WO2014065659A1

WO2014065659A1 - Spectacles for training accommodation

Info

Publication number: WO2014065659A1
Application number: PCT/NL2013/050742
Authority: WO
Inventors: Aleksey Nikolaevich Simonov; Michiel Christiaan Rombach
Original assignee: Akkolens International B.V.
Priority date: 2012-10-22
Filing date: 2013-10-22
Publication date: 2014-05-01

Abstract

This invention discloses spectacles adapted to be worn by a person having at least one eye implanted with an artificial accommodative intraocular lens. The lens positioned in front of the treated eye has an optical power such that provision of a sharp image on the retina of the eye requires accommodation by the accommodative intraocular lens while the lens positioned in front of the untreated eye has optical power which does not require accommodation. Alternative embodiments for designs of such spectacles as well as the use of such spectacles are provided.

Description

Spectacles for training accommodation

Intra Ocular Lenses (henceforth abbreviated to:'IOLs') are implanted in the eye by an eye-surgeon to replace the natural lens when the natural lens lost its optical function due to, for example, formation of cataract. Current IOLs are generally monofocal lenses providing a optical power in the order of +15-25 Diopters (henceforth: 'D') to correct the refraction of the aphakic, the lens-less, and presbyope, non-accommodative, eye with the specific optical focusing power (also: Optical power' or 'focusing power') depending on the refractive requirements of the individual eye. The monofocal lens provides the eye with a single optical power. The optical power of the IOL is generally such that eye becomes emmetrope, or, in practice, close to emmetrope, meaning that the distance at which a objects appear sharp is, in theory, at 'infinity', in practice, at 'over 6 meters' . Note that the terms 'spectacles' and 'training spectacles' are used in this present document which words means the same.

An implant of an IOL in one eye only, a 'uni-lateral implant', can result in a patient with two emmetrope eyes because the non-implanted, non-cataracterous, eye is likely to be presbyope, given the age of over 60 years old at which most people develop cataracts. Presbyope means that the eye has lost the ability to accommodate, to adjust focus depending on the distance of the object, and that the eye thus remains focused at 'far away' . Such patient with two presbyope eyes, in alternative terms 'bi-laterally presbyope', has one eye containing the, fixed focus, IOL and another eye containing the, also fixed focus, natural lens. Closer distances can be brought only into focus by spectacles providing a positive optical power of fixed focus or, alternatively, by multifocal or progressive spectacles providing multiple fixed, focal powers with the focal power depending on which area of the spectacles is used to look through; generally the top section of the lenses provide focal powers for far-vision and the bottom section focal powers for near- vision. Reading spectacles with a optical power of, say, 2-3 D, allow such bi-lateral presbyope patients to read standard printed texts such as standard newpaper print.

Presently truly Accommodative Intra Ocular Lenses (henceforth: 'AIOLs') are being developed which such AIOLs providing the eye, firstly, with a fixed correction for basic refraction, as do non- accommodating mono-focal IOLs, but such AIOLs also provide the eye with, secondly, a variable focus which, ideally, ranges from a lower limit required to maintain said emmetropia, sharp distance vision, at with the variable lens provides a optical power close to zero D so that, as a total sum, only the optical power of the fixed refractive lens remains, to an upper limit of optical power of the variable lens required for close up sharp vision, for, for example, reading, equivalent to, say, +2- 3 D of optical power which allows for a sharp vision at a distance of ~30-50cm.

Prior art discloses several concepts for such AIOLs, including, for example prior art documents US2009062912, NL1025622, WO2011065833 and US2010094413 and related documents thereto and related documents mentioned therein which prior art discloses a concept for an AIOL which includes a variable lens comprising at least two optical elements and at least two cubic surfaces, with at least one such cubic surface fitted to each optical element, in such construction that the variable lens is adapted to provide a variable optical power to the eye of which the optical power depends on the degree of mutual shift of the optical elements in a direction perpendicular to the optical axis, with the movement, the perpendicular shift of the optical elements generated by the ciliary muscle of the eye.

Prior art documents US2010324673 and US2004015236 disclose a concept for an AIOL which employs a variable lens comprising at least two optical elements with two convex lenses or, alternatively, at least one convex and one concave lens fitted to two optical elements, both elements fitted with a convex lens, or, alternatively, one element fitted with the convex lens and the other element with the concave lens, in a traditional telescopic arrangement, for example a Galilean telescopic arrangement, with the construction of the AIOL being such that the variable lens is adapted to provide a variable optical power to the eye of which the optical power depends on the degree of mutual movement of the optical elements and consequently the lenses fitted thereto in opposite directions along the optical axis, parallel to the optical axis, with the lens based in the capsular bag and movement of the optical elements generated by the ciliary muscle which, in turn, flattens the capsular bag.

Prior art document US2012078361, WO200807040, US2010121444 and documents mentioned therein and related thereto disclose a variable lens for an AIOL which variable lens comprises a fluid filled lens adapted to provide a variable optical power with the degree of optical power depending on the degree of pressure exerted by fluid on at least one elastic membrane containing said fluid and which pressure on the fluid is achieved either by a system of pumps operated by the ciliary muscle of the eye or, alternatively, by pressure generated by intraocular fluids. Note that the designs mentioned above are examples of accommodating lenses and that all other designs for accommodating lenses are hereby included in the present document.

