JP2024507815A - Composite light-accommodating intraocular lens with diffractive structure - Google Patents

Abstract

A composite photoaccommodating intraocular lens includes an acrylic diffractive intraocular lens with diffractive structures and haptics, and a silicone photoaccommodating lens attached to the acrylic diffractive intraocular lens. The diffractive structure produces constructive interference in at least four successive diffraction orders corresponding to the vision range from near vision to distance vision, and the constructive interference corresponds to the near focus, base power of the ophthalmic lens. Producing a far focus and an intermediate focus between the near and far focuses, the diffraction efficiency of at least one of the diffraction orders is suppressed to less than 10 percent.

Description

TECHNICAL FIELD The present invention relates to photoaccommodative intraocular lenses, and in particular to complex intraocular lenses that are accommodative by illumination.

[Reference to related applications]
This application was filed on May 29, 2017 by I. Golds Leger, J. Kandis, RM Kurtz, and R. Shrestha. and I. Giyani, a continuation-in-part of U.S. patent application Ser. Co-pending U.S. Patent Application No. 16/849,556 filed by M. Goldschleger, J. Condis, R.M. Kurtz, and R. Shrestha entitled Composite Light Adjustable Intraocular Lens with Adhesion Promoter. Part Continuation Application, both of which are hereby incorporated by reference and hereby incorporated by reference in their entirety.

In recent years, cataract surgery technology has made rapid and remarkable progress. Next-generation phacoemulsification platforms and newly invented surgical lasers continue to improve intraocular lens (IOL) placement accuracy and reduce undesirable medical outcomes. There is. Current generation IOLs based on soft acrylate materials also offer very good visual outcomes as well as a number of additional medical advantages, including ease and control of the implantation process and advantageous haptic designs.

Nevertheless, even with the latest generation devices and IOLs, there continue to be several types of challenges. One of these challenges is that despite surgeons' meticulous preoperative diagnosis to determine optimal IOL implantation, postoperative medical outcomes are suboptimal in a significant number of cases. It is a point. This may be due to a variety of factors, including differences in the healing process of incisions that tilt or move the implanted IOL, or incomplete modeling of the eye, among others.

Recently, notable results have been achieved with the development of lenses that can be adjusted non-invasively after cataract surgery. These lenses contain a photosensitive material that photopolymerizes upon activation by radiation. Irradiation with a carefully designed radial profile initiates photopolymerization with a corresponding radial profile, which further changes the physical shape of the IOL and thus its optical power. These light-accommodating lenses hold great promise for adjusting and eliminating residual post-operative malposition and non-invasively fine-tuning the "final diopter" of the IOL post-operatively.

However, the current generation of these light-modulating lenses is still capable of further improvement. Areas of potential improvement include optimal material properties to reduce implantation problems and better haptic design.

Accordingly, there is an unmet medical need for an intraocular lens that provides the benefits of both of today's standard acrylate and photoaccommodative IOLs while minimizing the undesirable performance aspects of these.

A composite photoaccommodating intraocular lens has an acrylic diffractive intraocular lens with diffractive structures and haptics, and a silicone photoaccommodating lens attached to the acrylic diffractive intraocular lens. . The diffractive structure produces constructive interference in at least four successive diffraction orders corresponding to the vision range from near vision to distance vision, and the constructive interference corresponds to the near focus, base power of the ophthalmic lens. Producing a far focus and an intermediate focus between the near and far focuses, the diffraction efficiency of at least one of the diffraction orders is suppressed to less than 10 percent. In some embodiments, a composite photoaccommodating intraocular lens comprises an acrylic diffractive intraocular lens with diffractive structures and haptics and a silicone photoaccommodating lens attached to the acrylic diffractive intraocular lens. Often, the diffractive structure has multiple annular diffraction steps and four consecutive diffraction orders, and the complex photoaccommodative intraocular lens produces a near focus, an intermediate focus, and a far focus, each focus having four A plurality of annular diffraction steps of the diffractive structure, each corresponding to a different one of the four successive diffraction orders, wherein one of the four diffraction orders is suppressed, and at least a portion of the energy associated with the suppressed diffraction order is It is configured to be redistributed to one of a near focus, an intermediate focus, and a far focus.

FIG. 2 is a plan view of a composite photoaccommodative IOL. 1 is a side view of an embodiment of a hybrid photoaccommodative IOL, or CLA IOL. FIG. 1 is a side view of an embodiment of a hybrid photoaccommodative IOL, or CLA IOL. FIG. 1 is a side view of an embodiment of a hybrid photoaccommodative IOL, or CLA IOL. FIG. FIG. 4 is a side view of another embodiment of a composite photoaccommodative IOL. FIG. 3 is a diagram illustrating steps of a light adjustment procedure. FIG. 2 illustrates an embodiment of a composite photomodulating IOL that includes a UV absorbing layer. FIG. 3 is a diagram showing a CLA/IOL including an attachment structure. FIG. 3 illustrates the formation of a counter-rotating toric pattern in an implanted and rotated toric CLA IOL. FIG. 3 illustrates the formation of a counter-rotating toric pattern in an implanted and rotated toric CLA IOL. FIG. 3 illustrates the formation of a counter-rotating toric pattern in an implanted and rotated toric CLA IOL. FIG. 4 illustrates the formation of a similar counter-rotating cylinder using a vector formulation. FIG. 4 illustrates the formation of a similar counter-rotating cylinder using a vector formulation. FIG. 4 illustrates the formation of a similar counter-rotating cylinder using a vector formulation. FIG. 3 is a diagram illustrating a method of adjusting a composite photoaccommodative IOL. It is a diagram showing a CLA/IOL for reducing chromatic aberration. It is a diagram showing a CLA/IOL for reducing chromatic aberration. FIG. 3 shows the color shift of the CLA IOL compared to the standard IOL. FIG. 3 illustrates a PCO suppression aspect of a chromatic aberration correction embodiment of a complex photoaccommodative IOL. FIG. 3 illustrates a PCO suppression aspect of a chromatic aberration correction embodiment of a complex photoaccommodative IOL. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes an adhesion promoter. FIG. 2 is a cross-sectional view of an embodiment of a composite photoaccommodative IOL. FIG. 2 is a cross-sectional view of an embodiment of a composite photoaccommodative IOL. FIG. 2 is a cross-sectional view of an embodiment of a composite photoaccommodative IOL. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulated IOL that includes adhesion promoters with different incorporations of adhesion promoters. FIG. 3 illustrates an embodiment of a composite photomodulating IOL that includes UV absorbing layers in different positions. FIG. 3 illustrates an embodiment of a composite photomodulating IOL that includes UV absorbing layers in different positions. FIG. 3 illustrates an embodiment of a hybrid photoaccommodative IOL in which the acrylic intraocular insert has a diffractive structure. FIG. 3 illustrates an embodiment of a composite photoaccommodative IOL in which the acrylic intraocular insert has a diffractive structure. FIG. 3 shows an IOL with a diffractive structure. FIG. 3 is a diagram showing a trifocal IOL. FIG. 3 is a diagram showing a trifocal IOL. FIG. 3 is a diagram showing a trifocal IOL. FIG. 3 is a diagram showing an IOL including a diffraction structure with suppressed diffraction peaks. FIG. 3 is a diagram showing an IOL including a diffraction structure with suppressed diffraction peaks. FIG. 3 illustrates an embodiment of a composite photoaccommodative IOL. FIG. 3 illustrates an embodiment of a composite photoaccommodative IOL. FIG. 3 illustrates an embodiment of a composite photoaccommodative IOL. FIG. 3 illustrates an embodiment of a composite photoaccommodative IOL with suppressed diffraction orders. FIG. 3 shows a composite photomodulable IOL with adhesion promoter. FIG. 3 shows a composite photoaccommodative IOL with an attachment structure. FIG. 3 shows a composite optically accommodative IOL with a lens in which diffracted light is adjustable.

Existing light-modulating intraocular lenses are often made of silicone-based polymers such as polysiloxanes and corresponding copolymers. Existing non-photoaccommodative intraocular lenses are often made of various acrylates. Problems (L) and advantages (B) of these two classes of IOLs include:

(L1) The elastic constants of silicone-based IOLs (herein referred to as "silicone IOLs") are often stronger or more robust than those of some other IOLs, and therefore these silicone IOLs are often "elastic" by comparison. As a result of this resiliency, the folded silicone IOL unfolds very quickly when pushed from the surgical inserter handpiece into the eye during the IOL implantation process. This rapid deployment of silicone IOLs can make it somewhat difficult for the surgeon to control insertion and proper positioning of the silicone IOL during surgery.

(B1) In contrast, acrylate-based IOLs (referred to herein as "acrylate IOLs") have softer elastic constants and therefore deploy more slowly during insertion. This feature allows the surgeon greater control over the insertion of the acrylate IOL.

(L2) Silicone IOL designs are often three-part, where the two haptics are fabricated separately and then inserted into the inner lens body. This design feature increases manufacturing costs, increases the rate of haptic misalignment during manufacturing, and can result in separation of the haptics from the IOL lens body during insertion.

(B2) In contrast, some acrylate IOLs address these issues by having a monolithic design that forms the monolithic haptics from the same lens material as the central lens body of the IOL and in the same molding step. There are things we are dealing with. Such a one-piece design is cheaper to manufacture, provides better alignment of the haptics with the lens body, and reduces the risk of separation of the haptics from the lens body during insertion.

However, currently known acrylate IOLs are not photomodulable. These non-photoaccommodative, often acrylate-based IOLs have their own drawbacks. These drawbacks include:

(L3) When planning cataract surgery, surgeons first carefully and extensively diagnose the cataractous eye. Based on this diagnosis, surgeons determine the optimal placement, alignment, and optical power of the IOL. However, as discussed above, the IOL often ends up deviating from its optimal, planned placement and, in some cases, becoming tilted or misaligned relative to the plan. This may be due to various causes such as variations in the development of ocular tissue after surgery.

(B3) Optically modulated IOLs provide an advanced solution to this problem of misplacement and misalignment. Once the IOL has been implanted and adhered to the lens capsule of the eye after surgery, post-operative diagnostics can be performed to identify unintentional misalignment and misplacement of the implanted IOL. The results of this post-operative diagnosis can be used to determine how to correct the IOL to compensate for misplacement and misalignment of the implanted IOL. This postoperative determination can be used to perform a photomodulation procedure that makes the determined IOL correction of the implanted photomodulation IOL.

(L4) The above problem of misalignment is particularly serious for toric IOLs whose implantation purpose is to eliminate the ocular cylinder. With toric IOLs, even an unintended 10° rotation of the axis of the toric IOL after implantation can result in an efficiency loss of approximately 30%. For example, even if the cylinder axis ultimately rotates by only 10 degrees during or after implantation, the nominal 3D cylinder power or power of the toric IOL may decrease to the effective 2D cylinder power or power.

(B4) Photomodulated IOLs can be implanted without any preformed toric cylinders. After implantation, once the IOL is settled and its inadvertent rotation has ceased, the surgeon can apply illumination to form a cylinder within the settled IOL and orient its axis precisely in the planning or target direction. Accordingly, photoaccommodative IOLs can avoid potential efficiency losses induced by unintentional misalignment of the cylindrical axis of toric IOLs.

In this document, we aim to combine the advantages (B1) to (B4) of the above two classes of IOLs and thus provide an eye that has the possibility of overcoming and avoiding the disadvantages (L1) to (L4) of each class of IOLs themselves. The inner lens will be explained. Further advantages of the various embodiments will also become clear below.

FIG. 1 shows an intraocular lens (IOL) 110, a light-accommodating lens (LAL) 120 attached to the intraocular lens 110, and haptics 114, also collectively referred to as haptics 114. 114-1 and 114-2. FIG. Haptics 114 can include various numbers of haptic arms. Embodiments including one, two, three or more haptic arms all have advantages. For the sake of brevity and specificity, the remaining description will be in terms of a compound photoaccommodative intraocular lens 100 that includes two haptic arms 114-1 and 114-2, although embodiments that include other numbers of haptic arms are also contemplated. It is understood to be within the scope of the overall description.

2A-2C and 3 are side views of an embodiment of a composite photoaccommodative intraocular lens 100, or CLA IOL 100. 2A-2C illustrate a CLA IOL 100 in which a photomodulating lens 120 can be attached to the proximal surface of the IOL 110. In this document, the terms "proximal" and "distal" are used in relation to light entering the pupil of the eye. Proximal indicates a position closer to the pupil. The illustrated embodiments differ in the manner in which haptics 114-1 and 114-2 (again collectively haptics 114) are attached to the components of CLA IOL 100.

