WO2014140905A1

WO2014140905A1 - Modulation of refractive index for presbynsert and esthetical intacs

Info

Publication number: WO2014140905A1
Application number: PCT/IB2014/001161
Authority: WO
Inventors: Alain Telandro
Original assignee: Alain Telandro
Priority date: 2013-03-15
Filing date: 2014-03-13
Publication date: 2014-09-18

Abstract

The present invention relates in one aspect to improving the performance of an ophthalmic lens for the eye by creating a progressive optical system wherein the lens is made of different materials having different optical refractive indeces (RI), in another aspect use of refractive indeces to form esthetical Intacs.

Description

MODULATION OF REFRACTIVE INDEX FOR PRESBYNSERT AND

ESTHETICAL INTACS

RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. provisional patent application number 61/794,396, filed March 15, 2013, which is herein incorporated by reference in its entirety.

SUMMARY OF THE INVENTION

[0002] The present invention relates to improving the performance of an ophthalmic lens for the eye by creating a progressive optical system wherein the lens is made of different materials having different optical refractive indeces (RI).

[0003] In one embodiment the lens with different RI creates a multifocal lens.

[0004] In one embodiment the multifocal ophthalmic lens (presbynsert )is an intraocular lens

(IOL).

[0005] In another embodiment the multifocal ophthalmic lens (presbynsert) is a corneal inlay (ICL) for presbyopia.

[0006] In one embodiment the central part of the lens nucleus is silicone oil with high RI and an external bag of silicone hydro gel soft material with lower RI.

[0007] In another embodiment the central part of the lens is silicone hydro gel and the external part is an acrylic bag.

[0008] In an alternate embodiment the central nucleus of the lens is silicon oil enveloped with layers of silicon hydro gel and silicone oil.

[0009] In yet another embodiment the change in refractive index and the multifocal properties result from the addition of dyes.

[0010] In one embodiment the central part of IOL is transparent and progressively changes to yellow from the center to the peripheral area of the near vision.

[0011] In an alternate embodiment the corneal inlay has a central nucleus material with a different RI from the external area.

[0012] In another embodiment the corneal inlay possess a central part and a lower sector with a different refractive index.

[0013] In one embodiment the corneal inlay possess central and upper sectors with different refractive indeces.

[0014] In one embodiment implementing the corneal inlay with different RI's creates a pseudo accommodation.

[0015] In one embodiment the multi-focal lens disperses light to create a myopic island with near vision at the center and far vision at the periphery. [0016] In another embodiment the multifocal lens disperses light to create a ring of myopia.

[0017] In one embodiment the performance of the ophthalmic lens is improved by the Kerr optic effect (quadratic electro-optic effect).

[0018] In another embodiment the electromagnetic field is a ring connected to an external control device.

[0019] In another embodiment the external control changes the RI of the corneal inlay.

[0020] In one embodiment the shape of the ring inserted at the periphery of the cornea modifies the curvature of the cornea's central area.

[0021] In another embodiment a ring of separated magnetic elements creates a corneal accommodation.

[0022] In one embodiment at least one decorative object or marking is inserted into the cornea of an eye to create esthetical Intacs.

[0023] In one embodiment the cavity defines: at least one housing for the reception of the decorative material with the main axis parallel to the surface of the cornea.

[0024] In another embodiment the decorative marking is an object (O) covered by some biocompatible material with the nature of the cornea prior to its insertion.

[0025] In another embodiment the material is a gel (G) or colored liquid, incapable of diffusion into the cornea.

[0026] In an alternate embodiment the decorative object is liquid crystals (CL) with an external control system (RFID).

INCORPORATION BY REFERENCE

[0027] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF DRAWINGS

[0028] Figure 1 ; illustrates bifocal intraocular lens (IOL) with variable RI.

[0029] Figure 2; describes different types of IOL using modified RI.

[0030] Figure 3; presents presbynsert with the disk in central part of the lens.

[0031] Figure 4; illustrates presbynsert with lower section having variable RI materials.

[0032] Figure 5; describes presbynsert with upper section having variable RI materials.

[0033] Figure 6; describes dynamics Intacs.

