shown in each and every drawing describing such embodiment, the presence of this detail in the drawing may be implied unless the context of the description requires otherwise. In other instances, well known structures, details, materials, or operations may be not shown in a given drawing or described in detail to avoid obscuring aspects of an embodiment of the invention that are being discussed. Furthermore, the described single features, structures, or characteristics of the invention may be combined in any suitable manner in one or more further embodiments.
The invention as recited in claims appended to this disclosure is intended to be assessed in light of the disclosure as a whole. Disclosed aspects, or portions of these aspects, may be combined in ways not listed above. Accordingly, the invention is not intended and should not be viewed as being limited to the disclosed embodiment(s).
The present U.S. Patent application claims priority from and benefit of the U.S. Provisional Patent Applications Nos. 61/773,909 filed on Mar. 7, 2013 and titled “Fluidic Membrane Accommodating Intraocular Lens” and 61/775,752 filed on Mar. 11, 2013 and titled “Aspheric Intraocular Lens With Continuously Variable Focal Length.” The present patent application is also a continuation-in-part from the U.S. patent application Ser. No. 14/193,301 filed on Feb. 28, 2014, and titled “Refocusable Intraocular Lens With Flexible Aspherical Surface” (attorney docket 147923.00010), which in turn claims priority from U.S. Provisional Patent Application 61/775,752. The disclosure of each of the above-mentioned patent documents is incorporated herein by reference in its entirety.
Number | Date | Country | |
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61773909 | Mar 2013 | US | |
61775752 | Mar 2013 | US | |
61775752 | Mar 2013 | US |
Number | Date | Country | |
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Parent | 14193301 | Feb 2014 | US |
Child | 14195345 | US |