FIG. 2A shows a CLA IOL 100 with haptics 114 attached to the IOL 110. For example, haptics 114 can be molded with IOL 110 as is the case with many acrylic or acrylate IOLs described above. These haptics 114 can be formed of the same acrylic material as the IOL 110 itself and can be molded in the same single step as the IOL 110 itself. As discussed above, such integrated haptics 114 are easy to manufacture, securely align with IOL 110, and are difficult to separate from IOL 110 during insertion.

FIG. 2B shows a CLA IOL 100 with haptics 110 attached to an optically accommodative lens 120. Finally, FIG. 2C shows a CLA IOL 100 in which haptics 114 are commonly attached to both the IOL 110 and the photoaccommodative lens 120.

FIG. 3 illustrates a CLA IOL 100 in which a light-accommodating lens 120 can be attached to the distal surface of the IOL 110. Both the ordering of photoaccommodative lens 120 and IOL 110 in FIGS. 2A-2C and the ordering of IOL 110 and photoaccommodative lens 120 in FIG. 3 have unique advantages.

In some embodiments, IOL 110 can be designed or selected to provide most or all of the intended optical power of CLA IOL 100. In such embodiments, the photoaccommodative lens 120 only allows for corrections and adjustments that the surgeon anticipates may be necessary after the CLA IOL 100 is bonded into the eye with some unintentional misalignment. can be designed to. Since the role of the optically adjustable lens 120 in such embodiments is only to enable correction of 1D to 2D optical power or cylindrical power, a non-complex type in which all optical power is produced by the optically adjustable material Lenses can be much thinner than photoaccommodative IOLs. Accordingly, embodiments of CLA IOLs that include only the corrective accommodative lens 120 may include a much thinner accommodative lens 120. Therefore, the adjustment and lock-in of the photomodulating lens 120 in such a CLA IOL 100 as described in connection with FIG. Safety can be increased.

The optically accommodating lens 120 can be designed to provide vision correction up to 2D, whereas in other embodiments it is only up to 1D. In some embodiments, either IOL 110 or photomodulating lens 120 can be a meniscus lens.

With respect to chemical composition, in acrylate embodiments, the IOL 110 can include monomers, macromers, or polymers, any of which are acrylates, alkyl acrylates, aryl acrylates, substituted aryl acrylates, substituted alkyl acrylates, vinyl, or Copolymers of combinations of alkyl acrylates and aryl acrylates can be included. In some IOLs 110, the alkyl acrylate can include methyl acrylate, ethyl acrylate, phenyl acrylate, or polymers and copolymers thereof.

In some embodiments, the chemical composition of IOL 110 can include a partial blend of the chemical composition of photoaccommodative lens 120. Such an IOL 110 may include silicone-based monomers or macromers forming polymers or copolymers, including acrylates, alkyl acrylates, aryl acrylates, substituted aryl acrylates, substituted alkyl acrylates, vinyl, or copolymers of combinations of alkyl acrylates and aryl acrylates, and optionally crosslinks. It is better to include an agent.

In some embodiments, the monomers, macromers, or polymers of IOL 110 can have functional groups that can include hydroxy, amino, vinyl, mercapto, isocyanate, nitrile, carboxyl, or hydride. Functional groups can be cationic, anionic or neutral.

In some embodiments, the light modulating lens 120 can include a first polymer matrix and a refractive modulating composition dispersed within the first polymer matrix, the refractive modulating composition having a light modulating composition. Stimulus-induced polymerization that modulates the refraction of the formula lens 120 is possible. The first polymer matrix can include a siloxane-based polymer formed from macromers and monomer building blocks that include alkyl or aryl groups.

In some embodiments of the composite photoaccommodative intraocular lens 100, the first polymer matrix comprises acrylates, alkyl acrylates, aryl acrylates, substituted aryl acrylates, substituted alkyl acrylates, vinyl, and combining alkyl acrylates and aryl acrylates. may include partial mixing of at least one of the copolymers. These can form at least one of a polymer and a copolymer with the compounds of the first polymer matrix.

The embodiments described above in which IOL 110 includes a partial blend of the materials of photoaccommodative lens 120 and the embodiments described above in which photoaccommodative lens 120 includes a partial blend of the materials of IOL 110 are compatible with the materials of lenses 110 and 120. By increasing the strength, the CLA IOL 100 can be configured to have increased mechanical, physical, and chemical robustness.

Embodiments of the light-modulating lens 120 may also include a photoinitiator to absorb refraction-modulating illumination and become activated upon absorption of the illumination to initiate polymerization of the refraction-modulating compound. In some embodiments, the photoinitiator of phototunable intraocular lens 120 can also include a UV absorber.

Embodiments of the light-accommodating lens 120 are disclosed in U.S. Patent No. 6,450,642 to J. M. Jethmalani et al. of post-fabrication power modification), which is hereby incorporated by reference and incorporated herein by reference.

FIG. 4 shows four steps 101a-101d of the process of modifying the refractive properties of the light-adjustable lens 120 by means of illumination. Very briefly, in step 101a, a light-modulating lens 120 comprising a matrix and a photosensitive macromer formed from a suitable material such as silicone is formed into a lens having a radial profile. Illumination by controlled light.

In step 101b, exposure to modulating light causes the photosensitive macromer to polymerize, the radial profile of which is determined by the radial profile of the modulating light.

In step 101c, unpolymerized macromer diffuses into the central region where the photosensitive macromer has already been photopolymerized. This causes the central region of the light-adjustable lens 120 to expand. (In a complementary process in which the radial profile of the illumination light becomes stronger toward the peripheral annulus of the light-tuning lens 120, unpolymerized macromer diffuses outward toward the peripheral annulus and expands this peripheral annulus.) )

Furthermore, in step 101c, after this expansion, a lock-in light with an essentially uniform radial profile and even higher intensity can be applied to polymerize any remaining macromer. In step 101d, this lock-in causes the light-adjustable lens 120 to reach a shape with light-adjusted refractive power by expanding its center and stabilize this shape. The above is only a very brief summary of light-adjustable lenses and their light-adjustment procedures. Further details are provided in US Pat. No. 6,450,642 to J.M. Jethmalani et al.

In some embodiments, IOL 110 and photomodulating lens 120 are adapted to maintain chemical separation after installation. This chemical separation can be achieved, for example, by employing a refractive modulating composition in the photomodulating lens 120 that is not soluble in the material of the IOL 110, such that this composition is present in the first part of the photomodulating lens 120 itself. Despite the movement of its constituent macromers within the polymer matrix, they do not diffuse from the light modulating lens 120 into the IOL 110.

As mentioned above, one of the advantages of combining the IOL 110, which is preferably made of acrylic (acrylic acid resin), and the light-adjustable lens 120, which is preferably made of silicone, is the elasticity of the acrylic IOL 110. The advantage is that the constant can be made more flexible than the corresponding elastic constant of the silicone optically adjustable lens 120. In the CLA/IOL 100 in which the IOL 110 is significantly more flexible than the photoaccommodative lens 120, the "elasticity" of the entire CLA/IOL 100 can be significantly weakened compared to the elasticity of the photoaccommodative lens 120 alone. Such a CLA IOL 100 can be inserted with substantially improved control and predictability during cataract surgery, thus improving surgical outcomes.

As discussed with respect to FIG. 4, in some embodiments, the refractive properties of the light-modulating lens 120 are modified by applying ultraviolet (UV) illumination. For safety reasons, the applied UV illumination should be prevented from reaching the retina of the eye, or at least the intensity of its transmitted component should be significantly attenuated. To this end, some embodiments of CLA IOL 100 can include UV absorbers. There are several different designs for including UV absorbers.

In some embodiments, a UV absorber can be associated with the light-modulating lens 120. FIG. 5 shows that in some designs, a UV absorbing layer 130 can be formed on the distal surface of the light modulating lens 120. In another embodiment, ultraviolet absorbing material can be dispersed throughout the light-tuning lens 120. In some cases, a UV absorbing layer 130 may also be formed on the proximal surface of the light control lens 120.

In another design, a UV absorber can be associated with the IOL 110. Because UV light needs to reach the photoaccommodative lens 120 for the accommodation procedure, in such embodiments the UV absorber within the IOL 110 does not prevent the UV illumination from reaching the photoaccommodative lens 120. Additionally, a photomodulating lens 120 can be attached to the proximal surface of IOL 110. With such an arrangement, in some embodiments, the UV-absorbing material can be dispersed throughout the IOL 110, and in other embodiments, the CLA IOL 100 can include the UV-absorbing layer 130. Either design is possible because the UV-absorbing layer 130 is located distally to the photomodulating lens 120, whether on the proximal or distal surface of the IOL 110. be.

In embodiments of the composite photoaccommodative intraocular lens 100, the photoaccommodative lens 120 can be attached to the IOL 110 in a variety of designs. In some examples, the light-modulating lens 120 can be formed by a chemical reaction, a heat treatment, a lighting treatment, a polymerization process, a molding step, a curing step, a lathing step, a low temperature lasing step, a mechanical process, the application of an adhesion promoter, or can be attached to IOL 110 by any combination of these methods.

FIG. 6 shows that some embodiments of the CLA IOL 100 can include an attachment structure 135 for attaching the photomodulating lens 120 to the IOL 110. The mounting structure 135 can include, among other things, a cylinder, a ring, an open tab, or a clasp into which an optical element can be inserted. Such a structure can have multiple advantages.

(a) For example, the CLA IOL 100, including the attachment structure 135, can be modular. This may be advantageous for pre-operative purposes as the surgeon may need to maintain much less inventory. When the surgeon determines which IOL 110 needs to be paired with which light-adjustable lens 120 through preoperative diagnosis, the surgeon selects the separately stored IOL 110 and the separately stored light-adjustable lens 120; CLA IOL 100 can be assembled by inserting the two selected lenses into mounting structure 135.

(b) This modularity can also be advantageous post-operatively. If, for whatever reason, it is determined that the choice of IOL 110 is not optimal at the end of cataract surgery, if a non-modular CLA IOL 100 is used, the surgeon can reopen the eye and include the expanded haptics 114. It is necessary to remove the entire implanted CLA/IOL 100. Removal of such an entire IOL is a considerable challenge and can lead to undesirable medical outcomes such as breakage of haptic components.

In contrast, if the modular CLA IOL 100 had been implanted, the surgeon would not have to remove the entire CLA IOL 100 when the eye reopened, but would only remove the non-optimal IOL 110 to ensure a good selection. It is only necessary to replace it with the IOL 110 that has been replaced. This procedure avoids the need to remove the entire CLA IOL 100, thus reducing the risk of undesirable medical outcomes. Another medical advantage is that because only a portion of the IOL is replaced, the incisions typically required for such replacement procedures may be shorter.

(c) Finally, IOLs containing elongated structures have advantages in relation to reducing posterior capsular opacification, or PCO. This point will be discussed in more detail below with respect to FIGS. 12A and 12B. The length of the CLA IOL 100, including the attachment structure 135, can be as long as desired by the surgeon.

In embodiments of the CLA IOL 100, the IOL 110 can be an advanced complex IOL, such as a multifocal IOL, an aspheric IOL, a toric IOL, or a diffractive IOL. Such advanced IOLs provide not only refractive power correction but also vision correction. These IOLs help reduce presbyopia, astigmatism, cylinder power, or other types of aberrations. However, for these advanced IOLs to perform well, they must be placed with greater precision than usual. If the final misplacement or misalignment of the implanted IOL is discovered at the end of cataract surgery or afterward, the visual improvement and benefit may be significantly inferior to the expected outcomes for the patient. There is a risk that it will become something. The fact that such unintentional misalignment and rotation occurs in a significant proportion of cataract surgeries is a major reason for limiting widespread market acceptance of such advanced IOLs.

In contrast, the optically accommodative lens 120 of the CLA IOL 100 is capable of correcting misalignment or rotation if the CLA IOL 100 is misplaced, misaligned, or rotated relative to the intended intraocular position, angle, or orientation. It can be adjusted to compensate for rotation. Therefore, the CLA IOL 100 may reliably bring the expected visual acuity improvement to the patient. This advantage of the CLA IOL 100 could lead to rapid expansion of market acceptance and market share for advanced IOLs.

In some other embodiments, insertion of the embodiment of FIG. 6 may be facilitated by making the attachment structure 135 a fluid-filled structure rather than a rigid structure. Such a fluid-filled attachment structure 135 may be inserted into the eye in an unfilled form and filled with fluid only after insertion. In some embodiments, a UV absorbing layer 130 can also be provided on the distal surface of the light-modulating lens 120.

7A-7C and FIGS. 8A-8C and 9 illustrate the above general considerations for a CLA IOL 100, including a toric IOL 110, for the purpose of correcting the cylindrical power of the eye.