[0034] Figure 7; illustrates front view the housing for esthetical Intacs.

[0035] Figures 8, 9 and 10; describe partial transversal view of the area of the cornea and different stages of insertion of a decorative object.

[0036] Figures 11, 12 and 13; describe the application of decorative marking using a gel. [0037] Figures 14 and 15; describe the use of liquid crystal for esthetical Intacs.

[0038] Figure 16 illustrates one embodiment of the invention.

DETAILED DESCRIPTION OF THE INVENTION

[0039] The parameter associated with the visual system can be, but are not limited to, an optical parameter, a subject parameter, or an environment parameter. The optical parameter, the subject parameter, and the environmental parameter, in the aggregate, are referred to herein as "vision parameters". The optical parameters can include, but are not limited to, photopic pupil diameter, mesopic pupil diameter, cycloplegic pupil diameter, near-vision preoperative refraction sphere, near-vision preoperative refraction cylinder, near-vision preoperative refraction axis, far-vision preoperative refraction sphere, far-vision preoperative refraction cylinder, far-vision

preoperative refraction axis, near-vision postoperative refraction sphere, near-vision

postoperative refraction cylinder, near-vision postoperative refraction axis, far-vision postoperative refraction sphere, far-vision postoperative refraction cylinder, far-vision postoperative refraction axis, left eye, right eye, asphericity, axis angle, optical zone diameter, transition zone diameter, central pachymetry, spherical aberration as a percent of total root- mean-square (RMS) aberration, coma as a percent of total RMS aberration, trefoil as a percent of total RMS aberration, high-order aberrations as a percent of total RMS aberration, astigmatism index, corneal width, front surface corneal curvature, back surface corneal curvature, front-to-back alignment, or any combination of these optical parameters.

[0040] The subject parameters, can include, but are not limited to, age, side of dominant eye, preference between day vision and night vision, treatment purpose, ethnicity, iris color, gender, or any combination of these subject parameters.

[0041] The environmental parameters can include, but are not limited to, temperature, humidity, microkeratome used for corneal resection.

[0042] The pupil of the eye responds to the photopic retinal illuminance, in trolands, which is the product of the incident flux with the wavelength-dependent sensitivity of the retina and the projected area of the pupil. This sensitivity is described in Wyszecki and Stiles, Color Science: Concepts and Methods, Quantitative Data and Formulae (Wiley: New York) 1982, esp. pages 102-107.

[0043] The human retina includes multiple layers. These layers, listed in order from the first exposed to any light entering the eye to the deepest, include:

[0044] 1) Nerve Fiber Layer

[0045] 2) Ganglion Cells

[0046] 3) Inner Plexiform Layer

[0047] 4) Bipolar and Horizontal Cells [0048] 5) Outer Plexiform Layer

[0049] 6) Photoreceptors (Rods and Cones)

[0050] 7) Retinal Pigment Epithelium (RPE)

[0051] 8) Bruch's Membrane

[0052] 9) Choroid

[0053] Since the 1940's optical devices in the form of intraocular lens (IOL) implants have been utilized as replacements for diseased or damaged natural ocular lenses. In most cases, an intraocular lens is implanted within an eye at the time of surgically removing the diseased or damaged natural lens, such as for example, in the case of cataracts. For decades, the preferred material for fabricating such intraocular lens implants was poly methyl methacrylate, which is a rigid, glassy polymer.

[0054] Softer, more flexible IOL implants have gained in popularity in more recent years due to their ability to be compressed, folded, rolled or otherwise deformed. Such softer IOL implants may be deformed prior to insertion thereof through an incision in the cornea of an eye.

Following insertion of the IOL in an eye, the IOL returns to its original pre-deformed shape due to the memory characteristics of the soft material. Softer, more flexible IOL implants as just described may be implanted into an eye through an incision that is much smaller, i.e., less than 4.0 mm, than that necessary for more rigid IOLs, i.e., 5.5 to 7.0 mm. A larger incision is necessary for more rigid IOL implants because the lens must be inserted through an incision in the cornea slightly larger than the diameter of the inflexible IOL optic portion. Accordingly, more rigid IOL implants have become less popular in the market since larger incisions have been found to be associated with an increased incidence of postoperative complications, such as induced astigmatism.

