This disclosure relates generally to optical systems. More specifically, this disclosure relates to an intraocular pseudophakic contact lens (IOPCL) for treating age-related macular degeneration (AMD) or other eye disorders.
Age-related macular degeneration (AMD) causes deterioration of the macula in the retina of an eye. The retina is a paper-thin tissue at the back of the eye where light-sensitive cells send visual signals to the brain, and the macula supports finely-detailed vision. Sharp, clear, straight-ahead vision is centered in the macula, and damage to the macula results in central blind spots of various sizes and blurred or distorted central vision. Those affected by AMD find many daily activities, such as driving and reading, increasingly difficult and eventually impossible as the disease progresses. Common difficulties and symptoms of AMD include loss of ability to drive a car, loss of ability to read, distortion or loss of central vision, progressive decrease in contrast sensitivity, increase in glare and light sensitivity, need for increased illumination to read, and impaired depth perception.
AMD is the leading cause of visual impairment and irreversible vision loss in the United States. AMD is more prevalent among people 50 years of age or older, and it is one of the leading causes of legal blindness. As many as 15 million Americans currently have some type of AMD, including both early and intermediate stages. This number is expected to increase to nearly 22 million by 2050. Worldwide, it is estimated that more than 196 million people suffer from some level of AMD and that this number will increase to 288 million by 2040. Risk factors for developing AMD include positive family history, cigarette smoking, hyperopia, lightly-pigmented eye population, hypertension, and cardiovascular disease.
This disclosure provides an intraocular pseudophakic contact lens (IOPCL) for treating age-related macular degeneration (AMD) or other eye disorders.
In a first embodiment, an apparatus includes an intraocular pseudophakic contact lens having an optical lens and haptics extending radially from the optical lens and configured to contact a capsular bag in an eye in order to secure the intraocular pseudophakic contact lens against an artificial intraocular lens. The optical lens includes a central portion and at least one annular portion surrounding the central portion, where the central and annular portions are configured to provide different optical powers.
In a second embodiment, a system includes an artificial intraocular lens having a first optical lens and first haptics configured to be implanted within a capsular bag in an eye. The system also includes an intraocular pseudophakic contact lens having a second optical lens and second haptics extending radially from the second optical lens and configured to contact the capsular bag in order to secure the intraocular pseudophakic contact lens against the artificial intraocular lens. The second optical lens includes a central portion and at least one annular portion surrounding the central portion, where the central and annular portions are configured to provide different optical powers.
In a third embodiment, an apparatus includes an intraocular pseudophakic contact lens having an optical lens and haptics extending radially from the optical lens and configured to contact a capsular bag in an eye in order to secure the intraocular pseudophakic contact lens against an artificial intraocular lens. The optical lens includes a central portion and at least one annular portion surrounding the central portion, where the central and annular portions are configured to provide different optical powers. Anterior surfaces of the haptics include capsular wall-engaging surfaces configured to contact an inner capsular wall surface at an anterior leaflet of the capsular bag, where the capsular wall-engaging surfaces are configured to promote confinement, capture, or attachment of the haptics. Posterior surfaces of the haptics include ridges configured to capture at least one edge of the artificial intraocular lens. The haptics are flexible such that outer portions of the haptics are configured to drive the ridges into the at least one edge of the artificial intraocular lens based on surface pressure from an anterior leaflet of the capsular bag against the outer portions of the haptics. The central portion of the optical lens is configured to provide a central optical magnification, and the at least one annular portion of the optical lens is configured to provide at least one different optical magnification or no optical magnification.
Other technical features may be readily apparent to one skilled in the art from the following figures, descriptions, and claims.
For a more complete understanding of this disclosure and its features, reference is now made to the following description, taken in conjunction with the accompanying drawings, in which:
This disclosure relates to devices, systems, and techniques for treating age-related macular degeneration (AMD) or other types of eye disorders using an intraocular pseudophakic contact lens (IOPCL) that can be mounted on, attached to, or otherwise secured to an artificial intraocular lens (IOL) for each of one or more eyes of a patient. The intraocular pseudophakic contact lens includes an optical lens having different regions with different optical powers (refractive powers). For instance, the central region of the optical lens may provide a first amount of optical magnification (such as a high plus power optical magnification), and at least one annular region of the optical lens around the central region may provide at least one different amount of optical magnification (or no optical magnification). Among other things, this approach can be used to deliver a customized treatment for early and intermediate-stage AMD in pseudophakic patients. These patients may, for instance, have lost sufficient vision to support keeping their driving privileges. They may have also actually lost their drivers' licenses and/or the ability to read normal print.