FIG. 7A shows that a surgeon has decided to implant a CLA IOL 100 including a toric IOL 110 to compensate for the cylindrical power of the eye, and that the target toric axis 202 is vertically aligned in the plane of FIG. 7A for simplicity and clarity. Figure 2 depicts a surgical situation planned to be oriented in a direction selected to be oriented. Toric IOLs often include an axis marker 203 to indicate the direction of the toric axis to the surgeon.

Figure 7B shows that after cataract surgery is completed and the incision is closed, the implanted CLA/IOL 100 may rotate for various reasons, and as a result, the implanted CLA/IOL 100 rotates after the implant. The figure shows a state in which the toric axis 204 forms an unintended rotation angle α with the target toric axis 202.

FIG. 7C shows that the surgeon creates and performs an illumination procedure on the photomodulating lens 120 of the CLA IOL 100 to create a counterrotating toric pattern 206, thereby causing a counterrotation of the entire toric axis, resulting in a photomodulating procedure. A state in which the later corrected toric axis 208 now points in the same direction as the originally planned target toric axis 202 is shown.

FIG. 8A shows the same procedure for the levels of cylindrical patterns 212-218. A surgeon in the preoperative planning stage of cataract surgery determines that a patient's cylindrical vision problem should be treated by implanting a CLA IOL 100 that includes a toric IOL 110 with a target cylindrical pattern 212 oriented as shown. be able to. However, after implantation, the CLA IOL 100 is unintentionally rotated by the implanted and rotated cylinder 214. Such misaligned and rotated cylinders 214 significantly reduce visual acuity improvement, as discussed above. An implanted and rotated cylinder 214 may have a net negative effect as the angle of rotation increases, causing more discomfort and disorientation to the patient than benefit.

To compensate for this undesirable medical outcome, the surgeon performs a post-operative diagnostic procedure to determine and implement a corrective counter-rotating cylinder 216 to prevent unintended and undesired rotation of the CLA IOL 100. Can be corrected. As shown, the surgeon may perform a photomodulation procedure on the photomodulation lens 120 of the CLA IOL 100 to form a counter-rotating cylinder 216 within the photomodulation lens 120. When the implanted rotated cylinder 214 and the counter-rotated cylinder 216 overlap, they form a light modulating lens having a corrected cylinder 218 with an orientation that matches the originally planned orientation of the target cylinder 212. Can be done. These steps are similar to those of FIGS. 7A-7C described above.

FIG. 8B illustrates the same procedure in geometric terms, representing the cylindrical pattern by the corresponding vectors. The direction of the vector indicates the direction of the cylinder being represented, and the magnitude of the vector can represent the strength, curvature, or diopter of the cylinder. Target toric vector 222 represents the target cylinder 212 and implanted rotated toric vector 224 represents the implanted rotated cylinder 214 of the post-implanted CLA IOL 100. As discussed above, the surgeon can postoperatively determine the counter-rotating toric vector 226 that represents the counter-rotating cylinder 216 necessary to correct for unintended post-operative rotation of the toric IOL 110. When a surgeon performs a photomodulation procedure that uses counter-rotating toric vector 226 to adjust a photoaccommodative lens, the overlap of rotated toric vector 224 and counter-rotating toric vector 226 after implantation causes the target toric vector to be adjusted. The corrected toric vector 228 is restored to have the same direction and magnitude as 222.

FIG. 8C shows in vector representation terms that there are different ways to effect the necessary correction. For example, the correction pattern may include a reductional toric vector 227 that reduces or eliminates the implanted and rotated toric vector 224. The counter-rotated toric vector 226 can then be selected to rotate the remaining portion of vector 224 (equal to the sum of vectors 224 and 227) into a corrected toric vector 228.

In an illustrative example, in an embodiment of a CLA IOL 100 that includes a toric IOL 110 for correction of cylinder power higher than 2D, the photoaccommodative lens 120 can be adapted to correct cylinder power up to 2D. For example, if a toric IOL 110 was intended to correct a 6D cylinder power, but the toric axis rotated by 10 degrees, this would lead to a 30% loss in efficiency as discussed above, which would result in a net benefit to the patient. Only a 4D cylinder power improvement is provided. However, the surgeon can perform an optical conditioning procedure on the optically adjustable lens 120 to correct for the lost 2D cylinder power due to unintended rotation, thereby achieving the full expected degree for the patient. It is also possible to restore the 6D cylinder power.

FIG. 9 illustrates in more general terms the steps of a corresponding method 230 for conditioning an implanted complex photoaccommodative intraocular lens 100. Method 230 may include the following steps.
231: Planning the target visual outcome of implanting a complex photoaccommodative intraocular lens in the eye.
232: Implanting a complex photoaccommodative intraocular lens into the eye.
233: Performing diagnostic measurements to assess implant visual outcomes of the implant.
234: Determining a correction based on a comparison of the planned visual outcome and the implanted visual outcome.
235: Applying a stimulus to adjust the optical properties of the complex photoaccommodative intraocular lens to cause the determined correction.

In the procedure described in connection with FIGS. 7A-7C and 8A-8C, the target visual outcome is the target cylinder axis 202/212/222 and the implanted visual outcome is the implanted rotated cylinder axis 204/214. /224 and the correction determined is a counter-rotating cylinder axis 206/216/226. These steps may adjust the implanted and rotated cylinder axis 204/214/224 to a corrected cylinder axis 208/218/228 that is closely related to the target cylinder axis 202/212/222.

10-11 now illustrate an embodiment of a CLA IOL 100 that provides the additional medical benefit of reduced chromatic aberration. This embodiment assumes that the optical system of the eye, whose main components are the cornea and the lens, is such that the effective refractive index n _e of the ocular tissues involved depends on the wavelength of the light, i.e. n _e = n _e (λ). It is developed starting from the observation that chromatic dispersion is exhibited by chromatic dispersion. It has been found that the derivative of n _e (λ) is typically negative, ie ∂n _e /∂λ<0. Therefore, the refractive power P _e of the eye, which is proportional to ( _ne −1), also has a negative derivative with respect to wavelength, ie ∂P _e /∂λ<0. Even in a healthy person with 20/20 visual acuity, this chromatic dispersion of the ocular tissue causes the short wavelength ("blue") component of the image to be focused proximal to the retina, while the long wavelength ("red") component is focused proximal to the retina. ”) component is focused distally on the retina, which causes a degree of blurring and a reduction in image quality. This blurring of the color components of an image is often called chromatic aberration.

The human brain has learned to accept this chromatic aberration to some extent. Nevertheless, cataract surgery may be an additional medical step by implanting an achromatic IOL that compensates for the eye's unique chromatic aberration and images all wavelength components onto the retina, reducing chromatic aberration and sharpening vision. potential benefits.

The wavelength dependence of the refractive index is often characterized by the Abbe number defined as V = (nD-1)/(nF-nC), where nD, nF and nC are 589 and 486, respectively. and the refractive index in the Fraunhofer D, F and C spectral lines at 656 nm. Most Abbe numbers are within the range of 20-90. Abbe numbers are in the range of 50-60 for corneal and lens tissues. The refractive power P _l of an intraocular lens depends on the refractive index n _l (λ) through the lens manufacturer's equation P _l = (n _l -1) (1/R _l -1/R ₂ ), where R _l and _R2 are the radii of curvature of the two surfaces of the intraocular lens. Therefore, the λ dependence of n _l also makes the refractive power P _l of the intraocular lens dependent on the wavelength λ, ie P _l =P _l (λ). Note that this dependence also affects the sign of the refractive power of the lens. For a positive power lens, a negative ∂n _l /∂λ<0 typically results in a negative ∂P _l /∂λ<0, whereas for a negative power lens, a negative ∂n _l /∂λ <0 yields a positive ∂P _l /∂λ>0.

With these prefaces, an intraocular lens has chromatic aberration when the wavelength differential of its refractive power becomes ∂P _l /∂λ+∂P _e /∂λ≒0 by compensating for the negative wavelength differential of the eye's refractive power. can be compensated. In other words, ∂P _l /∂λ≒−∂P _e /∂λ>0.

By the way, a normal (non-diffractive) intraocular lens provides a positive refractive power P _l of about 20 D, so in the light of the introduction these ∂P _l /∂λ are negative, and ∂P _e /∂ Since λ is also negative, it is not possible to compensate for the chromatic aberration of the eye itself.

However, embodiments of CLA IOL 100 are formed from two different lenses: IOL 110 and photoaccommodative lens 120. Such a two-lens design offers genuinely new possibilities. One of the lenses of the CLA-IOL 100 can have negative refractive power and therefore a positive ∂P/∂λ>0 in intensity, so that the combined two-lens CLA-IOL 100 compensates for the chromatic aberration of the eye's optical system. While possible, the combined refractive power of the two lenses can still perform the primary function of an intraocular lens and yield approximately 20D. In the formula, the refractive power P _l,1 of the first lens and the refractive power P _l,2 of the second lens of the two-lens CLA/IOL 100 can simultaneously satisfy the following two relationships.
P _l,1 +P _l,2 =20D (1)
∂P _l,1 /∂λ+∂P _l,2 /∂λ≒−∂P _e /∂λ>0 (2)

In some detail, FIGS. 10A and 10B illustrate an embodiment of a CLA IOL 100 that provides such reduced chromatic aberration. Conventionally, in such compound lenses, the negative power lens is often referred to as a "flint" and the positive power lens is referred to as a "crown." If the compound lens itself exhibits near-zero chromatic aberration, the CLA/IOL 100 can be called an "achromat."The compound lens forms a larger aggregate, such as the CLA/IOL 100 plus the eye. CLA IOL 100 can be referred to as an "achromator" if it exhibits near zero chromatic aberration.

FIG. 10A shows an embodiment in which the IOL 110 with negative optical power P _IOL <0 is a flint and the light-accommodating lens (LAL) 120 with positive optical power P _LAL >0 is a crown. FIG. 10B shows a reverse embodiment in which IOL 110 has a positive optical power P _IOL >0 and photoaccommodative lens 120 has a negative optical power P _LAL <0.

The magnitude of ∂n/∂λ, |∂n/∂λ|, is relatively high for PMMA and generally low for silicone. Accordingly, embodiments of the CLA IOL 100 include the design of FIG. 10A, where the negative power IOL 110 is formed of PMMA or other acrylate or the like, and the positive power optically accommodating lens 120 is formed of silicone. can effectively reduce chromatic aberration. In this embodiment, the high |∂n/∂λ| PMMA IOL 110 can be given a low negative optical power, such as P _IOL ≈-10D, and the low |∂n/∂λ| silicone LAL 120 can provide a high refractive power of P _LAL ≈+30D, so the combined refractive power of the entire CLA IOL 100 is:
P _IOL + P _LAL ≒ +20D (3)

On the other hand, at the same time, the CLA IOL 100 can also compensate for the chromatic aberration of the eye as follows.
∂P _IOL /∂λ+∂P _LAL /∂λ≒−∂P _e /∂λ (4)

Such a CLA IOL 100 provides an overall optical power of approximately 20 D, while the combined wavelength derivatives of the optical powers of the IOL 110 and LAL 120 largely compensate for the chromatic aberrations of the eye's optics, thereby making the CLA IOL 100 implantable. The overall chromatic aberration of the posterior eye can be substantially reduced. (Here, the "optical system of the eye" primarily refers to the cornea, since the crystalline lens has been removed during cataract surgery.)

FIG. 11 is a diagram explaining the above concept in terms of color shift. The color shift characterizes the distance of the image from the target/image plane (from the retina in the case of the eye) and is expressed in diopters. A negative color shift indicates that the image was formed proximally to the front of the retina, whereas a positive color shift indicates that the image was formed distally to the back of the retina. Therefore, a color shift that increases with wavelength represents a decrease in optical power with wavelength, ie, ∂P/∂λ<0.

FIG. 11 shows that the natural eye optics alone increases the color shift consistent with ∂P _e /∂λ<0. Typically, one component, IOL 110 alone, will increase the color shift consistent with ∂P _IOL /∂λ<0. The dashed line for "composite photoaccommodative IOL" indicates that when the chromatic aberration compensation embodiment of CLA IOL 100 is implanted in the eye, the system that combines CLA IOL 100 and the eye produces minimal color shift and chromatic aberration. Show that you can demonstrate your abilities.

Thus, in embodiments of the CLA IOL 100, the IOL 110 has the color shift variation of an IOL, the photoaccommodative lens 120 has the color shift variation of a photoaccommodative lens, and the lens-removed eye has the color shift variation of the eye. , the color shift variation in the eye implanted with the complex photoaccommodative intraocular lens 100 can be smaller than the color shift variation in the eye with the crystalline lens in place, where the color shift variation is It is defined from the difference in color shift at 450 nm and 650 nm.