[0055] With recent advances in small-incision cataract surgery, increased emphasis has been placed on developing soft, foldable materials suitable for use in artificial IOL implants

(Mazzocco, U.S. Pat.) through a relatively small incision. The deformable lens is inserted while it is held in its distorted configuration, then released inside the chamber of the eye, whereupon the elastic property of the lens causes it to resume its molded shape. As suitable materials for the deformable lens, Mazzocco discloses polyurethane elastomers, silicone elastomers, hydrogel polymer compounds, organic or synthetic gel compounds and

combinations thereof.

[0056] In optics the refractive index or index of refraction n of a substance (optical medium) is a dimensionless number that describes how light, or any other radiation, propagates through that medium. C

[0057] "' v.

[0058] where c is the speed of light in vacuum and v is the speed of light in the substance.

[0059] The ondulatory theory of the light discovered by Thomas Young and Augustin Fresnel , combined with the theory of electromagnetic wave of light by Maxwell and Helmholtz link the refractive index to the property of a material ( medium); light having wavelengths of about 400 nm to about 470 nm, either by itself or in combination with ultraviolet light, may contribute to oxidative changes within the human crystalline resulting in presbyopia. Presbyopia is a dioptric change in power of the eye that occurs to allow near objects to be focused on the retina. The ability to accommodate is lost with increasing age in humans and monkeys. This phenomenon, called presbyopia, is the most common human ocular affliction, and its pathophysiology remains uncertain. The progressive loss of human accommodative amplitude begins early in life and results in a complete loss of accommodation by age 50 to 55 years. Presbyopia is correctable by various optical means and, although not a blinding condition, its cost in devices, lost productivity, and (more recently), for surgical interventions is considerable. Theories to explain the pathophysiology of presbyopia fall into two main categories, involving dysfunction of either the lens or the ciliary muscle.

[0060] Many factors can modify the refractive index of a material, like temperature, pressure or density creating birefringence. A change in the refractive index of the medium can be obtained by applying variable electrostatic fields to the medium, which is known as the Kerr Optic effect (quadratic electro-optic effect). Materials used in lenses, IOL or ICL and other Intacs built with PPMA possess refractive indeces (RI) of 1.4893 to 1.490. Silicon oil possess an RI of 3.96, Germanium has an RI of 4.01. The silicone soft lens material has a relative lower RI than hydrophobic acrylic material.

[00 1] The refractive index can be modified by insertion of a dye into the optical path; this modification is accomplished by diverse methods familiar to those practiced in the art of optical manufacturing. The dye or dyes may be incorporated directly into the substrate, added to a polymeric coating, imbibed into the lens, incorporated in a laminated structure that includes a dye-impregnated layer, or as a composite material with dye-impregnated micro particles. These dye materials can absorb at the fundamental peak wavelength of the dye or at shorter resonance wavelengths due to the presence of a Soret band typically found in porphyrin materials.

Exemplary ophthalmic materials include various glasses and polymers such as CR-39®, TRIVEX®, polycarbonate, polymethylmethacrylate, silicone, and fluoropolymers, though other materials may be used and are known for various ophthalmic systems. [0062] Object of present invention is to provide a new concept of creating a multifocal lens using a variation of refractive indeces.

[0063] Surgical pseudo accommodation:

[0064] A young non-presbyopic eye focuses automatically in a direction the brain decides; a presbyopic eye with progressive loss in elasticity does not have the ability to accommodate for near vision. It's usual to observe patients with a progressive variation of refraction with the change of color on their crystalline; they became progressively myopic with change on the capacity of focusing; a -3 Dioptries of myopia has the reading ability at 35 cm without glasses. The analyze of this eye with a total wave front analyze system like the OPD scan from Nidek, can create a map of defocus, named OPD map. This map allows the understanding of the light trajectory and the focus on the central area of the retina: the macula. The OPD maps had allowed the understanding that there is a natural multifocality and absence of unique focus.