The eye 102 also includes a capsular bag 110, which typically holds the natural crystalline lens of the eye 102. However, in this example, the natural crystalline lens has been removed and replaced with an artificial intraocular lens (IOL) 112. The intraocular lens 112 generally includes an optical lens and one or more haptics. The optical lens of the intraocular lens 112 receives light entering the eye 102 and focuses the light onto the retina of the eye 102. The haptics of the intraocular lens 112 help to hold the intraocular lens 112 within the capsular bag 110 so that the optical lens of the intraocular lens 112 is in a desired position within the eye. An eye 102 in which the natural crystalline lens has been replaced with an artificial intraocular lens 112 is often referred to as a “pseudophakic” eye. Note that there are a wide variety of artificial intraocular lenses that may be used in a patient, and additional artificial intraocular lenses are sure to be developed in the future. The intraocular lens 112 shown here is for illustration only, and any other suitable artificial intraocular lens now known or later developed may be used in the system 100. Also, the intraocular lens 112 may be used here to provide any desired optical correction or other modification of light passing through the eye 102.
An intraocular pseudophakic contact lens (IOPCL) 114 has been placed on or otherwise in front of the intraocular lens 112 (possibly without touching the uveal tissue). The intraocular pseudophakic contact lens 114 represents an additional lens that can be mounted on, attached to, or otherwise secured to the intraocular lens 112. As shown here, the intraocular pseudophakic contact lens 114 may be placed on or in front of the anterior surface of the intraocular lens 112, meaning the front surface of the intraocular lens 112 with respect to the eye 102. Light enters through the cornea 104 and passes through the pupil before entering the intraocular pseudophakic contact lens 114, which modifies the light. The modified light then passes through the optical lens of the intraocular lens 112 and is again modified. The twice-modified light then travels through the remainder of the eye 102 to reach the retina at the back of the eye 102.
As described below, the intraocular pseudophakic contact lens 114 includes an optical lens and optionally a mechanism for securing the intraocular pseudophakic contact lens 114 to or against the intraocular lens 112. In some embodiments, for example, the intraocular pseudophakic contact lens 114 includes one or more haptics that extend a short distance and fit under an anterior leaflet of the capsular bag 110 in the eye 102. This allows the haptics to be captured and confined by the anterior leaflet and possibly attach to the capsular wall of the anterior leaflet via fibrosis or re-fibrosis. The anterior leaflet represents the outer portion of the front side of the capsular bag 110 that remains after an opening (referred to as a capsulorhexis) is formed in the capsular bag 110 so that the natural crystalline lens can be removed. The insertion of the haptics of the intraocular pseudophakic contact lens 114 under the anterior leaflet helps to secure the intraocular pseudophakic contact lens 114 in place. In some cases, the healing process in the eye 102 can cause fibrosis or re-fibrosis to occur, which could also attach the anterior leaflet to the haptics of the intraocular pseudophakic contact lens 114. In other embodiments, the intraocular pseudophakic contact lens 114 includes one or more pins that can pierce the lens material of the intraocular lens 112. In still other embodiments, the intraocular pseudophakic contact lens 114 may be designed to mate with or otherwise connect to one or more components of the intraocular lens 112 specifically designed for use with the intraocular pseudophakic contact lens 114. In general, any suitable mechanism(s) may be used to mount, attach, or otherwise secure the intraocular pseudophakic contact lens 114 in place relative to the intraocular lens 112.
Depending on the implementation, the intraocular pseudophakic contact lens 114 may be multi-focal and include a combination of lens powers, such as a high plus power optical segment and at least one other optical segment with a different power or no power. The desired optical powers of the intraocular pseudophakic contact lens 114 may be achieved in any suitable manner. For example, in some embodiments, the optical powers of the intraocular pseudophakic contact lens 114 could be delivered by varying one or both of the anterior and posterior sides of the optic in the intraocular pseudophakic contact lens 114.