In embodiments of the CLA IOL 100, the refractive power of the IOL 110 can be negative and the refractive power of the photoaccommodative lens 120 can be positive, such that a complex photoaccommodative intraocular lens is implanted and Color shift variations can be less than 0.5D. In other embodiments, this color shift variation may be less than 0.2D. In an eye implanted with such an Achromata CLA IOL 100, an additional apparent medical advantage is that vision is improved in a further aspect by the fact that the image blur due to chromatic dispersion is substantially smaller than that of the natural eye. It can become clear.

Technical ideas regarding achromata IOLs, including related aspects, are provided by E. J. Fernandez and P. Artal, Achromatic Doublet Intraocular Lens for Full Aberration Collection. "Achromatic doublet intraocular lens for full aberration correction", published in Biomedical Optics Express, Volume 8 (2017), page 2396, which is hereby incorporated by reference. The contents herein are incorporated herein by reference. Although this article is helpful in several respects, it does not specifically address aspects of the photomodulatory function of the relevant IOL. Adapting the technology of this paper to light-adjustable lenses requires more advanced technical thinking.

12A and 12B illustrate further medical advantages of the CLA IOL 100, particularly where the IOL 110 or photoaccommodative lens 120 has negative refractive power and therefore has very long sides 142 and sharp IOL edges 144. It shows. In such embodiments, the sharp IOL edge 144 can be pressed against the lens capsule 15 of the eye into which it is inserted with a force that is greater than the force that would push against a single component, the intraocular lens.

This increased force provides the following notable medical benefits: Posterior capsule opacification, PCO, is one of the well-known negative outcomes or complications of cataract surgery. PCO is caused by growth and abnormal proliferation of lens epithelial cells (LECs) in the posterior capsule. Most PCOs are fibrous or nacreous, or a combination thereof. PCO can be detected clinically, for example, as a wrinkle in the posterior capsule. The development of PCO often involves three basic events: proliferation, migration, and differentiation of residual LECs.

Although various drug solutions have been developed to reduce PCO, the formation of a sharp mechanical barrier in contact with the lens capsule 15 has also been shown to reduce PCO. Such barriers alleviate PCO by suppressing fiber growth and reducing LEC movement.

In embodiments of the CLA IOL 100, the achromatic flint lens has a very long side 142 due to its negative refractive power, and therefore the side is longer than the center so that the sharp IOL edge 144 is very long. It is pressed against the lens capsule 15 with a large force. Therefore, the achromat embodiment of CLA IOL 100 exhibits the additional medical benefit of reducing PCO.

12A and 12B show that there may be multiple combinations and designs of the CLA/IOL 100 that press against the lens capsule 15 with a force greater than normal. For example, the order of IOL 110 and photoaccommodative lens 120 can be reversed. In other embodiments, the flint material and crown material can be interchanged. A CLA IOL 100 with a distal crown lens, ie, a crown lens close to the retina, can advantageously exhibit low aberrations because the shape of its most distal surface is closest to the shape of the retina. In contrast, if the flint is closer to the retina, the most distal surface will be substantially different from the surface of the retina, thus producing high aberrations.

Yet another medical advantage of these CLA IOLs 100 that include a long profile is that the high compression force causes high capsular tension. This high capsular tension tends to stabilize the location and axis of the CLA IOL 100 better than the lower capsular tension caused by a flat standard IOL, thereby causing the CLA IOL 100 to tilt or behave differently. This can prevent misalignment.

The longer IOL side 142 may require the creation of a larger or longer surgical incision. Furthermore, this may lead to unintended astigmatism after cataract surgery. However, in embodiments of the CLA IOL 100, the photoaccommodative lens 120 can be adjusted post-surgery, thereby effectively compensating for and eliminating this astigmatism by applying an astigmatism-compensating photoadjustment procedure to the photoaccommodative lens 120. can do.

FIG. 13 shows an embodiment of a composite photoaccommodating intraocular lens 100, which includes an acrylic intraocular insert 110', an adhesion promoter 300, and an acrylic intraocular insert 110'. It has a silicone-based light adjusting lens 120 attached to the lens 110', and haptics 114-1 and 114-2. In embodiments, the adhesion promoter 300 includes a first orthogonal functional group configured to bind to the acrylic component of the acrylic intraocular insert 110' and the silicone phototunable lens 120, as described in detail below. The silicone component may include a second orthogonal functional group configured to bond with the silicone component. For brevity, silicone light adjustable lens 120 may be abbreviated as light adjustable lens 120, or LAL 120, in some parts of the description and in the drawings.

Acrylic intraocular insert 110' may include an intraocular lens (IOL) 110 with refractive power and may be considered one embodiment of IOL 110. In some cases, the acrylic intraocular insert 110' may include a carrier with near zero refractive power, and conversely, the intraocular lens (IOL) 110 may be inserted into the acrylic intraocular insert with or without refractive power. 110'.

These embodiments demonstrate that the two main components of the composite photomodulating IOL 100, the acrylic intraocular insert 110' and the silicone photomodulating lens 120, are chemically bonded to each other and peeled off after implantation and the photomodulating procedure. Contains an adhesion promoter 300 to prevent any build-up.

Attachment of acrylic IOLs by chemical means around the edges of silicone frames or to silicone biasing elements for presbyopic applications has been described above. However, there are at least the following differences between these IOLs and the CLA/IOL 100 currently being described.

(1) The optical or viewing element in an IOL has an unchanging, fixed shape. Therefore, strain and tension at the acrylic-silicone joint can be minimized by a suitable fabrication process. Additionally, IOLs with substandard joints may be discarded as part of quality control during the fabrication process. This essentially changes the shape of the acrylic intraocular insert 100' while the photomodulating procedure changes the shape of the silicone photoaccommodative lens 120 after implantation, as detailed in FIGS. 14A-14C. In contrast to embodiments of CLA IOL 100, which remain unchanged. In these CLA IOLs 100, the photomodulation procedure induces shear and stress in the silicone-acrylic joint after implantation, potentially even causing these two elements to separate from each other. Since the amount of accommodation varies from patient to patient, photo-induced stresses and tensions cannot be minimized by appropriate fabrication processes prior to implantation. Instead, the silicone-acrylic joint needs to be stress resistant and withstand photo-induced tension to the extent necessary, including the fact that the silicone photoaccommodative lens 120 can act as a result of photoaccommodation in the acrylic eye. This includes resisting the tendency to delaminate from the inner insert 110'. This is a particularly demanding expectation since an implanted CLA IOL 100 with detached components cannot be discarded.

(2) For most of the IOLs described above, the silicone forms the frame or biasing element, or is positioned around the edges of the acrylic IOL. In such IOLs, the silicone-acrylate interface is not in the optical path, so the requirements for the silicone-acrylic junction are not significant in order to avoid compromising image quality. In contrast, in embodiments of the CLA IOL 100, the silicone-acrylic interface is in the optical path, and thus the entire interface is exposed to light that induces tension and strain at the silicone-acrylic interface. Despite the adjustment procedure, it is expected that light will be transmitted without distortion. The two considerations discussed above demonstrate significant differences between conventional designs and embodiments of CLA IOL 100.

14A-14C illustrate issue (1) discussed above regarding the difference of the now described CLA-IOL 100 from conventional systems, which is accentuated by the photoaccommodative properties of the silicone LAL 120. FIG. 14A shows the application of refractive modulated illumination of CLA IOL 100. FIG. 14B shows that silicone LAL 120 of CLA IOL 100 changes its shape in response to this illumination. The illustrated case shows a light modulation scheme that increases the optical power of the silicone LAL 120, where the radius of curvature of the anterior surface is decreased, whereas the radius of curvature of the posterior surface is often increased. Optical modulation schemes that reduce optical power induce the opposite change in curvature. FIG. 14C is an enlarged view of a portion of the interface between acrylic intraocular insert 110' and silicone LAL 120. The refractive modulated illumination causes a change in curvature of the silicone LAL 120 and a lateral shearing action 111 that causes the silicone LAL 120 to detach from the acrylic intraocular insert 110', thus potentially inducing a septum 112. Therefore, in contrast to IOLs with fixed-geometry elements, refractive modulated illumination inevitably induces tension and strain at the interface of the acrylic intraocular insert 110' and the silicone LAL 120. This strain and tension is only induced after the fabrication process and after implantation, and thus it cannot be eliminated by fabrication changes. Thus, the CLA IOL 100 is constructed with sufficient strength to prevent separation of the acrylic intraocular insert 110' and the silicone LAL 120 despite the tension and strain induced by shape changes caused by refractive modulated illumination. An adhesion promoter 300 is required to chemically bond the surfaces.

15A and 15B show that, as before, in some embodiments of a composite light adjustable intraocular lens 100 or a CLA/IOL 100, haptics 114-1, 114-2 are In other embodiments, haptics 114-1/114-2 may be part of acrylic intraocular insert 110'; The haptics 114-1/114-2 can be attached to the silicone photoaccommodative lens 120, and finally, in some CLA IOLs 100, the haptics 114-1/114-2 can be attached to the acrylic intraocular insert 110'. It is shown that it can be attached to both silicone optically adjustable lenses 120.

13-17 illustrate embodiments of a CLA IOL 100 in which a silicone photoaccommodative lens 120 is attached proximally to an acrylic intraocular insert 110', i.e., positioned near the cornea of the eye. .

Just like IOL 110, embodiments of acrylic intraocular insert 110' include acrylic intraocular inserts that include acrylates, alkyl acrylates, aryl acrylates, substituted aryl acrylates, substituted alkyl acrylates, halogen-substituted acrylates, halogen-substituted methacrylates, acrylic esters. or at least one of monomers, macromers, oligomers, and polymers selected from the group consisting of acrylic acid, acrylamide, vinyl, and copolymers of combinations of alkyl acrylates and aryl acrylates. For some CLA IOL 100, the monomers mentioned above include methyl acrylate, ethyl acrylate, ethylhexyl acrylate, phenyl acrylate, ethyl methacrylate, trifluoroethyl acrylate, trifluoroethyl methacrylate, n-butyl acrylate, hydroxyethyl acrylate, hydroxymethyl acrylate. , n-vinylpyrrolidone, phenoxyethyl acrylate, or polymers or copolymers thereof.

In addition, a corresponding bis- or multifunctional crosslinking agent may be present to aid in polymerization. For some CLA IOLs 100, the crosslinking agents may be ethylene glycol dimethacrylate, tetraethylene glycol dimethacrylate, propylene glycol dimethacrylate, and propylene glycol diethacrylate. Furthermore, the cross-linked network may be induced by thermal, UV-initiated or catalytically promoted reactions. For some CLA IOL 100, the thermal initiators include 2,2-azobis(2,4-dimethylpentanitrile), 2,2-azobis(2,4-dimethylbutanenitrile), azobisisobutyro-nitrile , azobisisopropionitrile, or azobisisomethylpropionitrile. For some CLA IOLs 100, the photoinitiator may be benzophenone, benzoin alkyl ether, benzyl ketal, phosphine oxide, acyl oxime ester, acetophenone or acetophenone derivative.

As discussed above with respect to FIG. 4, the silicone light modulating lens 120 may be comprised of a first polymer matrix and a refraction modulating composition dispersed within the first polymer matrix, the refraction modulating composition comprising: Stimulus-induced polymerization that modulates the refractive index of silicone phototunable lens 120 is possible. The first polymer matrix may include a siloxane-based polymer formed from macromer and monomer building blocks with at least one of an alkyl group and an aryl group.

Additionally, the CLA IOL 100 may include a photoinitiator that is activated upon absorption of the refractive modulating illumination and configured to initiate stimulus-induced polymerization of the refractive modulating composition. To provide protection and safety, CLA IOL 100 may include UV absorbers.

16A and 16B illustrate various ways in which adhesion promoter 300 can be incorporated into CLA IOL 100. FIG. 16A shows that in some CLA IOLs 100, adhesion promoter 300 may be dispersed within acrylic intraocular insert 110'. FIG. 16B shows that in some CLA IOLs 100, an adhesion promoter 300 may be dispersed within the adhesive layer 310 between the acrylic intraocular insert 110' and the silicone photoaccommodative lens 120. ing. Finally, in some CLA IOLs 100, the adhesion promoter 300 may be dispersed within the silicone photoaccommodative lens 120. In some embodiments, adhesion promoter 300 may be distributed within some combination of the embodiments of FIGS. 17A-17C.