So, the present invention disclosed in the present document supports vision of wearers of the types of truly accommodating lenses listed above as well as the vision of wearers of any other type of truly accommodating lens.

The present invention disclosed in the present document addresses the following issue which can occur in patients with uni-lateral implants with truly functioning AIOLs, namely: post- implant the patient is most likely to suffer fro accommodative mono- vision and use his standard reading spectacles for close-up vision, firstly, because he patient has likely used the same reading spectacles for maybe decades prior to the cataract and subsequent lens replacement and, secondly, a uni-lateral implant with an AIOL leads to 'accommodative mono-vision', an undesirable visual effect, with accommodative mono-vision meaning a variable difference in optical power between both eyes with the degree of difference being variable and increasing with

accommodation at closer distances. So, in the worst case, with a fully functional AIOL, the degree of accommodative mono-vision can reach for example +2-3 D at reading distances. Under such circumstances the AIOL is unlikely to be allowed to function properly by the wearer and will likely remain unused and stuck at a optical power closer to far-vision, the emmetrope position, a result comparable to the result which can be expected with a standard monofocal IOL.

The present document discloses an invention, an apparatus, largely comprising adaptations to spectacles which adaptations will allow the patient's treated eye to practice, to train, proper accommodation while at the same time correct for said accommodative mono-vision.

With the Figures:

Figure 1: An artist sketch of a person wearing the novel spectacles, wearing the most basic embodiment of the present invention as disclosed in the present document. The spectacles for training of the eye comprise a standard spectacle frame, 1, to which is fitted a combination of two lenses, 2, which, for near-vision, comprise one, relatively weak, mono-focal lens (or a planar lens), 3, providing optical power to the treated eye, in this example the right eye, 4, and one, relatively strong, positive diopter power monofocal lens, 5, providing optical power to the untreated eye, 6, in this example the left eye of the person, with the lens for the treated eye providing no, or very low, optical power and the lens for the untreated eye, in this example, providing 2.5 D of optical power. Such embodiment provides correction of near-vision accommodative mono-vison (due to accommodation) and provides accommodative exercise.

Alternatively, for far-vision, the combination of two lenses, 2, can comprise one, negative diopter power mono-focal lens, 3, providing optical power to the treated eye, in this example the right eye, 4, and one, relatively weak diopter power mono-focal lens (or a planar lens), 5, providing optical power to the untreated eye, 6, in this example the left eye of the person with the treated eye providing for example -2.5 D of optical power. Such embodiment provides correction of far- vision accommodative mono-vison (due the negative power lens) and provides accommodative exercise.

Figure 2: Example of spectacles for training of the eye designed to provide optical power by one, relatively weak, mono-focal lens, 7, to the treated eye, in this example the right eye, and one mono-focal lens, 8, providing significant positive optical power to the untreated eye, in this example the left eye of the person, with the lens for the treated eye providing zero D of optical power and the lens for the untreated eye, in this example, providing 2.5 D of optical power and, as an example, 1 diopter of astigmatic correction power in the vertical axis; the circles, 9, on the lens surface provide an indication of the sag, by isoclines, with circular isoclines indicating a spherical correction, defocus, and oval isoclines indicating astigmatic correction, of the optical surfaces.

Figure 3: Example of spectacles of the preferred embodiment which spectacles correct for accommodative mono-vision as well as exercise the accommodation by the bottom sections, during near-vision, and exercises accommodation by, artificially, introducing accommodative mono-vision by the top sections, during far-vision. Such bi-focal spectacles, with one bi-focal element, 10, 13, for each eye, can comprise, for the treated right eye, 10, a top section, 12a, with a negative diopter power mono-focal lens, for example -2.5 D, and a bottom section, 11a, with a lens of weak optical power and, for the untreated eye, 13, a top section, 12, with a weak optical power lens and a bottom section, 11, with a positive power lens, for example +2.5 D. Such design of a spectacle maximizes the training, exercising, of the eye with the accommodative lens and is therefore the preferred embodiment of the present invention. Note that, for correction of only accommodative mono-vision during near-vision a spectacle with a planar lens a weak optical power lens, for the right eye, 10, would be sufficient.

Figure 4: Example of spectacles for training of the eye designed to provide optical power by one mono-focal lens, 14, to the treated eye, in this example the right eye, and one tri-focal lens, 15, providing three degrees of optical power to the untreated eye, in this example the left eye of the person, with the lens for the treated eye providing zero D of optical power and the tri-focal lens for the untreated eye, in this example, providing 0.75 D, 16, and 1.5 D, 17, and 2.5 D, 18, of optical power; the circles, 9, on the lens surface indicate sag of the optical surface. Figure 5: Example of spectacles for training of the eye designed to provide optical power by one mono-focal lens, 19, to the treated eye, in this example the right eye, and one progressive lens, 20, providing multiple degrees of optical power over a gliding scale to the untreated eye, in this example the left eye of the person, with the lens for the treated eye providing zero D of optical power and the progressive lens for the untreated eye, in this example, providing 1-2.5 D, 21, of optical power; the circles, 9, on the lens surface indicate sag of the optical surface.