While often described as being used to treat both eyes 102 of a patient, this is not necessarily required. For instance, a single eye 102 of a patient may be treated using an intraocular pseudophakic contact lens 114. The other eye 102 of the patient may or may not include an intraocular pseudophakic contact lens 114, and there is no requirement that the other eye 102 include the same type of intraocular pseudophakic contact lens 114. In general, the approaches described here can be easily customized to provide desired correction(s) of each patient's eye(s) 102 individually or collectively.
Although
As shown in
Multiple haptics 304a-304c extend from multiple sides of the optical lens 302. The haptics 304a-304c are sized and shaped so that they extend a short distance from the optical lens 302 and fit under the anterior leaflet of the capsular wall in a patient's eye 102 after implantation. Each haptic 304a-304c could be formed from any suitable material(s) and in any suitable manner. For example, each haptic 304a-304c could be formed from the same material(s) as the optical lens 302. Note that while three haptics 304a-304c are shown here, the intraocular pseudophakic contact lens 300 could include any number of haptics, including a single haptic. Also note that while the haptics 304a-304c angle downward (meaning the haptics 304a-304c generally extend outward and posteriorly from the optical lens 302), the haptics 304a-304c could have any other suitable arrangement. In addition, note that the haptics 304a-304c may be coupled to the optical lens 302 in any suitable manner, such as when the haptics 304a-304c are formed integral with the optical lens 302 or are attached to the optical lens 302 or to a retaining ring or other structure (integral with or attached to the optical lens 302) using adhesive or other suitable connecting mechanism.
Each of the haptics 304a-304c may include a textured surface 306, which may facilitate capture or confinement of the haptics 304a-304c by the anterior leaflet of the capsular wall in a patient's eye 102. Among other things, this can help the haptics 304a-304c to secure the intraocular pseudophakic contact lens 300 in place on or to the intraocular lens 112. In some cases, the textured surfaces 306 allow the haptics 304a-304c to actually physically bond to the anterior leaflet of the capsular wall in the patient's eye 102, such as through fibrosis or re-fibrosis during the healing process. In other cases, the textured surfaces 306 may simply resist movement of the haptics 304a-304c relative to the anterior leaflet of the capsular wall in the patient's eye 102.
Each textured surface 306 represents any suitable structure that facilitates confinement, capture, or attachment of the haptics 304a-304c by or to the anterior leaflet of the capsular wall. In some cases, each textured surface 306 may represent an electrical discharge machining (EDM) finish, or each textured surface 306 may represent holes formed partially or completely through the haptics 304a-304c (in which case the numbers and sizes of the holes in the textured surfaces 306 may vary as needed or desired). Note that other forms of texturing may be used here, or no texturing may be needed. Also note that the haptics 304a-304c may be omitted if not needed, such as when the intraocular pseudophakic contact lens 300 can be held in place on an intraocular lens 112 via surface tension, adhesive, or other technique. In addition, note that other types of haptics may be used with the intraocular pseudophakic contact lens 300, or pins embedded in or passing through projections from the optical lens of the intraocular pseudophakic contact lens 300 or other structures of the intraocular pseudophakic contact lens 300 may be used to secure the intraocular pseudophakic contact lens 300 to the intraocular lens 112. In general, this disclosure is not limited to any particular haptic design or mechanism for mounting or attaching the intraocular pseudophakic contact lens 300 on or to the intraocular lens 112.