[0065] The multifocal allows to understand and create pseudo accommodation.

[0066] Two major models have been described:

[0067] 1 - Central myopic island, near the center of vision, far from the periphery

[0068] 2- Ring of myopia, for near, around a central distance vision island, described by D

Alain Telandro, PAC concept, patented.

[0069] The multifocal concept can be applied to corneal refractive surgery, in the use IOL during cataract surgery or in Corneal Inlay examples such as Revision Optical Raindrop or the Kamra ring.

[0070] These optical modifications are based on a refractive modification of the cornea or the lens:

[0071] by reshaping the curve of the cornea, Lasik, PRK

[0072] by introducing an inlay , small lens inside the cornea

[0073] by diffraction , special design of some IOL or with ring inside the cornea, Kamra

[0074] A majority of described optical systems are bifocal and, on rare occasions, trifocal. These systems are not real progressive with light auto divided in two or more focus; resulting in losses of contrast and sensitivity.

[0075] Provided herein are tools and methods incorporating optical refractive indeces and colors to create multifocality for an artificial lens or inlay and create pseudo accommodation; the light dispersing through varied refractive index lens is divided in multiple focus and correct far near distance vision.

[0076] In one embodiment, a lens creates a central myopic island or an external ring near the visual optical zone.

[0077] Pseudo phakic solution [0078] The refractive index is used to construct IOL; the IOL built with a central nucleus of silicone and an external lay of acrylic material can create a multifocal transparent lens with an appropriate asphericity, optimized for night vision and very little loss of contrast, sensitivity and spherical aberrations, Figure 1.

[0079] Different types of materials will be able to create layer by layer, a progressive optical system, with a progressive variation in the refractive index (RI). This type of structure is reproducing the natural lens like an onion.

[0080] Different types of IOL:

[0081] Example 1 : The central part of the IOL nucleus is silicone oil with high RI and an external bag consisting of silicone hydro gel soft material with a lower refractive index.

[0082] Example 2: The central part of IOL nucleus is silicone hydrogel and the external bag is an acrylic bag

[0083] Example 3 : Alternate slides of silicone oil and layers of silicone hydro gel around a central nucleus in silicone oil, Figure 2.

[0084] These soft architectures provide for the accommodation of the crystalline lens bag under variable tension: the ciliary muscle is still able to modify the tension of the zonula connected to the bag; provides an IOL both, refractive and accommodative.

[0085] Example 4: Use of dyes for changing the refractive index of the material; central transparent area for distance and a yellow periphery area for near vision without affecting the night vision in mesopic diameter pupil; a progressive change, from the center to the periphery.

[0086] Corneal Inlay:

[0087] Femto second lasers are creating very precise and reproducible cuts in the cornea, allowing introduction of variable Inlays and Intacs.

[0088] These corneal approaches are effectuated with precise target such as:

[0089] bilateral procedure to keep binocular vision balanced

[0090] no significant loses of distance vision

[0091] reversible

[0092] predictable, and totally reproducible in any hands

[0093] fast and simple

[0094] pupil size adjustable

[0095] OPD map pre determined to create a customized multifocal.

[0096] The refractive index variation in corneal inlay is similar to refractive index variation described for IOL and multifocality is achieved using different materials with variable RI or the dyes used in the material. The thickness of the inlay is also a refractive factor and can change the power of the cornea (allowing to correct other types of ametropia) and be in combination of the variable refractive index to correct both distance and near vision.

[0097] Use of conventional Lasik procedure simultaneously with the Corneal Inlay can modulate the ametropia of the presbyopia; ametropia such as : myopia, hyperopia, astigmatism. Examples of corneal Inlays:

[0098] Example 1 : Corneal Inlay with a central disc and an external area for near vision, Figure 3.

[0099] Example 2: Corneal Inlay with a central disc and a central area for near vision.

[00100] Example 3: Corneal Inlay with a disc and in lower sector, Figure 4.

[00101] Example 4: Corneal Inlay with a disc and in upper sector, Figure 5.

[00102] Kerr Optic effect and Corneal Inlay

[00103] The last generation of Femto lasers are able to create a stromal tunnel in a ring shape, with and external diameter up to 12.5 mm (Victus , Bausch et Lomb , CE market approved).