17A-17C illustrate these same embodiments with intermixing in a somewhat different manner. FIG. 17A shows that the adhesion promoter 300 is primarily dispersed within the acrylic intraocular insert 110' and is bonded to the silicone LAL 120 by a silicon-carbon covalent bond 320 and bonded to the acrylate of the acrylic intraocular insert 110' by a bond 322. 16B shows the embodiment of FIG. 16A coupled to the FIG. The circled area is a schematic representation of a first orthogonal functional group configured to couple with the acrylic component of the acrylic intraocular insert 110' by bond 322. The triangle is a schematic representation of a second orthogonal functional group configured to bond to the silicone component of the silicone photomodulating lens 120 by a covalent bond 320. Both orthogonal functional groups, shown schematically as circles and triangles, are selected to uniquely bond with their complementary counterparts. FIG. 17B shows that the adhesion promoter 300 is primarily dispersed within an adhesive layer 310 that is bonded to the silicone LAL 120 by a covalent chemical bond 320 and to the acrylate of the acrylic intraocular insert insert 110' by a bond 322. 16B shows the embodiment of FIG. 16B combined. FIG. 17C shows an embodiment in which the adhesion promoter 300 is primarily dispersed within the silicone LAL 120 and is bonded to the silicone LAL 120 by a covalent chemical bond 320 and to the acrylate of the acrylic intraocular insert 110' by a bond 322. It shows.

を有するのがよく、Ｒ₃、Ｒ₃′及びＲ₃″のうちの少なくとも１つは、次の構造式（２）、すなわち

を有するビニルジアルキルシロキシペンダント基であり、
Ｒ₃、Ｒ₃′及びＲ₃″の残りのものは、Ｃ１‐Ｃ１０ペンダントアルキル基、例えば、メチル、エチル、ｎ‐プロピル、イソプロピル、シクロプロピル、ｎ‐ブチル、ｓｅｃ‐ブチル、ｔ‐ブチル、シクロブチル、又はメチルシクロプロピルからなる群から独立して選択され、
第１の直交官能基は、Ｒ₂の左に導入された官能基であり、
第２の直交官能基はＲ₆であり、
Ｒ₁は、水素、１価の炭化水素基、及び置換Ｃ１‐Ｃ１２アルキルから成る群から選択され、アルキルは、メチル、エチル、ｎ‐プロピル、イソプロピル、シクロプロピル、ｎ‐ブチル、ｓｅｃ‐ブチル、ｔ‐ブチル、シクロブチル、又はメチルシクロプロピルであるのがよく、
Ｒ₂は、１‐１０炭素原子、（‐ＣＨ₂）ｎ（ただし、ｎ＝１～１０）を含むアルキルスペーサであり、
Ｒ₄及びＲ₅は、Ｃ１‐Ｃ１０ペンダントアルキル基、例えばメチル、エチル、ｎ‐プロピル、イソプロピル、シクロプロピル、ｎ‐ブチル、ｓｅｃ‐ブチル、ｔ‐ブチル、シクロブチル、又はメチルシクロプロピルから成る群から独立して選択され、
Ｒ₆は、ビニル基、ビニルオキシ基、アリール基、アリールオキシ基、及び炭素鎖Ｃ１‐Ｃ１０を含む基のうちの１つである。 Next, embodiments of the adhesion promoter 300 will be described in detail. As mentioned above, the adhesion promoter 300 may include two orthogonal functional groups that can participate separately and independently in polymerization using their unique chemistries, the first orthogonal functional group being: The second orthogonal functional group is configured to bond with the acrylic component of the acrylic intraocular inserter 110', and the second orthogonal functional group is configured to bond with the silicone component of the silicone photomodulating lens 120. In some embodiments of the CLA IOL 100, the adhesion promoter 300 has the following structural formula (1):

and at least one of R ₃ , R ₃ ′ and R ₃ ″ has the following structural formula (2), i.e.

a vinyldialkylsiloxy pendant group having
The remainder of R ₃ , R ₃ ′ and R ₃ ″ are C1-C10 pendant alkyl groups, such as methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, t-butyl, independently selected from the group consisting of cyclobutyl, or methylcyclopropyl;
The first orthogonal functional group is a functional group introduced to the left of _R2 ,
the second orthogonal functional group is R ₆ ;
R ₁ is selected from the group consisting of hydrogen, monovalent hydrocarbon groups, and substituted C1-C12 alkyl, where alkyl is methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, preferably t-butyl, cyclobutyl, or methylcyclopropyl;
R ₂ is an alkyl spacer containing 1-10 carbon atoms, (-CH ₂ )n (where n = 1 to 10),
R ₄ and R ₅ are C1-C10 pendant alkyl groups, such as from the group consisting of methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, t-butyl, cyclobutyl, or methylcyclopropyl. independently selected,
R ₆ is one of a vinyl group, a vinyloxy group, an aryl group, an aryloxy group, and a group containing a carbon chain C1-C10.

In some embodiments of CLA IOL 100, R ₁ is methyl, R ₂ is propyl, R ₃ , R ₃ ' and R ₃ '' are each vinyldialkylsiloxy, R ₄ and Each R ₅ is a C1-C10 alkyl chain and R ₆ is vinyl.

In some embodiments, R ₂ may be a chain, and in other embodiments, R ₂ may be an alkyl spacer, such as a branched or cyclic isomer of cyclopentyl. Furthermore, R ₂ is preferably substituted vinylaryl. Optionally, R ₂ may further carry a substituted aromatic group, such as substituted phenyl or substituted naphthyl.

The first orthogonal functional group introduced to the left of R ₂ creates a covalent bond 322 with the acrylic intraocular insert 110'. The second orthogonal functional group is R ₆ which forms a covalent bond 320 with the silicone LAL 120 by the double bond interacting with the silicon hydrate to form a new covalent silicon-carbon bond 320 .

で示される。 Adhesion promoters 300 with more double bonds result in more covalent bonds 320 with silicone LAL 120. Increasing the number of effective double bonds is achieved by selecting two or all three of R ₃ , R ₃ ', R ₃ '', each containing R ₆ with a double bond, to be vinyldialkylsiloxy pendant groups. The resulting adhesion promoter 300 has the following structural formula (3):

It is indicated by.

This embodiment of adhesion promoter 300 is called methacryloxypropyltris(vinyldimethylsiloxy)silane, which has the structural formula (3), where R ₁ is methyl and R ₂ is propyl, R ₃ , R ₃ ′, R ₃ ″ are vinyldimethylsiloxy, R ₄ and R ₅ are methyl, and R ₆ is vinyl. This structural formula (3) can be expressed as appropriate. adhesion promoter 300, because it contains three vinyl R ₆ , each with a double bond, and thus can bond to silicone LAL 120 with double the strength, and such strength As discussed above, shows promise in preventing delamination of the acrylic intraocular insert 110' and silicone LAL 120 and optical distortion at their interface.

The overall anchor strength between the acrylic intraocular insert 110' and the silicone LAL 120 created by the adhesion promoter 300 is determined by the strength and number of covalent bonds 320 per individual adhesion promoter molecule and the concentration of these molecules. It has been determined that a concentration of methacryloxypropyltris(vinyldimethylsiloxy)silane as adhesion promoter 300 of greater than 5% by weight dispersed within the acrylic intraocular insert 110' (1) after refractive modulated illumination; (2) is sufficient to prevent delamination of the acrylic intraocular insert 110' and silicone LAL 120, and (2) to avoid optical distortion caused by the acrylic intraocular insert 110'-silicone LAL 120 interface. CLA IOL 100 with a concentration greater than 10% by weight worked particularly well. For adhesion promoter 300 having structural formula (1) but in which only one of the _R groups is a vinyldialkylsiloxy pendant group, concentrations higher than 10% by weight may result in a bond of sufficient quality. found.

Structural formula (3) can be viewed as a monomer unit within the formulation of the acrylic intraocular insert 110', in which case structural formula (3) can serve as the adhesion promoter 300. In related embodiments, the corresponding building blocks may include, to name but a few:
methacryloxypropyl di(vinyldimethylsiloxy)methylsilane,
methacryloxypropyl (vinyldimethylsiloxy) dimethylsilane,
Acryloxypropyltris(vinyldimethylsiloxy)silane,
methacryloxybutyltris(vinyldimethylsiloxy)silane,
Acryloxybutyltris(vinyldimethylsiloxy)silane,
Acryloxypropyl di(vinyldimethylsiloxy)methylsilane,
methacryloxybutyldi(vinyldimethylsiloxy)methylsilane,
Acryloxybutyldi(vinyldimethylsiloxy)methylsilane,
Acryloxypropyl (vinyldimethylsiloxy)dimethylsilane,
methacryloxybutyl(vinyldimethylsiloxy)dimethylsilane,
acryloxybutyl(vinyldimethylsiloxy)dimethylsilane,
styrylmethyltris(vinyldimethylsiloxy)silane,
styrylethyltris(vinyldimethylsiloxy)silane,
styrylmethyltrisdi(vinyldimethylsiloxy)silane,
styrylethyldi(vinyldimethylsiloxy)methylsilane,
They may be styrylethyl(vinyldimethylsiloxy)dimethylsilane, and styrylethyl(vinyldimethylsiloxy)dimethylsilane.

This unit is bonded to silicone LAL 120 by a covalent bond 320 between one or more silicon atoms of silicone LAL 120 and one or more carbon atoms of adhesion promoter 300, typically through its R ₆ group. It is better to

In some CLA IOLs 100, the covalent bond is created by a hydrosilylation reaction between the vinyl group of the vinyldialkylsiloxy group and the Si-H group of the silicone phototunable lens 120. Adhesion promoters 300 with more branches (n>1) have more double-bonded second orthogonal functional groups, and thus are as mentioned in connection with Structural Formula (3) above. As such, a strong bond to the silicone optically adjustable lens 120 can be provided.

18A and 18B illustrate that in some CLA IOLs 100, a silicone photoaccommodative lens 120 is coupled to the acrylic intraocular insert 110' at the proximal surface of the acrylic intraocular insert 110'. It shows. In these CLA IOLs 100, the acrylic intraocular insert 110' may have an ultraviolet absorbing material or ultraviolet (UV) absorbing layer 340 dispersed throughout the acrylic intraocular insert 110'. This UV absorbing layer 340 may be located at the proximal surface of the acrylic intraocular insert 110', as shown in FIG. 18A, or at the acrylic intraocular insert 110', as shown in FIG. 18B. It may be located at the distal surface of insert 110'. The CLA IOL 100 of FIG. 18A may be characterized as having a UV absorbing layer 340 formed at the distal surface of the silicone photomodulating lens 120. All of these embodiments serve to further enhance the retinal safety of refractive modulated illumination.

In the CLA IOL 100, the silicone photomodulating lens 120 undergoes a chemical reaction, a heat treatment, an illumination treatment, a polymerization process, a molding step, a curing step, a lasing step, a low temperature lasing step, a mechanical process, the application of an adhesion promoter, and the like. The acrylic intraocular insert 110' may be attached to the acrylic intraocular insert 110' by at least one of the combinations.

19A and 19B illustrate that an acrylic intraocular insert 110' having optical power may include a diffractive structure 350 to provide this optical power as described above. The diffractive structure 350 may be located on the distal surface of the acrylic intraocular insert 110', as shown. In other cases, the diffractive structure 350 may be located at the proximal surface of the acrylic intraocular insert 110' facing the silicone LAL 120. This latter design reduces the halos and glare inherent in diffractive IOLs.

In some embodiments of the composite photoaccommodative IOL 100, the acrylic intraocular insert 110' may be a toric acrylic intraocular insert 110'. The toric acrylic intraocular insert 110' can have optical power in some embodiments.

We conclude this description by mentioning some additional advantages of the composite photoaccommodative IOL 100. (1) The composite photoaccommodative IOL 100 can reduce the volume of photopolymerized material compared to a silicone-only LAL, since the acrylic IOL 110 or the acrylic intraocular insert 110' has a 10D, 15D , or a baseline optical power of 20D. Thus, silicone LAL 120 may be a very thin layer used solely to provide a change in optical power relative to the baseline optical power of acrylic IOL 110/insert 110'. The smaller the volume of photopolymerized material, the correspondingly lower the intensity and radiance of the refractive modulated illumination, thereby making the procedure safer.

(2) In some cases, refractive modulated illumination has competing effects on the two surfaces of silicone LAL 120. As shown in FIG. 14B, in some cases, the radius of curvature of the proximal surface of silicone LAL 120 can be decreased, thereby increasing its optical power. However, the same illumination can increase the radius of curvature of the distal surface, thereby decreasing the optical power of the silicone LAL 120. These two effects compete with each other, thus slightly reducing the efficiency of refractive modulated illumination. Embodiments of the CLA IOL 100 attach the distal surface of the silicone LAL 120 to the IOL 110 or to an acrylic intraocular insert 110'. This attachment increases the stiffness and resistance of the distal surface of the silicone LAL 120 to changes in curvature, thereby reducing its competitiveness to increases in optical power induced by the proximal surface of the silicone LAL 120. Reducing the curvature change of the distal surface is one of the beneficial effects of the CLA IOL 100, as it reduces the illumination radiance required to achieve the planned power change. This is because the amount of retina is reduced, thereby further increasing the safety of the retina.