Figure 6: Example of spectacles for training of the eye designed to provide optical power by one mono-focal lens, 22, to the treated eye, in this example the right eye, and one variable lens, 23, providing variable optical power, over a gliding scale, to the untreated eye, in this example the left eye of the person, with the lens for the treated eye providing zero D of optical power and the variable lens for the untreated eye, in this example, providing 0-2.5D of optical power. The variable lens comprises two optical elements, 24, 25, and two cubic surfaces, with one such cubic surface fitted to each optical element such that the variable lens is adapted to provide variable optical power to the eye of which the optical power depends on the degree of mutual shift, 26, of the optical elements in a direction perpendicular to the optical axis, 27, with the movement, the shift, of the optical elements generated by, for example, a simple screw mechanism, 27, connected to a knob, 28, which can be operated by the wearer of the spectacles or by the optometrist in charge of the training program for the patient's treated eye.

Figure 7: Example of spectacles for training of the eye designed to provide optical power by one mono-focal lens, 29, to the treated eye, in this example the right eye, and one variable lens, 30, providing variable optical power, over a gliding scale, to the untreated eye, in this example the left eye of the person, with the lens for the treated eye providing zero D of optical power and the variable lens for the untreated eye, in this example, providing 0-2.5 D of optical power. The variable lens, in this example, comprises variable lens comprises two optical elements, 31, 32, with one convex and one concave lens element fitted to two optical elements, with one element fitted with the convex lens and the other element with the concave lens, with said lenses in a traditional telescopic arrangement, in this example a traditional Galilean telescopic arrangement, with the construction of the variable lens being such that the variable lens is adapted to provide a variable optical power to the eye of which the optical power depends on the degree of mutual movement of the optical elements in opposite directions, 33, along the optical axis, with the movement of the optical elements generated by, for example, a simple screw mechanism, 34, connected to a knob, 35, which can be operated by the wearer of the spectacles or by the optometrist in charge of the training program for the patient's treated eye.

The present invention discloses spectacles, also: 'training spectacles', for training accommodation and correction of accommodative mono-vision for uni-lateral implants of a truly accommodative lens, meaning implant of an accommodative lens in one eye while the other eye remains presbyopic, with the spectacles comprising a first and a second lens with the first lens adapted to provide only limited optical power to the treated eye, being the eye implanted with the accommodating intraocular lens, and, the second lens being adapted to provide significant optical power to the untreated eye, being the eye not implanted with an accommodating intraocular lens, so, the second, the other eye, remains non-accommodative, or, alternatively and most likely, presbyopic, with the spectacles comprising a combination of at least two lenses, also: 'combination of lenses', with the combination of lenses including at least one lens adapted to provide only limited optical power to the treated eye, being the eye implanted with the accommodating intraocular lens, and with the combination including a lens adapted to provide significant optical power to the untreated eye, being the eye not implanted with an accommodating intraocular lens. Such spectacles will force the treated eye to accommodate. With training and practice said accommodation will increase over time, and eventually approach the optical power of the untreated eye, including the optical power of the reading spectacle lens in front of the untreated eye. For example, the combination of lenses can provide approximately zero optical power to the treated eye and an optical power exceeding +1.5 D, for example, +2.5 D, to the untreated eye.

So, the present document discloses spectacles for correction of accommodative mono- vision as well as exercising accommodation in an eye with an artificial accommodative intraocular lens. The spectacles comprise a combination of at least two lenses, with at least one such lens in front of each eye of a patient which patient has one treated eye, meaning an eye into which an artificial accommodative intraocular lens, meaning a variable power lens, is implanted and one untreated eye, meaning an eye comprising a fixed power lens. The combination of the at least two lenses is adapted to provide correction of accommodative mono-vision, meaning that the combination of lenses is adapted to provide correction of the difference in refraction of the eye comprising the variable power lens, in accommodated state, and the eye comprising the fixed power lens.

Such spectacles can, for near-vision, as 'reading-spectacles', comprise a combination of two lenses in a mono-focal arrangement, meaning one lens positioned in front of each eye with the combination of the two lenses comprising one lens of relative low optical power positioned in front of the treated eye and one lens of relatively high positive optical power positioned in front of the untreated eye with the degree of relatively high positive optical power such that said difference in refraction is corrected when the treated eye accommodates. Such arrangement results in, effectively, a pair of reading glasses. Alternatively, such spectacles can, for far-vision, comprise a combination of two lenses in a mono-focal arrangement, meaning one lens positioned in front of each eye with the combination of the two lenses comprising a lens of relative high negative optical power positioned in front of the treated eye and a lens of relatively low optical power positioned in front of the untreated eye with the degree of relatively high negative optical power such that said difference in refraction is corrected when the treated eye accommodates.