[00104] Materials exist that have variable and modularly refractive indeces when an

electromagnetic field (EF) is applied; this is known as the Kerr optic effect. A corneal Inlay made of such materials with modifiable refractive index under the influence of an

electromagnetic field can be connected to an external control system using the same RFID than the IOP sensor patented by Dr. Alain Telandro.

[00105] The space created by femto laser surgery can be used to insert different types of Inlay for various refractive effects. Femto laser surgery in conjunction with the Kerr optic effect allows accommodating systems, controlled by patient under two different modes.

[00106] Static mode:

[00107] The electromagnetic field can be created by a ring connected to an external control device in a RFID mode: this field can modify the RI of a central corneal Inlay.

[00108] The thickness and the shape of the ring inserted in the periphery of the cornea can change the central area by increasing is curvature, or at the inverse decreasing the central area.

[00109] Dynamic mode:

[00110] A ring of small separated magnetic elements will change the diameter under variation of an induced electromagnetic field; the mechanical effect of this change in diameter on the cornea will modify the central area by increasing the central curvature it will create a "corneal controlled accommodation", Figure 6.

[00111] Esthetical Inlay:

[00112] Relative to other lasers, femtosecond lasers make it possible to make intra-corneal cavities without it being necessary to cut away an external part to gain access to the part to be hollowed out. The precision of a femtosecond laser makes it possible to vaporize only the zones buried in the cornea without destroying the superficial zones. Such a laser may be programmed to create the cavity automatically.

[00113] The cavity created by means of the laser contains at least one space or housing designed to receive at least one ornamental material forming a decorative object or marking. The shapes and dimensions of this housing are therefore adapted to the dimensions of the object or marking. A slit or canal connecting the housing to the outside of the eye allows the material to be inserted. The cavity is mainly created in the corneal stroma whose thickness is compatible with various sizes of objects to be inserted. In practice, the maximum thickness of the housing must not exceed 200μιη so as to allow at least a thickness of the order of 250μηι of corneal stroma to remain under the housing. The thickness of stroma above the housing is for example at ΙΟΟμιη.

[00114] Figure 7 is a front view representing only housing 10 (cavity 11 and space 13) and slit 12. Figures 8, 9 and 10 are partial transversal section views of the area of the cornea at different stages of the insertion procedure. In the example shown, a housing of generally rectangular parallelepiped shape is assumed.

[00115] Figure 8 shows the empty cavity, created by the procedure described above, before the insertion of the object.

[00116] Figure 9 shows the insertion of a decorative object O. This is slid from slit 12 in the direction of the sliding space 13 by deforming, towards the interior of the eye, part 14 of the cornea located above part 1 12 of the housing 11. This part 14 forms in some way a lip by deforming itself downwards to allow object O to pass while part 15 of the cornea above part 11 1 of housing 1 1 deforms itself towards the outside. Object O is inserted until it clears lip 14 by entering into the sliding space 13. Then Figure 10, it is brought under lip 14 after this latter has resumed its normal position. Object O then occupies the whole of housing 11. Sliding space 13 as well as slit 12 close.

[00117] The proposed technique requires no suture of the cornea as slit 12 closes without tension.

[00118] Different types of objects may be inserted. For example, these may be reflecting metallic objects, colored plastic elements of various shapes, minerals (precious or semi-precious stones), slim objects in the form of plastic or metallic films, filaments and so on. According to the nature of the object, it may be necessary to cover it with a bio-compatible material prior to its insertion, for example with plexiglas. As a variant, several objects may be introduced by the same slit into the same cavity containing several housings and sliding spaces. According to another variation, one and the same cavity contains several slits.