A widely used design for IOLs is to redirect light by forming a diffraction pattern on the surface of the IOL, as described above in connection with FIGS. 19A and 19B. FIG. 20 shows the design concept of such a diffractive IOL. Diffractive IOLs achieve the same optical power as regular lenticular IOLs, but are much thinner, thereby giving them advantages of their own. In this section (Detailed Description), such a diffractive IOL is referred to as a diffractive IOL 110 to emphasize the diffractive nature of these IOLs. Nevertheless, these diffractive IOLs 110 are possible embodiments of the IOLs described in previous sections of this specification. Accordingly, the considerations provided for the IOL 110 embodiments in the preceding sections also apply to the diffractive IOL 110 described herein.

Diffractive IOL 110 has a diffractive structure 350 with a set of toroids, rings, or diffractive steps/zones 403i, each ring supporting a raised surface segment. The shape of these segments may be parabolic, sinusoidal, or otherwise described in the form of a function. The height of the jump at the boundary between the rings is selected such that the difference in the optical path length of the rays propagating from neighboring segments satisfies a certain interference criterion at a specified distance, e.g. at the focal length. Ru.

21A-21C illustrate various embodiments of a diffractive IOL 110. FIG. 21A shows a monofocal diffractive IOL 110 having a single focal point 404 where the rays that diffract to the leading diffraction peak intersect. FIG. 21B shows an example bifocal design that provides additional medical benefits. In these bifocal IOL design examples, a portion of the light is diffracted in the direction of the leading order diffraction peak and thereby converges at the leading focus, as in the case of Figure 21A, while most of the remaining light is , diffracts in the direction of another diffraction peak of the diffractive structure 350 and thus converges to a second focal point. The diffractive structure 350 is designed such that the portion of the light intensity directed to the second focal point may be significant, for example 30-40% of the total light intensity. Often, the leading far focus 404d associated with the zeroth diffraction order is selected to focus distant objects onto the retina. The near focus 404n associated with the lowest next diffraction order, typically the first diffraction order, is selected to focus nearby objects (approximately 40 cm distance) onto the retina. As discussed above, one of the benefits of such diffractive bifocal IOLs is that such IOLs create a second near focus 404n over the entire surface of the IOL, so that the patient's visual experience is more closely aligned with the pupil diameter. The reason is that it is not particularly affected by the This is in contrast to "zonal" IOLs that use only peripheral annular surface segments or zones to focus light to the near focus 404n. In such zonal IOLs, the portion of light that is refracted to near focus 404n, and thus visual acuity, is highly sensitive to pupil diameter. Such bifocal IOL designs, such as Alcon's ReStor and AMO's Tecnis IOLs, are now widely available and used in medical practice.

FIG. 21C shows that the idea of creating an additional focus on the IOL by a diffractive structure has been further extended by the introduction of a trifocal lens. A trifocal IOL uses three orders of diffraction to partially focus light into a far focus 404d, a near focus 404n, and an intermediate focus 404i. This latter intermediate focus is designed to focus light from an intermediate distance, eg 80 cm to 100 cm, onto the retina. Thus, if the intermediate focus 404i is positioned approximately halfway between the near focus 404n and the far focus 404d, i.e., "symmetrically", as measured in the widely used inverted length unit of diopter, There are many. Before proceeding, it is important to note that some diffractive IOLs 110 have diffractive structures on the anterior or proximal surface, while others have diffractive structures on the posterior or distal surface, as shown in FIGS. 21A-21C. It is pointed out that there are some locations. Any of these embodiments can achieve the benefits described herein.

However, all of these diffractive IOLs 110 share the drawbacks of traditional IOLs discussed above, and have some additional problems of their own, as listed below. Starting with a description of the known drawbacks of existing IOL technology, the list includes the drawbacks mentioned above. Disadvantages of existing acrylic diffractive IOLs include the following.

L1. In a significant number of cases, IOLs tend to drift away from these optimal positions after implantation. However, existing IOLs cannot be adjusted post-implant to compensate for these deviations and thus do not provide optimal results despite their premium pricing.

L2. The lack of adjustability necessitates extensive diagnostic tests using expensive diagnostic equipment prior to surgery, and even these tests do not guarantee optimal results.

L3. Toric IOLs are particularly susceptible to post-operative rotation caused by tissue healing. For toric IOLs, even an unintentional rotation of just 10 degrees of the toric IOL axis after implantation can result in approximately 30% loss of visual acuity.

L4. With diffractive IOLs, patients have reported undesirable light-related phenomena: blurred vision, glare, halos, dysphotopsia. These are created, for example, by the sharp edges of the pattern of diffractive structures being rounded off by chemical reactions, such as oxidation. These may be further exacerbated by residual refractive errors. These problems often require subsequent LASIK procedures to be performed after cataract surgery or even after IOL explantation. Such a second surgery introduces additional risks, such as corneal ectasia and persistent dry eye.

All of these drawbacks L1-L4 of diffractive acrylic IOLs can be reduced or alleviated when a diffractive IOL is combined with an adjustable LAL. The following discussion of embodiments of such a hybrid light-accommodating IOL 100, CLA IOL 100, begins with a list of these benefits.

B1. CLA IOL 100 is adjustable. Therefore, illumination adjustments after cataract surgery can correct post-operative IOL tilt, shear, pivoting and movement, thereby essentially ensuring optimal results.

B2. The adjustability of the CLA IOL 100 reduces, and in many cases eliminates, the need for extensive and costly diagnostic pre-surgical testing, as patient dissatisfaction with the outcome of surgery can be reduced by the optical adjustment of the CLA IOL 100. It can be resolved after surgery.

B3. A toric formulation can be introduced by irradiation after implantation of the CLA IOL 100. The direction and size of the postoperatively introduced toric are aligned and set according to a prescription with excellent precision. This feature also simplifies manufacturing and inventory, as currently 5-10 diffractive IOLs of the same spherical prescription are often supplied by the manufacturer to cover all possible toric prescriptions. , because it needs to be stored by an ophthalmologist. As noted, some of the toric prescriptions can be implemented with acrylic diffractive IOLs, thereby extending the range of correction for high levels of astigmatism that are less susceptible to axial prediction errors.

Surprisingly and encouragingly, the combination of acrylic diffractive IOL 110 and LAL 120, in particular, alleviates some of the challenges of LAL technology, including:

B4. Silicone LALs are more rigid than acrylic IOLs, so they often appear more "elastic" in comparison. One result of this elasticity is that during the LAL implantation process, as the folded LAL is being pushed out of the surgical inserter handpiece and into the eye, it spreads very quickly. This rapid spreading of silicone LALs makes controlling the insertion and proper alignment of the LAL somewhat challenging for the surgeon during surgery. In contrast, acrylate-based IOLs have relatively soft elastic constants and more desirable viscoelastic properties, thus expanding slowly during insertion. This aspect allows the surgeon greater control over the insertion of acrylate-based IOLs. Thus, acrylic CLA IOL 100 has less "elasticity" and spreads more smoothly.

B5. Some existing LALs are three-part, ie, the two haptics are often fabricated separately and then inserted into a central lens body. This design feature increases manufacturing costs, may have a high rate of haptic misalignment during manufacturing, and may result in separation of the haptics from the LAL lens body during insertion. In contrast, some acrylate-based IOLs alleviate these challenges by employing a one-piece design, where the integrated haptics are the same lens as the central lens body of the IOL. Formed from materials in the same molding step. Such a one-piece design is less expensive to manufacture and provides better haptic alignment with the lens body, reducing the risk of haptic separation from the lens body during insertion. A CLA IOL 100 with a one-piece design of acrylic diffractive IOL 110 in which the haptics are molded from the acrylic itself can achieve all of these benefits.

Additional benefits are associated with certain CLA/IOL designs, where LAL 120 is located proximally/anteriorly/anteriorly and acrylic diffractive IOL 110 is located posteriorly.

B6. As mentioned above, LAL technology protects the retina from UV exposure by employing a UV absorbing layer 130 formed behind the LAL 120. Fabricating this UV absorbing layer 130 requires additional manufacturing steps that have their own challenges. The CLA IOL can eliminate the need to form a separate UV blocking layer 130 by dispersing the same UV blocking material within the acrylic diffractive IOL 110 itself.

B7. Silicone LAL 120 may be contraindicated in patients likely to require a vitrectomy because visualization of the retinal sulcus during surgery may occur if air or silicone oil enters the vitreous cavity. This is because it tends to be difficult. However, the CLA IOL 100 with the acrylic diffractive IOL 110 placed on the posterior surface of the silicone LAL 120 prevents contact between the silicone LAL 120 and air or silicone oil during potential subsequent retinal procedures, thus contraindicating this can overcome.

B8. As shown for example in FIG. Either provides a reduction in curvature on the posterior/posterior surface of LAL 120. Since the interference caused by the diffractive structure 350 is susceptible to even small changes in optical path length, mounting the diffractive IOL 110 on the posterior/backward surface of the LAL 120 reduces bending of the diffractive structure 350 and thus This is a design method that maintains good optical performance of the diffractive IOL 110.

B9. Suppression of intermediate diffraction peaks in PanOptix IOLs is based on destructive interference of diffracted light corresponding to specific diffraction orders, and is thus particularly sensitive to the sharpness and shape accuracy of the diffractive structure 350. . Therefore, it is particularly beneficial to mount a pan-optic suppressed diffraction order IOL on the posterior side of the LAL 120, which is much less curved than the anterior side.

B10. The edges of the diffractive structure 350 are formed by a delicate trade-off relationship. Creating sharp edges minimizes wavefront errors, but increases scattering at non-design wavelengths. On the other hand, rounding the edges increases wavefront error but reduces scattering. Therefore, optimal rounding of the edges is selected for elongation during the design of such diffractive IOLs. In the CLA IOL 100, as shown in FIG. 23B, a diffractive IOL 110 is located behind the LAL 120, and its diffractive structure 350 is located at the interface of these lenses; such a CLA IOL 100 has a carefully designed diffractive Structure 350 is effectively protected from chemical and other forms of degradation, thereby advantageously inhibiting scattering and wavefront error enhancement.

The discussion of benefits B1-B10 above reveals many advantages and benefits of the CLA IOL 100, including the anterior/anterior silicone LAL 120 and the posterior/posterior acrylic diffractive IOL 110. The considerations provided with reference to FIGS. 1-19 were already illustrative in relation to these benefits. Further advantages and combinations of these advantages will now be described with reference to FIGS. 20-28.

20-22 illustrate existing diffractive IOLs 110 that constitute one class of embodiments of IOLs 110 described above. These diffractive IOLs 110 have a central lens and haptics 114-1, 114-2. The central lens has a diffractive structure 350 shown in side view at the bottom of the figure. A particularly notable class of diffractive IOL 110 embodiments are diffractive IOLs 110 with suppressed diffraction orders.

As mentioned above, FIGS. 21A-21C illustrate the propagation of light through the diffractive IOL 110. In some diffractive IOLs 110, diffractive structures 350 are formed on the anterior/front surface of diffractive IOL 110, and in other diffractive IOLs 110, diffractive structures 350 are formed on the posterior/posterior surface. FIG. 21A shows a bow of a diffractive feature 350 formed on the posterior/posterior surface of the diffractive IOL 110. Diffractive structure 350 has a series of raised surface rings that are repositioned with steep jumps. These surface rings form a diffraction grating that diffracts incoming light, so that light beams from different rings only constructively interfere in specific directions, called diffraction orders. . For the monofocal diffractive IOL 110, most of the light intensity is diffracted into a single diffraction order, often referred to as the zeroth diffraction order, as shown. These diffracted lights converge on a single focal point 404.

FIG. 21B shows a bifocal diffractive IOL 110. In such a diffractive IOL 110, a first portion of the light is diffracted, for example, into the 0th diffraction order that is in focus at the far focal point 404d, and a second portion is diffracted into the near diffractive order, which is located closer to the diffractive IOL 110 than the far focal point 404d. It is diffracted into the first diffraction order which is focused on the focal point 404n. Near focus 404n is designed so that light from objects located at a distance of about 40-50 cm is focused on the retina. Since the reciprocals of 0.5 m and 0.4 m are 2.0D (diopters) and 2.5D, the optical powers corresponding to the far focus 404d and the near focus 404n differ by about 2.0 to 2.5D. Other designs may reverse the roles of the 0th and 1st diffraction orders, while other designs may also use negative diffraction orders. A portion of the light becomes diffracted into higher diffraction orders, and a portion is more diffusely scattered, so the sum of the first and second portions is typically less than 100%. . When implanted into the eye, such a bifocal diffractive IOL 110 focuses objects located far away on the retina with their 0th orders of diffraction, and objects located nearby are focused on the retina with their 1st orders of diffraction. let Therefore, these bifocal diffractive IOLs can provide significant medical benefit to presbyopic patients who have a diminished ability to adjust the focal length of the crystalline lens.