Spectacles can also comprise a combination of four lenses in a bi-focal arrangement, meaning that two lenses are positioned in front of each eye so that the bi-focal arrangement positioned in front of the treated eye comprises a combination of a lens of relative low optical power and a lens of relatively high negative power, and that the bifocal arrangement positioned in front of the untreated eye comprises a combination of lens of relatively high positive optical power and a lens of relative low optical power with the bi-focal arrangements such that the eyes are provided with a combination of lenses for near- vision, as outlined above, and with a combination of lenses of lenses for far-vision, as outlined above.

Alternatively, such spectacles can comprise a combination of multiple lenses in a multi- focal arrangement, meaning that multiple lenses are positioned in front of each eye such that the multi-focal arrangement positioned in front of the treated eye comprises at least three lenses with optical powers ranging from relative low optical power to relatively high negative power, and that the multi-focal arrangement positioned in front of the untreated eye comprises at least three lenses with optical powers ranging from relatively high positive optical power to relative low optical power with the multi-focal arrangements assembled such that the eyes are provided with a combination of lenses for near-vision, as oulined above, and lenses for far-vision, outlined above also, and with any number of combinations of lenses for intermediate vision with the combination such that the difference in refraction at least one intermediate distance is corrected when the treated eye accommodates. An embodiment of a multi-focal lens comprising unlimited multiple foci is a 'progressive' lens, providing multiple foci in a smoothly gliding scale.

It should be noted that the lens providing the limited optical power to the treated eye should not be a completely planar, but have, for example, a very weak spherical surface, for example equivalent to, say, +/- 0.1-0.2 D, to prevent the undesired reflections and glare which can be generated by pure planar optical surfaces. If necessary, the very weak positive optical surface can be corrected for by a similar but opposite very weak negative surface, in our example -0.2D, on the posterior surface of the spectacle lens. The preferred, and likely most effective, embodiment of the present invention, as illustrated in Figure 3, corrects, during near-vision, for example, during reading, by the bottom sections for accommodative mono-vision due to accommodation of the treated eye in combination with fixed refraction of the untreated eye and thereby exercises said accommodation. The preferred embodiment also corrects, during far-vision, by the top sections, for accommodative mono-vision due to accommodation of the treated eye, artificially initiated by the negative optical power in combination with fixed refraction of the, likely emmetrope, untreated eye and thereby also exercises said accommodation. Such bi-focal spectacles of the preferred embodiment can comprise, for the treated right eye a top section with a negative diopter power mono-focal lens, for example -2.5 D, and a bottom section with a lens of very weak optical power, almost planar, and, for the untreated eye a top section with a weak optical power lens and a bottom section with a positive power lens, for example standard reading- spectacle power of, for example, +2.5 D. Such design of a spectacle maximizes both correction of accommodative mono- vision and the exercising of accommodation.

Note that a man skilled in the art will conclude that the concept of said preferred embodiment, the concept of correcting mono-vision at near-vision thereby also exercising the accommodation in combination with, artificially, introducing mono- vision with a negative power lens at far-vision thereby also exercising accommodation can be equally implement in all multi-focal en progressive lens designs which can implement said concepts also for intermediate distances and for, consequently, intermediate accommodative amplitudes.

Such spectacles can comprise a combination of lenses providing optical power for near- vision with such combination including a lens for the treated eye adapted to provide approximately zero optical power and a lens for the untreated eye adapted to provide a optical power exceeding a positive 1.5 D, and, alternatively, such spectacles can comprise a combination of lenses providing optical power for far- vision with such combination including a lens for the treated eye adapted to provide a optical power exceeding a negative 1.5 D and a lens for the untreated eye adapted to provide approximately zero optical power. It should be noted that the lens for the untreated eye can, if required, comprises additional optical surfaces of low optical power adapted to provide correction of at least one refractive error of any order, for example correction of astigmatism, coma, or any other aberration including defocus aberration.

The combination of lenses can comprise at least one variable lens, meaning a lens adapted to provide a single focus of which the optical power is variable, which variable lens can comprises at least two optical elements each comprising at least two cubic surfaces, with at least one such cubic surface fitted to each optical element such that the variable lens is adapted to provide a variable optical power with the degree of power depending on the degree of mutual shift of at least one optical elements in a direction perpendicular to the optical axis, or, alternatively, which variable lens can comprise at least one fluid filled lens adapted to provide a variable optical power with the degree of power depending on the degree of pressure exerted by the fluid on the elastic lens- membranes containing said fluid, or which variable lens can, alternatively, comprise at least two optical elements with at least one spherical lens fitted to each optical element, such that the variable lens is adapted to provide a variable optical power of which the power depends on the degree of mutual shift of the optical elements in a direction along the optical axis.