In this example, the haptics 304a-304c of the intraocular pseudophakic contact lens 300 are formed as large projections that extend from the sides of the optical lens 302, effectively forming long “wings” extending from the optical lens 302. An inner portion of each haptic 304a-304c projects outward and downward (posteriorly) in this example, and an outer portion of each haptic 304a-304c projects outward and slightly upward in this example (although the outer portion of each haptic 304a-304c may be flexible as described below). Note, however, that other forms for the haptics 304a-304c could also be used. Each of the outer portions of the haptics 304a-304c has a thickness that tapers towards the outer edge of the haptic 304a-304c, which may facilitate easier insertion of the haptics 304a-304c under the anterior leaflet of the capsular wall in a patient's eye 102. The lower surfaces of the haptics 304a-304c also include ridges 308, and multiple ridges 308 of multiple haptics 304a-304c can be used to capture one or more edges of the underlying intraocular lens 112. This can help to center the intraocular pseudophakic contact lens 300 on the intraocular lens 112. This can also help to retain the intraocular pseudophakic contact lens 300 in place on the intraocular lens 112 during the healing process or otherwise during use. While the ridges 308 are shown here as being generally flat or slightly curved, the ridges 308 may incorporate other features. For instance, lips may be formed by small inward projections extending from the bottoms or other portion(s) of the ridges 308 inward towards a central optical axis of the optical lens 302 (meaning a vertical axis through the center of the optical lens 302 in
The haptics 304a-304c may have any suitable positions in the intraocular pseudophakic contact lens 300. For example, in some embodiments, the haptics 304a-304c are evenly spaced about 120° apart. In other embodiments, the haptics 304a-304c are unevenly spaced, such as when the haptic 304a is separated from each of the haptics 304b-304c by about 125° and the haptics 304b-304c are separated from each other by about 110° (which may be based on, for instance, the positions of haptics of the intraocular lens 112 onto which the intraocular pseudophakic contact lens 300 will be placed). Also, in some cases, the intraocular pseudophakic contact lens 300 may be designed for implantation into a patient's eye 102 at a specific orientation, and at least one alignment marking 310 may be provided to identify proper orientation of the intraocular pseudophakic contact lens 300 in the eye 102. In this example, a single alignment marking 310 having the form of a raised letter “R” may be used, such as to identify the haptic 304a to be positioned on the right side of the intraocular lens 112 as the intraocular lens 112 within the eye 102 is viewed by a surgeon or other personnel. However, any other or additional alignment markings 310 or no alignment markings may be used here.
The optical lens 302 may have any suitable optical power(s) depending on the implementation. In this example, the optical lens 302 includes a first lens portion 312 and a second lens portion 314, where the two portions 312-314 of the optical lens 302 may provide different levels of optical magnification. For instance, the first lens portion 312 may provide a specified amount of magnification (such as a high plus power magnification), and the second lens portion 314 may provide a different amount of magnification or possibly little or no magnification. To provide a high plus power in this example, the anterior surface of the first lens portion 312 may be convex, and the posterior surface of the first lens portion 312 may be concave. The amount of high plus power magnification can be adjusted here by altering the shape of one or more of the anterior and posterior surfaces of the first lens portion 312. For instance,
As a result, the first lens portion 312 in the intraocular pseudophakic contact lens 300 can be used to provide a high amount of plus power optical magnification. This supports the use of the intraocular pseudophakic contact lens 300 in the system 100 to help treat conditions such as AMD or other vision loss related to retinal disease, where the magnification can help a patient perform tasks such as reading normal-sized print more easily or regaining his or her driving privileges. The second lens portion 314 in the intraocular pseudophakic contact lens 300 can be used to provide a different amount of optical magnification or no optical magnification. For instance, the anterior surface of the second lens portion 314 may be convex (with less convexity compared to the first lens portion 312), and the posterior surface of the second lens portion 314 may be concave.
In this particular example, the first lens portion 312 is generally circular and positioned centrally in the intraocular pseudophakic contact lens 300, and the second lens portion 314 is generally annular and surrounds the first lens portion 312. However, each lens portion 312 and 314 may have any other suitable size, shape, and position within the intraocular pseudophakic contact lens 300. In general, the sizes, shapes, and positions of the lens portions 312-314 can vary as needed or desired in order to provide the desired optical magnification(s).
The intraocular pseudophakic contact lens 300 shown in
Moreover, the intraocular pseudophakic contact lens 300 could be easily removed from a patient's eyes 102, such as any suitable time after implantation or prior to bonding of the haptics 304a-304c to the capsular wall (assuming fibrosis or re-fibrosis holds the intraocular pseudophakic contact lens 300 in place). Among other things, this allows one intraocular pseudophakic contact lens 300 to be removed and replaced with a different intraocular pseudophakic contact lens 300 if a different optical magnification is needed or desired.
The intraocular pseudophakic contact lens 300 could have any suitable size, shape, and dimensions. For example, intraocular pseudophakic contact lenses 300 could be made available in a range of diameters from about 4 millimeters to about 6 millimeters. Also, the intraocular pseudophakic contact lenses 300 could be made available with varying base curvatures for their optical lenses 302. Of course, an intraocular pseudophakic contact lens 300 could also be custom designed for a particular patient's eye 102, such as when one or more specific curvatures are needed to provide a desired amount of optical magnification in the particular patient's eye 102.