Finally, FIG. 21C shows a more improved design in which the third diffraction order of the diffractive IOL 110 is also utilized. Bifocal IOLs provide good vision for distant and near objects. However, some patients wearing bifocal IOLs still have difficulty focusing on objects at intermediate distances. To address this challenge, the trifocal diffractive IOL 110 is designed with an intermediate focus 404i between a far focus 404d and a near focus 404n, where the higher diffraction orders focus the light. This intermediate order diffraction peak allows light coming from intermediate distances, eg 80 cm to 100 cm, to be focused onto the retina. Thus, if the intermediate focus 404i is positioned approximately halfway between the near focus 404n and the far focus 404d, i.e., "symmetrically", as measured in the widely used inverted length unit of diopter, There are many. The optical power corresponding to this intermediate focus 404i differs from both the optical power corresponding to the far focus and the optical power corresponding to the near focus by about 1.0 to 1.25D.

Figures 22A and 22B illustrate a particularly successful trifocal design, namely Alcon's Panoptix. Similar to FIGS. 20 and 21A-21C, the diffractive IOL 110 has a diffractive structure 350 that has individual diffractive steps or zones 403i that diffract incoming light rays into diffraction orders. The pan-optics IOL utilizes four diffraction orders to focus light into a far focus 404d, a near focus 404n, an intermediate focus 404i, and a suppression focus 404s. With careful design, less than about 10% of the total light intensity is directed to the suppression focus 404s. This design allows the intermediate focus 404i to be either close to the near focus 404n, which focuses objects onto the retina from an "arm's length" distance of, for example, 60 cm, or near the far focus 404d, for example at 120 cm. is moved asymmetrically. The upper panel of FIG. 22B shows the diffraction efficiency for the focal points and diffraction orders described above for a particular trifocal embodiment. The lower panel of FIG. 22B shows the segment droop height y (height from the x-axis) for such a trifocal IOL as a function of x, ie, the square of the radial distance. where A _i is the step height and φ _i is the phase delay. For further details, these trifocal IOLs are described in U.S. Pat. Nos. 9,335,564 and 10,278,811 to Choi et al. 10,285,806 (title of invention: Multifocal diffractive ophthalmic lens), also issued to Choi et al. and all three of these patents are incorporated by reference and incorporated herein in their entirety. In explaining the free-standing diffractive IOL 110, an embodiment of the CLA IOL 100 will be explained.

23A and 23B show a composite light-accommodating intraocular lens CLA/IOL 100, which includes an acrylic diffractive intraocular lens with a diffractive structure 350 and haptics 114-1, 114-2; That is, it has an acrylic diffractive IOL 110 and a silicone light-accommodating lens LAL 120 attached to the acrylic diffractive intraocular lens 110. In some cases, these CLA/IOLs 100 are referred to as diffractive CLA/IOLs 100. FIG. 23A shows an embodiment of a CLA IOL 100 in which a silicone photomodulating lens 120 is attached to an acrylic diffractive intraocular lens 110 on the opposite side of the diffractive structure 350; 12 shows an embodiment in which a formula lens 120 is attached to an acrylic diffractive intraocular lens 110 at a diffractive structure.

23A and 23B also illustrate that in some CLA IOLs 100, silicone optically adjustable lens 120 is located proximal to acrylic diffractive IOL 110.

FIG. 24 shows that in some CLA IOLs 100, a silicone photoaccommodative lens 120 is located distal to the acrylic diffractive IOL 110. In some embodiments of the CLA IOL 100, the acrylic diffractive IOL 110 may include at least one of a monomer, a macromer, and a polymer, such at least one being an acrylate, an alkyl acrylate, an aryl acrylate, a substituted aryl and at least one of acrylates, substituted alkyl acrylates, vinyl, and copolymers of combinations of alkyl acrylates and aryl acrylates. Alkyl acrylates include methyl acrylate, ethyl acrylate, phenyl acrylate, and polymers and copolymers thereof.

In some CLA IOLs 100, at least one of the monomers, macromers, and polymers of the acrylic diffractive intraocular lens 110 has at least one functional group, the functional group being hydroxy, amino, vinyl, mercapto, isocyanate. , nitrile, carboxyl, and hydride, and is one of cationic, anionic, and neutral.

In some CLA IOLs 100, the silicone photomodulating lens 120 includes a first polymer matrix and a refractive modulating composition dispersed within the first polymer matrix, and the refractive modulating composition is a silicone photomodulating lens 120. Stimulus-induced polymerization that modulates the refraction of lens 120 is possible. The first polymer matrix may include a siloxane-based polymer formed from monomer building blocks and macromers containing alkyl or aryl groups.

In some CLA IOLs 100, the silicone photomodulating lens 120 may include a photoinitiator that absorbs refractive modulating illumination, becomes activated upon absorption of the illumination, and initiates polymerization of the refractive modulating compound. The silicone phototuning lens 120 includes a UV absorber dispersed throughout the lens and a silicone phototuning layer similar to the UV absorbing layer 130 of FIG. 5 and the similar UV absorbing layer 340 of FIGS. 18A and 18B. The lens 120 may further include a UV absorbing layer on the distal surface thereof.

In another embodiment of the CLA IOL 100, the acrylic diffractive IOL 110 includes a UV absorber dispersed throughout the IOL and a UV absorbing layer on the distal surface of the acrylic diffractive IOL 110. It is preferable to have at least one of them.

22B and 25 show that the diffractive structure 350 of the diffractive IOL 110 causes constructive interference in at least four consecutive diffraction orders corresponding to the vision range from near vision to distance vision, and that the constructive interference producing a far focus corresponding to the basic power of the Salmic lens and an intermediate focus between the near focus and the far focus, and showing that the diffraction efficiency of at least one of the diffraction orders is suppressed to less than 10 percent. ing. For example, in the table in the lower panel of FIG. 25, the four consecutive diffraction orders are (0, +1, +2, +3) and the suppressed diffraction order is the +1 diffraction order. As can be seen, this suppressed diffraction order has a diffraction efficiency of 3%, which is one embodiment of a diffraction peak suppressed to less than 10%. Since the 1st order of diffraction following the 0th order corresponding to the far focus 404d is suppressed within this CLA/IOL 100, the intermediate focus 404i is asymmetrically close to the near focus 404n in this embodiment. To position. For example, near focus 404n may correspond to visual acuity at 40 cm, and intermediate focus 404i may correspond to visual acuity at 60 cm. In other words, the near focus 404n may be selected for a particular patient to focus objects located as close as 40 cm onto the patient's retina, while the intermediate focus 404i focuses objects located as close as 40 cm on the patient's retina, while the intermediate focus 404i focuses objects located as close as 40 cm on the patient's retina, while the intermediate focus 404i Preferably it is chosen to focus the located object on the retina.

のように連続した半径方向ステップ境界部のところで前記オフサルミックレンズのベース曲率に対応したステップ高さを有する。 FIG. 22B shows that in the CLA/IOL 100, the diffraction structure 350 has a plurality of annular diffraction steps 403i, and the diffraction steps 403i have the following formula:

The continuous radial step boundary has a step height corresponding to the base curvature of the ophthalmic lens.

In the above equation, A _i is the step height corresponding to the base curvature of the acrylic diffractive intraocular lens, y _i is the step height with respect to the x-axis within the corresponding segment, and Φ _i is the step height from the x-axis. , and x _i is the position of the diffraction step 403i along the x-axis. The panel table in FIG. 25 illustrates a particular embodiment. The upper panel shows the step height A _i and the phase Φ _i of the three rings of CLA IOL 100, and the lower panel shows the diffraction efficiency for the 0th to 3rd order diffraction peaks. . As can be seen, the first order peak is the suppressed diffraction order where the diffraction efficiency is 3%, well below 10%.

In some composite photoaccommodative intraocular lenses CLA IOLs 100, the acrylic diffractive IOL 110 has an anterior surface and a posterior surface, and the diffractive structure 350 is disposed on at least one of the anterior surface and the posterior surface. ing. As shown in FIGS. 22B and 25, the diffractive structure 350 has multiple annular diffraction steps 403i and four consecutive diffraction orders, and the acrylic diffractive IOL 110 has a near focus 404n, an intermediate focus 404i, and a far focus 404d. each focal point corresponds to a different one of the four successive diffraction orders. In these embodiments, the four consecutive diffraction orders include a lowest diffraction order, a highest diffraction order, a near-intermediate diffraction order, and a far-intermediate diffraction order, and the plurality of annular diffraction steps 403i of the diffraction structure 350 include: The far-intermediate diffraction order is suppressed and at least a portion of the energy associated with the suppressed diffraction order is configured to be redistributed to one of the near focus, the intermediate focus, and the far focus. In some parts of this specification, the term "focus" is used as an equivalent term to "focal point" where clarity is not lost by doing so.

In some of these CLA IOLs 100, the plurality of annular diffraction steps 403i have a diffraction efficiency of at least 40% for the lowest diffraction order for the 3mm aperture and a diffraction efficiency for the highest diffraction order for the 3mm aperture. and the diffraction efficiency of each of the near-intermediate and far-intermediate diffraction orders for a 3 mm aperture is in the range of 10-20%. Therefore, in these CLA IOLs 100, the suppression of one of the diffraction orders to the range 10-20% is lower than in the embodiments described above, which means that one of the intermediate orders It had a diffraction efficiency that was suppressed to below.

In yet another embodiment of the CLA IOL 100, the diffractive structure 350 has a plurality of annular diffraction steps 403i and four consecutive diffraction orders, and the complex photoaccommodative intraocular lens 100 has a near focus 404n, an intermediate focus 404i, and a far focus 404d, each focus corresponding to a different one of the four successive diffraction orders, and a plurality of annular diffraction steps 403i of the diffraction structure 350 producing one of the four diffraction orders. is suppressed, and at least a portion of the energy associated with the suppressed diffraction order is configured to be redistributed to one of near focus 404n, intermediate focus 404i, and far focus 404d. In some CLA IOLs 100, the four consecutive diffraction orders include a lowest diffraction order, a highest diffraction order, and two intermediate diffraction orders, and the suppressed diffraction order is one of the two intermediate diffraction orders. .

FIG. 26 shows that in some CLA IOLs 100, a silicone photoaccommodative lens 120 is attached to an acrylic diffractive intraocular lens 110 with an adhesion promoter 300. The embodiment of adhesion promoter 300 described with reference to FIGS. 13-19 can also be embodied in this embodiment of FIG. 26, in which case the acrylic intraocular insert 110/110' is diffractive. In some CLA IOLs 100, the adhesion promoter 300 has a first orthogonal functional group configured to bond with the acrylic component of the acrylic intraocular insert 110/110' and the silicone component of the silicone light modulating lens 120. a second orthogonal functional group configured to As mentioned above, acrylic intraocular insert 110' can be viewed as one embodiment of acrylic diffractive IOL 110. Adhesion promoter 300 is often incorporated into an adhesive layer 310 that joins acrylic diffractive IOL 110 and silicone LAL 120.

を有し、Ｒ３、Ｒ３′及びＲ３″のうちの少なくとも１つは、次の構造式、すなわち、

を有するビニルジアルキルシロキシペンダント基であり、Ｒ₃、Ｒ₃′及びＲ₃″の残りのものは、Ｃ１‐Ｃ１０ペンダントアルキル基、例えば、メチル、エチル、ｎ‐プロピル、イソプロピル、シクロプロピル、ｎ‐ブチル、ｓｅｃ‐ブチル、ｔ‐ブチル、シクロブチル、又はメチルシクロプロピルからなる群から独立して選択され、第１の直交官能基は、Ｒ₂の左に導入された官能基であり、第２の直交官能基はＲ₆であり、Ｒ₁は、水素、１価の炭化水素基、及び置換Ｃ１‐Ｃ１２アルキルから成る群から選択され、アルキルは、メチル、エチル、ｎ‐プロピル、イソプロピル、シクロプロピル、ｎ‐ブチル、ｓｅｃ‐ブチル、ｔ‐ブチル、シクロブチル、又はメチルシクロプロピルであるのがよく、Ｒ₂は、１‐１０炭素原子、（‐ＣＨ₂）ｎ（ただし、ｎ＝１～１０）を含むアルキルスペーサであり、Ｒ₄及びＲ₅は、Ｃ１‐Ｃ１０ペンダントアルキル基、例えばメチル、エチル、ｎ‐プロピル、イソプロピル、シクロプロピル、ｎ‐ブチル、ｓｅｃ‐ブチル、ｔ‐ブチル、シクロブチル、又はメチルシクロプロピルから成る群から独立して選択され、Ｒ₆は、ビニル基、ビニルオキシ基、アリール基、アリールオキシ基、及び炭素鎖Ｃ１‐Ｃ１０を含む基のうちの１つである。 In embodiments, the adhesion promoter 300 has the following structural formula:

and at least one of R3, R3' and R3'' has the following structural formula, namely:

and the remainder of R ₃ , R ₃ ′ and R ₃ ″ are C1-C10 pendant alkyl groups, such as methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n- independently selected from the group consisting of butyl, sec-butyl, t-butyl, cyclobutyl, or methylcyclopropyl, the first orthogonal functional group is the functional group introduced to the left of R ₂ , and the second The orthogonal functional group is R ₆ and R ₁ is selected from the group consisting of hydrogen, monovalent hydrocarbon groups, and substituted C1-C12 alkyl, where alkyl is methyl, ethyl, n-propyl, isopropyl, cyclopropyl. , n-butyl, sec-butyl, t-butyl, cyclobutyl, or methylcyclopropyl, R ₂ is 1-10 carbon atoms, (-CH ₂ )n (where n=1-10) and R ₄ and R ₅ are C1-C10 pendant alkyl groups, such as methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, t-butyl, cyclobutyl, or independently selected from the group consisting of methylcyclopropyl, R ₆ is one of vinyl, vinyloxy, aryl, aryloxy, and groups containing carbon chains C1-C10.