So, the combination of lenses can comprise lenses of a number of designs, of optical concepts, with preferably the same design of lenses included in the same spectacles. So, the combination of lenses can comprises at least one mono-focal lens adapted to provide one fixed optical power, or, alternatively, the combination of lenses can comprise a combination of foci, or, alternatively, the combination of lenses can include at least one lens of variable optical power, which multifocality can be beneficial for said training purposes because the wearer can easily switch, by selection a different area of the spectacle, or, alternatively, adjust the optical power, between different optical powers. Examples of a number of multifocal designs, and designs comprising lenses with variable optical power are also provided in the illustrations. So, at least one bi-focal lens adapted to provide two fixed focal powers, or, alternatively the combination of lenses can comprise at least one tri-focal lens adapted to provide three fixed focal powers, or, alternatively, the combination of lenses can comprise at least one multi-focal lens adapted to provide multiple fixed focal powers, or, alternatively, the combination of lenses can comprises at least one progressive lens adapted to provide a progression of fixed focal powers of which the specific power depends on the specific area of the lens which is in use. Also, the combination of lenses can comprise at least one variable lens of certain design, meaning a lens adapted to provide a single focus of which the optical power can be varied over a specific range of optical powers. Employing manufacturing technology to obtain modern free-form surfaces the variable lens can comprise at least two optical elements comprising at least two cubic surfaces, with at least one such cubic surface fitted to each optical element such that the variable lens is adapted to provide a variable optical power with the degree of optical power depends on the degree of mutual shift of the optical elements in a direction perpendicular to the optical axis, optical surfaces as disclosed by, for example, Louis Alvarez in US3305294.

Alternatively, the variable lens can comprise a fluid filled lens adapted to provide a variable optical power with the degree of optical power depending on the degree of pressure exerted by the fluid on the elastic membranes containing said fluid, as disclosed by, for example, Joshua Silver in US2011157712. The combination of lenses can be adapted to provide, over a period of time, a stepwise increase in positive optical power to the untreated eye for a

combination of lenses for near-vision, or, alternatively, the combination of lenses can be adapted to provide, over a period of time, a stepwise decrease in negative optical power to the treated eye for a combination of lenses for far- vision. The spectacles can be reading-spectacles including a customized lens for the individual untreated eye which lens is adapted to provide sufficient optical power to allow said individual untreated eye to read standard printed text.

So, the combination of lenses can also be adapted to provide, over a period of time, a stepwise reduction in optical power to the treated eye to, more over time, increase the demand for accommodation and thus train the accommodative processes and muscle power in the treated eye. For example, the reduction in optical power can range from a optical power equal to the optical power of the lens for the untreated eye, for example optical power required for reading, to approximately zero optical power. Such reduction in optical power should be achieved over a period of, for example, at least several weeks to allow the eye and its muscles to adapt to the accommodative process. The reduction in optical power, provided to the treated eye, can be provided by replacement of a lens according to any of the lenses of design mentioned above over time by such a lens of less optical power, or, alternatively, the reduction in optical power, provided to the treated eye, can be provided by downward adjustment over time of the optical power of a variable lens of any design including designs of variable lenses mentioned above in the present document.

The spectacles are intended to function also as reading spectacles, so the lens in front of the untreated eye should have sufficient optical power to function as a reading spectacle lens, to allow reading of, for example, standard newspaper print, and can include a customized lens for the individual untreated eye which lens is adapted to provide sufficient optical power to said allow said individual untreated eye for reading standard printed text. Also, the customized lens in the reading spectacles can comprise at least one additional optical correction adapted to correct for at least one additional optical aberration of the individual untreated eye which additional optical aberration of the individual eye can be, for example, astigmatic aberration.

The spectacles disclosed in the present document can be adapted to provide practice, to provide training, to an eye implanted with an AIOL. Also, the spectacles disclosed in the present document can be adapted to provide correction of accommodative monovision. Also, the spectacles disclosed in the present document can be adapted to provide practice, to provide training, to an eye implanted with an AIOL as well as correction of accommodative monovision. Such AIOL can comprise a variable lens comprising at least two optical elements and at least two cubic surfaces, with at least one such cubic surface fitted to each optical element, such that the variable lens is adapted to provide a variable optical power to the eye of which the optical power depends on the degree of mutual shift of the optical elements in a direction

perpendicular to the optical axis, or, alternatively, such accommodating lens can include a variable lens comprising at least two optical elements with at least one lens element fitted to each optical element, such that the variable lens is adapted to provide a variable optical power to the eye of which the optical power depends on the degree of mutual movement of the optical elements, in opposite directions, along the optical axis, alternatively: parallel to the optical axis, or, alternatively, such accommodating lens can include a fluid filled lens adapted to provide a variable optical power of which the degree of optical power depends on the degree of pressure exerted by the fluid on the elastic membranes containing said fluid causing the radius of the lens to change which, in turn, changes the optical power of the lens. Spectacles according to the disclosure thus far also include embodiments with designs which are deviations thereof, for example spectacles with a combination of two lenses of which one lens is represented by a lens-less space, in effect providing the optical functionality of a planar lens, or, alternatively, embodiments of spectacles with one lens of positive optical power, positioned in front of the untreated eye in combination with a lens-less space, as in the design of an 'monocle', a now maybe somewhat oldfashioned type of corrective lens used to correct vision in only one eye, comprising a circular lens in a fitting which is designed to fit in the eye socket, or, alternatively, which circular lens is fitted to a short handpiece for positioning by the wearer of the lens in front of the eye.

Practicing and training of an eye implanted with an accommodating lens is likely a necessary procedure to achieve proper functionality for all accommodating lenses, as well as prevention of the unnecessary effects of accommodative monovision of said designs and other designs not mentioned in the listing above. In cases when both eyes are implanted with an accommodating lens at the same time such training is also likely required, but in these cases the habit of simply not using reading spectacles, or only using reading spectacles with weak optical power might be sufficient. The invention of the present document, the adapted reading spectacles, is primarily intended to be employed in patients with uni-lateral implants and thus one, potentially accommodating, and one presbyope eye.