In some embodiments, the intraocular pseudophakic contact lens 300 and various components of the intraocular pseudophakic contact lens 300 may have the following design parameters. The diameter of the first lens portion 312 may be about 1.8 millimeters, the diameter of the second lens portion 314 may be about 4.5 millimeters, the diameter of a circle defined by the ridges 308 may be about 6.05 millimeters, and the diameter of a circle defined by outer edges of the haptics 304a-304c may be about 7 millimeters. The straight edges of each haptic 304a-304c when viewed from the top may taper from a separation of about 0.97 millimeters to about 0.63 millimeters, where the straight edges define an angle of about 15°. The optical lens 302 may have a thickness along its outer edge of about 0.375 millimeters, and there may be a step of about 0.065 millimeters between the posterior surface of the optical lens 302 along its outer edge and posterior surfaces of the haptics 304a-304c. Each of the ridges 308 may form an angle of about 10° relative to a central optical axis of the optical lens 302, and the posterior surfaces of the haptics 304a-304c may extend from the optical lens 302 at an angle of about 103° relative to the central optical axis of the optical lens 302. The distance between the ridge 308 and the outer edge of each haptics 304a-304c may be about 0.48 millimeters. Various corners and edges of the intraocular pseudophakic contact lens 300 can be rounded, and the radii of curvatures of the anterior and posterior surfaces of the first and second lens portions 312-314 can vary based on the desired optical magnification(s) to be provided by the lens portions 312-314. Note, however, that these dimensions and other design parameters are for illustration only and can vary as needed or desired depending on the implementation of the intraocular pseudophakic contact lens 300.
The intraocular pseudophakic contact lens 300 can be implanted non-invasively in a patient's eye 102 and easily positioned on an intraocular lens 112. The implantation is non-invasive because the intraocular pseudophakic contact lens 300 is being installed on the anterior surface of an intraocular lens 112, which is typically easily accessible by a surgeon or other personnel during an implantation procedure. The implantation is also non-invasive because the intraocular pseudophakic contact lens 300 can be attached to the intraocular lens 112 without requiring attachment of the intraocular pseudophakic contact lens 300 to anatomical structures within the patient's eye 102, such as to the suculus of the patient's eye 102. The non-invasive implantation and easy positioning of an intraocular pseudophakic contact lens 300 provide a safe and effective surgical procedure to correct AMD or other eye disorders.
If the haptics 304a-304c of the intraocular pseudophakic contact lens 300 include ridges 308, the ridges 308 can be used to center the intraocular pseudophakic contact lens 300 on an underlying intraocular lens 112 as described above. If the intraocular pseudophakic contact lens 300 includes multiple haptics 304a-304c with associated ridges 308, the ridges 308 could help to perfectly center the intraocular pseudophakic contact lens 300 on the underlying intraocular lens 112. Such an approach allows the ridges 308 of the intraocular pseudophakic contact lens' haptics 304a-304c to capture the underlying intraocular lens 112 at the edge and perfectly line up the optical center of the intraocular pseudophakic contact lens' optic with the optical center of the intraocular lens 112. This alignment helps to reduce or avoid induced optical aberrations or induced prisms caused by optical center misalignment.
Note that in the above example, the intraocular pseudophakic contact lens 300 could possibly be designed so that only the haptics 304a-304c of the intraocular pseudophakic contact lens 300 extend under the anterior leaflet of the capsular wall in a patient's eye 102. This allows the haptics 304a-304c to be captured and confined by the anterior leaflet while leaving the optical lens 302 of the intraocular pseudophakic contact lens 300 free and generally unobscured by the surrounding tissue in the patient's eye 102.
Also note that, in some embodiments, the surgical tool disclosed in U.S. Patent Application Publication No. 2019/0269555 A1 (which is hereby incorporated by reference in its entirety) may be used to help implant an intraocular pseudophakic contact lens 300. For example, this tool may be used to separate at least part of the anterior leaflet of a patient's eye 102 from an implanted intraocular lens 112, allowing haptics 304a-304c of the intraocular pseudophakic contact lens 300 to be inserted between the anterior leaflet and the intraocular lens 112. As another example, this tool may be used to separate the anterior leaflet of a patient's eye 102 from an implanted intraocular pseudophakic contact lens, allowing the intraocular pseudophakic contact lens to be removed (and possibly replaced).