FIG. 27 shows that some CLA IOLs 100 may include an attachment structure 135 that attaches the silicone phototunable lens 120 to the acrylic diffractive intraocular lens 110. As discussed above, such attachment structure 135 facilitates the implantation of additional IOLs should the diffractive IOL LAL 120 need to be replaced or years after the initial surgery.

In some CLA IOLs 100, the acrylic diffractive intraocular lens 110 is a toric acrylic diffractive intraocular lens 110.

23-25 also illustrate embodiments of a composite photoaccommodating intraocular lens 100, which includes a diffractive structure 350 and haptics 114-1, 114. -2 and a silicone phototunable lens 120 attached to the acrylic diffractive intraocular lens 110, the diffractive structure 350 includes a plurality of annular diffractive steps 403i and four consecutive Having diffraction orders, the compound photoaccommodative intraocular lens 110 produces a near focus 404n, an intermediate focus 404i, and a far focus 404d, each focus being a respective one of each of the four consecutive diffraction orders. Correspondingly, the plurality of annular diffraction steps 403i of the diffractive structure 350 causes one of the four diffraction orders to be suppressed such that at least a portion of the energy associated with the suppressed diffraction order is distributed between the near focus, the intermediate focus, and the far focus. It is configured to be redistributed to one of them.

FIG. 28 shows yet another modified embodiment of the CLA IOL 100. In this embodiment, a diffractive structure 350 may be formed on the optically adjustable lens 120, thereby forming a diffractive optically adjustable lens 120' as shown. Such a composite photoaccommodating intraocular lens 100 includes an acrylic intraocular lens 110 and a diffractive silicone photoaccommodating lens 120' attached to the acrylic intraocular lens 110, where the diffractive silicone photoaccommodating lens 120' includes: , has a diffraction structure 350. All descriptions regarding the previous embodiments provided with reference to FIGS. 1-27 can be applied to or combined with this embodiment of FIG. 28.

This patent document sets forth a number of particulars, details, and ranges that should not be construed as limitations on the scope of the disclosure or the claimed invention. , to the contrary, should be construed as a description of features specific to particular embodiments of the invention. Certain features that are described in this patent document in the context of separate embodiments can also be embodied in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable subcombination. Further, although a feature may be described above as working in a particular combination and may be claimed as such, it may also include one or more features from the claimed combination. In this case, the combination that can be omitted from this combination and is claimed may relate to another subcombination or a variant of a subcombination.

Claims (26)

A complex photoaccommodative intraocular lens, comprising:
an acrylic diffractive intraocular lens with a diffractive structure and haptics;
a silicone phototunable lens attached to the acrylic diffractive intraocular lens. 2. The composite phototunable intraocular lens of claim 1, wherein the silicone phototunable lens is attached to the acrylic diffractive intraocular lens at or opposite the diffractive structure. 2. The composite phototunable intraocular lens of claim 1, wherein the silicone phototunable lens is located proximal to the acrylic diffractive intraocular lens. 2. The composite phototunable intraocular lens of claim 1, wherein the silicone photoaccommodative lens is located distally to the acrylic diffractive intraocular lens. The acrylic diffractive intraocular lens includes:
consisting of at least one of a monomer, a macromer, and a polymer, said at least one comprising:
The composite photomodulating intraocular lens of claim 1, comprising at least one of acrylate, alkyl acrylate, aryl acrylate, substituted aryl acrylate, substituted alkyl acrylate, vinyl, and a copolymer of a combination of alkyl acrylate and aryl acrylate. . The alkyl acrylate is
6. The composite photomodulating intraocular lens of claim 5, comprising methyl acrylate, ethyl acrylate, phenyl acrylate, and polymers and copolymers thereof. At least one of the monomer, macromer, and polymer of the acrylic diffractive intraocular lens has at least one functional group, and the functional group is
The complex photomodulation according to claim 5, which contains at least one of hydroxy, amino, vinyl, mercapto, isocyanate, nitrile, carboxyl, and hydride, and is one of cationic, anionic, and neutral. formula intraocular lens. The silicone photochromic lens includes:
a first polymer matrix;
a refraction modulating composition dispersed within the first polymer matrix;
2. The composite phototunable intraocular lens of claim 1, wherein the refraction modulating composition is capable of stimulus-induced polymerization to modulate the refraction of the silicone phototunable lens. The first polymer matrix is
9. The composite photomodulating intraocular lens of claim 8, comprising a siloxane-based polymer formed from a macromer and monomer building blocks containing an alkyl group or an aryl group. The silicone photochromic lens includes:
Absorbs refractive modulated illumination,
9. The composite photomodulating intraocular lens of claim 8, comprising a photopolymerization initiator that is activated upon absorption of illumination and initiates polymerization of the refractive modulating compound. The silicone photochromic lens includes:
The composite light of claim 1, comprising at least one of: a UV absorber distributed throughout; and a UV absorbing layer at a distal surface of the silicone light-tuning lens. Adjustable intraocular lens. The acrylic diffractive intraocular lens includes:
2. The composite optical system of claim 1, comprising at least one of a UV absorber dispersed throughout and a UV absorbing layer at a distal surface of the acrylic diffractive intraocular lens. Adjustable intraocular lens. the diffractive structure produces constructive interference in at least four consecutive diffraction orders corresponding to a vision range from near vision to distance vision;
the constructive interference produces a near focus, a far focus corresponding to the base power of the ophthalmic lens, and an intermediate focus between the near focus and the far focus;
2. The composite photoaccommodative intraocular lens of claim 1, wherein the diffraction efficiency of at least one of the diffraction orders is suppressed to less than 10 percent. 14. The compound photoaccommodative intraocular lens of claim 13, wherein the near focus corresponds to a visual acuity at 40 cm and the intermediate focus corresponds to a visual acuity at 60 cm. The four consecutive diffraction orders are (0, +1, +2, +3),
14. The complex photoaccommodative intraocular lens of claim 13, wherein the suppressed diffraction order is the +1 diffraction order. the diffractive structure has a plurality of annular diffraction steps;
The diffraction step is calculated by the following equation, namely:

having a step height corresponding to the base curvature of the ophthalmic lens at a continuous radial step boundary, as shown in FIG.
In the above formula, A _i is the step height corresponding to the base curvature of the acrylic diffractive intraocular lens, y _i is the step height with respect to the x-axis within the corresponding segment, and Φ _i is the step height corresponding to the base curvature of the acrylic diffractive intraocular lens, y 14. The compound photoaccommodative intraocular lens of claim 13, wherein x i is a relative phase retardation from the x-axis, and x _i is the position of the diffraction step along the x-axis. The acrylic diffractive intraocular lens has an anterior surface and a posterior surface,
the diffractive structure is provided on at least one of the front surface and the rear surface, the diffractive structure having a plurality of annular diffraction steps and four consecutive diffraction orders;
The acrylic diffractive intraocular lens produces a near focus, an intermediate focus, and a far focus, each focus corresponding to a different one of the four consecutive diffraction orders,
the four consecutive diffraction orders include a lowest diffraction order, a highest diffraction order, a near-intermediate diffraction order, and a far-intermediate diffraction order;
The plurality of annular diffraction steps of the diffractive structure is such that the far-intermediate diffraction order is suppressed, and at least a portion of the energy associated with the suppressed diffraction order is located at one of the near focus, the intermediate focus, and the far focus. The compound photoaccommodative intraocular lens of claim 1, configured to be redistributed into one. The plurality of annular diffraction steps include:
the diffraction efficiency of the lowest diffraction order for a 3mm aperture is at least 40%;
the diffraction efficiency of the highest diffraction order for the 3mm aperture is at least 20%, and the diffraction efficiency for each of the near-intermediate diffraction orders and the far-intermediate diffraction orders for the 3mm aperture is from 10% to 20%. 18. The compound photoaccommodative intraocular lens of claim 17, wherein the compound photoaccommodative intraocular lens is configured to fall within the range. the diffractive structure has a plurality of annular diffraction steps and four consecutive diffraction orders;
The compound photoaccommodative intraocular lens produces a near focus, an intermediate focus, and a far focus, each focus corresponding to a different one of the four successive diffraction orders,
The plurality of annular diffraction steps of the diffractive structure is such that one of the four diffraction orders is suppressed, and at least a portion of the energy associated with the suppressed diffraction order is transmitted to the near focus, the intermediate focus, and the far focus. 2. The compound photoaccommodative intraocular lens of claim 1, configured to be redistributed to one of the following: The four consecutive diffraction orders include a lowest diffraction order, a highest diffraction order, and two intermediate diffraction orders,
20. The compound photoaccommodative intraocular lens of claim 19, wherein the suppressed diffraction order is one of the two intermediate diffraction orders. The silicone phototunable lens is attached to the acrylic diffractive intraocular lens with an adhesion promoter, the adhesion promoter comprising:
2. A first orthogonal functional group configured to bond with an acrylic component of the acrylic intraocular insert, and a second orthogonal functional group configured to bond with a silicone component of the silicone photomodulating lens. The compound photoaccommodating intraocular lens described. The adhesion promoter has the following structural formula:

and at least one of R3, R3' and R3'' has the following structural formula, namely:

a vinyldialkylsiloxy pendant group having
The remainder of R ₃ , R ₃ ′ and R ₃ ″ are C1-C10 pendant alkyl groups, such as methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, t-butyl, independently selected from the group consisting of cyclobutyl, or methylcyclopropyl;
The first orthogonal functional group is a functional group introduced to the left of _R2 ,
the second orthogonal functional group is R ₆ ;
R ₁ is selected from the group consisting of hydrogen, monovalent hydrocarbon groups, and substituted C1-C12 alkyl, wherein said alkyl is methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl. , t-butyl, cyclobutyl, or methylcyclopropyl;
R ₂ is an alkyl spacer containing 1-10 carbon atoms, (-CH ₂ )n (where n = 1 to 10),
R ₄ and R ₅ are C1-C10 pendant alkyl groups, such as from the group consisting of methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, t-butyl, cyclobutyl, or methylcyclopropyl. independently selected,
22. The composite photomodulating intraocular lens of claim 21, wherein _R6 is one of a vinyl group, a vinyloxy group, an aryl group, an aryloxy group, and a group containing carbon chains C1-C10. 2. The composite phototunable intraocular lens of claim 1, further comprising a mounting structure for attaching the silicone phototunable lens to the acrylic diffractive intraocular lens. The composite photoaccommodative intraocular lens of claim 1, wherein the acrylic diffractive intraocular lens is a toric acrylic diffractive intraocular lens. A complex photoaccommodative intraocular lens, comprising:
an acrylic diffractive intraocular lens with a diffractive structure and haptics;
a silicone photomodulating lens attached to the acrylic diffractive intraocular lens;
the diffractive structure has a plurality of annular diffraction steps and four consecutive diffraction orders;
The compound photoaccommodative intraocular lens produces a near focus, an intermediate focus, and a far focus, each focus corresponding to a different one of the four successive diffraction orders,
The plurality of annular diffraction steps of the diffractive structure is such that one of the four diffraction orders is suppressed, and at least a portion of the energy associated with the suppressed diffraction order is transmitted to the near focus, the intermediate focus, and the far focus. A compound light-accommodating intraocular lens configured to redistribute to one of the following: A complex photoaccommodative intraocular lens, comprising:
Acrylic intraocular lens with haptics,
a diffractive silicone phototuning lens attached to the acrylic intraocular lens, the diffractive silicone phototuning lens having a diffractive structure.

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