Also, such reading spectacles might be a preferred option for uni-laterally implanted patients while waiting for implant of a similar accommodative lens in the other eye also - experience shows that 'accommodative monovision' can be a distinctly uncomfortable visual effect which effect can be corrected by embodiments of novel spectacles as disclosed in the present document. So, the spectacles can comprise a combination of lenses which combination provides correction of accommodative monovision in patients with an uni-lateral implant of an accommodative intraocular lens with accommodative monovision meaning a variable discrepancy in optical power between both eyes which degree of discrepancy of optical power increases with closer objects, increases at accommodation. So, the present document discloses, inter alia, a method for correction of

accommodative mono-vision and for exercising accommodation in an eye comprising an artificial accommodative intraocular lens, with the method comprising a combining at least two lenses, with at least one such lens in front of each eye of a patient which patient has one treated eye, meaning an eye into which an artificial accommodative intraocular lens, meaning a variable power lens, is implanted and one untreated eye, meaning an eye comprising a fixed power lens which method combines said at least two lenses such that the combination is adapted to provide correction of accommodative mono-vision, meaning that the method combines said lenses such that the difference in refraction of the eye comprising the variable power lens and the eye comprising the fixed power lens is corrected.

The method provides optical power for near- vision by spectacles comprising a combination of two lenses in a mono-focal arrangement, meaning one lens positioned in front of each eye and combines said two lenses of which one lens provides relative low optical power and is positioned in front of the treated eye, and one lens provides relatively high positive optical power and is positioned in front of the untreated eye, with the method adapted such that the degree of relatively high positive optical power corrects for said difference in refraction between the eyes when the treated eye accommodates, or, alternatively, the method provides optical power for far-vision by spectacles comprising a combination of two lenses in a mono-focal arrangement, meaning one lens positioned in front of each eye with the method combining said two lenses of which one lens provides relative high negative optical power and is positioned in front of the treated eye and one lens provides relatively low optical power and is positioned in front of the untreated eye, with the method adapted such that the degree of relatively high negative optical power corrects for said difference in refraction between the eyes when the treated eye accommodates. In effect, the method provides correction of accommodative mono-vision, or, alternatively, the method provides accommodation exercise to the treated eye, or, alternatively, the method provides a combination of said correction of accommodative mono-vision and said accommodation exercise to the treated eye.

So, in summary, the present documents discloses spectacles to correct for

accommodative mono-vision and for exercising accommodation of the eye to be worn by a person having an eye with an artificial accommodative intraocular lens with the spectacles comprising a first combination of lenses to be positioned in front of the eye with the artificial accommodative intraocular lens, and with the spectacles comprising a second combination of lenses to be positioned in front of the second eye of the person with the combinations of lenses adapted to provide correction of the difference in refraction of the eye with the artificial accommodative intraocular lens, in its accommodated state, and the refraction of the second eye. These spectacles can be adapted to provide optical power for near-vision with the first combination of lenses comprising a single lens of no optical power and the second combination of lenses comprises a single lens of relatively high positive optical power, wherein the degree of relatively high positive optical power is such that said difference in refraction is corrected. Also, these spectacles can be adapted to provide optical power for far- vision with the first combination of lenses comprising a single lens of relative high negative optical power and the second combination of lenses comprising a single lens of no optical power, wherein the degree of relatively high negative optical power is such that said difference in refraction is corrected. Furthermore, these spectacles can be adapted to provide optical powers for near-vision and far- vision with the first combination of lenses and the second combination of lenses each comprising a single lower section having an optical power which deviates from the optical power of the single upper sections, thus making the first combination bi-focal and the second combination bi-focal with the first combination comprising a lower section which has no optical power and an upper section which also has no optical power, and that the second combination comprising a lower section which has a relatively high positive optical power and an upper section which has no optical power.