[00119] In another variation, the object or objects form a marking. [00120] Figures 11, 12 and 13 show another method of application in which housing 1 Γ is used to received gel G, not capable of being diffused in the cornea, forming the decorative object inserted or a marking. Housing 1 1 ', for example, is generally tubular in shape and

approximately parallel to the surface of the cornea. Slit 12 is replaced by a communication canal 12' permitting the introduction of a needle 25 for injection of gel G. A lip 16 forming a closing valve of canal 12' is defined by the laser during the formation of the cavity. This lip 16 deforms itself (Figure 12) during the insertion of the needle to take up its original shape again once the gel has been introduced and the needle withdrawn (Figure 13), thus blocking the canal 12' and maintaining gel G inside housing 11 '. The use of liquid crystals in conjunction with a RFID control system allow for the creation of different colors and aspects of the eye; using material RI and dyes can modify the color and transparency of the iris periphery. The combination of color of the esthetical Intacs and the color of the iris will create infinite esthetically modified eyes. Figures 14, 15 and 16 illustrate how the liquid crystals (LC) can be implemented in esthetical Intacs in the eye.

[00121] One advantage of the invention is that it maintains the appearance of the surface of the eye and forms no excrescence relative to the surface of the cornea. It is compatible with the wearing of corneal lenses, particularly corrective ones.

[00122] Another advantage is that the proposed technique is lasting and needs no maintenance contrary to the use of a lens.

[00123] A further advantage is that it makes it possible to carry out localized insertions whose angular position may be chosen.

[00124] Yet another advantage is that the modification is reversible. In the case of a solid object O, the decorative foreign body may be extracted. One only needs to bring the object out by its introduction slit by using the sliding space again. In fact, the intra-corneal cavity 11 and the slit 12, obtained by vaporization of the corneal structure with the laser, do not reform. The sliding space 13 therefore remains usable for extracting the object without trauma. In the case of a gel G or colored liquid, these may be withdrawn by washing out the cavity by opening the lip 16.

[00125] It is therefore possible to change the decorative objects (for example by replacing one precious stone by another) using the same housing. One may also give back to the eye its original appearance. In this case, once the object has been extracted, the cavity may be filled with physiological serum or, if the volume of the housing is too great, filled with a transparent implant, for example of reticulated hyaluronic acid, compatible with the nature of the cornea. Such transparent implants are already used, for example, in glaucoma surgery.

[00126] Some particular methods of applying the present invention have been described.

Variations and modifications will appear to the practitioner. In particular, the choice of material, the number of housings made in the cornea and their sitting depend on the effect desired. Besides, the use of a laser, its parametrization or programming for the application of the invention have not been given in detail, for they are within the scope of the practitioner skilled in the use of such a laser. In practice, a local anesthetic is used during the application of the procedure of insertion (creation of the cavity and insertion of the object). Finally, the various methods of application and variants may be combined.

Claims

CLAIMS WHAT IS CLAIMED IS:

1. A method for eye refractive surgery on a patient, the method comprising:

(i) analysing OPD maps of the patient,

(ii) generating a progressive optical system wherein a lens is constructed of different materials having different optical refractive indeces (RI) thereby forming a multifocal lens; and

(iii) implementing the multifocal lens (presbynert) during refractive surgery.

2. The method of claim 1, wherein the presbynsert is an intraocular lens (IOL).

3. The method of claim 1, wherein the presbynsert is a corneal inlay (ICL).

4. The method of claim 2, wherein the central part of lens nucleus is silicone oil with high RI and an external bag of silicone hydro gel soft material with lower RI.

5. The method of claim 2, wherein the central part of the lens is silicone hydro gel and the external part is an acrylic bag.

6. The method of claim 2, wherein the central nucleus of the lens is silicon oil enveloped with alternate layers of silicon hydro gel and silicone oil.

7. The method of claim 2, wherein the change in refractive index and the multifocality

results from the addition of dyes.

8. The method of claim 7, wherein the central part of IOL is transparent and progressively changes to yellow from the center to the peripheral area of the near vision.

9. The method of claim 3, wherein the corneal inlay has a central nucleus material with a different RI from the external area for near vision.

10. The method of claim 3, wherein the corneal inlay possess a central part and different refractive index material in lower sector.

11. The method of claim 3, wherein the corneal inlay consists of a central material and

different refractive material in the upper sector.