Although
In addition, the intraocular pseudophakic contact lens 300 shown in
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The intraocular pseudophakic contact lens is secured against an intraocular lens in the patient's eye at step 1306. In some embodiments, this may include, for example, one or more haptics 304a-304c of the intraocular pseudophakic contact lens 300 sliding or otherwise being inserted under the anterior leaflet of the capsular wall in the patient's eye 102. In other embodiments, this may include one or more pins of the intraocular pseudophakic contact lens 300 piercing the lens material of the optical lens 802 in the intraocular lens 112. Any other suitable mechanism may be used here to secure the intraocular pseudophakic contact lens 300 against the intraocular lens 112. The intraocular pseudophakic contact lens is used to provide optical magnification in the patient's eye at step 1308. This may include, for example, the first lens portion 312 of the intraocular pseudophakic contact lens 300 providing high plus power magnification during use of the intraocular pseudophakic contact lens 300.
Although
It may be advantageous to set forth definitions of certain words and phrases used throughout this patent document. The terms “include” and “comprise,” as well as derivatives thereof, mean inclusion without limitation. The term “or” is inclusive, meaning and/or. The phrase “associated with,” as well as derivatives thereof, may mean to include, be included within, interconnect with, contain, be contained within, connect to or with, couple to or with, be communicable with, cooperate with, interleave, juxtapose, be proximate to, be bound to or with, have, have a property of, have a relationship to or with, or the like. The phrase “at least one of,” when used with a list of items, means that different combinations of one or more of the listed items may be used, and only one item in the list may be needed. For example, “at least one of: A, B, and C” includes any of the following combinations: A, B, C, A and B, A and C, B and C, and A and B and C.
The description in this patent document should not be read as implying that any particular element, step, or function is an essential or critical element that must be included in the claim scope. Also, none of the claims is intended to invoke 35 U.S.C. § 112(f) with respect to any of the appended claims or claim elements unless the exact words “means for” or “step for” are explicitly used in the particular claim, followed by a participle phrase identifying a function. Use of terms such as (but not limited to) “mechanism,” “module,” “device,” “unit,” “component,” “element,” “member,” “apparatus,” “machine,” “system,” “processor,” “processing device,” or “controller” within a claim is understood and intended to refer to structures known to those skilled in the relevant art, as further modified or enhanced by the features of the claims themselves, and is not intended to invoke 35 U.S.C. § 112(f).
While this disclosure has described certain embodiments and generally associated methods, alterations and permutations of these embodiments and methods will be apparent to those skilled in the art. Accordingly, the above description of example embodiments does not define or constrain this disclosure. Other changes, substitutions, and alterations are also possible without departing from the spirit and scope of this disclosure, as defined by the following claims.
This application claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 63/057,738 filed on Jul. 28, 2020. This application also claims priority under 35 U.S.C. § 120 as a continuation-in-part of U.S. patent application Ser. No. 17/011,975 filed on Sep. 3, 2020, which is a continuation of U.S. patent application Ser. No. 16/190,959 filed on Nov. 14, 2018 (now U.S. Pat. No. 10,842,614), which is a continuation of U.S. patent application Ser. No. 14/860,629 filed on Sep. 21, 2015 (now U.S. Pat. No. 10,159,562), which claims priority under U.S.C. § 119(e) to U.S. Provisional Patent Application No. 62/053,771 filed on Sep. 22, 2014. This application further claims priority under 35 U.S.C. § 120 as a continuation-in-part of U.S. patent application Ser. No. 16/717,304 filed on Dec. 17, 2019, which is a continuation-in-part of U.S. patent application Ser. No. 16/398,627 filed on Apr. 30, 2019 (now U.S. Pat. No. 10,945,832), which is a continuation-in-part of U.S. patent application Ser. No. 15/646,254 filed on Jul. 11, 2017 (now U.S. Pat. No. 10,299,910), which is a continuation-in-part of U.S. patent application Ser. No. 14/860,629 filed on Sep. 21, 2015 (now U.S. Pat. No. 10,159,562), which claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 62/053,771 filed on Sep. 22, 2014. All of these applications are hereby incorporated by reference in their entirety.
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