Or, alternatively, these spectacles can be adapted to provide optical powers for near- vision and far-vision with the first combination of lenses and the second combination of lenses each comprising a single lower section having an optical power which deviates from the optical power of the single upper section, thus making the first combination bifocal and the second combination bi-focal with the first combination comprising a lower section which has no optical power and an upper section which has high negative optical power, and that the second combination comprising a lower section which has a relatively high positive optical power and an upper section which has no optical power. Or, alternatively, these spectacles can be adapted to provide optical powers for near- vision and far-vision with the first combination of lenses and the second combination of lenses each comprising at least one lower section having an optical power which deviates from the optical power of the at least one upper sections, thus making the first combination multi-focal and the second combination multi-focal with the first combination comprising a lower section which has no optical power and at least two upper sections which have no optical power, and that the second combination comprising a lower section which has a relatively high positive optical power and at least two upper sections which have an increasing positive optical power with the section with the highest optical power located at the top of the second combination of lenses. Furhermore and alternatively, these spectacles adapted to provide optical powers for near-vision and far- vision with the first combination of lenses and the second combination of lenses each comprising at least one lower section having an optical power which deviates from the optical power of the at least one upper sections, thus making the first combination multi-focal and the second combination multi-focal with the first combination comprising a lower section which has no optical power and at least two upper sections which have a decreasing negative optical power, and that the second combination comprising a lower section which has a relatively high positive optical power and at least two upper sections which have decreasing positive optical power. Any such spectacles can comprise a second combination of lenses including at least one lens adapted for near-vision which provides an optical power exceeding a positive 1.5 D, or, alternatively, such spectacles can comprise a first combination of lenses which includes at least one lens adapted for far-vision which provides a optical power exceeding a negative 1.5 D. Any of the spectacles disclosec above can include at least one lens which which comprises at least one additional optical surface adapted to provide provide correction of at least one optical aberration. The method for correction of accommodative mono-vision and for exercising accommodation in an eye can comprise an artificial accommodative intraocular lens with the method comprising the provision of spectacles comprising a first combination of lenses to be positioned in front of the eye with the artificial accommodative intraocular lens and a second combination of lenses to be positioned in front of the second eye of the person with the combinations of two lenses are adapted to provide correction of the difference in refraction of the eye with the artificial accommodative intraocular lens, in its accommodated state, and the refraction of the second eye. The method can comprise provision of optical power for near-vision with the method including provision of a first combination of lenses including a single lens of no optical power and the second combination of lenses including a single lens of relatively high positive optical power wherein the degree of relatively high positive optical power is such that said difference in refraction is corrected. Or, alternatively, the method can comprise provision of optical power for far- vision with the method including provision of a first combination of lenses including a single lens of relative high negative optical power and the second combination of lenses including a single lens of no optical power wherein the degree of relatively high negative optical power is such that said difference in refraction is corrected. Or.

Alternatively, the method can comprise provision of optical power for near-vison and for far- vision with the first combination comprising a lower section which has no optical power and, at least one, upper section which has no optical power, and that the second combination comprising a lower section which has a relatively high positive optical power and, at least one, upper section which has no optical power. Or, alternatively, the method can comprise provision of optical power for near- vision and for far- vision with the first combination comprising a lower section which has no optical power and, at least one, upper section which has high negative optical power, and that the second combination comprising a lower section which has a relatively high positive optical power and, at least one, an upper section which has no optical power. The method generally comprises provision of said optical powers by at least one ophthalmic measurement procedure which provides the difference in refraction of the eye with the artificial accommodative intraocular lens, in its accommodated state, and the refraction of the second eye. This difference in refraction provides the degree of optical power adapted to provide the correction of the difference in refraction between the lenses positioned in front of the first and second eye.

Also, spectacles for training accommodation of the eye to be worn by a person can have at least one eye implanted with an artificial accommodative intraocular lens, a treated eye, with the spectacles comprising two spectacle lenses, with one for each eye, including a lens to be positioned in front of the, at least one, the first treated eye, and with the spectacles comprising a at least one other lens to be positioned in front of the second eye of the person, which second eye may also be treated, the second treated eye, or may not be treated, the untreated eye, with at least one treated eye provided with a spectacle lens to provide an optical power to that eye such that provision of a sharp image on the retina of the eye requires accommodation by the accommodative intraocular lens. Also such training spectacles, also: 'spectacles', can be adapted to be worn by a person having at least one treated eye, implanted with an artificial accommodative intraocular lens, and a second eye, the training spectacles comprising a first spectacle lens to be positioned in front of the eye in which the artificial accommodative intraocular lens has been implanted, and a second lens to be positioned in front of the second eye of the person with the first lens which has an optical power such that provision of a sharp image on the retina of the eye requires accommodation by the accommodative intraocular lens. For example, in a most simple embodiment, for near-vision, for, for example reading, the lens in front of the untreated eye can have an optical power of 2- 3D (as in standard reading spectacles) while the lens in front of the treated eye can be a piano lens. Alternatively, for far- vision the lens in front of the untreated eye can have an optical power of -2 to -3D while the lens in front of the treated eye can be a piano, flat, lens, which alternative also requires accommodation of the treated eye to provide the retina with a sharp image of a distant

So, spectacles the second lens can provide a high positive optical power for near- vision to the second eye, and that the optical power of the first lens is such that

accommodation of the treated eye is required to provide the retina with a sharp image required for said near vision.

The optical power of the first lens provided to the treated eye can be a positive optical power, or, alternatively, the second lens can provide a low positive optical power for far- vision to the second eye and the optical power of the first lens can be such that accommodation of the treated eye is required to provide the retina with a sharp image required for said far- vision, with, for example, the optical power of the first lens providing to the treated eye a negative optical power.

A person can have two treated eyes, in which case the first and the second lenses can be adapted to provide an optical power for near-vision to both eyes with said optical powers such that accommodation of the eyes is required to provide the retina with a sharp image required for said near- vision, with, for example, the first and the second lenses having a positive optical power, or, alternatively, with the first and the second lenses providing an optical power for far-vision to both eyes with said optical powers are such that accommodation of the eyes is required to provide the retina with a sharp image required for said far- vision in both eyes, or, alternatively, with the optical power provided to the treated eyes is a negative optical power. All spectacles mentioned above can have at least one of said spectacle lenses comprising a combination of optical power and corrective optics adapted to provide correction of at least one optical aberration, for example, corrective optics providing correction for astigmatism.