12. A method of creating a pseudo accommodation using optical refractive index comprising:

(i) analysing OPD maps of a patient, and (ii) implementing a multifocal intra ocular lens (IOL) or corneal inlay (ICL) during refractive surgery, wherein the multifocal lens is constructed with materials having different refractive index and whereby light disperses and divides in multi focuses correcting far and near distance vision.

13. The method of claim 12, wherein the multifocal lens disperses light to create a myopic island with near vision at the center and far vision at the periphery.

14. The method of claim 12, wherein the multifocal lens disperses light to create a ring of myopia.

15. A method for eye refractive surgery with Kerr optic effect comprising: (i) Analysing OPD maps of a patient, (ii) creating a progressive optical system wherein the lens is constructed of different materials having modifiable optical refractive indeces (RI) in response to an electromagnetic field; and (iii) implementing the multifocal corneal inlay during refractive surgery.

16. The method of claim 15, wherein the electromagnetic field is a ring connected to an

external control device.

17. The method of claim 16, wherein the external control changes the RI of the corneal inlay.

18. The method of claim 17, wherein the shape of the ring inserted in the periphery of the cornea modifies the curvature of cornea's central area.

19. The method of claim 15, wherein a ring of separated magnetic elements creates a corneal accommodation.

20. A method of inserting at least one decorative object or marking into the cornea of an eye, comprising: creating, with a laser and outside the pupillary area, at least one intra-corneal cavity opening at the surface of the eye by at least one slit; and introducing material forming the decorative object or the marking into the cavity by the slit or canal.

21. The method of claim 14, wherein the cavity defines:- 13 - at least one housing for the reception of the material with the main axis parallel to the surface of the cornea.

22. The method of claim 20, wherein the decorative object is an object (O) covered with some material bio-compatible with the nature of the cornea prior to its insertion.

23. The method of claim 20, wherein the material is a gel (G) or colored liquid, incapable of diffusion into the cornea.

24. The method of claim 20, wherein the decorative object is liquid crystals (CL) with an external control system (RFID).

25. An ophthalmic lens selected from the group comprising: intra-ocular lens, corneal inlay wherein the lens is constructed of different material having different optical refractive index (RI), thereby forming a multifocal lens.

26. The ophthalmic lens of claim 25, wherein the central part of lens nucleus is silicone oil with high RI and an external bag of silicone hydro gel soft material with lower RI.

27. The ophthalmic lens of claim 25, wherein the central part of the lens is silicone hydro gel and the external part is an acrylic bag.

28. The ophthalmic lens of claim 25, wherein the central nucleus of the lens is silicon oil enveloped with alternate layers of silicon hydro gel and silicone oil.

29. The ophthalmic lens of claim 25, wherein the change in refractive index and the

multifocality results from the addition of dyes.

30. The ophthalmic lens of claim 29, wherein the central part of IOL is transparent and progressively changes to yellow from the center to the peripheral area of the near vision.

31. The ophthalmic lens of claim 25, wherein the corneal inlay has a central nucleus material with a different RI from the external area for near vision.

32. The ophthalmic lens of claim 25, wherein the corneal inlay possess a central part and different refractive index material in lower sector.

33. The ophthalmic lens of claim 25, wherein the corneal inlay consists of a central material and different refractive material in the upper sector.

34. The ophthalmic lens of claim 25, wherein the multifocal lens disperses light to create a myopic island with near vision at the center and far vision at the periphery.

35. The ophthalmic lens of claim 25, wherein the multifocal lens disperses light to create a ring of myopia.

36. A corneal inlay with Kerr optic effect, wherein the lens is constructed of different

materials having modifiable optical refractive indeces (RI) in response to an

electromagnetic field; and (iii) implementing the multifocal corneal inlay during refractive surgery.

37. The ophthalmic lens of claim 36, wherein the electromagnetic field is a ring connected to an external control device.

38. The ophthalmic lens of claim 36, wherein the external control changes the RI of the corneal inlay.

39. The ophthalmic lens of claim 36, wherein the shape of the ring inserted in the periphery of the cornea modifies the curvature of cornea's central area.

40. The ophthalmic lens of claim 36, wherein a ring of separated magnetic elements creates a corneal accommodation.