The spectacles mentioned above can have at least one spectacle lens which is a multifocal lens adapted to provide multiple foci, for example, a bi-focal lens adapted to provide two foci, or, alternatively, at least one of the spectacle lenses can have a fixed optical power to provide a single focus, or, alternatively, at least one of the spectacle lenses can have a variable optical power which can be any shape-changing lens, for example a lens comprising at least two optical elements with each optical element comprising at least one free-form surface including a cubic optical component with the combination adapted to provide said change in optical power by shift of at least one of the optical elements in a direction perpendicular to the optical axis, as in prior art . Any of said, and other, variable lenses can provide only variable positive optical power, or, alternatively, only variable negative optical power, or, alternatively, a combination of variable positive optical power and variable negative optical power. Any of these lenses can have a fixed optical power component and said variable optical power component.

Applying such spectacles a method for training accommodation of a person's treated eye implanted with an artificial accommodative intraocular lens can include providing the treated eye with a spectacle lens adapted to provide an optical power such that provision of a sharp image on the retina of the eye requires accommodation by the accommodative intraocular lens.

Claims

1. Spectacles adapted to be worn by a person having at least one treated eye, implanted with an artificial accommodative intraocular lens, and a second eye, the spectacles comprising a first spectacle lens to be positioned in front of the eye in which the artificial accommodative intraocular lens has been implanted, and a second lens to be positioned in front of the second eye of the person, characterized in that the first lens has an optical power such that provision of a sharp image on the retina of the eye requires accommodation by the accommodative intraocular lens.

2. Spectacles according to claim 1, characterized in that the second lens is adapted to provide a high positive optical power for near- vision to the second eye, and that the optical power of the first lens is such that accommodation of the treated eye is required to provide the retina with a sharp image required for said near vision.

3. Spectacles according to claim 2 characterized in that the optical power of the first lens provided to the treated eye is a positive optical power.

4. Spectacles according to claim 1, characterized in that the second lens is adapted to provide, a low positive optical power for far-vision to the second eye, characterized in that the optical power of the first lens is such that accommodation of the treated eye is required to provide the retina with a sharp image required for said far- vision.

5. Spectacles according to claim 4, characterized in that the optical power of the first lens provided to the treated eye is a negative optical power.

6. Spectacles according to claim 1, characterized in that the first and the second lenses are adapted to provide to a person with two treated eyes, an optical power for near-vision to both eyes, and that said optical powers are such that accommodation of the eyes is required to provide the retina with a sharp image required for said near- vision.

7. Spectacles according to claim 6, characterized in that the first and the second lenses have a positive optical power.

8. Spectacles according to claim 1, characterized in that the first and the second lenses are adapted to provide to a person with two treated eyes an optical power for far-vision to both eyes, and that said optical powers are such that accommodation of the eyes is required to provide the retina with a sharp image required for said far- vision.

9. Spectacles according to claim 8, characterized in that the optical power provided to the treated eyes is a negative optical power.

10. Spectacles according to any of the foregoing claims, characterized in that at least one of said spectacle lenses comprises a combination of optical power and corrective optics adapted to provide correction of at least one optical aberration.

11. Spectacles according to claim 10, characterized in that the corrective optics are adapted to provide correction for astigmatism.

12. Spectacles according to any of the foregoing claims, characterized in that at least one of the spectacle lenses is a multi-focal lens adapted to provide multiple foci.

13. Spectacles according to claim 12, characterized in that at least one of the spectacle lenses is a bi-focal lens adapted to provide two foci.

14. Spectacles according to claim 1-11, characterized in that at least one of the spectacle lenses has a fixed optical power adapted to provide a single focus.

15. Spectacles according to claims 1-11, characterized in that at least one of the spectacle lenses has a variable optical power..

16. Spectacles according to claim 15, characterized in that at least one of the lenses of variable optical power is any shape-changing lens.

17. Spectacles according to claim 16, characterized in that at least on of the lenses comprises a combination of at least two optical elements with each optical element comprising at least one free-form surface including a cubic optical component with the combination adapted to provide said change in optical power by shift of at least one of the optical elements in a direction perpendicular to the optical axis.

18. Spectacles according to claims 15, 16 or 17, characterized in that the variable lens is adapted to provide only variable positive optical power.

19. Spectacles according to claim 15, 16 or 17, characterized in that the variable lens is adapted to provide only variable negative optical power.

20. Spectacles according to claim 15, 16 or 17, characterized in that the variable lens is adapted to provide a combination of variable positive optical power and variable negative optical power.

21. Spectacles according to any of the claims 15-20, characterized in that the variable lens has a fixed optical power component and a variable optical power component.

22. Method for training accommodation of a person's treated eye implanted with an artificial accommodative intraocular lens characterized in that the method provides the treated eye with a spectacle lens adapted to provide an optical power such that provision of a sharp image on the retina of the eye requires accommodation by the accommodative intraocular lens.